Improvement in balance from diagnosis to return-to-play initiation following a sport-related concussion: BESS scores vs center-of-pressure measures.

OBJECTIVE: Accurate assessment of balance recovery throughout treatment of a sport-related concussion is imperative. This study examined differences in balance from diagnosis to return-to-play initiation in adolescent patients post-concussion. Second, this study investigated the extent to which the Balance Error Scoring System (BESS) correlated with center-of-pressure (COP) measures. METHODS: Forty participants performed the BESS while standing on a force platform such that COP data were obtained simultaneously. Spatial and velocity COP-based measures were computed for the double-stance conditions. RESULTS: BESS scores and COP-based measures indicated improved balance performance between visits. Specifically, 62.5/65.0% of participants exhibited improved firm/foam BESS final scores, respectively, and 56.4-71.8% exhibited improved COP-based measures. However, once normative ranges were referenced to identify maintained performance, the percentage of participants who substantially improved differed from initial findings (BESS: 2.5/7.5%, COP: 48.7-69.2%). Additionally, positive correlations between balance measures were primarily found at diagnosis (r=0.33-0.53), while only three correlations were maintained at return-to-play initiation (r=0.34-0.39). CONCLUSIONS: BESS scores successfully identified poor balance performance at diagnosis when symptoms were most pronounced, but failed to accurately depict performance once balance impairment, indicated by COP-based measures, became less apparent. Further work is needed to implement more advanced balance assessments into clinical environments.

Position comparison of sport-related concussions in female youth soccer players.

OBJECTIVES: Youth soccer participation, particularly among females, continues to grow worldwide. With the high incidence of sport-related concussion (SRC) in soccer, it is important to investigate if SRC occurs disproportionally by positions. Our hypothesis was to see no positional differences in SRCs, SRC-related characteristics, and outcomes among in female youth soccer athletes. METHODS: Data were prospectively collected from participants at a single sports medicine institution between August 2015-April 2021. Female participants aged 8-18 diagnosed with SRC sustained during an organized soccer practice, scrimmage, or game were separated into 4 groups based on position: Forward, Midfielder, Defender, and Goalkeeper. Demographics, medical history, injury-related details, and outcomes were reviewed. A chi-square test or Fisher's exact test was used for categorical variables. Continuous variables were compared with Mann-Whitney or Kruskal-Wallis test. RESULTS: Two hundred fourteen participants were included: 52 Forwards, 65 Midfielders, 63 Defenders, and 34 Goalkeepers. There were no significant differences between the groups in age, race, ethnicity, or previous concussion history. Differences in mechanism existed with Goalkeepers most commonly reporting Head to Body Part. Goalkeepers, which make up 1/11 of the total positions on the field, had a significantly higher proportion of SRCs compared to Field Positions. (9.1% vs 15.9%)At 3-month post-enrollment, there were no significant differences in reported symptoms or return-to-play between the different positions. CONCLUSION: In youth female soccer players, goalkeepers sustained a higher proportion of sport-related concussions compared to field players based upon the composition of a soccer team. The mechanism of injury also differed among the different soccer positions. However, no differences in concussion characteristics, outcomes, or RTP were seen across the different soccer positions.

Continued play following adolescent sport-related concussion: Prospective data from the North Texas Concussion Registry (ConTex).

Our study aims were to identify the frequency of continued play following sport-related concussion (SRC), defined as continuing athletic activity on the same day following a suspected SRC, characteristics associated with continued play, and whether continued play was associated with worse outcomes. A prospective study of participants ages 13-18 years diagnosed with SRC at a pediatric sports medicine clinic over a 4-year period was conducted. A comparison was performed between athletes who reported continued play following SRC (PLAY) and those who did not (NO PLAY). Of 441 participants, 231 (52.4%) were in the PLAY group. The PLAY group recalled less severe balance problems from the day of injury (p = 0.02), but reported greater symptoms of trouble falling asleep, concentrating, and remembering at their initial clinic visit (p < 0.05). There was no difference in recovery time between groups. Greater symptom severity score at the initial clinic visit and longer time to presentation were associated with prolonged recovery in both groups (p < 0.01). In conclusion, more than half of the athletes in this sample continued to play on the same day following SRC. Our results indicate the need for a heightened focus on education and additional efforts to reduce continued play following SRC in adolescents.

Epidemiology of Pediatric Basketball Injuries Presenting to Emergency Departments: Sex- and Age-Based Patterns.

BACKGROUND: There is limited epidemiologic data on pediatric basketball injuries and the comparison of these injuries before and after adolescence and between male and female athletes. PURPOSE: To assess common sex- and age-based injury patterns in pediatric basketball players. STUDY DESIGN: Descriptive epidemiology study. METHODS: Injury data from the National Electronic Injury Surveillance System (NEISS) and participation data from the National Sporting Goods Association were used to complete this study. Data on pediatric basketball injuries between January 2012 and December 2018 in patients aged 7 to 11 years (childhood) and 12 to 17 years (adolescence) were extracted and used to calculate national injury incidence rates with 95% CIs. Sex and age group patterns were examined utilizing Pearson chi-square tests. Z tests were conducted for the comparison of injury rates between female and male athletes in each age group and overall injury rate across age groups. RESULTS: An average of 9582 basketball injuries were reported annually in the NEISS, which calculated to an annual national estimate of 294,920 injuries. The most common diagnoses were ankle strain/sprain (17.7%), finger strain/sprain/fracture (12.1%), concussion/head injury (9.4%), knee strain/sprain (4.5%), and facial laceration (3.3%). There was a significant increase in injury prevalence in adolescents (12- to 17-year-old category: 238,678 injuries per year) when compared with childhood (7- to 11-year-old category: 56,242 injuries per year) (P < .0001). Concussions/head injuries occurred at a high rate in childhood, second only to finger strain/sprain/fracture, and at a similar rate in females and males (injuries per 100,000 athlete-days: 4.9 [95% CI, 3.1-6.7] vs. 5.9 [4.3-7.5], respectively; P = .41). From childhood to adolescence, injury prevalence increased for all areas and across both sexes, except for female finger strain/sprain/fracture; however, the rate of increase for concussion/head injuries and knee injuries was significantly higher in female compared with male athletes (P < .0001 for both). In adolescents, ankle injuries were the most common injury overall. CONCLUSION: Ankle injuries continue to be the most predominant pediatric basketball injury. However, disproportionate rates of both knee and concussion/head injuries in female athletes during adolescent basketball are of concern and have implications for injury prevention.

Activity Measures in Pediatric Athletes: A Comparison of the Hospital for Special Surgery Pediatric Functional Activity Brief Scale and Tegner Activity Level Scale.

BACKGROUND: In young athletes, patient-reported activity level is frequently used to determine return to the same level of sport after treatment. PURPOSE: To evaluate the validity and score distributions of the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) compared with the Tegner Activity Level Scale (Tegner) in pediatric athletes. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 2. METHODS: A retrospective review of 517 consecutive youth athletes who came to a sports medicine specialty clinic for a knee evaluation was performed. Patients completed the HSS Pedi-FABS, Tegner, and a sports participation survey before evaluation. Scores were compared with reported hours, days, and weeks of participation in sports as well as level of competition. Floor or ceiling effects were identified, and finally, the means and distributions of scores in the 8 most common primary sports were analyzed. RESULTS: A total of 398 participants (54.0% female) with an average age of 14.5 years (range, 10.0-18.8 years) were included in the study. The HSS Pedi-FABS demonstrated correlations with hours per week (r = 0.302; P < .001), days per week (r = 0.278; P < .001), and weeks per year (r = 0.136; P = .014) playing a primary sport. The Tegner only demonstrated a correlation with days per week (r = 0.211; P = .001). Additionally, club/select-level athletes scored higher than junior high/high school-level athletes on the HSS Pedi-FABS (23.8 vs 21.0; P = .004), but no difference was observed with the Tegner. No floor or ceiling effect was observed for the HSS Pedi-FABS, but a ceiling effect was present for the Tegner (32.8%). The HSS Pedi-FABS demonstrated a varied score distribution between the 8 most common primary sports (P < .001), with soccer players scoring the highest, on average (23.5). CONCLUSION: The HSS Pedi-FABS, compared with the Tegner, demonstrated more correlations with an athlete's participation in sport with no floor or ceiling effect and had a wide distribution of scores even among same-sport athletes. The HSS Pedi-FABS may be a more valuable activity measure than the Tegner in pediatric athletes.

Concurrent Bilateral Anterior Tibial Stress Fractures and Vitamin D Deficiency in an Adolescent Female Athlete: Treatment With Early Surgical Intervention.

Case: A 16-year-old African American multi-sport female athlete presents with bilateral worsening activity-related leg pain for 5 months. Multiple bilateral anterior tibial diaphyseal stress fractures and significant vitamin D deficiency were identified. She was treated with a combination of vitamin D supplements and static intramedullary nailing of the bilateral tibias resulting in clinical and radiographic healing and return to sports. Discussion: Vitamin D deficiency and high level of activity in a young athlete may be the etiology to atypical multiple stress fractures. In athletes who may want to return to sport rapidly, early operative intervention and correction of vitamin D deficiency may be treatment options. Level of Evidence: Level V- case report.

Association Between Sleep Quality and Recovery Following Sport-Related Concussion in Pediatrics.

Our objective was to determine the association between sleep quality, symptom severity, and recovery following sport-related concussion in pediatric athletes. A review of data from the North Texas Concussion Network Prospective Registry (ConTex) was performed. Participants were diagnosed with a sport-related concussion and were ≤18 years old. Participants were categorized based on their initial clinic visit Pittsburgh Sleep Quality Index composite score (0-21) into good sleep quality (GS≤5) and poor sleep quality (PS>5) groups. The PS group reported higher median total symptom scores at 3-month follow-up (3.0 vs 0.0, P < .01) and took more than a median of 2 weeks longer to recover compared to the GS group (35.0 days vs 20.0 days, P < .01). Poor sleep quality was strongly associated with greater symptom severity and longer time to recovery following sport-related concussion. Early recognition of concussed athletes with poor sleep quality at initial clinic visit may help predict prolonged recovery.

Sport Participation and Specialization Characteristics Among Pediatric Soccer Athletes.

BACKGROUND: Soccer is an increasingly popular sport for children and adolescents in the United States. Little is known about participation patterns related to sport specialization. PURPOSE: To investigate soccer participation levels and sport specialization characteristics among youth soccer athletes. STUDY DESIGN: Cross-sectional study. METHODS: Adolescent athletes aged between 12 and 18 years completed an online survey addressing participant demographics, sports and soccer participation history, and level of specialization. Descriptive analyses characterized participation, while chi-square and Kruskal-Wallis tests assessed the influence of specialization, sex, and grade on survey variables. RESULTS: Overall, 83.7% of 746 respondents participated in an organized soccer league outside of school, and 37% played in multiple leagues concurrently. Nearly three-quarters of respondents trained in soccer more than 8 months of the year, with those who participated in club soccer being more likely to train more than 8 months of the year. More respondents were classified as high specialization (37.5%), followed by moderate (35.6%) and low (28.6%) specialization. No differences between sexes were noted for level of specialization or quitting other sports to specialize in soccer, but male athletes were more likely to train more than 8 months per year compared with female athletes. Respondents in older grades (9th-10th and 11th-12th grades) were more likely to be highly specialized and quit other sports to focus on soccer. No differences between grade levels were found among respondents training more than 8 months per year. CONCLUSION: The study findings suggest that many youth soccer athletes participated in multiple teams or leagues at the same time and trained more than 8 months of the year. Characteristics including participation on a club team, level of specialization, and male sex were associated with a greater likelihood of exceeding the 8-month training recommendation.