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Peterson AB, Waltzman D, Daugherty J, Chen J, Breiding M. Sport and Recreation Related Concussion in Children: National Concussion Surveillance System. Am J Prev Med 2024; 67:370-379. [PMID: 38852098 PMCID: PMC11338698 DOI: 10.1016/j.amepre.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Concussions sustained during sports and recreational activities are a concern for young athletes. The purpose of this study was to estimate past 12-month sport- and recreation-related (SRR) traumatic brain injuries (TBIs) among a sample of children. METHODS Pilot data from the Centers for Disease Control and Prevention's National Concussion Surveillance System were analyzed. National Concussion Surveillance System utilized a cross-sectional random-digit-dial telephone survey using computer-assisted telephone interviewing to collect self/proxy-reported data from 2018 to 2019. Adults with children aged 5-17 in the household were asked about head injuries sustained by their children. Estimates were stratified by sociodemographic and injury circumstance characteristics. Data analysis occurred from April 2022 to July 2023. RESULTS Utilizing a tiered case definition developed by the Centers for Disease Control and Prevention, an estimated 6.9% (95% confidence interval [CI], 6.0%-7.8%) of the sample's 5-17-year-old children sustained at least one probable or possible SRR-TBI in the previous 12 months; 3.3% (95% CI, 2.7%-4.0%) of the children sustained at least one probable SRR-TBI. An estimated 63.6% (95% CI, 58.1%-69.0%) of all reported TBIs were attributed to SRR activities. Of the SRR-TBIs reported, 41.1% (95% CI, 33.0%-49.2%) were experienced while playing contact sports. Symptoms did not resolve for 8 or more days or had not resolved at the time of the interview for 18.1% (95% CI, 13.0%-23.1%) of the children's most recent SRR-TBI. CONCLUSIONS Many proxy-reported TBIs among children aged 5-17 years were due to sports and recreational activities. Athletic trainers and healthcare providers can play a role in the prevention, identification, and management of SRR-TBIs in their respective environments.
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Affiliation(s)
- Alexis B Peterson
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia.
| | - Dana Waltzman
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia
| | - Jill Daugherty
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia
| | - Jufu Chen
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia
| | - Matthew Breiding
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia
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Coghlan K, McDermott J, Molloy M, Nason G, Carton P, O'Kelly F. A Narrative Review of Contact Sports Participation in Children and Young Athletes With a Solitary (Functioning) Kidney. Am J Sports Med 2024; 52:2939-2947. [PMID: 38348484 DOI: 10.1177/03635465231216341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND Evidence is sparse regarding the incidence or prevalence of renal or genitourinary injuries arising from contact sports. There are currently no World Health Organization or European consensus guidelines relating to the participation in sport for children and young athletes with a solitary (functioning) kidney. PURPOSE To review the international literature and to make sport-specific recommendations for children and young athletes with a solitary (functioning) kidney participating in sports, based on the overall likelihood of potential renal or genitourinary injury. STUDY DESIGN Narrative review; Level of evidence, 4. METHODS A descriptive epidemiological study was conducted of current literature according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Embase, Google Scholar, Cochrane, and PubMed databases were queried from 1975 to 2023, to assess available evidence regarding the prevalence and risk of renal injury through sports participation and guidelines surrounding the participation in sports for children and young athletes with a solitary (functioning) kidney. Methodological quality and certainty of evidence were assessed according to the International Classification of Urological Disease guidelines. RESULTS A total of 28 publications were identified after database searches and exclusions, comprising 40,889 patients. The majority of papers providing recommendations arose from the United States. Of the recommendations, 79% permitted an unrestricted return to noncontact sports. A return to contact sports is permitted in most instances after physician consultation. CONCLUSION There is a dearth of good-quality published evidence in the literature relating to sports participation with a solitary (functioning) kidney. Overall, the risk of genitourinary injury in sports is low, and after physician assessment, there is currently no strong evidence to exclude children and young athletes with a solitary (functioning) kidney from full participation in contact and collision sports.
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Affiliation(s)
- Kate Coghlan
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jack McDermott
- Department of Paediatric & Adolescent Urology, Beacon Hospital, Dublin, Ireland
| | - Michael Molloy
- Department of Emergency Medicine, Wexford General Hospital, Wexford, Ireland
- Faculty of Sports and Exercise Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gregory Nason
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Urology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Patrick Carton
- Faculty of Sports and Exercise Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Orthopaedic Surgery, UPMC Ireland, Waterford, Ireland
| | - Fardod O'Kelly
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Paediatric & Adolescent Urology, Beacon Hospital, Dublin, Ireland
- Faculty of Sports and Exercise Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rogers AE, Wichman CS, Schenkelberg MA, Dzewaltowski DA. Inequality in Children's Physical Activity Across Time-Segmented Youth Sport Practice. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024:1-13. [PMID: 38990545 DOI: 10.1080/02701367.2024.2367565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/07/2024] [Indexed: 07/12/2024]
Abstract
Purpose: Youth sport (YS) is a community system for promoting children's physical activity (PA). Studies have examined mean PA during YS practices, but few have examined inequalities in the distribution of PA among children during practice time. This study examined PA inequality in time-segmented YS practices and differences in inequality by time segment characteristics. Methods: Children's PA and YS practices were examined using accelerometer and video observation data from a sample of YS teams (n = 36 teams, n = 101 practices) for third- through sixth-grade children (n = 392), approximately eight to 12 years old, in two rural U.S. communities. Practices were time-segmented into smaller units (episodes; n = 991). Episodes were assigned codes for purpose (e.g. warm-up), member arrangement (e.g. whole group), and setting demand (i.e. fosters participation, creates exclusion). Group accelerometer data were paired with episodes, and the Gini coefficient quantified inequality in activity counts and minutes of moderate-to-vigorous PA (MVPA). Beta generalized estimating equations examined the influence of episode structure on PA inequality. Results: Warm-up (Gini = 0.22), fitness (Gini = 0.24), and sport skill (Gini = 0.24) episodes had significantly lower inequality (p < .05) in activity counts than other purpose types. Management (Gini = 0.32) and strategy (Gini = 0.40) episodes had significantly greater inequality (p < .05) in MVPA minutes than other purpose types. Episodes fostering participation (Gini = 0.32) had significantly lower activity count inequality (p < .05) than episodes creating exclusion (Gini = 0.35). Conclusion: PA inequality among children during YS varied by practice structure. Metrics such as the Gini coefficient can illuminate inequalities in PA and may be useful for guiding efforts to improve population PA in children. Trial Registration: This study is registered at www.clinicaltrials.gov (Identifier: NCT03380143).
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Schussler E, Jagacinski RJ, Chaudhari A, Buford JA, Onate JA. Models of Video Feedback for Youth Athletes Performing an American Football Tackle. J Athl Train 2024; 59:281-288. [PMID: 37071504 PMCID: PMC10976344 DOI: 10.4085/1062-6050-0602.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
CONTEXT Video feedback is an expeditious method for improving athlete safety when performing activities with an inherent risk of injury. Providing appropriate and validated feedback during tackling training in American football may be a mechanism for athletes to learn safe tackling performance. OBJECTIVE To determine the effect of video feedback in the instruction of tackling form. DESIGN Controlled laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 32 youth football athletes (28 boys, 4 girls; age = 11.8 ± 0.8 years) participated in 1 day of training. Of those, 14 participants completed 2 additional days of training and a 48-hour retention and transfer test. INTERVENTION(S) Video feedback using self as model, expert as model, combined self and expert model, and oral feedback to promote safe tackling performance in a laboratory environment. MAIN OUTCOME MEASURE(S) Shoulder extension, cervical extension, trunk angle, pelvis height, and step length by training block and over time. RESULTS For the 1-day training group, main effects for time were observed for shoulder extension (P < .01), cervical extension (P = .01), pelvis height (P < .01), and step length (P < .01), with better performance for pelvis height and step length after combined feedback. For the 3-day training group, main effects of time were identified in pelvis height (P < .01) and step length (P < .01), with combined feedback showing better performance than other methods in shoulder extension and pelvis height. Combined feedback resulted in better performance compared with its component parts and oral feedback alone. In the combined model, participants viewed both their performance and the expert model, enabling them to see the difference between current and required performance. CONCLUSIONS Combined feedback may be superior to other forms of feedback in improving movement performance. This effect can be generalized across disciplines that provide instruction and feedback in movement.
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Affiliation(s)
- Eric Schussler
- Rehabilitation Sciences, Old Dominion University, Norfolk, VA
| | | | - Ajit Chaudhari
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - John A. Buford
- Department of Physical Therapy, The Ohio State University, Columbus
| | - James A. Onate
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
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Waltzman D, Sarmiento K, Daugherty J. Factors That May Influence Americans' Views on When Children Should Start Playing Tackle Football. J Athl Train 2024; 59:22-29. [PMID: 37459380 PMCID: PMC10783471 DOI: 10.4085/1062-6050-0004.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
CONTEXT American football is associated with the largest number of emergency department visits for pediatric sport-related traumatic brain injury, including concussions. Tackling is responsible for almost two-thirds of football concussions. Some have recommended implementing age restrictions on tackling in youth football. OBJECTIVE To determine whether the public would support age restrictions and the factors that may drive such support. DESIGN Cross-sectional study. SETTING Summer wave of Porter Novelli's 2020 US ConsumerStyles survey. PARTICIPANTS A total of 4053 adults. MAIN OUTCOME MEASURE(S) Respondents answered questions about a good age for children to start playing tackle football, past football playing history, concerns about safety, and the benefits and risks of playing football. RESULTS Most respondents believed that middle (32.8%) or high (27.8%) school was a good age to start playing tackle football. About 1 in 5 (19.8%) respondents reported that children should never play tackle football. Certain groups of individuals were more likely to support children starting to play tackle football at high school age or above or to say that they should never play tackle football, including those with a bachelor's degree or higher (rate ratio [RR]HS+ = 1.41, 95% CI = 1.14, 1.76; RRNEVER = 2.70, 95% CI = 1.93, 3.78), those who did not have children under 18 (RRHS+ = 1.54, 95% CI = 1.26, 1.90; RRNEVER = 1.54, 95% CI = 1.14, 2.07), those who were not football fans (RRNEVER = 3.07, 95% CI = 2.32, 4.06), and those who were very (RRHS+ = 3.94, 95% CI = 2.87, 5.42; RRNEVER = 11.52, 95% CI = 7.32, 18.15) or somewhat (RRHS+ = 1.88, 95% CI = 1.41, 2.52) concerned about the safety of children. CONCLUSION Despite acknowledging the benefits of playing football, many adults expressed concern about safety and endorsed high school age and older or never as a good age to start playing tackle football, highlighting a disconnect with current football program practices regarding age.
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Affiliation(s)
- Dana Waltzman
- Centers for Disease Control and Prevention, Atlanta, GA
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Braaten JA, Banovetz MT, Braaten MC, Kennedy NI, LaPrade RF. Increased Risk of Fracture, Dislocation, and Hospitalization Are Associated With Collision in Contact Sports. Arthrosc Sports Med Rehabil 2023; 5:100781. [PMID: 37564903 PMCID: PMC10410130 DOI: 10.1016/j.asmr.2023.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/15/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose To quantitatively determine whether there is an added risk of orthopaedic injury attributable to the collision forces that athletes participating in collision-contact (CC) sports regularly encounter. Methods The National Electronic Injury Surveillance System was used to collect data on patients presenting to an emergency department with a contact sports-related injury between 2014 and 2020. Select contact sports were classified as either belonging to a CC or noncollision-contact (NCC) sports group based on involvement of frequent and intentional player-to-player collisions. Results From 2014 to 2020, 25,784 patients with team-based sports related injuries presented to an emergency department, of whom 7,591 sustained an injury during a CC sport and 18,193 during a NCC sport. The CC group was associated with significantly increased odds of sustaining at least 1 fracture (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.35-1.52) (P < .001), dislocation (OR 1.2, 95 % CI 1.06-1.33) (P < .001), and being admitted into the hospital (OR 1.6, 95% CI 1.34-1.86) (P < .001), compared with the NCC group. Conclusions We found that frequent and intentional high-energy collisions associated with CC sports significantly increase the risk of sustaining fractures and dislocations. Furthermore, we found that that the injuries sustained by players engaging in CC sports required hospitalization at a significantly greater rate than those sustained in contact sports that do not involve frequent and intentional player-to-player collisions. Level of Evidence Level III, prognostic (retrospective cohort study).
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Affiliation(s)
- Jacob A. Braaten
- University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
| | - Mark T. Banovetz
- University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A
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Lee CD, Meehan WP, Bazarian J. Participation of Children in American Football. N Engl J Med 2023; 389:660-662. [PMID: 37585634 DOI: 10.1056/nejmclde2302021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
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8
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Muacevic A, Adler JR, Kalkbrenner MT, Kershaw Z, Seemann LL, Pujalte GGA. Effects of Athletic Trainer Direct Employment on the Management of Sports-Related Injuries in High School Athletes. Cureus 2022; 14:e32995. [PMID: 36712732 PMCID: PMC9878929 DOI: 10.7759/cureus.32995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hiring athletic trainers (ATs) in high schools has attracted rising interest as a potential way of improving adolescents' health by enhancing their safety and reducing their risk of injury. OBJECTIVE This study aims to determine if there is a difference in the referral patterns, injury diagnoses, and injury treatments performed at a metropolitan high school when an AT is employed versus not employed by the school. DESIGN This is a retrospective quantitative two-period study. SETTING The study was conducted in the high school athletic department in Norfolk, Virginia, and the study population was high school athletes (age 14-18). MAIN OUTCOME MEASURES Changes in referral patterns, injury diagnoses, and injury treatments performed at a local high school when an AT is employed versus not employed by the school; specifically, we examined the number of and percent changes in yearly treatments, referrals, evaluations, and re-evaluations during the two periods. RESULTS Our first t-test revealed a statistically significant increase in the number of reported injuries between 2011-2015 (M = 58.00, SD = 44.86) and 2016-2020 (M = 299.00, SD = 40.93, p = 0.006. The second t-test revealed a statistically significant increase in the number of referrals between 2011-2015 (M = 249.00, SD = 353.41) and 2016-2020 (M = 1188.00, SD = 158.21), p = 0.014. The third t-test revealed a statistically significant increase in the number of treatment items between 2011-2015 (M = 150.67, SD = 175.32) and 2016-2020 (M = 636.67, SD = 211.72), p = 0.01. CONCLUSIONS The present study found an increased frequency of reported injuries, referrals, and treatment after ATs directly joined the staff of a large metropolitan high school. These findings suggest that direct employment of ATs is associated with greater recording of injuries and treatment of conditions. A reduction in referrals occurs with the presence of directly employed ATs, which could result in improved health for student-athletes, but this needs further study.
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9
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Head Impact Exposure in Youth and Collegiate American Football. Ann Biomed Eng 2022; 50:1488-1497. [PMID: 35507229 PMCID: PMC10081156 DOI: 10.1007/s10439-022-02974-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/25/2022] [Indexed: 11/01/2022]
Abstract
The relationship between head impact and subsequent brain injury for American football players is not well-defined, especially for youth. The objective of this study is to quantify and assess Head Impact Exposure (HIE) metrics among youth and collegiate football players. This multi-season study enrolled 639 unique athletes (354 collegiate; 285 youth, ages 9-14), recording 476,209 head impacts (367,337 collegiate; 108,872 youth) over 971 sessions (480 collegiate; 491 youth). Youth players experienced 43 and 65% fewer impacts per competition and practice, respectively, and lower impact magnitudes compared to collegiate players (95th percentile peak linear acceleration (PLA, g) competition: 45.6 vs 61.9; 95th percentile PLA practice: 42.6 vs 58.8; 95th percentile peak rotational acceleration (PRA, rad·s-2) competition: 2262 vs 4422; 95th percentile PRA practice: 2081 vs 4052; 95th percentile HITsp competition: 25.4 vs 32.8; 95th percentile HITsp practice: 23.9 vs 30.2). Impacts during competition were more frequent and of greater magnitude than during practice at both levels. Quantified comparisons of head impact frequency and magnitude between youth and collegiate athletes reveal HIE differences as a function of age, and expanded insight better informs the development of age-appropriate guidelines for helmet design, prevention measures, standardized testing, brain injury diagnosis, and recovery management.
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10
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Hibshman N, Yengo-Kahn A, Wiseman A, Kelly PD, Wu J, Monk S, Harris G, Gannon S, Shannon C, Bonfield CM. Child participation in collision sports and football: what influences parental decisions? PHYSICIAN SPORTSMED 2022; 50:171-180. [PMID: 33764271 PMCID: PMC10565646 DOI: 10.1080/00913847.2021.1908867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Sport participation promotes health benefits for children. Current media and scientific coverage of sport-related head injury may influence a parent's decision on sports participation. Physicians must understand what influences these decisions to effectively counsel patients and families. This study sought to better understand and quantify the parental decisions to allow/disallow collision sports, including football participation. METHODS A 31-question survey related to child/parent demographics, sports history, and influences to allow/disallow sport participation was available to parents in the United States through a national volunteer registry, between November 2016 and September 2019. Pearson's chi-squared and Wilcoxon's signed-rank test were used to analyze categorical and continuous variables, respectively. Multivariate logistic regression was performed to identify the most powerful factors associated with the decision. RESULTS Of the 884 responses, 430 (49%) parents would disallow collision sport participation and 334 (38%) would disallow football. Parents who would allow collision sports more commonly cited child desire, while those parents who would disallow cited safety concern as the greatest influence to generally disallow a sport. Those who would disallow reported doctors (35.1% vs 25.3%; P = 0.002), media (12.8% vs 7.3%; P = 0.006) and other parents (11.2% vs 7.3%; P = 0.045) as influences. A child's age (OR 1.039, 95%CI 1.007-1.073; P = 0.018) was independently associated with their parent responding that they would allow collision sports. Parent educational status showed that those with higher than a bachelor's degree would be less likely to allow football participation (OR 0.635, 95%CI 0.443-0.910; P = 0.013). CONCLUSIONS Parents incorporate many sources of information into the decision to allow or disallow their child to participate in collision sports. A child's desire to play a sport and child safety are driving factors for parents faced with the decision of whether to allow participation in collision sports. Physician input is more frequently influential to parents than the media, underscoring the responsibility of physicians to engage families on the risks, benefits, and resources available for sport participation.
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Affiliation(s)
- Natalie Hibshman
- Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Surgical Outcomes Center for Kids, Vanderbilt University Monroe Carrell Jr. Hospital, Nashville, TN, USA
| | - Aaron Yengo-Kahn
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Surgical Outcomes Center for Kids, Vanderbilt University Monroe Carrell Jr. Hospital, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alyssa Wiseman
- Surgical Outcomes Center for Kids, Vanderbilt University Monroe Carrell Jr. Hospital, Nashville, TN, USA
| | - Patrick D. Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffanie Wu
- Vanderbilt University School of Medicine, Nashville, TN, USA
- Surgical Outcomes Center for Kids, Vanderbilt University Monroe Carrell Jr. Hospital, Nashville, TN, USA
| | - Steve Monk
- Department of Neurological Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Glenn Harris
- Department of Neurology, Northwestern University McGaw Hospital, Chicago, IL, USA
| | - Stephen Gannon
- Surgical Outcomes Center for Kids, Vanderbilt University Monroe Carrell Jr. Hospital, Nashville, TN, USA
| | - Chevis Shannon
- Surgical Outcomes Center for Kids, Vanderbilt University Monroe Carrell Jr. Hospital, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christopher M. Bonfield
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Surgical Outcomes Center for Kids, Vanderbilt University Monroe Carrell Jr. Hospital, Nashville, TN, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Roghair J, Espe-Pfeifer P, Peterson A. Neuropsychological Profiles of Athletes and Views of Parents Choosing Flag Versus Tackle Football Participation. Orthop J Sports Med 2022; 10:23259671221079360. [PMID: 35295552 PMCID: PMC8918748 DOI: 10.1177/23259671221079360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Previous studies have found that injury rates are slightly higher in children who play flag football versus tackle football. It is unclear if this difference is due to the way each type is played or taught or whether there are intrinsic differences in attitudes or neuropsychological characteristics in children and their parents. Purpose: To determine whether children who play flag football score differently from those who play tackle football on validated neuropsychological tests. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Each participating athlete (aged 8-12 years) was recruited in 2018 and 2019 by email through local youth football leagues and the local university. Each athlete was administered a 1-time multidimensional assessment battery. The battery included the Wechsler Abbreviated Scale of Intelligence-2nd Edition, the children’s version of the Trail Making Test, the Integrated Digit Span and Spatial Span subtests of the Wechsler Intelligence Scale for Children-4th Edition (WISC-IV), and the Beck Self-Concept Inventory for Youth. The parent/guardian of each athlete completed the Achenbach Child Behavior Checklist-Parent Report Form, the Behavior Rating Inventory of Executive Function (BRIEF)-Parent Form, and a custom survey. These tests were used to determine IQ estimates and standardized scores, measuring verbal comprehension, matrix reasoning, mental set-shifting, attention, cognitive processing speed, working memory, spatial processing, perception of self-concept, behavioral regulation index, metacognition index, and global executive composite. Scores were compared between flag football and tackle football groups by 2-sample t test, with the Wilcoxon rank-sum test used for nonparametric data. Results: A total of 64 athletes (41 tackle football, 23 flag football) were enrolled from youth football leagues (grades 4-6). Flag players scored significantly higher on the WISC-IV Spatial Span-Backward subtest (scaled mean, 12.0 vs 10.6; P = .046), while tackle players had significantly higher BRIEF-Inhibit subscores (mean t-score, 45 vs 42; P = .026). There were no significant differences in any of the other tests, including socioeconomic status and perceived concussion risks. Conclusion: Concerns that injury epidemiologic studies comparing flag with tackle football could be confounded by intrinsic differences in the children who choose to play each type seem to be unfounded.
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Affiliation(s)
- Jasmine Roghair
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Patricia Espe-Pfeifer
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Andrew Peterson
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
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12
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Fickling SD, Poel DN, Dorman JC, D’Arcy RCN, Munce TA. Subconcussive changes in youth football players: objective evidence using brain vital signs and instrumented accelerometers. Brain Commun 2021; 4:fcab286. [PMID: 35291689 PMCID: PMC8914875 DOI: 10.1093/braincomms/fcab286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
Brain vital signs, measured by EEG, were used for portable, objective,
neurophysiological evaluation of cognitive function in youth tackle football
players. Specifically, we investigated whether previously reported pre- and
post-season subconcussive changes detected in youth ice hockey players were
comparably detected in football. The two objectives were to: (i) replicate
previously published results showing subconcussive cognitive deficits; and (ii)
the relationship between brain vital sign changes and head-impact exposure.
Using a longitudinal design, 15 male football players (age
12.89 ± 0.35 years) were tested pre- and
post-season, with none having a concussion diagnosis during the season. Peak
latencies and amplitudes were quantified for Auditory sensation (N100), Basic
attention (P300) and Cognitive processing (N400). Regression analyses tested the
relationships between these brain vital signs and exposure to head impacts
through both number of impacts sustained, and total sessions (practices and
games) participated. The results demonstrated significant pre/post differences
in N400 latencies, with ∼70 ms delay
(P < 0.01), replicating prior findings.
Regression analysis also showed significant linear relationships between brain
vital signs changes and head impact exposure based on accelerometer data and
games/practices played (highest
R = 0.863, P
< 0.001 for overall sessions). Number of head impacts in youth
football (age 12–14 years) findings corresponded most closely
with prior Junior-A ice hockey (age 16–21 years) findings,
suggesting comparable contact levels at younger ages in football. The predictive
relationship of brain vital signs provided a notable complement to instrumented
accelerometers, with a direct physiological measure of potential individual
exposure to subconcussive impacts.
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Affiliation(s)
- Shaun D Fickling
- Faculty of Sciences and Applied Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- BrainNET, Health and Technology District, Surrey, BC V3V 0C6, Canada
- Center for Neurology Studies, HealthTech Connex, Surrey, BC V3V 0C6, Canada
| | - Daniel N Poel
- Sanford Sports Science Institute, Sanford Health, Sioux Falls, SD 57107, USA
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, SD 57104, USA
| | - Jason C Dorman
- Sanford Sports Science Institute, Sanford Health, Sioux Falls, SD 57107, USA
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, SD 57104, USA
| | - Ryan C N D’Arcy
- Faculty of Sciences and Applied Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- BrainNET, Health and Technology District, Surrey, BC V3V 0C6, Canada
- Center for Neurology Studies, HealthTech Connex, Surrey, BC V3V 0C6, Canada
| | - Thayne A Munce
- Sanford Sports Science Institute, Sanford Health, Sioux Falls, SD 57107, USA
- Environmental Influences on Health and Disease Group, Sanford Research, Sioux Falls, SD 57104, USA
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13
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Stinson ZS, Davelaar CMF, Kiebzak GM, Edmonds EW. Treatment Decisions in Pediatric Sports Medicine: Do Personal and Professional Bias Affect Decision-Making? Orthop J Sports Med 2021; 9:23259671211046258. [PMID: 34676272 PMCID: PMC8524719 DOI: 10.1177/23259671211046258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Personal and professional biases can affect decision-making regarding
important issues in pediatric sports medicine. Gaining insight into the
opinions of health care professionals who specialize in pediatric sports
medicine will provide information that may be useful for directing ongoing
research in this field. Hypothesis: It was hypothesized that surgeons would demonstrate bias toward early
surgical intervention versus nonsurgeons. In addition, it was hypothesized
that youth sports medicine professionals who were parents of a child with a
previous major sports injury or concussion would be less likely to allow
their child to play American tackle football or return to football after a
concussion. Study Design: Cross-sectional study. Methods: An online survey was provided to the active members of the Pediatric Research
in Sports Medicine Society. We used both professional background information
and responses to questions related to personal experiences with youth sports
injuries to determine potential factors associated with underlying biases.
Survey responses among subgroups were compared using the Fisher exact test.
The Pearson correlation coefficient was used to evaluate years in practice
versus opioid use. Results: Of the survey participants, 62.5% were pediatric surgeons, and 37.5%
represented different nonsurgical youth sports medicine professions.
Surgeons were less likely than nonsurgeons to agree to allow their child to
return to football after sustaining a concussion and completing a concussion
protocol (48% vs 76%, P = .013). Surgeons were more likely
than nonsurgeons to agree to both elective shoulder stabilization after a
first-time dislocation and elective drilling of a stable knee
osteochondritis dissecans (OCD) before nonoperative treatment (41% vs 10%,
P = .003 and 52% vs 23%, P = .013,
respectively). Those who reported having a child with a concussion history
were more likely to support him or her returning to football after a
concussion (65% vs 33%, P = .026). Conclusion: Surgeons were more likely to favor elective shoulder-stabilization surgery
after a first-time dislocation and drilling of a stable knee OCD instead of
nonoperative management. Personal experience of having a child who sustained
a major sports injury or concussion did not demonstrate a bias against
participation in football or return to football after a concussion.
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Iverson GL, Büttner F, Caccese JB. Age of First Exposure to Contact and Collision Sports and Later in Life Brain Health: A Narrative Review. Front Neurol 2021; 12:727089. [PMID: 34659092 PMCID: PMC8511696 DOI: 10.3389/fneur.2021.727089] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022] Open
Abstract
A controversial theory proposes that playing tackle football before the age of 12 causes later in life brain health problems. This theory arose from a small study of 42 retired National Football League (NFL) players, which reported that those who started playing tackle football at a younger age performed worse on selected neuropsychological tests and a word reading test. The authors concluded that these differences were likely due to greater exposure to repetitive neurotrauma during a developmentally sensitive maturational period in their lives. Several subsequent studies of current high school and collegiate contact/collision sports athletes, and former high school, collegiate, and professional tackle football players have not replicated these findings. This narrative review aims to (i) discuss the fundamental concepts, issues, and controversies surrounding existing research on age of first exposure (AFE) to contact/collision sport, and (ii) provide a balanced interpretation, including risk of bias assessment findings, of this body of evidence. Among 21 studies, 11 studies examined former athletes, 8 studies examined current athletes, and 2 studies examined both former and current athletes. Although the literature on whether younger AFE to tackle football is associated with later in life cognitive, neurobehavioral, or mental health problems in former NFL players is mixed, the largest study of retired NFL players (N = 3,506) suggested there was not a significant association between earlier AFE to organized tackle football and worse subjectively experienced cognitive functioning, depression, or anxiety. Furthermore, no published studies of current athletes show a significant association between playing tackle football (or other contact/collision sports) before the age of 12 and cognitive, neurobehavioral, or mental health problems. It is important to note that all studies were judged to be at high overall risk of bias, indicating that more methodologically rigorous research is needed to understand whether there is an association between AFE to contact/collision sports and later in life brain health. The accumulated research to date suggests that earlier AFE to contact/collision sports is not associated with worse cognitive functioning or mental health in (i) current high school athletes, (ii) current collegiate athletes, or (iii) middle-aged men who played high school football. The literature on former NFL players is mixed and does not, at present, clearly support the theory that exposure to tackle football before age 12 is associated with later in life cognitive impairment or mental health problems.
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Affiliation(s)
- Grant L. Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
- Spaulding Research Institute, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA, United States
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Fionn Büttner
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Jaclyn B. Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, United States
- Chronic Brain Injury Program, The Ohio State University, Columbus, OH, United States
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15
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Sarmiento K, Waltzman D, Devine O, Zhang X, DePadilla L, Kresnow MJ, Borradaile K, Hurwitz A, Jones D, Goyal R, Breiding MJ. Differences in Head Impact Exposures Between Youth Tackle and Flag Football Games and Practices: Potential Implications for Prevention Strategies. Am J Sports Med 2021; 49:2218-2226. [PMID: 33999722 PMCID: PMC8335321 DOI: 10.1177/03635465211011754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Interventions designed to reduce the risk for head impacts and concussion in youth football have increased over the past decade; however, understanding of the role of regular game play on head impact exposure among youth tackle and flag football athletes is currently limited. PURPOSE To explore head impact exposure among youth tackle and flag football athletes (age range, 6-14 years) during both practices and games. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Using the Vector MouthGuard sensor, the authors collected head impact data from 524 tackle and flag youth football athletes over the course of a football season. Quantities of interest were estimated from regression models using Bayesian methods. RESULTS For impacts ≥10g, a tackle football athlete had an estimated 17.55 (95% CI, 10.78-28.96) times more head impacts per practice compared with a flag football athlete (6.85 [95% CI, 6.05-7.76] and 0.39 [95% CI, 0.24-0.62] head impacts, respectively). Additionally, a tackle football athlete had an estimated 19.48 (95% CI, 12.74-29.98) times more head impacts per game compared with a flag football athlete (13.59 [95% CI, 11.97-15.41] and 0.70 [95% CI, 0.46-1.05] head impacts, respectively). Among tackle football athletes, the estimated average impact rate was 6.51 (95% CI, 5.75-7.37) head impacts during a practice and 12.97 (95% CI, 11.36-14.73) impacts during a game, resulting in 2.00 (95% CI, 1.74-2.29) times more ≥10g head impacts in games versus practices. Tackle football athletes had 2.06 (95% CI, 1.80-2.34) times more high-magnitude head impacts (≥40g) during a game than during a practice. On average, flag football athletes experienced an estimated 0.37 (95% CI, 0.20-0.60) head impacts during a practice and 0.77 (95% CI, 0.53-1.06) impacts during a game, resulting in 2.06 (95% CI, 1.29-3.58) times more ≥10g head impacts in games versus practices. Because of model instability caused by a large number of zero impacts for flag football athletes, a comparison of high-magnitude head impacts is not reported for practices or games. CONCLUSION This study provides a characterization of the head impact exposure of practices and games among a large population of youth tackle and flag football athletes aged 6 to 14 years. These findings suggest that a greater focus on game-based interventions, such as fair play interventions and strict officiating, may be beneficial to reduce head impact exposures for youth football athletes.
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Affiliation(s)
- Kelly Sarmiento
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
- Address correspondence to Kelly Sarmiento, MPH, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, 4770 Buford Hwy, NE, MS S106-09, Atlanta, GA 30341, USA ()
| | - Dana Waltzman
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | | | - Xinjian Zhang
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | - Lara DePadilla
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Overdose Prevention, Atlanta, Georgia, USA
| | - Marcie-Jo Kresnow
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | | | | | - David Jones
- Mathematica Policy Inc, Princeton, New Jersey, USA
| | - Ravi Goyal
- Mathematica Policy Inc, Princeton, New Jersey, USA
| | - Matthew J. Breiding
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
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16
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Mehta NK, Siegel J, Cowan B, Johnson J, Hojjat H, Chung MT, Carron MA. Head and Neck Injury Patterns among American Football Players. Ann Otol Rhinol Laryngol 2021; 131:463-470. [PMID: 34142563 DOI: 10.1177/00034894211026478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
IMPORTANCE American football is a popular high-impact sport, leading to 2.7 million injuries in the United States annually. Recent evidence in football-related neurological damage has spurred national interest in player-safety. Football players injure their head and neck in up to 26% of total injuries. Variation in injury patterns between age groups and correlated hospitalizations for football-related head and neck injury has yet to be characterized. OBJECTIVE Our aim is to evaluate injury patterns among American-football related head and neck trauma. METHODS A retrospective cohort study of patients with football-related head and neck injury in the National Electronic Injury Surveillance System (NEISS). RESULTS Nearly 100 000 ED visits for football-related head and neck injuries occur annually. Males comprised 95% of patients, with a median age of 13. The head comprised 70% of injuries followed by the face (13%). The most common diagnoses were concussions (39%), internal organ injury (26%), and lacerations (11%). Pediatric patients were more likely to sustain concussions while adults experienced more lacerations (P < .05%). Fractures and nerve damage were rare injuries but caused a disproportionate share of hospitalizations. CONCLUSION Pediatric males are most likely to present for emergency care from football-related injury to the head and neck. Evaluating physicians can anticipate concussions, internal organ injury, and lacerations among presenting patients. Concussions, facial fractures, and nerve damage are injuries most likely to lead to hospitalization.
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Affiliation(s)
- Neil K Mehta
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Justin Siegel
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Brandon Cowan
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Jared Johnson
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Houmehr Hojjat
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Michael T Chung
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
| | - Michael A Carron
- Wayne State University, Department of Otolaryngology, Division of Facial Plastic Surgery, Detroit, MI, USA
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17
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Waltzman D, Sarmiento K, Devine O, Zhang X, DePadilla L, Kresnow MJ, Borradaile K, Hurwitz A, Jones D, Goyal R, Breiding MJ. Head Impact Exposures Among Youth Tackle and Flag American Football Athletes. Sports Health 2021; 13:454-462. [PMID: 33618557 PMCID: PMC8404728 DOI: 10.1177/1941738121992324] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Promoted as a safer alternative to tackle football, there has been an increase in flag football participation in recent years. However, examinations of head impact exposure in flag football as compared with tackle football are currently limited. Hypothesis: Tackle football athletes will have a greater number and magnitude of head impacts compared with flag football athletes. Study Design: Cohort study. Level of Evidence: Level 4. Methods: Using mouthguard sensors, this observational, prospective cohort study captured data on the number and magnitude of head impacts among 524 male tackle and flag football athletes (6-14 years old) over the course of a single football season. Estimates of interest based on regression models used Bayesian methods to estimate differences between tackle and flag athletes. Results: There were 186,239 head impacts recorded during the study. Tackle football athletes sustained 14.67 (95% CI 9.75-21.95) times more head impacts during an athletic exposure (game or practice) compared with flag football athletes. Magnitude of impact for the 50th and 95th percentile was 18.15g (17.95-18.34) and 52.55g (51.06-54.09) for a tackle football athlete and 16.84g (15.57-18.21) and 33.51g (28.23-39.08) for a flag football athlete, respectively. A tackle football athlete sustained 23.00 (13.59-39.55) times more high-magnitude impacts (≥40g) per athletic exposure compared with a flag football athlete. Conclusion: This study demonstrates that youth athletes who play tackle football are more likely to experience a greater number of head impacts and are at a markedly increased risk for high-magnitude impacts compared with flag football athletes. Clinical Relevance: These results suggest that flag football has fewer head impact exposures, which potentially minimizes concussion risk, making it a safer alternative for 6- to 14-year-old youth football athletes.
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Affiliation(s)
- Dana Waltzman
- Dana Waltzman, PhD, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341 ()
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18
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Sarmiento K, Waltzman D, Borradaile K, Hurwitz A, Conroy K, Grazi J. A Qualitative Study of Youth Football Coaches' Perception of Concussion Safety in American Youth Football and Their Experiences With Implementing Tackling Interventions. INTERNATIONAL SPORT COACHING JOURNAL 2021; 1:10.1123/iscj.2020-0004. [PMID: 33598504 PMCID: PMC7884092 DOI: 10.1123/iscj.2020-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Due in part to concern about the potential long-term effects of concussion and repetitive head injuries in football, some programs have implemented tackling interventions. This paper explores youth football coaches' perception of football safety and their experiences implementing these interventions aimed at athlete safety. Using a qualitative approach, coaches were interviewed by means of a semi-structured protocol that covered: (a) demographics; (b) background and experiences; (c) personal relevance risks, safety, and benefits of youth football; (d) experiences with tackling technique; (e) experiences with mouth guard sensors; and (f) opinions on disseminating information on football safety. Most coaches felt that learning tackling at a young age helped prepare them for their playing later in life and believed that youth should begin playing tackle football at a young age. Coaches were mixed regarding their concerns about the risk for concussion and subconcussive head impacts. Still, most were receptive to changes in rules and policies aimed at making football safer. Findings from this study demonstrate that youth football coaches are important stakeholders to consider when implementing changes to youth football. Understanding coach perceptions and experiences may inform future efforts aimed to educate coaches on rules and policies to make the game safer for youth athletes.
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Affiliation(s)
- Kelly Sarmiento
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Dana Waltzman
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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19
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Ross LF. The Pediatrician’s Moral Obligation to Counsel Directively Against Youth Tackle Football. THE JOURNAL OF CLINICAL ETHICS 2020. [DOI: 10.1086/jce2020314331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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20
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Baugh CM. Athlete Concussion Reporting: It Is Time to Think Bigger. J Adolesc Health 2020; 66:643-644. [PMID: 32473716 DOI: 10.1016/j.jadohealth.2020.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Christine M Baugh
- Division of General Internal Medicine, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
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21
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Lerner A, Fost N. Informed Consent for Youth Tackle Football: Implications of the AAP Policy Statement. Pediatrics 2019; 144:peds.2019-1985. [PMID: 31645457 DOI: 10.1542/peds.2019-1985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alec Lerner
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Norman Fost
- Departments of Pediatrics and Medical History and Bioethics and
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22
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Abstract
Background: As football comes under greater scrutiny because of concussions and other injuries, many people are searching for safer alternatives, especially for youth athletes. The injury rate in TackleBar football, one such alternative, is not currently known. Purpose: To describe TackleBar football and calculate its injury rate over a single season to compare it with both traditional tackle and flag football. Study Design: Descriptive epidemiology study. Methods: TackleBar football was described, and injuries of male athletes (age range, 9-14 years) participating in TackleBar football were tracked over the course of a season (August 5 through October 27, 2018) and compared with published injury rates for traditional tackle and flag football. Results: The overall injury rate of TackleBar football was found to be 0.31 per 1000 athlete-exposures (AEs), which is lower than youth tackle (2.25-2.60/1000 AEs) and flag (5.77/1000 AEs) football. Conclusion: TackleBar football may represent a reasonable alternative to tackle and flag football with regard to injuries.
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Affiliation(s)
- Joseph Toninato
- Research & Development, UnitedHealth Group, Minnetonka, Minnesota, USA
| | - Tim Healy
- TackleBar, Long Lake, Minnesota, USA
| | - Uzma Samadani
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,Bioinformatics and Computational Biology Program, University of Minnesota College of Science and Engineering, Minneapolis, Minnesota, USA.,CentraCare Health, St Cloud, Minnesota, USA.,Division of Neurosurgery, Minneapolis VA Medical Center, Minneapolis, Minnesota, USA
| | - Eric Christianson
- Emergency Services, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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23
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Alosco ML, Stern RA. Youth Exposure to Repetitive Head Impacts From Tackle Football and Long-term Neurologic Outcomes: A Review of the Literature, Knowledge Gaps and Future Directions, and Societal and Clinical Implications. Semin Pediatr Neurol 2019; 30:107-116. [PMID: 31235012 DOI: 10.1016/j.spen.2019.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Youth participation in contact and collision sports, particularly tackle football, is associated with exposure to repetitive head impacts during a time period when tremendous brain maturation is occurring. Accumulating evidence suggests that exposure to repetitive head impacts from youth tackle football may increase vulnerability to long-term cognitive, neuropsychiatric, and neurologic disturbances. There are limitations to the current literature and conflicting findings exist. Nonetheless, participation in youth football has become a cause of concern to clinicians, scientists, politicians, coaches, parents, and children. The objective of this paper is to review the literature on the long-term cognitive, neuropsychiatric, and neurologic outcomes associated with participation in youth contact and collision sports, with a focus on tackle football. We provide an overview of the empirically derived framework that has served as the foundation for the investigation of youth tackle football and neurologic outcomes. The extant research studies on age of first exposure to tackle football and later-life cognitive and neuropsychiatric functioning, as well as structural brain changes are reviewed. We discuss the limitations of the current evidence, suggest future directions, and conclude with our opinions on societal and clinical implications.
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Affiliation(s)
- Michael L Alosco
- Boston University (BU), Alzheimer's Disease Center, BU CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA
| | - Robert A Stern
- Boston University (BU), Alzheimer's Disease Center, BU CTE Center, Department of Neurology, Boston University School of Medicine, Boston, MA; Departments of Neurosurgery and Anatomy & Neurobiology, Boston University School of Medicine, Boston, MA.
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24
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Li T, Johnson ST, Koester MC, Hommel A, Norcross MF. The impact of high school athletic trainer services on medical payments and utilizations: a microsimulation analysis on medical claims. Inj Epidemiol 2019; 6:15. [PMID: 31245264 PMCID: PMC6582695 DOI: 10.1186/s40621-019-0194-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/21/2019] [Indexed: 06/13/2024] Open
Abstract
Background Increasing athletic trainer (AT) services in high schools has attracted widespread interest across the nation as an effective instrument to manage injuries and improve children’s health, but there is a lack of evidence on potential medical savings. Our study aimed to address this knowledge gap and provide evidence of AT impacts on medical payments and utilizations to inform public policy decision. Methods We obtained medical claims of patients aged 14 to 18 years from the 2011–2014 Oregon All Payer All Claims limited dataset. We calculated payer payments and utilizations for medical claims under AT’s scope of practice. We used zip codes to link patients with the enrollment boundaries of Oregon public high schools, which were classified as either “AT group” or “non-AT group”. We implemented an innovative microsimulation analysis to address the uncertainty of linkage between children and schools. Results Our analysis included 64,115 and 84,968 eligible children with Medicaid and commercial insurance, respectively. Associated with high school AT services, Medicaid saved an average of $64 per patient during the study period, while commercial insurance payment rarely changed. AT services may reduce emergency visits for both insurance types but increase total visits for commercially insured patients. Conclusions Our study provides evidence for the differential impacts of AT services on medical payments and utilizations. The legislators should consider to allocate funds for high schools to directly employ ATs. This will encourage ATs to work to their highest ability to improve children’s wellbeing while containing avoidable medical cost.
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Affiliation(s)
- Tao Li
- 1Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon USA
| | - Samuel T Johnson
- 2Kinesiology Program, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon USA
| | - Michael C Koester
- 3Slocum Center for Orthopedics and Sports Medicine, Eugene, Oregon USA
| | - Annie Hommel
- 1Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon USA
| | - Marc F Norcross
- 2Kinesiology Program, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon USA
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25
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Perlman M, Williams WA, Ross LF. Missed Opportunities in the Preparticipation Physical Examination for High School Athletes. Clin Pediatr (Phila) 2019; 58:547-554. [PMID: 30788982 DOI: 10.1177/0009922819832021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The preparticipation sports examination (PPE) is required for US high school athletes. We queried members of the Illinois Chapter of the American Academy of Pediatrics (ICAAP) about what they actually include in a PPE, allotted PPE time, and counseling about full contact sports participation. Of 2300 ICAAP members contacted electronically, 228 (10%) responded, yielding 205 usable surveys. When performing a PPE, 34 (25%) always complete all of 6 selected AAP-recommended PPE components and 102 (74%) always get a concussion history. In contrast, 29 (21%) always complete all of the 6 selected AAP PPE components and 70 (49%) always get a concussion history as part of well-child checkup. Main interferences with clinician proficiency are lack of time and training cited by 49% and 37%, respectively. Pediatricians were evenly divided about whether or not to counsel against full contact sports, but were more likely to do so after the athlete sustained a first concussion.
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26
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Chrisman SPD, Lowry S, Herring SA, Kroshus E, Hoopes TR, Higgins SK, Rivara FP. Concussion Incidence, Duration, and Return to School and Sport in 5- to 14-Year-Old American Football Athletes. J Pediatr 2019; 207:176-184.e1. [PMID: 30554790 DOI: 10.1016/j.jpeds.2018.11.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/18/2018] [Accepted: 11/02/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To collect prospective data on concussion incidence, risk factors, duration of symptoms, and return to school and sport in 5- to 14-year-old American football participants. STUDY DESIGN We conducted a prospective cohort study over 2 years collecting data during two 10-week fall seasons. Youth with concussion were followed to determine time to return to school, sport, and baseline level of symptoms. Logistic regression was used to estimate the risk of sustaining a concussion associated with baseline demographic factors. Time to return to school, sport, and baseline symptoms were analyzed using Kaplan-Meier survival curves. RESULTS Of 863 youth followed (996 player-seasons), 51 sustained a football-related concussion, for an athlete-level incidence of 5.1% per season. Youth with history of concussion had a 2-fold increased risk for sustaining an incident concussion (OR, 2.2; 95% CI, 1.1-4.8). Youth with depression had a 5-fold increased risk of concussion (OR, 5.6; 95% CI, 1.7-18.8). After a concussion, 50% of athletes returned to school by 3 days, 50% returned to sport by 13 days, and 50% returned to a baseline level of symptoms by 3 weeks. CONCLUSIONS Concussion rates in this study were slightly higher than previously reported, with 5 of every 100 youth sustaining a football-related concussion each season. One-half of youth were still symptomatic 3 weeks after injury. Further research is needed to address the risk of concussion in youth football.
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Affiliation(s)
- Sara P D Chrisman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA.
| | - Sarah Lowry
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA; Department of Epidemiology, University of Washington, Seattle, WA
| | - Stanley A Herring
- Harborview Injury Prevention and Research Center, Seattle, WA; Department of Rehabilitation Medicine, Orthopedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, WA
| | - Emily Kroshus
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA
| | - Teah R Hoopes
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
| | - Shannon K Higgins
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
| | - Frederick P Rivara
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA
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Waltzman D, Sarmiento K. What the research says about concussion risk factors and prevention strategies for youth sports: A scoping review of six commonly played sports. JOURNAL OF SAFETY RESEARCH 2019; 68:157-172. [PMID: 30876507 PMCID: PMC6615041 DOI: 10.1016/j.jsr.2018.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/29/2018] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Given the growing research on potential adverse outcomes related to concussion and other serious brain injuries and the increased susceptibility for concussion among youth athletes, primary prevention is vital to protect the health and safety of this population. The purpose of this study is to summarize the current research on risk factors and primary concussion prevention strategies focused on specific youth sports, and to identify research gaps. METHODS A literature search was conducted using six electronic databases. A scoping review method was used to identify studies that addressed risk factors or primary concussion prevention strategies focused on youth athletes (ages 5-18 years) in six sports (football, ice hockey, soccer, lacrosse, basketball, and wrestling). RESULTS Of the 18 publications identified, the publications focused on risk factors (N = 11), policy (N = 1), rule changes (N = 3), education (N = 2), equipment (N = 2), and playing technique (N = 0). Some articles had information related to multiple topics. CONCLUSIONS Current research on concussion prevention has primarily been focused on risk factors. There are a dearth of studies that examine primary concussion prevention in sports. When studies do exist, most focus on football and ice hockey. Only a small number of studies focus solely on risk factors or primary prevention in soccer, lacrosse, basketball, and wrestling-all sports in which concussions are common. Practical applications: This scoping review summarizes current research on concussion risk factors and primary prevention strategies in specific sports focused on youth athletes and identifies research gaps to help inform future efforts.
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Affiliation(s)
- Dana Waltzman
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, GA 30341, USA.
| | - Kelly Sarmiento
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, GA 30341, USA
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Halstead ME, Walter KD, Moffatt K, LaBella CR, Brooks MA, Canty G, Diamond AB, Hennrikus W, Logan K, Nemeth BA, Pengel KB, Peterson AR, Stricker PR. Sport-Related Concussion in Children and Adolescents. Pediatrics 2018; 142:peds.2018-3074. [PMID: 30420472 DOI: 10.1542/peds.2018-3074] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sport-related concussion is an important topic in nearly all sports and at all levels of sport for children and adolescents. Concussion knowledge and approaches to management have progressed since the American Academy of Pediatrics published its first clinical report on the subject in 2010. Concussion's definition, signs, and symptoms must be understood to diagnose it and rule out more severe intracranial injury. Pediatric health care providers should have a good understanding of diagnostic evaluation and initial management strategies. Effective management can aid recovery and potentially reduce the risk of long-term symptoms and complications. Because concussion symptoms often interfere with school, social life, family relationships, and athletics, a concussion may affect the emotional well-being of the injured athlete. Because every concussion has its own unique spectrum and severity of symptoms, individualized management is appropriate. The reduction, not necessarily elimination, of physical and cognitive activity is the mainstay of treatment. A full return to activity and/or sport is accomplished by using a stepwise program while evaluating for a return of symptoms. An understanding of prolonged symptoms and complications will help the pediatric health care provider know when to refer to a specialist. Additional research is needed in nearly all aspects of concussion in the young athlete. This report provides education on the current state of sport-related concussion knowledge, diagnosis, and management in children and adolescents.
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Affiliation(s)
| | - Kevin D. Walter
- Department of Orthopaedic Surgery, Pediatric Sports Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Kody Moffatt
- Creighton University School of Medicine, Omaha, Nebraska
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29
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Noel-London K, Breitbach A, Belue R. Filling the Gaps in Adolescent Care and School Health Policy-Tackling Health Disparities through Sports Medicine Integration. Healthcare (Basel) 2018; 6:healthcare6040132. [PMID: 30428510 PMCID: PMC6316866 DOI: 10.3390/healthcare6040132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/06/2018] [Accepted: 11/10/2018] [Indexed: 12/29/2022] Open
Abstract
The School-Based Health Centre (SBHC) model of healthcare delivery in community health is designed to address the unique needs of adolescents. Through a collaborative interprofessional approach, they aim to provide comprehensive care with the goal of reducing health disparities in underserved, at-risk adolescents. Integration of sports medicine health professionals is a novel approach to increasing available services, as well as patient utilization, while addressing multiple public health issues, including lack of athletic training services for youth athletes.
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Affiliation(s)
- Kemba Noel-London
- College for Public Health and Social Justice Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, USA.
| | - Anthony Breitbach
- Doisy College of Health Sciences, Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO 63104, USA.
| | - Rhonda Belue
- College for Public Health and Social Justice Department of Health Management and Policy, Saint Louis University, St. Louis, MO 63104, USA.
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30
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Zuckerman SL, Totten DJ, Rubel KE, Kuhn AW, Yengo-Kahn AM, Solomon GS. Mechanisms of Injury as a Diagnostic Predictor of Sport-Related Concussion Severity in Football, Basketball, and Soccer: Results From a Regional Concussion Registry. Neurosurgery 2018; 63 Suppl 1:102-112. [PMID: 27399374 DOI: 10.1227/neu.0000000000001280] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Scott L Zuckerman
- Vanderbilt Sports Concussion Center and.,Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Kolin E Rubel
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew W Kuhn
- MedSpor-Sports Medicine and Physical Therapy, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Gary S Solomon
- Vanderbilt Sports Concussion Center and.,Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
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31
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Bellamkonda S, Woodward SJ, Campolettano E, Gellner R, Kelley ME, Jones DA, Genemaras A, Beckwith JG, Greenwald RM, Maerlender AC, Rowson S, Duma SM, Urban JE, Stitzel JD, Crisco JJ. Head Impact Exposure in Practices Correlates With Exposure in Games for Youth Football Players. J Appl Biomech 2018; 34:354-360. [PMID: 29651910 PMCID: PMC6600826 DOI: 10.1123/jab.2017-0207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to compare head impact exposures between practices and games in football players ages 9 to 14 years, who account for approximately 70% of all football players in the United States. Over a period of 2 seasons, 136 players were enrolled from 3 youth programs, and 49,847 head impacts were recorded from 345 practices and 137 games. During the study, individual players sustained a median of 211 impacts per season, with a maximum of 1226 impacts. Players sustained 50th (95th) percentile peak linear acceleration of 18.3 (46.9) g, peak rotational acceleration of 1305.4 (3316.6) rad·s-2, and Head Impact Technology Severity Profile of 13.7 (24.3), respectively. Overall, players with a higher frequency of head impacts at practices recorded a higher frequency of head impacts at games (P < .001, r2 = .52), and players who sustained a greater average magnitude of head impacts during practice also recorded a greater average magnitude of head impacts during games (P < .001). The youth football head impact data quantified in this study provide valuable insight into the player exposure profile, which should serve as a key baseline in efforts to reduce injury.
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Affiliation(s)
- Srinidhi Bellamkonda
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Samantha J. Woodward
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Eamon Campolettano
- Department of Biomedical Engineering and Mechanics at Virginia Tech, Blacksburg, VA, USA
| | - Ryan Gellner
- Department of Biomedical Engineering and Mechanics at Virginia Tech, Blacksburg, VA, USA
| | - Mireille E. Kelley
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Derek A. Jones
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | | | | | | | - Arthur C. Maerlender
- Center for Brain, Biology & Behavior at University of Nebraska, Lincoln, NE, USA
| | - Steven Rowson
- Department of Biomedical Engineering and Mechanics at Virginia Tech, Blacksburg, VA, USA
| | - Stefan M. Duma
- Department of Biomedical Engineering and Mechanics at Virginia Tech, Blacksburg, VA, USA
| | - Jillian E. Urban
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Joel D Stitzel
- Virginia Tech-Wake Forest University School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA
| | - Joseph J. Crisco
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
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32
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Kawasaki T, Tanabe Y, Tanaka H, Murakami K, Maki N, Ozaki H, Hirayama D, Kunda M, Nobuhara K, Okuwaki T, Kaneko K. Kinematics of Rugby Tackling: A Pilot Study With 3-dimensional Motion Analysis. Am J Sports Med 2018; 46:2514-2520. [PMID: 29979610 DOI: 10.1177/0363546518781808] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although improper tackling technique in rugby can affect the outcome of the tackle and lead to head, neck, and shoulder injuries, the effects of the height of the tackle or the side of the leading leg at the time of impact have not been investigated. Hypothesis/Purpose: The purpose was to characterize the trunk orientation at impact during various tackles. It was hypothesized that 3-dimensional motion analysis would be able to capture the critical kinematic differences in the 4 types of tackles studied. STUDY DESIGN Controlled laboratory study. METHODS A total of 66 tackles on a tackle bag were recorded among 13 elite rugby players. Four types of tackles were evaluated: the normal shoulder tackle, in which the tackler's dominant shoulder made impact while the leading foot was on the same side as that shoulder; the low tackle, in which the tackler targeted the lower portion of the tackle bag; the opposite-leg tackle, in which the tackler's leading leg was on the opposite side as the shoulder making impact; and the low and opposite-leg tackle, which was a combination of the previous 2 types of tackles. The orientation of the trunk at impact was calculated, and 2-way repeated-measures analyses of variance were used to compare the characteristics of these tackles. RESULTS Trunk inclination at impact was lower in the low tackle than in the normal tackle ( P < .01), regardless of the side of the leading leg. Trunk bending to the side of the impacted shoulder was lower in the opposite-leg tackle ( P < .01), and these findings were more significant in the normal-height tackles ( P < .01). Trunk rotation to the side of the impacted shoulder was lower in the opposite-leg tackles ( P < .01) and more significant in the lower-height tackles ( P = .03). CONCLUSION The 3-dimensional motion capture system was effective in investigating the kinematics of rugby tackling. The kinematics in the low and opposite-leg tackles were significantly different from those in the normal shoulder tackle, which may affect tackle performance and the possible risk of contact injury. CLINICAL RELEVANCE When a rugby coach provides tackling instructions to players, it is advantageous to have information about the kinematics of different types of tackles.
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Affiliation(s)
- Takayuki Kawasaki
- Department of Orthopaedics and Sports Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yasumasa Tanabe
- Mejiro Orthopaedics and Internal Medicine Clinic, Tokyo, Japan
| | - Hiroshi Tanaka
- Nobuhara Hospital and Institute of Biomechanics, Tatsuno, Japan
| | - Kenji Murakami
- Faculty of Sports Science, Sendai University, Miyagi, Japan
| | | | | | | | | | | | | | - Kazuo Kaneko
- Department of Orthopaedics and Sports Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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33
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Kerr ZY, Wilkerson GB, Caswell SV, Currie DW, Pierpoint LA, Wasserman EB, Knowles SB, Dompier TP, Comstock RD, Marshall SW. The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in United States High School Football (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Football (2004-2005 Through 2013-2014). J Athl Train 2018; 53:738-751. [PMID: 30138047 PMCID: PMC6188086 DOI: 10.4085/1062-6050-144-17] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT: The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of football injury data. OBJECTIVE: To describe the epidemiology of injuries sustained in high school football in the 2005-2006 through 2013-2014 academic years and collegiate football in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance. DESIGN: Descriptive epidemiology study. SETTING: Online injury surveillance from football teams of high school boys (annual average = 100) and collegiate men (annual average = 43). PATIENTS OR OTHER PARTICIPANTS: Football players who participated in practices and competitions during the 2005-2006 through 2013-2014 academic years in high school or the 2004-2005 through 2013-2014 academic years in college. MAIN OUTCOME MEASURE(S): Athletic trainers collected time-loss injury (≥24 hours) and exposure data. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), and injury proportions by body site and diagnosis were calculated. RESULTS: The High School Reporting Information Online system documented 18 189 time-loss injuries during 4 539 636 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 22 766 time-loss injuries during 3 121 476 AEs. The injury rate was higher among collegiate than high school (7.29 versus 4.01/1000 AEs; IRR = 1.82; 95% CI = 1.79, 1.86) athletes. Most injuries occurred during competitions in high school (53.2%) and practices in college (60.9%). The competition injury rate was higher than the practice injury rate among both high school (IRR = 5.62; 95% CI = 5.46, 5.78) and collegiate (IRR = 6.59; 95% CI = 6.41, 6.76) players. Most injuries at both levels affected the lower extremity and the shoulder/clavicle and were diagnosed as ligament sprains and muscle/tendon strains. However, concussion was a common injury during competitions among most positions. CONCLUSIONS: Injury rates were higher in college than in high school and higher for competitions than for practices. Concussion was a frequent injury sustained during competitions, which confirms the need to develop interventions to mitigate its incidence and severity.
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Affiliation(s)
- Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Gary B. Wilkerson
- Graduate Athletic Training Education Program, University of Tennessee at Chattanooga
| | - Shane V. Caswell
- Sports Medicine Assessment, Research & Testing (SMART) Laboratory, George Mason University, Manassas, VA
| | - Dustin W. Currie
- Department of Epidemiology, University of Colorado Anschutz, Aurora
| | | | - Erin B. Wasserman
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | | | - Thomas P. Dompier
- Department of Athletic Training, Lebanon Valley College, Annville, PA
| | - R. Dawn Comstock
- Department of Epidemiology, University of Colorado Anschutz, Aurora
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Stephen W. Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
- Department of Epidemiology, University of North Carolina at Chapel Hill
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34
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Pierpoint LA, LaBella CR, Collins CL, Fields SK, Dawn Comstock R. Injuries in girls' soccer and basketball: a comparison of high schools with and without athletic trainers. Inj Epidemiol 2018; 5:29. [PMID: 30009338 PMCID: PMC6046284 DOI: 10.1186/s40621-018-0159-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/30/2018] [Indexed: 01/19/2023] Open
Abstract
Background Sports injuries impose physical and economic burdens on high school athletes, yet only 37% of high schools have access to a fulltime certified athletic trainer (AT). Although intuitively there are multiple benefits of AT coverage, research demonstrating the measurable effect of AT coverage on rates and patterns of injury is limited. Our objective was to investigate the epidemiology of girls’ basketball and soccer injuries in high schools with and without an AT. Methods We compared data captured by two similar sports injury surveillance systems during the 2006/07–2008/09 academic years. High School Reporting Information Online (RIO) included a national sample of schools with ATs, and the Sports Injury Surveillance System (SISS) included a sample of Chicago public high schools without ATs. Results Overall injury rates were higher in schools without ATs than schools with ATs in girls’ soccer (RR: 1.73, 95% CI: 1.51–2.00) and basketball (RR: 1.22, 95% CI: 1.03–1.45). Recurrent injury rates were even higher in schools without ATs compared to schools with ATs in soccer (RR: 6.00 95% CI: 4.54-7.91) and basketball (RR: 2.99, 95% CI: 2.12–4.14). Conversely, concussion rates were higher in schools with ATs than schools without ATs in soccer (RR: 8.05, 95% CI: 2.00–32.51) and basketball (RR: 4.50, 95% CI: 1.43–14.16). Other injury patterns were similar between the two samples. Conclusions This study demonstrated the effectiveness of AT coverage of high school girls’ soccer and basketball, both in reducing overall and recurrent injury rates and in identifying athletes with concussions. Future studies should evaluate the effect of ATs on other high school sports and on youth sports to determine if these findings are generalizable across sports and age groups.
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Affiliation(s)
- Lauren A Pierpoint
- Department of Epidemiology, Program for Injury Prevention, Education and Research, University of Colorado Anschutz, Aurora, CO, USA.
| | - Cynthia R LaBella
- Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN, USA
| | - Sarah K Fields
- Department of Communication, University of Colorado Denver, Denver, CO, USA
| | - R Dawn Comstock
- Department of Epidemiology, Program for Injury Prevention, Education and Research, University of Colorado Anschutz, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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35
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Laker SR, Greiss C, Finnoff JT, Singh JR. Football Participation and Chronic Traumatic Encephalopathy. PM R 2018; 10:655-660. [DOI: 10.1016/j.pmrj.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 12/14/2022]
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36
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Kerr ZY, Thomas LC, Simon JE, McCrea M, Guskiewicz KM. Association Between History of Multiple Concussions and Health Outcomes Among Former College Football Players: 15-Year Follow-up From the NCAA Concussion Study (1999-2001). Am J Sports Med 2018; 46:1733-1741. [PMID: 29620911 DOI: 10.1177/0363546518765121] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous research has examined associations between concussion history and adverse health outcomes among former professional football players. Less is known about the potential effects of concussion among former college football players without additional exposure at the professional level. PURPOSE To examine the association between concussion and adverse health outcomes in a cohort of former college football players without exposure to professional football, 15 years after their playing careers ended. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A sample of 204 former collegiate football players (23.4% of eligible athletes with available contact information)-all of whom played at least 1 season of football from 1999 to 2001 in the National Collegiate Athletic Association (NCAA) and had no professional football exposure-completed a general health survey that assessed lifetime concussion history and included the following: the Veterans RAND 36 Item Health Survey, containing a physical composite score (PCS) and mental composite score (MCS); the depression module of the Patient Health Questionnaire; and the 4-item CAGE alcohol dependence questionnaire (for "cutting down, annoyance by criticism, guilty feeling, and eye-openers"). Multivariable binomial regression models estimated adjusted prevalence ratios (PRs) with 95% CIs while controlling for demographics and playing history covariates through forward selection model building. RESULTS Most participants reported a concussion history (84.3%). Overall, 22.1% and 39.2% of participants reported a PCS and an MCS <50, respectively (indicating worse health than the US national average); 19.1% reported Patient Health Questionnaire scores ≥10 (indicating moderate/severe depression); and 24.8% reported CAGE scores ≥2 (indicating alcohol dependence). The prevalence of having an MCS <50 was higher among those reporting ≥3 versus 0 concussions (PR, 2.5; 95% CI, 1.3-4.9). Controlling for body mass index (BMI), the prevalence of moderate/severe depression was higher among those reporting ≥3 versus 0 concussions (PR, 4.2; 95% CI, 1.0-16.3). Controlling for BMI, the prevalence of having a PCS <50 was higher among those reporting ≥3 versus 1 or 2 concussions (PR, 2.6; 95% CI, 1.3-5.0) but not 0 concussions (PR, 1.5; 95% CI, 0.6-3.6). No associations were found for alcohol dependence. CONCLUSION Associations between a history of multiple concussions and adverse health outcomes were found among former collegiate football players without professional football exposure but were limited to those reporting ≥3 prior concussions. Because only 23.4% of eligible athletes responded to the survey, the possibility of ascertainment bias exists, and our findings should thus be interpreted with some caution. Continued examination within nonprofessional football populations is needed, but findings highlight the need for prevention efforts to reduce concussion incidence.
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Affiliation(s)
- Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Leah C Thomas
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Janet E Simon
- Division of Athletic Training, School of Applied Health and Wellness, Ohio University, Athens, Ohio, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA
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37
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Abstract
BACKGROUND As a collision sport, football carries a significant risk of injury, as indicated by the large number of pediatric football-related injuries seen in emergency departments. There is little information in the medical literature focusing on the age-related injury patterns of this sport. Our purpose was to evaluate the types of football-related injuries that occur in children and adolescents and assess which patient characteristics, if any, affect injury pattern. METHODS Retrospective chart review was performed of football-related injuries treated at a level 1 pediatric referral hospital emergency department and surrounding urgent care clinics between January 2010 and January 2014. Patients with e-codes for tackle football selected from the electronic medical record were divided into 4 age groups: younger than 8 years old, 8 to 11, 12 to 14, and 15 to 18 years. Data collected included diagnosis codes, procedure codes, and hospital admission status. RESULTS Review identified 1494 patients with 1664 football-related injuries, including 596 appendicular skeleton fractures, 310 sprains, 335 contusions, 170 closed head injuries, 62 dislocations, 9 spinal cord injuries, and 14 solid organ injuries. There were 646 (43.2%) athletes with upper extremity injuries and 487 (32.6%) with injuries to the lower extremity. Hospital admissions were required in 109 (7.3%) patients. Fracture was the most common injury in all four patient age groups, but occurred at a lower rate in the 15 to 18 years old age group. The rate of soft tissue injury was higher in the 15 to 18 years old age group. The rate of closed head injury, which included concussions, was highest in the younger than 8 years old age group. CONCLUSIONS Age does influence the rates of certain football-related injuries in children and adolescents. Fractures decrease with increasing age, while the rate of soft tissue trauma increases with increasing age. Younger patients (younger than 8 y old) trended toward higher rates of closed head injury compared with other age groups. Awareness of these variations in injury patterns based on age could result in age-specific changes in equipment, training, and safety rules. LEVEL OF EVIDENCE Level IV-case series.
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38
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Fridinger S, Stephenson D. Post-concussion Syndrome and Neurologic Complications. CURRENT PEDIATRICS REPORTS 2018. [DOI: 10.1007/s40124-018-0149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kroshus E, Sonnen AJ, Chrisman SP, Rivara FP. Association between community socioeconomic characteristics and access to youth flag football. Inj Prev 2018; 25:278-282. [PMID: 29330199 DOI: 10.1136/injuryprev-2017-042677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND The American Academy of Pediatrics has recommended that opportunities for non-tackling American football (e.g., flag football) be expanded, given concerns about the risks of brain trauma from tackle football. This study tested the hypothesis that flag football would be more accessible in communities characterised by higher socioeconomic status residents. METHODS In July 2017, the locations of community-based organisations offering youth flag and tackle football for youth between the ages of 6 and 13 in two US states (Georgia and Washington) were aggregated (n=440). Organisations were coded in terms of the availability of tackle and/or flag football teams for youth at each year of age between 6 and 13. Multivariate logistic regression analyses were used to assess the odds of a community-based football organisation offering flag football, by community socioeconomic and demographic characteristics. RESULTS In both states, communities with more educated residents were more likely to offer flag football for youth aged 6-12. For example, among 6 year-olds every 10% increase in the number of adult residents with a college education was associated with 1.51 times the odds of flag football availability (95% CI 1.22 to 1.86, P<0.001). CONCLUSION These results suggest that youth living in communities characterised by low educational attainment are less likely than other youth to have the option of a lower contact alternative to tackle football. Relying on voluntary community-level adoption of lower contact alternatives to tackle football may result in inequitable access to such sport options. This may contribute to an inequitable burden of brain trauma from youth sport.
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Affiliation(s)
- Emily Kroshus
- Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Aly J Sonnen
- University of Notre Dame, South Bend, Indiana, USA
| | - Sara Pd Chrisman
- Division of Adolescent Medicine, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
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40
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Bachynski KE, Goldberg DS. Time out: NFL conflicts of interest with public health efforts to prevent TBI. Inj Prev 2017; 24:180-184. [PMID: 29142020 DOI: 10.1136/injuryprev-2017-042404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/18/2017] [Accepted: 08/30/2017] [Indexed: 11/04/2022]
Affiliation(s)
| | - Daniel S Goldberg
- Department of Family Medicine, University of Colorado at Denver-Anschutz Medical Campus, Aurora, Colorado, USA
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41
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Kroshus E, Parsons J, Hainline B. Calling Injury Timeouts for the Medical Evaluation of Concussion: Determinants of Collegiate Football Officials' Behavior. J Athl Train 2017; 52:1041-1047. [PMID: 29140129 DOI: 10.4085/1062-6050-52.11.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sports officials can play an important role in concussion safety by calling injury timeouts so that athletic trainers can evaluate athletes with possible concussions. Understanding the determinants of whether officials call an injury timeout when they suspect a concussion has important implications for the design of interventions to better support officials in this role. OBJECTIVE To assess the knowledge of US collegiate football officials about concussion symptoms and to determine the associations between knowledge, perceived injunctive norms, and self-efficacy in calling injury timeouts for suspected concussions. DESIGN Cross-sectional study. SETTING Electronic survey. PATIENTS OR OTHER PARTICIPANTS Of the 3074 US collegiate football officials contacted, 1324 (43% response rate) participated. MAIN OUTCOME MEASURE(S) Concussion knowledge, injunctive norms (belief about what others would want them to do), and behavioral self-efficacy (confidence in their ability to call injury timeouts for suspected concussions in athletes during challenging game-day conditions). RESULTS Officials reported calling approximately 1 injury timeout for a suspected concussion every 4 games during the 2015 season. Structural equation modeling indicated that officials with more concussion-symptom knowledge had greater self-efficacy. Independent of an official's symptom knowledge, injunctive norms that were more supportive of calling an injury timeout were associated with greater self-efficacy. CONCLUSIONS Concussion education for officials is important because when officials are aware of concussion symptoms, they are more confident in calling injury timeouts. Beyond increasing symptom knowledge, fostering sports environments that encourage concussion safety can support officials in calling injury timeouts. Athletic trainers can help by educating stakeholders, including officials, about the importance of concussion safety. When officials believe that other stakeholders support concussion safety, they are more likely to call injury timeouts if they suspect a concussion has occurred.
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Affiliation(s)
- Emily Kroshus
- Department of Pediatrics and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, University of Washington-Seattle
| | - John Parsons
- National Collegiate Athletic Association, Indianapolis, IN
| | - Brian Hainline
- National Collegiate Athletic Association, Indianapolis, IN
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42
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Leopold SS, Dobbs MB, Gebhardt MC, Gioe TJ, Rimnac CM, Wongworawat MD. Editorial: Do Orthopaedic Surgeons Belong on the Sidelines at American Football Games? Clin Orthop Relat Res 2017; 475:2615-2618. [PMID: 28875317 PMCID: PMC5638753 DOI: 10.1007/s11999-017-5483-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Seth S Leopold
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA.
| | - Matthew B Dobbs
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Mark C Gebhardt
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Terence J Gioe
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Clare M Rimnac
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
| | - Montri D Wongworawat
- Clinical Orthopaedics and Related Research®, 1600 Spruce St., Philadelphia, PA, 19103, USA
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43
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MacDonald J, Myer GD. 'Don't let kids play football': a killer idea. Br J Sports Med 2017; 51:1448-1449. [PMID: 28525883 DOI: 10.1136/bjsports-2016-096833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2016] [Indexed: 11/04/2022]
Affiliation(s)
- James MacDonald
- Department of Pediatric and Family Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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44
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Fishman M, Taranto E, Perlman M, Quinlan K, Benjamin HJ, Ross LF. Attitudes and Counseling Practices of Pediatricians Regarding Youth Sports Participation and Concussion Risks. J Pediatr 2017; 184:19-25. [PMID: 28238481 DOI: 10.1016/j.jpeds.2017.01.048] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/01/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine attitudes and practices of pediatricians toward sports-related head trauma and youth participation in tackle football and ice hockey. STUDY DESIGN A respondent-anonymous electronic survey was distributed 3 times to members of the American Academy of Pediatrics Section of Bioethics, Council on Injury, Violence, and Poison Prevention, and Council on Sports Medicine and Fitness. RESULTS Of 791 eligible pediatricians, 227 (29%) responded. Most respondents (189/223; 85%) treat sports-related concussions, among whom 83% (137/165) reported access to an established return-to-play protocol within their practice. Virtually all (160/166; 96%) reported increased parental awareness/concern regarding concussions and 85% (139/163) reported increased visits for head trauma. Overall, 77% (140/183) would not allow their son to play tackle football and 35% (64/181) and 34% (63/184) would not allow their son or daughter, respectively, to participate in ice hockey. Most respondents endorsed limiting or eliminating tackling (143/176; 81%) and checking (144/179; 80%) from practice. Respondents were evenly divided in their support for counseling against youth participation in full-contact sports, with 48% in favor (87/180). CONCLUSIONS Most respondents would not allow their own child to play tackle football and endorsed limiting or eliminating tackling in practice. The American Academy of Pediatrics should consider recommending restrictions on tackling in football to support the current concussion concerns of its members.
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Affiliation(s)
- Michael Fishman
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Eleanor Taranto
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Meryl Perlman
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
| | - Kyran Quinlan
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Holly J Benjamin
- Department of Pediatrics, University of Chicago, Chicago, IL; Department of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Lainie Friedman Ross
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL; Department of Pediatrics, University of Chicago, Chicago, IL.
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45
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Pike AM, Pryor RR, Vandermark LW, Mazerolle SM, Casa DJ. Athletic Trainer Services in Public and Private Secondary Schools. J Athl Train 2017; 52:5-11. [PMID: 28157403 DOI: 10.4085/1062-6050-51.11.15] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The presence of athletic trainers (ATs) in secondary schools to provide medical care is crucial, especially with the rise in sports participation and resulting high volume of injuries. Previous authors have investigated the level of AT services offered, but the differences in medical care offered between the public and private sectors have not been explored. OBJECTIVE To compare the level of AT services in public and private secondary schools. DESIGN Concurrent mixed-methods study. SETTING Public and private secondary schools in the United States. PATIENTS OR OTHER PARTICIPANTS A total of 10 553 secondary schools responded to the survey (8509 public, 2044 private). MAIN OUTCOME MEASURE(S) School administrators responded to the survey via telephone or e-mail. Descriptive statistics depict national data. Open-ended questions were evaluated through content analysis. RESULTS A greater percentage of public secondary schools than private secondary schools hired ATs. Public secondary schools provided a higher percentage of full-time, part-time, and clinic AT services than private secondary schools. Only per diem AT services were more frequent in the private sector. Regardless of the extent of services, reasons for not employing an AT were similar between sectors. Common barriers were budget, school size, and lack of awareness of the role of an AT. Unique to the public sector, remote location was identified as a challenge faced by some administrators. CONCLUSIONS Both public and private secondary schools lacked ATs, but higher percentages of total AT services and full-time services were available in the public sector. Despite differences in AT services, both settings provided a similar number of student-athletes with access to medical care. Barriers to hiring ATs were comparable between public and private secondary schools; however, remote location was a unique challenge for the public sector.
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Affiliation(s)
- Alicia M Pike
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Riana R Pryor
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs.,Central California Sports Sciences Institute, California State University, Fresno
| | - Lesley W Vandermark
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Stephanie M Mazerolle
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
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46
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Peterson AR, Kruse AJ, Meester SM, Olson TS, Riedle BN, Slayman TG, Domeyer TJ, Cavanaugh JE, Smoot MK. Youth Football Injuries: A Prospective Cohort. Orthop J Sports Med 2017; 5:2325967116686784. [PMID: 28255566 PMCID: PMC5305025 DOI: 10.1177/2325967116686784] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: There are approximately 2.8 million youth football players between the ages of 7 and 14 years in the United States. Rates of injury in this population are poorly described. Recent studies have reported injury rates between 2.3% and 30.4% per season and between 8.5 and 43 per 1000 exposures. Hypothesis: Youth flag football has a lower injury rate than youth tackle football. The concussion rates in flag football are lower than in tackle football. Study Design: Cohort study; Level of evidence, 3. Methods: Three large youth (grades 2-7) football leagues with a total of 3794 players were enrolled. Research personnel partnered with the leagues to provide electronic attendance and injury reporting systems. Researchers had access to deidentified player data and injury information. Injury rates for both the tackle and flag leagues were calculated and compared using Poisson regression with a log link. The probability an injury was severe and an injury resulted in a concussion were modeled using logistic regression. For these 2 responses, best subset model selection was performed, and the model with the minimum Akaike information criterion value was chosen as best. Kaplan-Meier curves were examined to compare time loss due to injury for various subgroups of the population. Finally, time loss was modeled using Cox proportional hazards regression models. Results: A total of 46,416 exposures and 128 injuries were reported. The mean age at injury was 10.64 years. The hazard ratio for tackle football (compared with flag football) was 0.45 (95% CI, 0.25-0.80; P = .0065). The rate of severe injuries per exposure for tackle football was 1.1 (95% CI, 0.33-3.4; P = .93) times that of the flag league. The rate for concussions in tackle football per exposure was 0.51 (95% CI, 0.16-1.7; P = .27) times that of the flag league. Conclusion: Injury is more likely to occur in youth flag football than in youth tackle football. Severe injuries and concussions were not significantly different between leagues. Concussion was more likely to occur during games than during practice. Players in the sixth or seventh grade were more likely to suffer a concussion than were younger players.
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Affiliation(s)
| | | | | | | | | | | | | | | | - M Kyle Smoot
- University of Kentucky, Lexington, Kentucky, USA
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47
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Burger N, Lambert MI, Viljoen W, Brown JC, Readhead C, den Hollander S, Hendricks S. Mechanisms and Factors Associated With Tackle-Related Injuries in South African Youth Rugby Union Players. Am J Sports Med 2017; 45:278-285. [PMID: 28125898 DOI: 10.1177/0363546516677548] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The majority of injuries in rugby union occur during tackle events. The mechanisms and causes of these injuries are well established in senior rugby union. PURPOSE To use information from an injury database and assess video footage of tackle-related injuries in youth rugby union matches to identify environmental factors and mechanisms that are potentially confounding to these injuries. STUDY DESIGN Descriptive epidemiological study. METHODS Injury surveillance was conducted at the under-18 Craven Week rugby tournament. Tackle-related injury information was used to identify injury events in match video footage (role-matched noninjury tackle events were identified for the cohort of injured players). Events were coded using match situational variables (precontact, contact, and postcontact). Relative risk ratio (RRR; ratio of probability of an injury or noninjury outcome occurring when a characteristic was observed) was reported by use of logistic regression. RESULTS In comparison with the first quarter, injury risk was greater in the third (RRR = 9.75 [95% CI, 1.71-55.64]; P = .010) and fourth quarters (RRR = 6.97 [95% CI, 1.09-44.57]; P = .040) for ball carriers and in the fourth quarter (RRR = 9.63 [95% CI, 1.94-47.79]; P = .006) for tacklers. Ball carriers were less likely to be injured when they were aware of impending contact (RRR = 0.14 [95% CI, 0.03-0.66]; P = .012) or when they executed a moderate fend (hand-off) (RRR = 0.22 [95% CI, 0.06-0.84]; P = .026). Tacklers were less likely to be injured when performing shoulder tackles (same side as leading leg) in comparison to an arm-only tackle (RRR = 0.02 [95% CI, 0.001-0.79]; P = .037). Ball carriers (RRR = 0.09 [95% CI, 0.01-0.89]; P = .040) and tacklers (RRR = 0.02 [95% CI, 0.001-0.32]; P =.006) were less likely to be injured when initial contact was made with the tackler's shoulder/arm instead of his head/neck. CONCLUSION The relative risk of tackle-related injury was higher toward the end of matches. Incorrect technique may contribute to increased injury risk. Implementing recovery strategies between matches, training safe and effective techniques, and improving levels of conditioning may counter the negative effects of fatigue. These findings may assist stakeholders in youth rugby to formulate injury prevention strategies and may improve the preparation of field-side medical staff for managing tackle-related injuries at these or similar tournaments.
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Affiliation(s)
- Nicholas Burger
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mike Ian Lambert
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Public & Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Wayne Viljoen
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,South African Rugby Union (SA Rugby), Cape Town, South Africa
| | - James Craig Brown
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Public & Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Clint Readhead
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,South African Rugby Union (SA Rugby), Cape Town, South Africa
| | - Steve den Hollander
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sharief Hendricks
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Institute for Sport, Physical Activity and Leisure, Centre for Sport Performance, School of Sport, Fairfax Hall, Headingley Campus, Leeds Beckett University, Leeds, UK
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48
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Johnson ST, Norcross MF, Bovbjerg VE, Hoffman MA, Chang E, Koester MC. Sports-Related Emergency Preparedness in Oregon High Schools. Sports Health 2017; 9:181-184. [PMID: 28129072 PMCID: PMC5349394 DOI: 10.1177/1941738116686782] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Best practice recommendations for sports-related emergency preparation include implementation of venue-specific emergency action plans (EAPs), access to early defibrillation, and first responders—specifically coaches—trained in cardiopulmonary resuscitation and automated external defibrillator (AED) use. The objective was to determine whether high schools had implemented these 3 recommendations and whether schools with a certified athletic trainer (AT) were more likely to have done so. Hypothesis: Schools with an AT were more likely to have implemented the recommendations. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: All Oregon School Activities Association member school athletic directors were invited to complete a survey on sports-related emergency preparedness and AT availability at their school. Chi-square and Fisher exact tests were used to analyze the associations between emergency preparedness and AT availability. Results: In total, 108 respondents (37% response rate) completed the survey. Exactly half reported having an AT available. Only 11% (95% CI, 6%-19%) of the schools had implemented all 3 recommendations, 29% (95% CI, 21%-39%) had implemented 2, 32% (95% CI, 24%-42%) had implemented 1, and 27% (95% CI, 19%-36%) had not implemented any of the recommendations. AT availability was associated with implementation of the recommendations (χ2 = 10.3, P = 0.02), and the proportion of schools with ATs increased with the number of recommendations implemented (χ2 = 9.3, P < 0.01). Schools with an AT were more likely to implement venue-specific EAPs (52% vs 24%, P < 0.01) and have an AED available for early defibrillation (69% vs 44%, P = 0.02) but not more likely to require coach training (33% vs 28%, P = 0.68). Conclusions: Despite best practice recommendations, most schools were inadequately prepared for sports-related emergencies. Schools with an AT were more likely to implement some, but not all, of the recommendations. Policy changes may be needed to improve implementation. Clinical Relevance: Most Oregon high schools need to do more to prepare for sports-related emergencies. The results provide evidence for sports medicine professionals and administrators to inform policy changes that ensure the safety of athletes.
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Affiliation(s)
- Samuel T Johnson
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon
| | - Marc F Norcross
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon
| | - Viktor E Bovbjerg
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon
| | - Mark A Hoffman
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon
| | - Eunwook Chang
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon
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49
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Leopold SS, Dobbs MB. Editorial: Orthopaedic Surgeons Should Recommend That Children and Young Adults Not Play Tackle Football. Clin Orthop Relat Res 2016; 474:1533-7. [PMID: 27113594 PMCID: PMC4887376 DOI: 10.1007/s11999-016-4835-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/08/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Seth S Leopold
- Clinical Orthopaedics and Related Research, Philadelphia, PA, 19103, USA.
| | - Matthew B Dobbs
- Clinical Orthopaedics and Related Research, Philadelphia, PA, 19103, USA
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50
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Margolis LH, Franchino H. Whatever Happened to First Do No Harm? Pediatrics 2016; 137:peds.2016-0047A. [PMID: 27033111 DOI: 10.1542/peds.2016-0047a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lewis H Margolis
- Associate Professor of Maternal and Child Health, University of North Carolina, Gillings School of Global Public Health
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