Andrea Stracciolini

Symptom Severity Predicts Prolonged Recovery after Sport-Related Concussion, but Age and Amnesia Do Not

OBJECTIVE To identify predictors of prolonged symptoms in athletes who sustain concussions. STUDY DESIGN This was a multicenter prospective cohort study of patients in 2 sport concussion clinics. Possible predictors of prolonged symptoms from concussion were compared in 2 groups, those whose symptoms resolved within 28 days and those whose symptoms persisted beyond 28 days. Candidate predictor variables were entered into a logistic regression model that was used to generate aORs. RESULTS A total of 182 patients met the inclusion criteria during the study period. The mean patient age was 15.2 ± 3.04 years. More than one-third of the patients (n = 65) underwent computerized neurocognitive testing on their initial visit. On univariate analyses, Post-Concussion Symptom Scale (PCSS) score and all composite scores on computerized neurocognitive testing were apparently associated with prolonged symptom duration. Sex, age, loss of consciousness at time of injury, and amnesia at time of injury were not associated with prolonged symptom duration. After adjusting for potential confounding, only total PCSS score was associated with the odds of suffering prolonged symptoms. CONCLUSION Further efforts to develop clinical tools for predicting which athletes will suffer prolonged recoveries after concussion should focus on initial symptom score.

Pediatric Sports Injuries An Age Comparison of Children Versus Adolescents

Background: Significant knowledge deficits exist regarding sports injuries in the young child. Children continue to engage in physically demanding, organized sports to a greater extent despite the lack of physical readiness, predisposing themselves to injury. Purpose: To evaluate sports injuries sustained in very young children (5-12 years) versus their older counterparts (13-17 years) with regard to the type and location of injuries, severity, and diagnosis. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective chart review was performed on a 5% random probability sample (final N = 2133) of 5- to 17-year-old patients treated for sports injuries in the Division of Sports Medicine at a large, academic pediatric medical center between 2000 and 2009. Using descriptive statistics, correlates of injuries by age group, injury type, and body area are shown. Results: Five- to 12-year-old patients differed in key ways from older patients. Children in this category sustained injuries that were more often traumatic in nature and more commonly of the upper extremity. Older patients (13-17 years) were more likely to be treated for injuries to the chest, hip/pelvis, and spine. A greater proportion of the older children were treated for overuse injuries, as compared with their younger counterparts (54.4% vs 49.2%, respectively), and a much larger proportion of these injuries were classified as soft tissue injuries as opposed to bony injuries (37.9% vs 26.1%, respectively). Injury diagnosis differed between the 2 age groups. The 13- to 17-year age group sustained more anterior cruciate ligament injuries, meniscal tears, and spondylolysis, while younger children were diagnosed with fractures, including physeal fractures, apophysitis, and osteochondritis dissecans. The 5- to 12-year-old patients treated for spine injuries were disproportionately female (75.8%); most of these injuries were overuse (78.8%) and bony (60.6%); over one third of the youngest children were diagnosed with spondylolysis. Surgery was required in 40% of the injuries in the full sample. Conclusion: Sports injuries to children differ by age in injury diagnosis, type, and body area. Older children sustain a greater proportion of overuse injuries classified as soft tissue in nature. Children of all ages are sustaining significant sports injuries that require surgical intervention.

Pediatric sports injuries: A comparison of males versus females

Background: There is still much that we do not know about differences in sports injuries between young male and female athletes and the factors that may increase the risk for injuries in this regard. Purpose: To describe and compare differences between males and females in pediatric sports-related injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective chart review was performed using a 5% random sampling (N = 2133) of medical records of children aged 5 to 17 years seen over 10 years in a sports medicine clinic at a large academic pediatric hospital. Information was collected and analyzed on age, sex, height, weight, injury type (overuse vs acute/traumatic), location of injury, and sports involvement. Results: Overall, female athletes had a higher percentage of overuse injuries (62.5%) compared with traumatic injuries (37.5%); the opposite was seen in male athletes (41.9% vs 58.2%, respectively; P < .001). Looking at specific areas of injury, female athletes sustained more injuries to the lower extremity (65.8%) and spine (11.3%) as compared with male athletes (53.7% and 8.2%, respectively). Male patients had a greater percentage of injuries to the upper extremity (29.8%) as compared with female patients (15.1%). The type of hip/pelvis injuries differed greatly by sex, with females sustaining more overuse (90.9%) and soft tissue injuries (75.3%) versus males, who suffered injuries that tended to be traumatic (58.3%) and bony (55.6%) in nature. Males were more likely than females to participate in team and contact/collision sports. The percentage of females with patellofemoral knee pain was approximately 3 times greater than that of males (14.3% vs 4.0%, respectively; P < .001). Males were twice as likely as females to be diagnosed with osteochondritis dissecans (8.6% vs 4.3%, respectively; P < .001) and fractures (19.5% vs 8.2%, respectively; P < .001). The percentage of males and females who sustained an anterior cruciate ligament injury was almost equal (10.0% and 8.9%, respectively; P = .369). Conclusion: Sports injuries in young males and females differed by injury type, diagnosis, and body area. These results may be related to the referral patterns unique to the division of the hospital, including a high number of female dancers. Further investigation is required to better understand the injury risk in pediatric male and female athletes.

Exercise deficit disorder in youth: a hidden truth

1.Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ, USA 2.Division of Sports Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA 3.Cincinnati Children’s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH, USA 4.Departments of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA 5.Athletic Training Division, School of Allied Medical Professions, The Ohio State University, Columbus, OH, USA 6.Departments of Athletic Training, Sports Orthopaedics, and Pediatric Science, Rocky Mountain University of Health Professions, Provo, UT, USA

Youth sports specialization and musculoskeletal injury: a systematic review of the literature

ABSTRACT Objectives: Early sports specialization is being seen with increasing frequency in children and adolescents in an attempt to achieve elite performance status. This phenomenon has attracted negative medical and lay media attention due, in part, to the possibility of an increased risk of acute and overuse injuries. The purpose of this study was to systematically review available research on youth sport specialization and musculoskeletal injury. Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies evaluating sports specialization and injury rates in participants under age 18. Inclusion criteria were: (1) youth patient population (defined as <18 years of age), (2) peer-reviewed investigation of association(s) between sports specialization and incidence of injury, and (3) original research article (rather than a review, case report, or meta-analysis). Exclusion criteria were: (1) reliance on surrogate measure(s) of sports specialization (eg. hours of participation), (2) language other than English, and (3) not a clinically-based study. Rates of sport specialization, acute and overuse injuries, and frequency of organized training regimens were recorded. Results: Three studies met final inclusion and exclusion criteria. Of these studies two were retrospective cohort studies and one was a case-control study. All three studies reported an increased risk of overuse injures (OR range: 1.27–4.0; P < 0.05) which varied by sport and anatomic pathology. One study noted an increased rate of withdrawal from tennis matches (OR = 1.55, P < 0.05) in athletes who participated only in tennis compared to multisport athletes who competed in tennis. Based on the consistency of the results from included studies, the strength of recommendation grade for the current evidence against early sports specialization is “B” (recommendation based on limited-quality patient-oriented evidence). Conclusions: The primary evidence that currently exists with regard to early sport specialization is scarce, retrospective, and shows only modest associations between early sports specialization and overuse injury. Further prospective research is needed to more definitively determine if early sports specialization in children is associated with increased injury risk. Level of Evidence: Systematic Review, Level III

Exercise deficit disorder in youth: a paradigm shift toward disease prevention and comprehensive care.

Despite the widely recognized benefits of daily play, recreation, sports, and physical education on the physical and psychosocial well-being of children and adolescents, many contemporary children and adolescents worldwide do not meet the recommendations for daily physical activity (PA). The decline in PA seems to start early in life, which leads to conditions characterized by reduced levels of PA in the pediatric population that are inconsistent with current public health recommendations. Unlike many other diseases and disorders in pediatrics, physical inactivity in youth is unique in that it currently lacks a clinical gold standard for diagnosis. This makes the diagnosis and treatment medically challenging, though no less important, as the resultant ramifications of a missed diagnosis are of significant detriment. Exercise-deficient children need to be identified early in life and treated with developmentally appropriate exercise programs designed to target movement deficiencies and physical weaknesses in a supportive environment. Without such interventions early in life, children are more likely to become resistant to our interventions later in life and consequently experience adverse health consequences. Integrative approaches that link health care professionals, pediatric exercise specialists, school administrators, community leaders, and policy makers may provide the best opportunity to promote daily PA, reinforce desirable behaviors, and educate parents about the exercise-health link.

A closer look at overuse injuries in the pediatric athlete.

Objective:To examine male-female differences in pediatric overuse sports injuries. Study Design:Cross-sectional epidemiological study. Setting:Tertiary level sports medicine division in a large academic pediatric medical center. Participants:Five percent probability sample of patients 5 to 17 years seen from January 1, 2000 to December 31, 2009. About 3813 charts reviewed. Final study cohort included 1614 patients. Intervention:Nonlinear decomposition analysis of male-female differences in overuse injuries. Main Outcome Measures:Age, body mass index, history of previous injury, and activity type (contact/collision, team vs individual, “high overuse”). Results:Females sustained approximately half of the total injuries. Fifty-two percent of the injuries were overuse, 61% to the lower extremity. A high proportion of tennis players, swimmers, dancers, track athletes, runners, gymnasts, and cheerleaders were seen for overuse injuries. Females sustained more overuse injuries versus males (63% and 40%, respectively). Males playing team sports have a 5.3 times higher likelihood of being seen for an overuse injury compared with males not playing team sports (P < 0.01). High-overuse sport participation increased overuse injury odds by a factor of 10 for males versus 3.6 for females (P ⩽ 0.01 for males and females). Forty-six percent of the male-female difference in overuse injuries could be attributed to sport/activity characteristics—contact/collision, team, and high overuse. Conclusions:A large proportion of the sex discrepancy in overuse injuries in this cohort was attributed to compositional differences in sports played. Future research is needed to investigate the independent effect of sex on risk for pediatric sports injuries. Clinical Relevance:This study provides a unique analysis of male-female differences in pediatric sports injuries and is the first study to estimate the impact of the different characteristics (ie, collision, team, high overuse) of sports children play on overuse injuries sustained by young athletes. The findings will help guide future prevention efforts.

Anterior Cruciate Ligament Injuries in Pediatric Athletes Presenting to Sports Medicine Clinic A Comparison of Males and Females Through Growth and Development

Background: Limited data exist regarding the effect of the growth process on anterior cruciate ligament (ACL) injury risk in male versus female children. Hypothesis: The proportion of ACL injuries/sports injuries presenting to clinic will vary by age, sex, and body mass index (BMI). Study Design: Cross-sectional epidemiologic study. Level of Evidence: Level 3. Methods: The study group consisted of a randomly selected 5% probability sample of all children 5 to 17 years of age presenting to a sports medicine clinic from January 1, 2000 to December 31, 2009; 2133 charts were reviewed. Data collected included demographics, height and weight, injury mechanism, diagnosis, treatment, previous injury, and organized sports. Results: A total of 206 ACL tears were analyzed (104 girls, 102 boys). Girls were slightly older than boys (15.1 ± 1.7 vs 14.3 ± 2.1 years; P < 0.01). Male-female comparison of ACL injury/total injury by age revealed that girls had a steeper increase by age than boys. Among 5- to 12-year-olds, boys had a higher ACL injury/total injury ratio than girls (all P < 0.01). Children 13 to 17 years of age showed no significant difference for sex in ACL injury/total injury ratio. As age advanced, the proportion of ACL injuries/total injuries increased for both girls (P < 0.01) and boys (P = 0.04). BMI was independently associated with an ACL injury (P < 0.01). Conclusion: The proportion of ACL injuries/total injuries was similar for boys and girls aged 13 to 17 years. Girls showed a significantly steeper increase in ACL injury proportion versus boys through puberty. Clinical Relevance: This study will increase clinician awareness of ACL injury occurrence in young male and female athletes 5 to 12 years of age. Injury prevention efforts should target young girls before the onset of puberty and before injury occurs.

Assessment of the Postural Stability of Female and Male Athletes.

Objective: Postural stability is often affected by sport-related injuries and subsequently evaluated during postinjury examinations. Intrinsic factors, however, may also affect postural control. We sought to compare the postural control of female and male athletes as measured simultaneously by (1) the modified balance error scoring system (mBESS) and (2) a video-force plate system. Design: Cross-sectional study. Setting: Sports injury prevention center. Participants: Pediatric, adolescent, and young adult athletes who performed mBESS during an injury prevention evaluation. Independent Variables: We compared the postural control of female and male athletes. We also accounted for independent variables associated with postural stability, including age, body mass index, and history of ankle injury, concussion, and migraine headache. Main Outcome Measures: Total errors committed during the mBESS and measurements derived from integrated kinematic and kinetic data obtained by a video-force plate system. Differences between males and females were tested using analysis of covariance. Results: Participants (n = 409) ranged in age from 10 to 29 years (mean = 14.6 ± 2.8); 60% were female. No significant differences on mBESS were detected between females and males; however, female athletes demonstrated significantly better postural stability on the video-force plate analysis during double-leg (P = 0.03, d = 0.28), single-leg (P < 0.001, d = 0.62), and tandem stances (P < 0.001, d = 0.53) when compared with males. Conclusions: Uninjured female athletes demonstrate better postural stability on video-force plate analysis than their uninjured male counterparts. These findings provide an important information assistive to clinicians during interpretation of postinjury balance tests.

Pediatric Dance Injuries: A Cross-Sectional Epidemiological Study.

The purpose of this study was to analyze characteristics of dance injuries evaluated by sports medicine physicians.