The Role of Concussion History and Biological Sex on Pupillary Light Reflex Metrics in Adolescent Rugby Players: A Cross-Sectional Study.

Background: Concussion examination is based primarily on clinical evaluation and symptomatic reporting. Pupillary light reflex (PLR) metrics may provide an objective physiological marker to inform concussion diagnosis and recovery, but few studies have assessed PLR, and normative data are lacking, particularly for adolescents. Aim: To capture PLR data in adolescent rugby players and examine the effects of concussion history and biological sex. Design: Cross-sectional. Methods: Male and female adolescent rugby union players aged 16 to 18 years were recruited at the start of the 2022-2023 playing season. PLR was recorded using a handheld pupillometer which provided seven different metrics relating to pupil diameter, constriction/dilation latency, and velocity. Data were analysed using a series of 2 × 2 ANOVAs to examine the main effects of independent variables: biological sex, concussion history, and their interactions, using adjusted p-values (p < 0.05). Results: 149 participants (75% male) were included. A total of 42% reported at least one previous concussion. Most metrics were unaffected by the independent variables. There were however significant main effects for concussion history (F = 4.11 (1); p = 0.05) and sex (F = 5.42 (1); p = 0.02) in end pupil diameters, and a main effect for sex in initial pupil diameters (F = 4.45 (1); p = 0.04). Although no significant interaction effects were found, on average, females with a concussion history presented with greater pupillary diameters and velocity metrics, with many pairwise comparisons showing large effects (SMD > 0.8). Conclusions: Pupillary diameters in adolescent athletes were significantly affected by concussion history and sex. The most extreme PLR metrics were recorded in females with a history of concussion (higher pupillary diameters and velocities). This highlights the importance of establishing baseline PLR metrics prior to interpretation of the PLR post-concussion. Long-standing PLR abnormalities post-concussion may reflect ongoing autonomic nervous system dysfunction. This warrants further investigation in longitudinal studies.

The role of concussion history and biological sex on baseline concussion clinical profile symptoms in adolescent rugby players.

BACKGROUND: Accurate concussion monitoring requires access to preinjury baseline data. This is particularly important in adolescent athletes who have a high risk of concussion and are prone to prolonged recovery. As Rugby Union is governed by similar laws for men and women, it is also an ideal population to rigorously examine the impact of biological sex on concussion symptoms. AIMS: To evaluate self-reported concussion symptoms at baseline in adolescent rugby union players, and examine if subtype-specific symptoms are affected by concussion history and biological sex. METHODS: Adolescent rugby union players aged 16-18 years were recruited during the 2022-2023 playing season. Participants completed a series of questionnaires covering post-concussion symptoms, concussion clinical profiles, anxiety, depression and fear avoidance behaviours. Independent variables of interest in analysis were biological sex and concussion history. RESULTS: 149 participants (75% male) were included. 42% (63/149) reported at least one previous concussion (average time since concussion: 18.7 months, range 1-72). Adolescents with a concussion history reported significantly higher scores than those with no history, across two clinical profiles (ocular and sleep), concussion symptom severity, and depression, all based on medium effect sizes (SMD 0.3-0.5). Females had significantly higher scores across cognitive/fatigue, ocular and sleep clinical profiles, concussion symptoms, anxiety and depression, each with large effect sizes (SMD > 0.5). CONCLUSIONS: Concussion history and sex are associated with higher baseline scores on specific concussion clinical profile, concussion symptom severity, and anxiety symptoms. These findings highlight the importance of considering baseline differences when interpreting post-injury clinical profile symptoms in adolescent rugby players. (Trial registration: ACTRN12622000931774).

Multisystem recovery after sport-related concussion in adolescent rugby players: a prospective study protocol.

INTRODUCTION: Sport-related concussion is one of the most common injuries in adolescent rugby players with evidence of prolonged recovery in some concussed athletes. Concussion is a complex pathophysiological process that can affect a variety of subsystems with multifactorial presentation. Most research on adolescents recovery after concussion focuses on neurocognitive functioning and symptom outcomes over the short term. There is a need to explore concussion recovery over time across multiple subsystems in adolescent rugby players. METHODS AND ANALYSIS: This prospective study will use sensorimotor and oculomotor outcomes in adolescent male and female rugby players aged 16-18 years. Players will be recruited from school or club rugby teams across the province of Ulster. Baseline assessment will be undertaken at the start of the playing season and will include questionnaires, Quantified Y Balance Test and Pupillary Light Reflex. Players who sustain a concussive event will be reassessed on all outcomes at 3 days, 7 days, 14 days, 23 days, 90 days, 180 days and 365 days postconcussion. For serial outcome data, we will examine response curves for each participant and make comparisons between known groups. We will use logistic regression to explore any association between demographic variables and recovery. The strength of the predictive model will be determined using R2, p values and ORs, with 95% CIs. ETHICS AND DISSEMINATION: Ethical approval has been granted for this study from Ulster University Research Ethics Committee (REC/14/0060). This study will be published in an open-access research journal on completion. TRIAL REGISTRATION NUMBER: ACTRN12622000931774p.

Mortality rate comparison after switching from continuous to prolonged intermittent renal replacement for acute kidney injury in three intensive care units from different countries.

BACKGROUND: Prolonged intermittent renal replacement therapy (PIRRT) is a dialysis modality for critically ill patients that in theory combines the superior detoxification and haemodynamic stability of the continuous renal replacement therapy (CRRT) with the operational convenience, reduced haemorrhagic risk and low cost of conventional intermittent haemodialysis. However, the extent to which PIRRT should replace these other modalities is uncertain because comparative studies of mortality are lacking. We retrospectively examined the mortality data from three general intensive care units (ICUs) in different countries that have switched their predominant therapeutic approach from CRRT to PIRRT. We assessed whether this practice change was associated with a change in mortality rate. METHODS: Data were analysed from ICUs in New Zealand, Australia and Italy. The study population comprised all patients requiring renal replacement therapy from 1 January 1995 to 31 December 2005 (n = 1347), the period of time spanning the change from CRRT to PIRRT in each unit. Poisson regression models were used to estimate the incident rate ratio (IRR) for death, comparing the periods before and after change to PIRRT in each unit. Estimates were adjusted for patient illness severity (APACHE II score) and for the underlying time trend in mortality rate over time. RESULTS: The change from CRRT to PIRRT was not associated with any increase in mortality rate, with an adjusted IRR of 1.02 (0.61-1.71). The IRR was virtually identical in the three ICUs (P-value = 0.63 for the difference in the IRR between ICUs). CONCLUSIONS: Switching from CRRT to PIRRT was not associated with a change in mortality rate. Pending the results of a randomized trial, our study provides evidence that PIRRT might be equivalent to CRRT in the general ICU patient.

Concussion History and Balance Performance in Adolescent Rugby Union Players.

BACKGROUND: Sports-related concussion is a worldwide problem. There is a concern that an initial concussion can cause prolonged subclinical disturbances to sensorimotor function that increase the risk of subsequent injury. The primary aim of this study was to examine whether a history of sports-related concussion has effects on static and dynamic balance performance in adolescent rugby players. HYPOTHESIS: Dynamic balance would be worse in players with a history of concussion compared with those with no history of concussion. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Male adolescent rugby players aged 14 to 18 years from 5 schools were recruited before the start of the 2018-2019 playing season. Participants completed questionnaires and physical tests, including dynamic Y balance and single-leg static balance (eyes closed) tests, while performing single and dual tasks. Dynamic balance was assessed using inertial sensor instrumentation. Dependent variables were normalized reach distance and the sample entropy (SEn) of the 3 axes (x, y, and z). RESULTS: Of the 195 participants, 100 reported a history of concussion. Those with a history of concussion demonstrated higher SEn in all directions, with highest values during anterior (standardized mean difference [SMD], 0.4; 95% CI, 0.0-0.7; P = .027) and posteromedial (SMD, 0.5; 95% CI, 0.2-0.9; P = .004) reach directions compared with those with no history. There was no difference between groups (concussion history vs control) in traditional Y balance reach distances in the anterior or posteromedial directions or single-leg static balance during both single- (P = .47) and dual-task (P = .67) conditions. CONCLUSION: Adolescent rugby union athletes with a history of concussion had poorer dynamic balance during performance tasks compared with healthy controls. Static single-leg balance tests, either single or dual task, may not be sensitive enough to detect sensorimotor deficits in those with a history of concussion.

Distinct microbiome composition and metabolome exists across subgroups of elite Irish athletes.

OBJECTIVES: The gut microbiome has begun to be characterised in athlete groups, albeit, to date, only across a subset of sports. This study aimed to determine if the gut microbiome and metabolome differed across sports classification groups (SCGs) among elite Irish athletes, many of whom were participating in the 2016 Summer Olympics. METHODS: Faecal and urine samples were collected from 37 international level athletes. Faecal samples were prepared for shotgun metagenomic sequencing and faecal and urine samples underwent metabolomic profiling. RESULTS: Differences were observed in the composition and functional capacity of the gut microbiome of athletes across SCGs. The microbiomes of athletes participating in sports with a high dynamic component were the most distinct compositionally (greater differences in proportions of species), while those of athletes participating in sports with high dynamic and static components were the most functionally distinct (greater differences in functional potential). Additionally, both microbial (faecal) and human (urine) derived metabolites were found to vary between SCGs. In particular cis-aconitate, succinic acid and lactate, in urine samples, and creatinine, in faeces, were found to be significantly different between groups. These differences were evident despite the absence of significant differences in diet, as determined using food frequency questionnaires, which were translated into nutrient intake values using FETA. CONCLUSIONS: Differences in the gut microbiome and metabolome between groups, in the absence of dietary changes, indicates a role for training load or type as a contributory factor. Further exploration of this hypothesis has the potential to benefit athletes, aspiring athletes and the general public.

A One-Season Prospective Study of Illnesses, Acute, and Overuse Injuries in Elite Youth and Junior Track and Field Athletes.

Background: In high-level adult athletes, injury incidences and characteristics have been reported during international championships and during one season. Youth track and field athletes are also exposed to injury risk, although less information is available on this specific population, as well as on illness risk. Aim: To determine the prevalence of health problems (i.e., illnesses, acute, and overuse injuries) in high level Youth and Junior Track & Field athletes. Method: During the 2015-16 athletics season (30 weeks from December 2015 to July 2016), we conducted a prospective cohort study on a population of Youth and Junior Irish national level athletes, during which athletes were asked to complete a weekly web-based questionnaire (Oslo Sports Trauma Research Center questionnaire on health problems) regarding their health problems. Results: A total of 70 athletes participated (37 male and 33 female athletes), with an average weekly response rate of 71%. The average weekly prevalence for all athletes was 27% (95%CI 17 to 38%) for all health problems, and 11% (95%CI 3 to 18%) for substantial health problems. Average prevalence varied significantly between endurance and explosive disciplines: a higher prevalence of all and substantial health problems and all and substantial overuse injuries was found in endurance disciplines. A higher prevalence of acute injuries was found in explosive disciplines. Characteristics of acute and overuse injuries differed according to sex and discipline: hamstring strain/cramps/spasms was the main injuries in explosive disciplines, and knee tendinopathy and lower leg strain/cramp/spasms in endurance disciplines, trunk cramps/spasms being frequent in both disciplines. Upper respiratory tract problems were the most commonly reported illnesses regardless of sex and disciplines. Conclusion: This study provides important information regarding the extent of health problem in Youth and Junior track and field athletes. This could help orient injury prevention measures. For injuries, it should be focused on muscle injuries, especially located on the hamstring, calf, and trunk. For illness, prevention measures could include: screening tests for airway problems, but also general illness prevention measures (e.g., drinking regularly, eating "safe" food, regular hand washing, decreasing contact with sick people, avoiding dehydration).

Hip Joint Pathology as a Leading Cause of Groin Pain in the Sporting Population: A 6-Year Review of 894 Cases.

BACKGROUND: Chronic hip and groin pain offers a diagnostic challenge for the sports medicine practitioner. Recent consensus suggests diagnostic categorization based on 5 clinical entities: hip joint-, adductor-, pubic bone stress injury-, iliopsoas-, or abdominal wall-related pathology. However, their prevalence patterns and coexistence in an active population are unclear. PURPOSE: This study presents a descriptive epidemiology based on a large sample of active individuals with long-standing pain in the hip and groin region. The objectives were to examine the prevalence of key clinical entities, document coexisting pathologies, and present prevalence patterns based on key demographics. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A retrospective review was conducted of clinical records of all hip and groin injuries seen between January 2006 and December 2011 under the care of a single experienced sports medicine consultant. In all cases, imaging was undertaken by a team of specialist musculoskeletal radiologists. Diagnoses were categorized according to 5 clinical entities using contemporary diagnostic nomenclature. The chi-square test was used to compare observed and expected frequencies across each subgroup's prevalence figures based on sex, age, and sports participation. RESULTS: Full medical records were retrieved from 894 patients with chronic hip and groin pain. The majority of patients were male (73%), aged between 26 and 30 years, and participating in footballing codes (soccer, rugby, and Gaelic sports) or running. A total of 24 combinations of clinical entities were found. There were significant differences (P < .001) in prevalence patterns based on age, sex, and sports activity. Adductor-related pain or pubic bone stress injury rarely presented in isolation. Hip joint pathology was the most common clinical entity (55.98%) and was significantly more likely to present in isolation. The majority of hip joint pathologies related to femoroacetabular impingement (40%), labral tears (33%), and osteoarthritis (24%). These figures were significantly different across male and female patients (P < .001), with a higher percentage of cases of femoroacetabular impingement and labral tears in male and female patients, respectively. CONCLUSION: Chronic hip and groin pain is often associated with multiple clinical entities. Hip joint pathology is the most common clinical entity and is most likely to relate to femoroacetabular impingement, labral tears, and osteoarthritis. These pathologies seem to be associated with secondary breakdown of surrounding structures; however, underpinning mechanisms are unclear.