To the Editor: The authors of a recent article on football spinal injuries1 restate the case made in 1987 “for an independent registry of football-related ASCIs [acute spinal cord injuries]”2 and conclude that “the games must be made safer than they presently are, and a national registry is the first step in this direction”.1

The Australian Spinal Cord Injury Register (ASCIR) was established in 1995 by the National Injury Surveillance Unit of the Australian Institute of Health and Welfare and the directors of all six Australian spinal units. The ASCIR collects data from these units on persisting ASCI from all causes. Published reports are available at <http://www.nisu.flinders.edu.au/publications. php#hdr16>.

We think that this existing register provides the basis for the function advocated by Carmody et al.1 The ASCIR can be used to identify particular types of ASCI cases, such as those due to football, and can provide basic demographic and clinical information. Indeed, The ASCIR was used to identify relevant cases when Carmody and colleagues1 asked spinal units for this information.

Ideally, data for a sports injury register are obtained from injured players, witnesses and clinicians to enable detailed analysis of mechanisms and circumstances. A good example is a register of catastrophic head and neck injuries in American football which has, since 1977, collected data from each injured player’s coach, physician and athletic director, prompting rule changes and equipment improvements.3 As a register of ASCI generally, the ASCIR does not normally obtain such detailed information about cases occurring during football. There is no obvious reason why football-related cases ascertained by the ASCIR should not be flagged for supplementary information collection, perhaps by or in collaboration with interested researchers such as Carmody and colleagues.1

In addition to case data, participation numbers over time are necessary for trend analysis. The Australian Rugby Union has published comprehensive annual participation data since 1996, but the Australian Rugby League has not. The American football register is supplied with participation figures by national school and collegiate associations,3 and similar information from Australian sports-governing bodies would be beneficial.

The brief statement of methods and the omission of year-specific case numbers by Carmody et al1 left us unsure how trends had been modelled (eg, Were trends based on annual rates? Were annual exposure data interpolated from their Box 1 figures?) We note that their figure of 68 179 registered rugby union players in 1996 is more than 20 000 lower than the figure published by the Australian Rugby Union.4

In reply: We welcome the opportunity to comment briefly on what we consider a registry for spinal injuries in football should actually be. The raw data collected by the Australian Spinal Cord Injury Register is valuable for governments and other statutory bodies — for example, to plan for the enormous costs of acute spinal cord injuries (ASCIs), irrespective of their causation. However, a proper registry for spinal injuries from football (all codes) is a far cry from this. In particular, hospital records are notoriously inaccurate as to the way in which injuries sustained are documented, and to rely on them ensures misleading, if not spurious, data. We established long ago that interviewing players was the only accurate way to identify the mechanisms of injury, which are the keys to possible preventive measures.1

It is entirely relevant that ASCIs are at one end of a spectrum of vertebral column injuries (eg, fractures, dislocations) sustained in all football codes. Between 1986 and 2002, 65 footballers were admitted to the Royal North Shore Hospital with vertebral column injuries but no spinal cord damage. These injuries were sustained by the same mechanisms as their more serious counterparts and differed from them in degree rather than absolute kind. We contend there should be mandatory reporting of all spinal injuries to an independent registry and that football club registration should depend upon compliance with this requirement.