Evaluation of the early weigh-in policy for mixed martial arts events adopted by North American athletic commissions.

OBJECTIVE: To characterize the epidemiology of overweight athletes before and after the introduction of the Early Weigh-In Policy (EWIP). METHODS: A retrospective cohort study examined the weigh-in results for professional mixed martial arts (MMA) events over a 2-year period around the introduction of the new EWIP between 2014 and 2018. Descriptive statistics were used to characterize the study populations. Risk ratios were used to identify differences in the study populations before and after the introduction of the EWIP. RESULTS: After the introduction of the EWIP, the number of overweight athletes increased from 5.7% to 8.4% and the average overweight mass increased from 1.3 kg (2.9 lbs) to 1.8 kg (3.9 lbs) [difference, 0.5 kg (1.0 lb), p = 4.35 × 10^(-5)]. The proportion of athletes is not distributed similarly across the different overweight mass categories when comparing the pre- and post-EWIP time frames (p = 0.006). More athletes in the pre-EWIP period were overweight by smaller amount, while in the post-EWIP period athletes were overweight by larger amount. Of the athletes who were overweight before the regulation change, 28.7% were over the weight limit by greater than 1.8 kg (4 lbs), compared to 39.5% after the new EWIP introduction. On average, the ratio of overweight athletes per events by commission was 1.2 before the introduction of the EWIP and 2.1 after. CONCLUSION: These results appear to indicate that the EWIP has not altered weight-cutting culture in MMA in a positive manner. This study casts doubt on the benefits of an EWIP and raised the possibility of utilizing the longitudinal weight monitoring approach to mitigate rapid weight-cycling behavior. However, before additional changes are made by any athletic commission, further research is needed to examine the efficacy of the abovementioned longitudinal weight monitoring approach or any other strategy.

A Review of Black Widow (Araneae: Theridiidae) Envenomation, Epidemiology, and Antivenom Utilization in Canada.

Two species of black widow spider (BWS-Latrodectus hesperus Chamberlin & Ivie and Latrodectus variolus Walckenaer) naturally occur in Canada and are capable of causing deleterious envenomation to humans. No Canadian literature exists on the frequency of envenomations by these species or the use of antivenom in the treatment of those patients. A review of primary Canadian arachnology data was undertaken to identify BWS populations. A retrospective review of the Health Canada Special Access Program records generated epidemiology and the utilization of antivenom for BWS envenomations in Canada. The geographical distribution of BWS species is limited to along the southern Canadian border. From January 2009 to December 2015, there were five BWS envenomations that required treatment with antivenom and all cases occurred in British Columbia. An average patient age of 41 yr ± 21 SD (range 7-59) was observed, along with three of the five patients being female. The average number of vials used for treatment was 2 ± 1 SD (range 1-3). BWS Antivenin was also obtained by facilities in Alberta, Ontario, and Nova Scotia, but not used in any of these jurisdictions. Further investigation is necessary to determine the annual incidence of BWS envenomations and if treatment with BWS antivenin is required.

Venomous Snakebites in Canada: A National Review of Patient Epidemiology and Antivenom Usage.

INTRODUCTION: There are 3 pit viper species in Canada. Limited Canadian literature exists on the epidemiology of venomous snakebites and the treatment patterns with antivenom. This study described the epidemiology, the utilization of antivenom, and estimated expenditures due to forfeited antivenom for pit viper envenomations in Canada. METHODS: A retrospective review of the Health Canada Special Access Program records to generate descriptive statistics. Data are presented as mean±SD (range), as appropriate. RESULTS: The geographic distribution of Canadian pit viper species is presented. There were 99 envenomations reported in Canada from January 2009 to December 2015. The number of envenomations per year was 14±6 (6-21). CroFab and Antivipmyn are used in Canada to treat envenomations. The number of vials for patient treatment was 17±12 (3-66) and 16±9 (6-42) for CroFab and Antivipmyn, respectively. Antivenom stock usage for patient treatment varied across the country with provincial means reported for British Columbia (33%), Alberta (37%), Saskatchewan (27%), and Ontario (71%). The costs incurred secondary to forfeited stock where estimated as: $1,280,000 USD in British Columbia, $255,000 in Alberta, $60,000 in Saskatchewan, and $0 in Ontario. CONCLUSIONS: The absolute number of annual envenomations is small and the 3 Crotalinae species are limited to relatively narrow geographic areas in British Columbia, Alberta, Saskatchewan, and Ontario. The utilization of antivenom in the treatment of patients revealed that regions where the western and prairie rattlesnake reside forfeited a substantial amount of antivenom from 2009 to 2015. Organizations responsible for maintaining antivenom supplies on a provincial or regional level could use these data to guide antidote stocking and reduce costs.

Risk factors associated with injury and concussion in sanctioned amateur and professional mixed martial arts bouts in Calgary, Alberta.

BACKGROUND: There is limited literature that examines risk factors for injury and mild traumatic brain injury (mTBI) in mixed martial arts (MMA). An examination of previously unstudied bout and athlete characteristics that may pose health risks while partaking in this sport is warranted. HYPOTHESIS/PURPOSE: To determine the incidence of injury and concussion, along with the identification of risk factors that contribute to injury and mTBI in amateur and professional MMA bouts in Calgary, Alberta. STUDY DESIGN: A retrospective cohort study with case-control design. METHODS: Calgary amateur and professional MMA records were examined from 1 January 2010 to 31 December 2015. Descriptive statistics were used to describe the incidence of injury and concussion, along with univariate and multivariable logistic regression to identify risk factors for injury and mTBI. RESULTS: The injury rate per 100 athlete exposure (AE), the injury rate per 100 min of exposure and the concussion rate per 100 AE were 23.6 (95% CI 20.5 to 27.0), 4.1 (95% CI 3.48 to 4.70) and 14.7 (95% CI 11.8 to 17.2), respectively. The most common location of injury was the head and mTBI was the most common type of injury. Athletes whose bout was finished by a knockout/technical knockout, corner stoppage, draw, no contest or physician, and those whose country of origin was non-Canadian, were more likely to sustain an injury. No risk factors for concussion were shown to be significant. CONCLUSION: Engaging in MMA exposes athletes to inherent risk and several recommendations are proposed to reduce these risks. Future prospective investigations are necessary to better delineate the findings in this study.

Safety in Mixed Martial Arts: a 7-Year Review of Cancelled MMA Bouts in Calgary, Alberta, During the Pre-bout Medical Examination Period.

BACKGROUND: Presently, there is no literature that examines the reasons for the cancellation of amateur or professional mixed martial arts (MMA) bouts. The purpose of this study was to review the circumstances that lead to the cancellation of MMA bouts by Calgary ringside physicians during the pre-bout examination period and to identify any emerging patterns that may guide the regulatoin of this sport. METHODS: The case-series  was constructed from the Calgary Combative Sports Commission pre-bout examination records and the medical records submitted by each athlete from January 2010 to December 2016. RESULTS: Cancelled bouts in the pre-bout examination periods represented 5.4% of all MMA bouts in Calgary. A total of 25 reasons lead to bout cancellation and included the following: failure to obtain required neuroimaging (28.0%), neuroimaging abnormalities (24.0%), incomplete routine screening investigations (16.0%), exceeding maximum weight differential between the two athletes (16.0%), injury in the pre-competition period (8.0%), dehydration (4.0%), and ECG abnormalities (4.0%). The abnormalities on neuroimaging (n of 6) included the following: post traumatic gliosis on MRI (n = 1, 16.7%), flares diffusely and findings consistent with microhemorrhage on MRI (n = 1, 16.7%), chronic orbital fracture with fat pad extrusion on CT (n = 2, 33.3%), lacunar infarct on MRI (1), and unspecified MRI abnormality (n = 1, 16.7%). Twenty-two athletes had bouts cancelled and of these three athletes had their bouts stopped for two reasons. CONCLUSIONS: The following recommendations are presented and include: the creation of guidelines regarding pre- and post-bout neuroimaging, the implementation of industry-wide minimum medical screening standards, the adoption of a longitudinal approach to weight monitoring, the development of competent ringside physician groups, and active oversight by the Combative Sports Commission during the matchmaking process.

A pilot study examining the speed and accuracy of triage for simulated disaster patients in an emergency department setting: Comparison of a computerized version of Canadian Triage Acuity Scale (CTAS) and Simple Triage and Rapid Treatment (START) methods.

OBJECTIVE: To compare emergency department triage nurses' time to triage and accuracy of a simulated mass casualty incident (MCI) population using a computerized version of CTAS or START systems. METHODS: This pilot study was a prospective trial using a convenience sample. A total of 20 ED triage nurses, 10 in each arm of the study, were recruited. The paper-based questionnaire contained nine simulated MCI vignettes. An expert panel arrived at consensuses on the wording of the vignettes and created a standard triage score from which to compare the study participants. Linear regression and chi-squared test were used to examine the time to triage and accuracy of triage, respectively. RESULTS: The mean triage time for computerized CTAS (cCTAS) and START were 138 seconds/patient and 33 seconds/patient, respectively. The effect size due to triage method was 108 seconds/patient (95% CI 83-134 seconds/patient). The cumulative triage accuracy for the cCTAS and START tools were 70/90 (77.8%) and 65/90 (72.2%), respectively. The percent difference between cumulative triage was 6% (95% CI -19-8%). CONCLUSIONS: Triage nurses completed START triage 105 seconds/patient faster when compared to cCTAS triage and a similar level of accuracy between the two methods was achieved. However, when the typing time is taken into consideration cCTAS took 45 seconds/patient longer. The use of either CTAS or START in the ED during a MCI may be reasonable but choosing one method over another is not justified from this investigation.

Outcomes and characteristics of non-immobilised, spine-injured trauma patients: a systematic review of prehospital selective immobilisation protocols.

OBJECTIVES: This review assesses prehospital selective immobilisation protocols across a range of outcomes, including neurological deterioration and characteristics of injured, non-immobilised patients. METHODS: Six electronic reference databases and eight grey literature sources were systematically searched. We included studies that enrolled acute trauma patients in the prehospital setting who were assessed for spine injury according to predefined clinical criteria and either immobilised or not. Data items included instances of neurological deterioration among patients with spine injuries, as well as available characteristics of those who were injured and not immobilised. Available data and study heterogeneity prevented meta-analyses. Bias was assessed for both individual studies and across studies by outcome. RESULTS: 604 unique articles were retrieved, of which 7 met inclusion criteria. There was moderate or high risk of bias across studies in all outcomes. Of 76 patients with spine injuries who were not immobilised, 72 had no neurological deficit that appeared after emergency medical services contact, and the remaining four were not followed. Within this group, there appears to be a trend towards elderly patients who suffered a thoracic or lumbar injury from a low-risk mechanism of injury. Among studies that report both the results of the protocol assessment and immobilisation status, there is variable correspondence between the two. CONCLUSIONS: Data limitations and study biases suggest caution when interpreting and applying the results of this review. Its findings are consistent with the conclusions of individual studies. The characteristics of injured, non-immobilised patients point to areas of future research to investigate apparent trends.

Epidemiological Trends in Search and Rescue Incidents Documented by the Alpine Club of Canada From 1970 to 2005.

OBJECTIVE: To provide a descriptive review of the epidemiology of search and rescue (SAR) incidents across Canada as documented in the Alpine Club of Canada (ACC) database. METHODS: A retrospective, cross-sectional review of SAR reports collected by the ACC with incidents dating from January 1, 1970 to June 12, 2005, was analyzed. RESULTS: The ACC database contained 1088 incidents with 1377 casualties. Casualties had 944 (68.6%; 95% CI, 64.2 to 73.1) injuries or illness, and 433 (31.4%; 95% CI, 28.6 34.6) fatalities. Males accounted for 76.1% of all casualties and 82.3% of the fatalities when sex was reported. A bimodal distribution of casualties was seen, with the peaks around February and August. Hiking and mountaineering resulted in more than half of all casualties that yielded any type of morbidity, whereas mountaineering and skiing, ski mountaineering, or snowboarding accounted for almost two thirds of all fatalities. Human error and slips and falls were the major contributors to the presumptive cause of incidents. The lower limb was the most common anatomic location of traumatic injury, accounting for 41.6% (95% CI, 37.6 to 45.9) of these injuries. Hypothermia, exhaustion, frostbite, and dehydration represented the majority of all nontraumatic conditions. British Columbia and Alberta accounted for 91.6% (95% CI, 86.0 to 97.5) of the incidents in the database. CONCLUSIONS: The study serves to illustrate trends in SAR epidemiology that may be encountered by SAR personnel within British Columbia and Alberta. Furthermore, it highlights the need for additional Canadian-based studies to better understand this area of prehospital medical encounters.