Are Different Aged Youth Skiers and Snowboarders Experiencing Different Injury Characteristics?

INTRODUCTION: Skiing and snowboarding are popular winter sports with significant youth participation and inherent potential for injury. We investigated the relationship between age and injury characteristics exhibited by youth skiers and snowboarders. METHODS: In this cross-sectional study, we investigated injury characteristics among youth skiers and snowboarders at a ski resort, examining the association between age and injury type. We compared injury characteristics among young children (aged 3-6 y), school-aged children (aged 7-14 y), and older adolescents (aged 15-17 y) using χ2, and examined predictive variables for injuries at different anatomical locations using logistic regression. RESULTS: Compared with snowboarding, skiing was associated with greater odds of lower extremity (adjusted odds ratio [aOR]=6.8, 95% confidence interval [CI]: 4.89, 9.47, P<0.001) and head/face/neck (aOR=1.63, 95% CI: 1.20, 2.21, P=0.002) injuries. Compared with skiing, snowboarding was associated with greater odds of upper extremity injury (aOR=5.9, 95% CI: 4.6, 7.6, P<0.001). Age group significantly affected injury mechanism (χ2 [df=12, n=1129]=42.882, P<0.0001) and diagnosis (χ2 [df=12, n=1129]=43.093, P<0.0001). Young child skiers had the highest proportion of injuries to the head/neck/face and lower extremities and a significantly higher proportion of collision injuries and fractures than older skiers. Young child skiers most frequently injured the lower leg/ankle, while older skiers most frequently injured the knee. CONCLUSIONS: Youth skiers exhibited predominately lower extremity injuries, while snowboarders exhibited predominately upper extremity injuries. Age significantly affected injury mechanism and injury diagnosis in youth skiers. Specifically, younger skiers tended to suffer more fractures and collision injuries than older youth skiers.

Facilitators and barriers for parental consent to pediatric emergency research.

BACKGROUND: Obtaining informed consent for clinical research in the pediatric emergency department (ED) is challenging. Our objective was to understand the factors that influence parental consent for ED studies. METHODS: This was a cross-sectional survey assessing parents' willingness to enroll their children into an ED research study. Parents reporting a willingness to enroll in ED studies were presented with two hypothetical scenarios, a low-risk and a high-risk study, and then asked about decision influencers affecting consent. Parents expressing a lack of willingness to enroll were asked which decision influencers impacted their consent decision. RESULTS: Among 118 parents, 90 (76%) stated they would be willing to enroll their child into an ED study; of these, 86 (96%) would consent for a low-risk study and 54 (60%) would consent for a high-risk study. Caucasian parents, and those with previous research exposure, were more likely to report willingness to participate. Those who would consent to the high-risk study cited "benefits that research would provide to future children" most strongly influenced their decision to agree. CONCLUSIONS: ED investigators should highlight the benefits for future children and inquire about parents' previous exposure to research to enhance ED research enrollment. Barriers to consent in non-Caucasian families should be further investigated. IMPACT: Obtaining consent for pediatric emergency research is challenging and this study identified factors influencing parental consent for research in EDs. Benefits for future children and parents' previous research experience were two of the most influential factors in parents' willingness to consent to ED research studies. These findings will help to improve enrollment in ED research studies and better our understanding of how to promote the health and well-being of pediatric patients.

Fair Play as an Injury Prevention Intervention: Do Yellow Card Accumulation Policies Reduce High School Soccer Injuries?

OBJECTIVES: Evaluate yellow card policies' (YCPs) effectiveness in reducing competition contact injuries (CCIs). DESIGN: Retrospective cohort. SETTING: High schools. PARTICIPANTS: Soccer players from High School (HS) Reporting Information Online participating schools, 2005/06 to 2017/18. INDEPENDENT VARIABLES: Athlete exposure (AE), CCIs from HS competitions collected from states with/without YCPs. MAIN OUTCOME MEASURES: Rate and rate ratio (RR) of athlete-athlete CCIs recorded by athletic trainers were compared between states with/without YCPs and pre-YCPs/post-YCPs among the states with YCPs using Poisson regressions. Proportions of severe athlete-athlete CCIs were also described in states with/without YCPs. RESULTS: Fifteen states implemented YCPs between 2005/06 and 2017/18; 901 athlete-athlete CCIs occurred during 352 775 competition AEs in states with YCPs, and 3525 injuries during 1 459 708 competition AEs in states without YCPs. There was no significant difference in injury rates between schools in states with/without YCPs (RR 1.07; 95% confidence interval [CI]: 0.97-1.17). Among state with YCPs, injury rates were not significantly different between pre-YCP and post-YCP implementation (RR 1.15; 95% CI: 0.98-1.34). Although a significantly lower proportion of injuries resulting in >3 weeks' time loss (TL) occurred in states with YCPs (injury proportion ratio 0.81; 95% CI: 0.66-0.997), no significant differences were observed in proportions of other severe athlete-athlete CCIs between states with/without YCPs. CONCLUSIONS: Yellow card policies were ineffective in lowering HS soccer athlete-athlete CCI rates, although injuries resulting in >3 weeks' TL were less prevalent in states with YCPs. Implementation of YCPs alone, without proper enforcement, may not be a sufficient injury prevention strategy.

Effect of environmental conditions on injury rates at a Colorado ski resort.

OBJECTIVE: To determine the effect of daily environmental conditions on skiing and snowboarding-related injury rates. METHODS: Injury information was collected from a mountainside clinic at a large Colorado ski resort for the 2012/2013 through 2016/2017 seasons. Daily environmental conditions including snowfall, snow base depth, temperature, open terrain and participant visits were obtained from historical resort records. Snowpack and visibility information were obtained for the 2013/2014 through 2014/2015 seasons and included in a subanalysis. Negative binomial regression was used to estimate injury rate ratios (IRRs) and 95% CIs. RESULTS: The overall injury rate among skiers and snowboarders was 1.37 per 1000 participant visits during 2012/2013 through 2016/2017. After adjustment for other environmental covariates, injury rates were 22% higher (IRR=1.22, 95% CI 1.14 to 1.29) on days with <2.5 compared with ≥2.5 cm of snowfall, and 14% higher on days with average temperature in the highest quartile (≥-3.1°C) compared with the lowest (<-10.6°C; IRR=1.14, 95% CI 1.03 to 1.26). Rates decreased by 8% for every 25 cm increase in snow base depth (IRR=0.92, 95% CI 0.88 to 0.95). In a subanalysis of the 2013/2014 and 2014/2015 seasons including the same covariates plus snowpack and visibility, only snowpack remained significantly associated with injury rates. Rates were 71% higher on hardpack compared with powder days (IRR=1.71, 95% CI 1.18 to 2.49) and 36% higher on packed powder compared with powder days (IRR 1.36, 95% CI 1.12 to 1.64). CONCLUSIONS: Environmental conditions, particularly snowfall and snowpack, have a significant impact on injury rates. Injury prevention efforts should consider environmental factors to decrease injury rates in skiers and snowboarders.

A comparison of recreational skiing- and snowboarding-related injuries at a Colorado ski resort, 2012/13-2016/17.

The purpose of this study was to compare injury patterns between recreational skiers and snowboarders. Injured skiers (n = 3,961) and snowboarders (n = 2,428) presented to a mountainside medical clinic, 2012/13-2016/17. Variables investigated for analysis included demographics/characteristics, injury event information, and injury information. Skiers were older than snowboarders (34.3 ± 19.3 vs. 23.2 ± 10.5 years, p < 0.001); a greater proportion of skiers were female (46.3% vs. 27.8%, p < 0.001). Most skiers (84.4%) and snowboarders (84.5%) were helmeted at the time of injury (p = 0.93). Snowboarders were most frequently beginners (38.9%), skiers were intermediates (37.8%). Falls to snow (skiers = 72.3%, snowboarders = 84.8%) and collisions with natural objects (skiers = 9.7%, snowboarders = 7.4%) were common injury mechanisms. Common skiing injuries were knee sprains (20.5%) and head trauma (8.9%); common snowboarding injuries were wrist fractures (25.7%), shoulder separations (9.1%), and head trauma (9.0%). Given that injury patterns significantly differ between sports, it is important for clinicians, ski patrollers, and resorts to develop and deliver sport-specific injury prevention interventions to most effectively decrease injury burden.

Postconcussion Academic Support in Children Who Attend a Primary Care Provider Follow-up Visit after Presenting to the Emergency Department.

OBJECTIVE: To examine whether a primary care provider (PCP) follow-up visit after emergency department evaluation of concussion improved the children's likelihood of receiving academic support. STUDY DESIGN: This was a prospective cohort study. Concussed children, aged 8-18 years, presenting to a regional pediatric trauma center emergency department (n = 160) were contacted 7 and 30 days after injury to gather data on PCP follow-up, symptoms, quality of life, and receipt of academic support instituted after and because of the concussion. Bivariate comparisons of demographics, concussion characteristics, quality of life, and symptoms were made between children who did and did not receive support using independent samples t tests, Wilcoxon rank sum tests, or χ2 tests. ORs and 95% CIs were calculated using multivariable logistic regression with backwards elimination to test the association between attending an outpatient follow-up visit and the receipt of academic support for variables where P < .2 in bivariate comparisons. RESULTS: Overall, 51.3% (n = 82) received academic support; of these, 84.2% attended a follow-up visit compared with 71.8% of 78 children who attended a follow-up visit but did not receive support (P = .06). Children who received support were more likely to have commercial insurance; experience a sports-related injury mechanism; have parents whose primary language was English; suffer from learning disabilities and migraines; and be non-Hispanic (P < .05). There was no association between attending a follow-up visit and receipt of academic support (adjusted OR 1.83; 95% CI 0.75-4.45). CONCLUSIONS: Although the majority of children received academic support postconcussion, accommodations were associated with several demographic, medical history, and injury characteristics, but not attending a PCP follow-up visit.

Factors Influencing Primary Care Follow-Up After Pediatric Mild Traumatic Brain Injury.

OBJECTIVE: To identify socioeconomic, demographic, and caregiver factors associated with children attending primary care provider (PCP) follow-up after emergency department (ED) evaluation for mild traumatic brain injury (mTBI). SETTING: Pediatric trauma center ED. PARTICIPANTS: Children 8 to 18 years of age sustaining mTBI less than 48 hours prior to an ED visit. Mean age of the 183 participants was 12 years with no significant differences between those who attended follow-up and those who did not in race, ethnicity, insurance provider, or PCP office setting. DESIGN: Thirty-day longitudinal cohort study. MAIN MEASURES: Insurance type, PCP practice setting, and a caregiver attitudes survey regarding mTBI recovery and management (5 questions each scored on a 5-point Likert scale). The primary outcome was attending a PCP follow-up visit within 1 month of injury. RESULTS: Females were more likely than males to attend PCP follow-up (adjusted odds ratio: 2.27 [95% confidence interval: 1.00-5.18]). Increasing scores on the caregiver attitudes survey indicating greater concerns about recovery were significantly associated with attending PCP follow-up (adjusted odds ratio: 1.12 per unit increase in composite score [95% confidence interval: 1.02-1.23]). No other socioeconomic, demographic, or injury characteristics were associated with attending PCP follow-up. CONCLUSIONS: The ED counseling regarding PCP follow-up of mTBI should stress the importance of follow-up care to monitor recovery and identify presence of lingering symptoms.

Healthcare professional involvement and RTP compliance in high school athletes with concussion.

OBJECTIVES: To describe concussion rates in high school athletes and involvement of healthcare professionals in concussion diagnosis, management and compliance with return to play (RTP) guidelines. METHODS: Data were analysed from injury reports in the National High School Sports-Related Injury Surveillance System between 2009/2010 and 2012/2013 to identify student athletes with concussion and determine compliance with RTP guidelines. Compliance with RTP guidelines was examined using logistic regression, adjusting for sport and injury-related variables. RESULTS: There were 5611 concussions recorded during 15 712 475 athlete exposures (AEs), a rate of 3.6 concussions per 10 000 AEs. Rates were higher during competition and among girls compared to boys in gender equitable sports. Healthcare professionals were less likely to be present at the time of concussion for girls' sports, lower competition levels and practices. Compliance with RTP guidelines was higher for athletes with recurrent concussions, those sustained in collision sports, for athletes reporting more symptoms and when a physician made the RTP decision. CONCLUSIONS: Presence of healthcare professionals and compliance with RTP guidelines varied by sport, gender, level of play and exposure type. High school athletes with concussion are best served by assessment teams with athletic trainers and physicians working together to manage concussions and contribute to RTP decisions.

Carbon Monoxide Alarm and Smoke Alarm Use Among Parents Recruited From a Pediatric Emergency Department.

Although the proper installation and maintenance of carbon monoxide (CO) and smoke alarms can protect individuals from residential CO-related and fire-related injuries, these devices are underutilized. We describe characteristics associated with self-reported CO and smoke alarm use of parents recruited from a pediatric emergency department to improve CO alarm use. Parents of children ≤ 18 years (N = 299) reported socio-demographic characteristics and CO and smoke alarm ownership and practices. We assigned participants to a behavioral profile and a Precaution Adoption Process Model stage based on their self-reported CO and smoke alarm use. Most participants (71%) did not have CO alarms in their homes, but reported owning at least one working smoke alarm (98%). Participants who reported "perfect" CO alarm behavior (defined as having a working CO alarm, one near a sleeping area, with batteries replaced every 6 months; 9%) were more likely to earn a higher income, own their home, and have lived at their current residence for at least 2 years. Participants who reported "perfect" smoke alarm behavior (defined as having a working smoke alarm on every level, with batteries replaced every 6 months; 49%) were more likely to rent their home, receive federal assistance, and have lived at their current residence for at least 2 years. Interventions to increase correct CO alarm use are necessary.

New and Recurrent Concussions in High-School Athletes Before and After Traumatic Brain Injury Laws, 2005-2016.

OBJECTIVES: To examine the trends of new and recurrent sports-related concussions in high-school athletes before and after youth sports traumatic brain injury laws. METHODS: We used an interrupted time-series design and analyzed the concussion data (2005-2016) from High School Reporting Injury Online. We examined the trends of new or recurrent concussion rates among US representative high-school athletes participating in 9 sports across prelaw, immediate-postlaw, and postlaw periods by using general linear models. We defined 1 athlete exposure as attending 1 competition or practice. RESULTS: We included a total of 8043 reported concussions (88.7% new, 11.3% recurrent). The average annual concussion rate was 39.8 per 100 000 athlete exposures. We observed significantly increased trends of reported new and recurrent concussions from the prelaw, through immediate-postlaw, into the postlaw period. However, the recurrent concussion rate showed a significant decline 2.6 years after the laws went into effect. Football exhibited different trends compared with other boys' sports and girls' sports. CONCLUSIONS: Observed trends of increased concussion rates are likely attributable to increased identification and reporting. Additional research is needed to evaluate intended long-term impact of traumatic brain injury laws.

Paediatric emergency department-based carbon monoxide detector intervention: a randomised trial.

BACKGROUND: Although non-fire-related carbon monoxide (CO) poisoning is almost entirely preventable, over 400 people die and 20 000 people are injured each year in the USA from unintentional CO poisoning. Thus, there is a critical need for evidence-based interventions for preventing CO poisoning and increasing the proper use and installation of CO detectors. METHODS: A randomised, controlled trial (Project CODE, a Carbon Monoxide Detector Education intervention) with 2-week and 6-month follow-up home observations was conducted in 299 parents of children aged ≤18 years recruited in the emergency department of a level 1 paediatric trauma centre. The intervention group received an educational tool, a spiral-bound, laminated booklet that resembled a CO detector containing theory-based safety messages based on the precaution adoption process model, a plug-in CO detector and 9 V battery. The control group received a one page flyer on CO poisoning prevention. RESULTS: Although the difference was not statistically significant, mean CO knowledge score increased at a greater rate for the intervention group than the control group. Intervention group parents were more likely to exhibit 'safe' CO detector use than control group parents at the 2-week follow-up (RR: 2.75; 95% CI 2.06 to 3.69) and 6-month follow-up (RR: 2.78; 95% CI 2.06 to 3.76), after adjusting for self-reported CO detector use behaviour at enrolment and annual per capita income. CONCLUSIONS: An emergency department-delivered intervention containing a theory-based educational tool paired with a CO detector can be an effective method for increasing knowledge about CO poisoning, for prevention and for appropriate use of a CO detector. TRIAL REGISTRATION NUMBER: NCT00959478.

A Paired Comparison of Initial and Recurrent Concussions Sustained by US High School Athletes Within a Single Athletic Season.

OBJECTIVE: To compare initial and recurrent concussions regarding average number of days between concussions, acute concussion symptoms and symptom resolution time, and return to play time. SETTING/PARTICIPANTS: High school athletes sustaining multiple concussions linked within sport seasons drawn from a large sports injury surveillance study. DESIGN: Retrospective analysis of longitudinal surveillance data. MEASURES: Number of days between concussions, number of symptoms endorsed, specific symptoms endorsed, symptom resolution time, return to play time. RESULTS: Median time between initial and recurrent concussions was 21 days (interquartile range = 10-43 days). Loss of consciousness, the only significant symptom difference, occurred more frequently in recurrent (6.8%) than initial (1.7%) concussions (P = .04). No significant difference was found in the number of symptoms (P = .84) or symptom resolution time (P = .74). Recurrent concussions kept athletes from play longer than initial concussions (P < .0001); 26.6% of recurrent concussions were season ending. CONCLUSIONS: We found that athletes' initial and recurrent concussions had similar symptom presentations and resolution time. Despite these similarities, athletes were restricted from returning to play for longer periods following a recurrent concussion, indicating clinicians are managing recurrent concussions more conservatively. It is probable that concussion recognition and management are superior now compared with when previous studies were published, possibly improving recurrent concussion outcomes.

Nine-year study of US high school soccer injuries: data from a national sports injury surveillance programme.

BACKGROUND: Research on high school soccer injury epidemiology is sparse. AIM: To describe high school soccer injury rates, trends and patterns by type of athlete exposure (AE), position and sex. METHODS: This descriptive epidemiological study used data from a large national high school sports injury surveillance programme to describe rates and patterns of soccer-related injuries including concussion sustained from 2005/2006 to 2013/2014. Injury rates are calculated per 1000 AEs. RESULTS: Overall, 6154 soccer injuries occurred during 2 985 991 AEs; injury rate=2.06 per 1000 AEs. Injury rates were higher during competition (4.42) than practice (1.05; rate ratio (RR)=4.19; 95% CI 3.98 to 4.41), and in girls (2.33) than boys (1.83; RR=1.27, 95% CI 1.21 to 1.34). Boys' non-concussion injury rates decreased significantly (p=0.001) during the study period while reported concussion rates increased significantly (p=0.002). Girls' non-concussion rates were relatively stable and reported concussion rates increased significantly (p=0.004). Player-player contact was the injury mechanism that led to the most competition injuries (injury proportion ratio (IPR)=2.87; 95% CI 2.57 to 3.21), while non-contact injuries were the most common mechanisms among practice injuries (IPR=2.10; 95% CI 1.86 to 2.38). Recovery from concussion was >7 days in a third of the cases. Injury patterns were similar between sexes with respect to position played and location on the field at the time of injury. CONCLUSIONS: High school soccer injury rates vary by sex and type of exposure, while injury patterns are more similar across sexes. Reported concussion rates increased significantly over the study period in male and female athletes.

Epidemiology of Chest, Rib, Thoracic Spine, and Abdomen Injuries Among United States High School Athletes, 2005/06 to 2013/14.

OBJECTIVE: Describe chest and abdominal injury epidemiology among US high school athletes. DESIGN: Retrospective analysis of longitudinal surveillance data. SETTING: Injury data from 2005/06 to 2013/14 academic years were collected using an internet-based surveillance system. PARTICIPANTS: A large sample of US high schools. ASSESSMENT OF RISK FACTORS: Injuries sustained as a function of sport. MAIN OUTCOME MEASURES: Chest, rib, thoracic spine, and abdominal injuries sustained during high school athletic events. RESULTS: Overall 1487 chest, rib, thoracic spine, and abdominal injuries occurred during 30 415 179 athletic exposures (AEs); an injury rate of 4.9 injuries per 100 000 AEs. Over half (56.8%) of injured athletes were evaluated by another medical provider in addition to the athletic trainer, and 34 injuries (2.3%) required surgery. Diagnostic techniques, including x-ray, magnetic resonance imaging or computed tomography were used in 729 (49.0%) injuries. The injury rate was higher in boys' (6.8) than girls' (2.0) sports [rate ratio (RR), 3.43; 95% CI, 3.04-4.10]. Football (47.7%) accounted for the highest proportion of injuries followed by wrestling (18.5%), boys' soccer (4.6%), and girls' soccer (3.7%). The rate of injury was higher in competition than practice, (RR, 2.86; 95% CI, 2.59-3.23). Only 57.7% of injured athletes were able to return to play within 1 week. CONCLUSIONS: Chest and abdominal injuries in high school sports although relatively rare, can result in loss of playing time and frequently prompt medical evaluation. Thus, they present a physical and economic burden. To optimize prevention, further studies can focus on subgroup risk factor identification to drive development of targeted prevention strategies.

Psychological Factors Associated with Delayed Symptom Resolution in Children with Concussion.

OBJECTIVE: To characterize the psychological factors associated with persistent symptoms after pediatric concussion. STUDY DESIGN: Longitudinal cohort study of 179 children with concussion 8-18 years old evaluated in a pediatric emergency department. Participants were followed for 1 month for delayed symptom resolution, defined as ≥3 symptoms that were new/worse than preinjury symptoms measured by the use of graded symptom inventory. Preinjury psychological traits were measured by parental report on subscales of the Personality Inventory for Children-2 (maladjustment, cognitive abilities, somatization). Child report of postinjury anxiety and injury perception were measured with the State-Trait Anxiety Inventory for Children and Children's Illness Perception Questionnaire. Psychological instrument scores were compared between those with and without delayed symptom resolution via a Kruskal-Wallis test. Associations between psychological traits and delayed symptom resolution were investigated by the use of logistic regression. RESULTS: Delayed symptom resolution occurred in 21% of participants. Score distributions were significantly worse on the State-Trait Anxiety Inventory for Children (38 [IQR 33-40] vs 35 [IQR 31-39]; P = .04) and somatization subscale (1 [IQR 0-3] vs 1 [IQR 0-1]; P = .01) among children with delayed symptom resolution compared with children with early symptom resolution. Somatization was associated with delayed symptom resolution (aOR 1.35, 95% CI 1.08-1.69). The proportion of children with abnormal somatization scores was significantly greater in the delayed symptom resolution group (34.2%) than the early symptom resolution group (12.8%; P < .01). Other psychological measures were not different between groups. CONCLUSION: Somatization is associated with delayed symptom resolution in this cohort of children with concussion. Postconcussive symptoms lasting at least 1 month may warrant referral to a neuropsychologist familiar with postconcussion care.

Skin infections among US high school athletes: A national survey.

BACKGROUND: Skin infections have long been a reported problem among high school athletes, particularly wrestlers. There has yet to be a national study describing the epidemiology of skin infections across multiple high school sports. OBJECTIVE: We sought to report the epidemiology of skin infections among US high school athletes. METHODS: High school sports-related skin infections resulting in time loss were reported by a convenience sample of US high schools from 2009/2010 through 2013/2014 via High School Reporting Information Online. RESULTS: During the study, 474 skin infections were reported among 20,858,781 athlete exposures, a rate of 2.27 per 100,000 athlete exposures. The largest number of skin infections occurred in wrestling (73.6%) followed by football (17.9%). The most common infections were bacterial (60.6%) and tinea (28.4%) infections. Body parts most often affected were the head/face (25.3%) followed by the forearm (12.7%). LIMITATIONS: The study included only high schools with National Athletic Trainers' Association-affiliated athletic trainers, which may limit generalizability. However, using athletic trainers as data reporters improved data quality. CONCLUSIONS: Skin infections are an important subset of high school sports-related adverse events. An understanding of the epidemiology of sports-related skin infections should promote awareness and drive evidence-based prevention efforts.

Epidemiology of meniscal injuries in US high school athletes between 2007 and 2013.

PURPOSE: Knowledge of epidemiologic trends of meniscal injuries in young active populations is limited. Better awareness of injury patterns is a first step to lowering injury rates. Our hypothesis was that meniscal injuries in high school athletes would vary by gender, sport, and type of exposure. METHODS: During the 2007/2008 and 2012/2013 academic years, a large nationally disperse sample of US high schools reported athlete exposure and injury data for 22 sports by having certified athletic trainers complete an internet-based data collection tool. RESULTS: One thousand and eighty-two meniscal injuries were reported during 21,088,365 athlete exposures for an overall injury rate of 5.1 per 100,000 athlete exposures. The overall rate of injury was higher in competition (11.9) than practice (2.7) (RR = 4.4; 95% CI 3.9-5.0), and 12/19 sports showed significantly higher injury rates in competition compared to practice. Of all injuries, 68.0% occurred in boys, yet among the gender-comparable sports of soccer, basketball, track and field, lacrosse, and baseball/softball injury rates were higher for girls than boys (5.5 and 2.5, respectively, RR = 2.2; 95% CI 1.8-2.7). Contact injury represented the most common mechanism (55.9%). Surgery was performed for the majority of injuries (63.8%), and 54.0% of athletes had associated intra-articular knee pathology. CONCLUSIONS: Meniscal injury patterns among high school athletes vary by gender, sport, and type of exposure. Our study is clinically relevant because recognition of distinct differences in these injury patterns will help drive evidence-based, targeted injury prevention strategies and efforts. LEVEL OF EVIDENCE: III.

Dental injuries sustained by high school athletes in the United States, from 2008/2009 through 2013/2014 academic years.

BACKGROUND/AIM: Risk of dental injuries is present in a variety of sports. Mouthguards are effective yet underutilized. This study aimed to estimate the rate of dental injuries among high school athletes and investigate the utilization of mouthguards across multiple high school sports. MATERIALS AND METHODS: Athlete exposure and dental injury data were collected during the 2008/2009 through 2013/2014 academic years from a large sample of high schools in the United States as part of the National High School Sports-Related Injury Surveillance Study. RESULTS: There were 222 dental injuries sustained during 24,787,258 athlete exposures for a rate of 0.90 per 100,000 athlete exposures. The rate of dental injuries in competition (1.8) was three times higher than the rate in practice (0.6) (RR: 3.1, 95% CI: 2.3-4.0). Rates of dental injuries varied by sport with the highest rates in girls' field hockey (3.9) and boys' basketball (2.6). Dental injuries most commonly occurred as a result of contact with another player (61.3%) and contact with a playing apparatus (31.5%). For the majority of dental injuries, the athlete was not wearing a mouthguard (72.5%). Among injuries where athletes were wearing mouthguards, the majority were self-fitted (95.9%). CONCLUSIONS: Although dental injuries were relatively uncommon, the majority occurred while the athlete was not wearing a mouthguard. As previous studies have shown that mouthguards are effective in preventing injuries, all high school athletes participating in a sport that places them at risk of sustaining a dental injury should wear a mouthguard consistently in both competition and practice.

Epidemiology of overuse injuries among high-school athletes in the United States.

OBJECTIVE: To examine high school overuse injury rates and patterns by sex and sport. STUDY DESIGN: High school athletes participating in the High School Reporting Information Online study were examined in a descriptive epidemiologic study. Overuse injury data for the 2006/2007-2011/2012 academic years collected via High School Reporting Information Online from a large national sample of US high schools where certified athletic trainers completed detailed injury reports were evaluated. RESULTS: From 2006/2007 to 2011/2012, a total of 2834 overuse injuries were reported during 18 889 141 athletic exposures (1.50 per 10 000 athletic exposures). Girls had greater rates of overuse injury (1.88) than boys (1.26) (rate ratio 1.50, 95% CI 1.39-1.61). The greatest rates were in girls' track and field (3.82) and girls' field hockey (2.93). Overuse injuries represented 7.7% of all injuries, ranging from a low of 1.4% of all boys' ice hockey injuries to a high of 55.7% of all boys' swimming and diving injuries. Overall, overuse injuries were evenly distributed across athletes in each year of high school (freshman, 25.6%; sophomore, 25.3%; junior, 24.9%; senior, 24.3%). However, there were distinct differences by sex. The most frequent site of injury was the lower leg (21.8%). Injuries most frequently resulted in time loss of less than 1 week (50.0%), with only 7.6% resulting in time loss greater than 3 weeks. CONCLUSIONS: Overuse injury patterns differed by sex and sport. A better understanding of overuse injury patterns and criteria for return to play may help direct preventative measures and injury management.

Outpatient follow-up and return to school after emergency department evaluation among children with persistent post-concussion symptoms.

OBJECTIVE: To describe differences in outpatient follow-up and academic accommodations received by children with and without persistent post-concussion symptoms (PPCS) after emergency department (ED) evaluation. It was hypothesized that children with PPCS would have more outpatient visits and receive academic accommodations more often than children without PPCS and that follow-up would be positively associated with receiving accommodations. METHODS: Children aged 8-18 years with acute (≤6hours) concussion at time of presentation to a paediatric ED were enrolled in an observational study. Outcomes were assessed through a telephone survey 30 days after injury. RESULTS: Of 234 enrolled participants, 179 (76%) completed follow-up. PPCS occurred in 21%. Only 45% of subjects had follow-up visits after ED discharge. Follow-up visit rates were similar for those with and without PPCS (58% vs. 41%, respectively; p = 0.07). Children with PPCS missed twice as many school days as those without (3 vs. 1.5; p < 0.001), but did not differ in receiving academic accommodations (36% vs. 53%; p = 0.082). Outpatient follow-up was associated with receiving academic accommodations (RR = 2.2; 95% CI = 1.4-3.5). CONCLUSIONS: Outpatient follow-up is not routine for concussed children. Despite missing more school days, children with PPCS do not receive academic accommodations more often. Outpatient follow-up may facilitate academic accommodations.