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To the Editor: Dr Marshall and colleagues¹ reported that there was a low incidence of injury in youth baseball, but that reduced-impact balls and faceguards were associated with an even lower risk of injury. I believe that Marshall et al underestimated this incidence by basing their estimates of injury rates on compensated claims submitted to Little League insurance carriers. Many serious injuries will not be captured by this mechanism, because families may prefer to go through their own health insurance organization or they may not be aware of league-provided insurance. A serious injury might also elude detection because of delayed recognition.

Although underregistration may not bias the relative proportion of players injured between groups who did and did not use safety equipment, it is not possible to estimate the absolute injury rate without medical evaluation of all injuries. In a prospective survey study of youth league baseball in Indiana during . . . [Full Text of this Article]

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