Predictors of mortality and rehabilitation location in adults with prolonged coma following traumatic brain injury.

INTRODUCTION: Traumatic brain injury (TBI) is a leading cause of death and disability, often resulting in prolonged coma and disordered consciousness. There are currently gaps in understanding the factors affecting rehabilitation location and outcome after TBI. OBJECTIVE: To identify the impact of demographics, comorbidities, and complications on discharge disposition in adults with prolonged coma following TBI. DESIGN: Retrospective cohort study. SETTING: Tertiary care hospitals and trauma centers in the United States. PARTICIPANTS: Patients 18 years of age or older with TBI and prolonged coma during the years 2008 to 2015. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Demographics, clinical injury data, comorbidities, and complications were collected, and odds ratios (ORs) and descriptive analysis were calculated for mortality, long-term rehabilitation, and home discharge without services. RESULTS: A total of 6929 patients with TBI and prolonged coma were included in the final analysis; 3318 (47.9%) were discharged to rehabilitation facilities, 1859 (26.8%) died, and 1752 (25.3%) were discharged home. Older patients and those with higher injury severity scores had significantly higher ORs for mortality and rehab discharge. A total of 58.3% of patients presented with at least one comorbidity. Non-White ethnicities and self-pay/uninsured patients were significantly less likely to be discharged to a rehab facility. Furthermore, comorbidities including congestive heart failure (CHF) and diabetes were associated with a significantly increased OR for mortality and rehab discharge compared to home discharge without services. CONCLUSIONS: Comorbidities, age, and injury severity were the most significant risk factors for increased mortality and acute rehab discharge. Maximizing the treatment of comorbidities including CHF and diabetes has the potential to decrease mortality and adverse outcomes following TBI with prolonged coma.

Lung Cancer Clinical Trials in Latin America in the Era of Cooperative Groups: A 20-Year Analysis.

PURPOSE: The aim of this study is to characterize lung cancer treatment clinical trials in Latin America before (January 2001-December 2011) and after (January 2012-December 2021) the organization of major Latin American oncology cooperative groups. MATERIALS AND METHODS: Interventional clinical trials were identified in ClinicalTrials.gov using the search terms "lung cancer," country filters for 20 Latin American countries, and study start dates January 1, 2001-December 31, 2011, and January 1, 2012-December 31, 2021. Clinical trials were categorized as either originating in Latin America (LA) or outside Latin America (non-LA) with participation of Latin American countries. Descriptive statistics, two-sided Z-scores, and chi-square analyses with 95% CIs were calculated. RESULTS: Overall, 273 clinical trials involving Latin American countries between 2001 and 2021 were identified. Comparing 2001-2011 with 2012-2021, there was an increase in total clinical trials (100 v 173; P < .001). Only 9% (26 of 273) of all trials were LA trials. There was a marked decrease in the proportion of LA trials (14% v 7%, P = .058) and estimated enrollment to LA trials (3,245 v 1,190 patients; P < .001). Recruiting of patients with EGFR (29% v 7%; P < .01) and KRAS (18% v 2%; P < .01) driver mutations also decreased. Trial participation was highest in Brazil, Mexico, Argentina, Chile, and Peru and increased over time: Brazil (61 v 108; 77% increase), Mexico (40 v 88; 120% increase), Argentina (50 v 78; 56% increase), Chile (25 v 57; 128% increase), and Peru (14 v 37; 164% increase). CONCLUSION: There was a significant increase in clinical trial participation by Latin American countries, from 2001-2011 to 2012-2021. However, there were few clinical trials which originated in Latin America or focused on patients with driver mutations.

Multivariate Analysis of Risk Factors for Injury and Surgical Interventions in Ankle and Knee Injuries in NBA Athletes.

Objective: Lower extremity ankle and knee injuries occur at a high rate in the National Basketball Association (NBA) often requiring surgical intervention. This study aimed to identify surgical rates and risk factors for surgical intervention using multivariate analysis in ankle and knee injuries in NBA player. Methods: Player demographics, performance metrics, advanced statistics, and injury characteristics were recorded using publicly available data. To standardize injury events over multiple years, injury events per 1000 athlete exposure events (AE, one player participating in one game) were calculated. Descriptive analysis and multivariate logistic regression were completed to find associations with surgical intervention in ankle and knee injuries. Results: A total of 1153 ankle and knee injuries were included in the analysis with 73 (6.33%) lower extremity injuries treated with surgery. Knee injuries had a higher incidence of surgical intervention (0.23 AE) than ankle injuries (0.04 AE). The most frequent surgical knee injury was meniscus tear treated with meniscus repair (0.05 AE) and the most frequent ankle surgery was surgical debridement (0.01 AE) Multivariate logistic regression indicated lower extremity injuries that required surgery were associated with more minutes per game played (odds ratio [OR] 1.13; p = 0.02), a greater usage rate (OR 1.02 p < 0.001), the center position (OR 1.64; 95% [CI] 1.2-2.24; p = 0.002) and lower player efficiency rating (OR 0.96; 95% p < 0.001). Conclusion: Knee surgery was significantly more frequent than ankle surgery despite similar injury rates per 1000 exposures. The center position had the greatest risk for lower extremity injury followed by minutes played while a higher player efficiency rating was protective against surgical intervention. Developing strategies to address these factors will help in the management and prevention of lower extremity injuries requiring surgical intervention.

Changes in injury type among NBA athletes in response to the COVID-19 pandemic.

CONTEXT: The 2019-2020 NBA season was altered significantly by the COVID-19 pandemic with a midseason suspension of games, the NBA 'bubble' tournament, and a shortened offseason. Concerns were raised regarding player conditioning and the potential increased risk of injury due to the schedule changes. The purpose of this study was to determine the impact of the COVID-19 pandemic and associated schedule changes on NBA injuries. It was hypothesized that injury rates would be higher in the year following the pandemic and teams who participated in the bubble would have higher injury rates in the following season than non-bubble teams. Furthermore, the types of injuries would shift toward more severe injuries in the condensed 2019-20 season and the following 2020-21 season. DESIGN: Retrospective Cohort Study. METHODS: The NBA's public injury reports were queried to identify players listed on an injury report. Standardized injury events were calculated for four pre-COVID-19 seasons (2015-2019), the COVID-19 season (2019-2020), and the post-COVID-19 season (2020-2021). Injury characteristics including type and location were extracted for each year and differences within each period were calculated. RESULTS: When excluding injury events related to COVID-19 health and safety protocols, the overall injury events per 1000 exposures were not significantly different between time periods of pre-COVID-19, COVID-19, and post-COVID-19 seasons; (p = 0.199), and no difference was found in the rates of teams who participated in the bubble. Injuries, including soreness and strains, significantly decreased while fracture injuries significantly increased in the COVID-19 year. CONCLUSIONS: The COVID-19 pandemic led to an increased number of games missed, but no increase in injury rates when accounting for health and safety protocols. Additionally, bubble participation had no impact on injury rates. However, despite no changes in injury rates, the types of injuries changed with an increased proportion of severe injuries and decreased proportion of minor injuries.

Performance of Orthopaedic Shoulder and Elbow Surgeons on a Biostatistical Knowledge Examination.

Background: The objective of this study is to evaluate the biostatistical interpretation abilities of fellowship trained orthopaedic surgeons. Methods: A cross-sectional survey was administered to orthopaedic surgeon members of the American Shoulder and Elbow Surgeons (ASES), assessing orthopaedic surgeon attitudes towards biostatistics, confidence in understanding biostatistics, and ability to interpret biostatistical measures on a multiple-choice test. Results: A 4.5% response rate was achieved with 55 complete survey responses. The mean percent correct was 55.2%. Higher knowledge test scores were associated with younger age and fewer years since board exam completion (p ≤ 0.001). Greater average number of publications per year correlated with superior statistical interpretation (p=0.009). Respondents with higher self-reported confidence were more likely to accurately interpret results (p ≤ 0.017). Of the respondents, 93% reported frequently using statistics to form medical opinions, 98% answered that statistical competency is important in the practice of orthopaedic surgery, and 80% were eager to continue learning biostatistics. Conclusions: It is concerning that fellowship-trained shoulder and elbow surgeons, many of whom frequently publish or are reviewing scientific literature for publication, are scoring 55.2% correctly on average on this biostatistical knowledge examination. Surgeons that are further from formal statistical knowledge training are more likely to have lower biostatistical knowledge test scores. Respondents who published at the highest rate were associated with higher scores. Continuing medical education in biostatistics may be beneficial for maintaining statistical knowledge utilised in the current literature.

The effect of increasing exercise in the intellectually disabled community.

BACKGROUND: Intellectually disabled individuals have been observed to lead sedentary lifestyles resulting in poor health. Physical fitness has been positively correlated to better health outcomes with small changes in fitness translating to major health changes among unfit older adults with intellectual disability. However, there is currently no literature on safe exercise regimens for the intellectually disabled population. METHODS: In this article, a retrospective review was conducted using the Special Olympics Athlete database and analyzed the mean differences of various performance metrics based on self-reported exercise frequency. RESULTS: These results demonstrated that those who exercised daily performed significantly better in flexibility, static balance and functional strength as compared to those who did not exercise. No statistically significant differences were found among athletes and self-reported exercise frequency for aerobic fitness. CONCLUSION: Overall, these findings suggest that 3-6 days-a-week of moderate exercise would be a recommended exercise dose to see significant improvement in performance and physiological adaptations.

Is Video-Based Analysis a Valid Method for Determining Mechanisms of Ankle Injuries During Gameplay in the National Basketball Association?

Background: In the National Basketball Association (NBA), lower extremity injuries account for over 70% of games missed, with ankle injuries being the most common. High-quality video analysis has been successful for studying injury mechanism. Purpose: To (1) determine the validity of video-based analysis as a method to evaluate ankle injury mechanisms in NBA players and (2) analyze the circumstances associated with injury, games missed due to injury, and associated costs in player salary due to time missed. Study Design: Case series; Level of evidence, 4. Methods: Ankle injuries were identified using an injury report database, and corresponding videos were searched using YouTube.com to access high-quality video evidence of these injuries during the 2015-2020 NBA regular season. We reviewed 822 injuries, of which 93 had corresponding videos (video subset), in our final analysis. Variables including number of games missed, necessity for surgical treatment, and injury recurrence were reported for the entire cohort. In the video subset, the mechanism of injury and other corresponding situational data were evaluated. Results: The most common mechanism of injury occurred via ankle inversion (83.9%; n = 78; P < .001). These injuries were significantly associated with indirect contact with the player's ankle (79.6%; n = 74; P < .001). There were significant differences based on player position, within both the video subset (P = .008) and the entire cohort (P < .001), with guards being injured the most frequently. The average number of games missed due to injury was 7 games in the video subset and 5 games in the entire cohort (P = .14). There were significant differences between the groups in average player salary per game ($133,878 [video subset] versus $87,577 [entire cohort]; P < .001). Conclusion: Despite its low yield of 11.3%, video analysis proved to be a useful tool to determine ankle injury mechanisms as well as the distribution of injuries based on player position. However, this methodology was subject to selection bias, as evidenced by a $50,000 increase in player salary among the video cohort. These findings should be considered when using video analysis in future studies.