Samantha E. Scarneo

Top 10 Research Questions Related to Preventing Sudden Death in Sport and Physical Activity

ABSTRACT Participation in organized sport and recreational activities presents an innate risk for serious morbidity and mortality. Although death during sport or physical activity has many causes, advancements in sports medicine and evidence-based standards of care have allowed clinicians to prevent, recognize, and treat potentially fatal injuries more effectively. With the continual progress of research and technology, current standards of care are evolving to enhance patient outcomes. In this article, we provided 10 key questions related to the leading causes and treatment of sudden death in sport and physical activity, where future research will support safer participation for athletes and recreational enthusiasts. The current evidence indicates that most deaths can be avoided when proper strategies are in place to prevent occurrence or provide optimal care.

State-Level Implementation of Health and Safety Policies to Prevent Sudden Death and Catastrophic Injuries Within Secondary School Athletics: Response:

We read with attentiveness the letter to the editor regarding our recently published article,1 and we thank the authors for sharing their thoughts. As in every study, there are limitations; however, we also wish to express urgency for the implementation of the 2013 best-practice recommendations for preventing sudden death in secondary school athletics.5 The letter to the editor calls into question the methodological approach used in our study, indicating that it undermines the subsequent conclusions—a statement with which we strongly disagree. The rubric was developed to assess health and safety policies at the secondary school level and was derived from “The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations,”5 which is fully endorsed by 14 medical and sport organizations, including the National Federation of State High School Associations, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, Canadian Athletic Therapists Association, Gatorade Sports Science Institute, Korey Stringer Institute, Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, National Athletic Trainers’ Association, National Center for Catastrophic Sport Injury Research, National Council on Strength and Fitness, National Interscholastic Athletic Administrators Association, and National Strength and Conditioning Association.5 Furthermore, accompanying position statements,2,4,8,9 consensus statements,3,12 and interassociation task force documents6,7,10 were also used to ensure that rubric contained the most current evidence-based best practices for preventing the leading causes of sudden death and catastrophic injury in sport and physical activity.

Occupational Settings: Considerations for the Laborer

Many occupational conditions expose workers to thermal stressors. The combination of heavy activity and environmental heat stress can create a dangerous work environment. These factors in combination with the limited safety standards for this population have resulted in an increased incidence of heat illnesses. Therefore, employers and employees must work together to develop appropriate heat illness prevention and treatment plans and procedures.

Assessment of Evidence-Based Health and Safety Policies on Sudden Death and Concussion Management in Secondary School Athletics: A Benchmark Study

CONTEXT: Implementation of best-practice health and safety policies has been shown to be effective at reducing the risk of sudden death in sport; however, little is known about the extent to which these policies are required within secondary school athletics. OBJECTIVE: To examine best-practice health and safety policies pertaining to the leading causes of sudden death and to concussion management in sport mandated at the state level for secondary school athletics. DESIGN: Descriptive observational study. SETTING: State high school athletic associations (SHSAAs), state departments of education, and enacted legislation. PATIENTS OR OTHER PARTICIPANTS:  United States (including the District of Columbia) SHSAAs. MAIN OUTCOME MEASURE(S):  A review of SHSAA health and safety policies for the 2016-2017 academic year, state department of education policies, and enacted legislation was undertaken to assess the polices related to the leading causes of sudden death and concussion management in sport. Current best-practice recommendations used to assess health and safety policies were specific to emergency action plans, automated external defibrillators, heat acclimatization, environmental monitoring and modification, and concussion management. The total number of best-practice recommendations required for each SHSAAs member schools for the aforementioned areas was quantified and presented as total number and percentage of recommendations required. RESULTS: Four of 51 SHSAA member schools were required to follow best practices for emergency action plans, 7 of 51 for access to automated external defibrillators, 8 of 51 for heat acclimatization, and 3 of 51 for management of concussion. CONCLUSIONS: At the time of this study, SHSAA member schools were not required to follow all best-practice recommendations for preventing the leading causes of sudden death and for concussion management in sport. Continued advocacy for the development and implementation of best practices at the state level to be required of all secondary schools is needed to appropriately serve the health and well-being of our young student-athletes.

Acute Sport-Related Concussion Screening for Collegiate Athletes Using an Instrumented Balance Assessment

CONTEXT   Without a true criterion standard assessment, the sport-related concussion (SRC) diagnosis remains subjective. Inertial balance sensors have been proposed to improve acute SRC assessment, but few researchers have studied their clinical utility. OBJECTIVE   To determine if group differences exist when using objective measures of balance in a sample of collegiate athletes with recent SRCs and participants serving as the control group and to calculate sensitivity and specificity to determine the diagnostic utility of the inertial balance sensor for acute SRC injuries. DESIGN   Cross-sectional cohort study. SETTING   Multicenter clinical trial. PATIENTS OR OTHER PARTICIPANTS   We enrolled 48 participants with SRC (age = 20.62 ± 1.52 years, height = 179.76 ± 10.00 cm, mass = 83.92 ± 23.22 kg) and 45 control participants (age = 20.85 ± 1.42 years, height = 177.02 ± 9.59 cm, mass = 74.61 ± 14.92 kg) at 7 clinical sites in the United States. All were varsity or club collegiate athletes, and all participants with SRC were tested within 72 hours of SRC. MAIN OUTCOME MEASURE(S)   Balance performance was assessed using an inertial balance sensor. Two measures (root mean square sway and 95% ellipse sway area) were analyzed to represent a range of general balance measures. Balance assessments were conducted in double-legged, single-legged, and tandem stances. RESULTS   A main effect for group was associated with the root mean square sway measure ( F1,91 = 11.75, P = .001), with the SRC group demonstrating balance deficits compared with the control group. We observed group differences in the 95% ellipse sway area measure for the double-legged ( F1,91 = 11.59, P = .001), single-legged ( F1,91 = 6.91, P = .01), and tandem ( F1,91 = 7.54, P = .007) stances. Sensitivity was greatest using a cutoff value of 0.5 standard deviations (54% [specificity = 71%]), whereas specificity was greatest using a cutoff value of 2 standard deviations (98% [sensitivity = 33%]). CONCLUSIONS   Inertial balance sensors may be useful tools for objectively measuring balance during acute SRC evaluation. However, low sensitivity suggests that they may be best used in conjunction with other assessments to form a comprehensive screening that may improve sensitivity.

The Inter-Association Task Force Document on Emergency Health and Safety: Best-Practice Recommendations for Youth Sports Leagues

This document is intended to serve as a call to action for all youth sport NGBs to provide support systems for member organizations through the education of league leaders and their members on the current policy and procedure best practices regarding EAPs, SCA, brain and neck injury, EHS, and other potentially threatening medical conditions (Appendix B). This document also discusses preexisting medical conditions, environmental conditions, and emergency medical care, such as athletic training services. The Task Force recognizes that each organization is unique and, therefore, will need to address policy and procedure recommendations differently to ensure the implementation of best practices. Furthermore, the Task Force recognizes that all best-practice policy and procedure recommendations may not be necessary for each sport (eg, lightning policy for indoor sports). Many of the deaths in youth sports are preventable, and it is the goal of the Task Force to support youth sport NGBs in this mission of prevention.

An Exploration of the Relationship of Body Mass Index with Motor Performance Measures and Quality of Life in Children Living in an Urban Setting

While the prevalence of obesity in children and adolescents aged 2-19 in the United States has remained stable at about 17% since 2003 (1) childhood obesity continues to be an area of significant concern. Obesity rates tend to be highest among children in families who function at or below the poverty threshold (2). While studies have found higher than average prevalence of obesity in urban youth (3), comparative studies indicate that children residing in rural areas also run higher than average risk of obesity (4,5) with children in rural areas having up to 30% greater chance of being overweight or obese than children in non-rural areas even after adjustments for sociodemographic, health, diet and exercise (6).