Disparities in concussion diagnoses compared to ankle injuries.

BACKGROUND: Health disparities related to concussions have been reported in the literature for certain minority populations. Given the significant impact of concussions on long- and short-term function, the mitigation of barriers to accessing care is an important public health objective. OBJECTIVE: To determine if racial and ethnic disparities exist in patients who seek care for concussions compared to a control group with orthopedic ankle injuries (sprains and fractures) to minimize confounding factors that predispose to injury. DESIGN: Cohort study. SETTING: Single institution between February 2016 and December 2020. PATIENTS: A retrospective review of electronic medical records was completed for patients with International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes for concussion, ankle sprain, and ankle fracture. A total of 10,312 patients were identified: 1568 (15.2%) with concussion, 4871 (47.3%) with ankle sprain, and 3863 (37.5%) with ankle fracture. INTERVENTIONS: Patients were stratified by demographic factors, including sex, ethnicity, race, and insurance type. MAIN OUTCOME MEASURES: Diagnosis of concussion. RESULTS: The concussion group was the youngest (28.3 years ± 18.0) and had the fewest females (53.1%) compared to the ankle sprain (35.1 years ± 19.7; 58.7%) and fracture groups (44.1 years ± 21.3; 57.3%). The concussion group had a smaller proportion of Hispanic patients than the ankle sprain group (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.55-0.92, p = .010) and fracture group (OR 0.58, 95% CI 0.44-0.75, p = <.001). In addition, the concussion group was less likely to be Asian (OR 0.70, CI 0.52-0.95, p = .023) than the sprain group and less likely to be Black/African American than both sprain (OR 0.65, 95% CI 0.46-0.93, p = .017) and fracture groups (OR 0.62, 95% CI 0.43-0.89, p = .010). There were no differences across racial groups between ankle sprains and fractures. Patients with Medicaid/Medicare and self-pay had a higher likelihood of being in the concussion group than those with private insurance. CONCLUSION: Differences in concussion diagnosis may exist between certain demographic groups compared to those with ankle injuries. Efforts to mitigate disparities in concussion care are worthwhile with a focus on patient and caregiver education.

Fluid and diet patterns associated with weight cycling and changes in body composition assessed by continuous monitoring throughout a college wrestling season.

This study examined the methods used to meet certification weight for wrestling and to measure the changes in body composition during 1 season for Division III college wrestlers. Nine college wrestlers completed this study. Body composition was analyzed by underwater weighing (UWW) and multifrequency bioelectrical impedance before and throughout the competitive season. Hydration status was measured by urine osmolality (Uosm) and urine specific gravity (Usg). Nutritional intake was measured for 2 1-week periods, once at the beginning and again near the end of the season. Subjects' fat-free mass (FFM) increased an average of 1.8 kg, whereas fat mass (FM) decreased 2.2 kg as indicated by UWW from the beginning to the end of the season. Wrestlers on average cycled their weight 3.4 kg (4.7% of body weight) per week. The majority of wrestlers cut weight by reducing calories and restricting fluids starting 2 days before the competition. Uosm and body weights on Friday suggested that for wrestlers to achieve the necessary weight loss by dehydration to "make weight" for a Saturday meet, wrestlers would approach a 5% level of dehydration. No loss of FFM because of weight cycling (WC) was evident to achieve competitive weight. Most wrestlers significantly restricted fluids and caloric intake in the 48 hours before weigh-in.