American Academy of Pediatrics: Technical report: knee brace use in the young athlete

This statement is a revision of a previous statement on prophylactic knee bracing and provides information for pediatricians regarding the use of various types of knee braces, indications for the use of knee braces, and the background knowledge necessary to prescribe the use of knee braces for children.     

Injury reduction and bounce characteristics of safety baseballs and acceptability by youth leagues

The only reasonable way to reduce the potential for ball-related youth baseball injuries sustained by the defensive players (the majority of ball-related injuries) is to make the ball less injurious. The American Academy of Pediatrics' 1994 statement on youth baseball injuries in this regard reads, "Consideration should be given to utilizing low-impact NOCSAE-approved baseballs and softballs for children 5 to 14 years of age, if these balls demonstrate satisfactory playing characteristics and reduce injury risk. A variety of studies should be undertaken to determine the efficacy of low-impact balls in reducing serious impact injuries." The purpose of this study, in accordance with this AAP policy, is to investigate the following: A) injury reduction potential of softer baseballs, B) their bounce characteristics, and C) their acceptability by youth leagues. Six simple injury models were studied, baseball bounce characteristics were analyzed, and attitudes of safety baseballs among statewide Little League district presidents were surveyed. Injury models demonstrated less injury potential with safety baseballs compared to that with standard hard baseballs. Safety baseballs bounced higher after vertical drops and slow throws, but during fast throws (with the greatest injury potential), the bounce heights were similar for all ball types. Of 27 survey cards sent out, 13 were returned. While 9 respondents indicated that they were already using safety baseballs for the younger players, none of the 13 respondents indicated that they were planning to expand the use of safety baseballs in their leagues. In conclusion, safety baseballs are less injurious in these models. The bounce characteristics of safety baseballs are satisfactory. Youth baseball league officials are not very willing to expand the use of safety baseballs. We recommend using safety baseballs as a standard for all youth baseball leagues because these balls are safer.     

High school soccer players with concussion education are more likely to notify their coach of a suspected concussion

Previously published studies have found that concussion symptoms are underreported in youth athletics. This study evaluated the likelihood high school soccer players would identify themselves as having concussion related symptoms during game situations. A questionnaire inquiring about past concussion education and the likelihood of notifying their coach of concussion symptoms was administered to 183 high school soccer players. Of the 60 (33%) who completed the survey, 18 (72%) athletes who had acknowledged receiving concussion training responded that they would always notify their coach of concussion symptoms, as compared with 12 (36%) of the players who reported having no such training (P = .01). The results of this study suggest that athletes with past concussion training are more likely to notify their coach of concussion symptoms, potentially reducing their risk for further injury. Concussion education should be considered for all high school soccer players.     

Acceptability of baseball face guards and reduction of oculofacial injury in receptive youth league players

GOALS: To assess the relative injury reduction effect and acceptability of face guards on batter's helmets. METHODS: A non-randomized prospective cohort study among 238 youth league baseball teams in Central and Southern Indiana during the 1997 season. Coaches, parents, and players were asked to respond to pre-season and post-season questionnaires. Approximately one half of the teams were supplied with face guard helmets (intervention); all others used this protection at their discretion (comparison). RESULTS: Parents, players, and coaches on the intervention teams reported a reduction in the incidence of oculofacial injuries compared with comparison team respondents (p=0.04). There was no reported adverse effect of face guard use on player performance. CONCLUSIONS: Helmet face guards should be required for batters to prevent facial injuries in baseball.     

Safety attitudes and beliefs of junior Australian football players

OBJECTIVES: To describe the safety attitudes and beliefs of junior (aged 16-18 years) Australian football players. SETTING: Six Victorian Football League Under 18 (VFL U18) clubs in Victoria, Australia. METHODS: Cross sectional survey. Altogether 103 players completed a self report questionnaire about their safety beliefs and perceptions of support when injured, across three contexts in which they played: VFL U18 club, local club, and school. RESULTS: Although only 6% believed it was safe to play with injuries, 58% were willing to risk doing so. This increased to almost 80% when players perceived that their chances of being selected to play for a senior elite team would be adversely affected if they did not play. There were significant differences in the perceived level of support for injured players and in the ranking of safety as a high priority across the three settings. In general, the VFL U18 clubs were perceived as providing good support for injured players and giving a high priority to safety issues, but local clubs and particularly schools were perceived to address these issues less well. CONCLUSIONS: Junior Australian football players have certain beliefs and perceptions in relation to injury risk that have the potential to increase injuries. These negative beliefs need to be addressed in any comprehensive injury prevention strategy aimed at these players.     

Should football players wear custom fitted mouthguards? Results from a group randomised controlled trial.

OBJECTIVE: Head/orofacial (H/O) injuries are common in Australian rules football. Mouthguards are widely promoted to prevent these injuries, in spite of the lack of formal evidence for their effectiveness. DESIGN: The Australian football injury prevention project was a cluster randomized controlled trial to evaluate the effectiveness of mouthguards for preventing H/O injuries in these players.Setting and SUBJECTS: Twenty three teams (301 players) were recruited from the largest community football league in Australia. INTERVENTION: Teams were randomly allocated to either the MG: custom made mouthguard or C: control (usual mouthguard behaviours) study arm. MAIN OUTCOME MEASURES: All injuries, participation in training and games, and mouthguard use were monitored over the 2001 playing season. Injury rates were calculated as the number of injuries per 1000 person hours of playing time. Adjusted incidence rate ratios were obtained from Poisson regression models. RESULTS: Players in both study arms wore mouthguards, though it is unlikely that many controls wore custom made ones. Wearing rates were higher during games than training. The overall rate of H/O injury was 2.7 injuries per 1000 exposure hours. The rate of H/O injury was higher during games than training. The adjusted H/O injury incidence rate ratio was 0.56 (95% CI 0.32 to 0.97) for MG versus C during games and training, combined. CONCLUSIONS: There was a significant protective effect of custom made mouthguards, relative to usual mouthguard use, during games. However, the control players still wore mouthguards throughout the majority of games and this could have diluted the effect.     

Injuries in youth football

The injury experience of 5,128 boys (8 to 15 years of age, weight 22.5 to 67.5 kg [50 to 150 lb]) participating in youth football revealed an overall rate of significant injury of 5%, with 61% classified as moderate and 38.9% as major injuries. No catastrophic injuries occurred, and it was rare for a permanent disability to result from any injury. The upper extremity was most likely to be injured, and fractures were the most common injury to occur. The rate, site, and type of injuries experienced by the pre- and early adolescent players differed from the pattern for older players at higher levels of competition. Variables related to an increased risk of injury included participation in the older and heavier divisions, heavier weight, and involvement in contact activities. Factors associated with the occurrence of an injury were evaluated and provided areas for future study for the prevention of injuries. The medical care received by youth football participants was appropriate, although improved sideline surveillance for injured players is required.     

Factors Associated With Firearm Injury Among Pediatric Members of a Large Integrated Healthcare System

Background and ObjectivesFew studies have tested multiple socio-ecological risk factors assocated with firearm injury among pediatric populations and distinguished self-inflicted from non–self-inflicted injury. To address this gap, the current study examined demographic, individual psychosocial, and neighborhood variables as risk factors for firearm injury among a large cohort of children and adolescents.MethodsRetrospective cohort study. Data were obtained from the electronic health records of a large integrated healthcare system. The cohort included children <18 years with at least one clinical encounter between January 1, 2010 and December 31, 2018. Poisson regression was used to examine demographic (age, gender, race and ethnicity, Medicaid status), psychosocial (depression, substance use disorder, medical comorbidities), and neighborhood education variables as potential risk factors for non–self-inflicted and self-inflicted firearm injuries.ResultsFor non-self-inflicted injury, the highest relative risk was found for children age 12–17 years old compared to 0–5 year olds (RR = 37.57); other risk factors included male gender, Black and Hispanic race and ethnicity (compared to White race), being a Medicaid recipient, lower neighborhood education, and substance use disorder diagnosis. For self-inflicted injury, only age 12–17 years old and male gender were associated with increased risk.ConclusionsThese results reinforce the established higher risk for firearm injury among adolescent males, highlight differences between self-inflicted and non–self-inflicted injuries, and the need to consider demographic, psychosocial, and neighborhood variables as risk factors to inform interventions aimed to reduce firearm injuries among children and adolescents.     

Surveillance of pediatric injury hospitalizations in Southern California.

OBJECTIVES: This study was designed to determine the incidence and causes of injury hospitalizations/fatalities to children less than 15 years of age. SETTING: Central Orange County, California. DESIGN: Cases were identified through a population based hospital and coroner's office surveillance system. SUBJECTS: The sample consisted of children 0-14 years of age who were residents of the study area and sustained an injury between 1 January 1991 and 31 December 1992 resulting in hospitalization or death. RESULTS: Over the two year study period, 1361 children 0-14 years of age were hospitalized or died as a result of injury. This represents a crude annual injury rate of 318/100,000 children. Rates were highest for children less than 5 years--this age group sustained the highest rate for eight of nine specific causes of injury. Falls were the leading cause of hospitalizations for all ages. Pedestrian injuries were more common among children 1-4 years and 5-9 years, while bicycle injuries were more common among older children. CONCLUSIONS: This study, one of the first population based studies in a Southern California urban/suburban community, found lower rates of injury hospitalization than studies conducted over a decade ago. These lower rates may reflect changes in hospitalization trends and/or injury prevention programs. Comparisons with more recent studies in inner city communities in the north east also show regional differences in rates and causes. Injury prevention efforts should particularly address the higher injury rates among children less than 5 years of age. This study also illustrates the need for regional and local data to guide injury control.     

Pediatric minor closed head injury

Many studies have found conflicting evidence over the use of clinical indicators to predict intracranial injury in pediatric mild head injury. Although altered mental status, loss of consciousness, and abnormal neurologic examination have all been found to be more prevalent among head-injured children, studies have observed inconsistent results over their specificity and predictive value. Children older than 2 years have been evaluated, managed, and studied differently than those less than 2 years old. Evidence strongly supports a lower threshold to perform a CT scan in younger children because they have a higher risk of significant brain injury after blunt head trauma.     

A systematic review of epidemiological studies investigating risk factors for work-related road traffic crashes and injuries

OBJECTIVE: To critically appraise the published evidence for risk factors for injuries and deaths relating to work-related road traffic crashes. DESIGN: Systematic review. DATA SOURCES: Electronic databases searched included Medline, EMBASE, PsycINFO, Transport database, and the Australian Transport and Road Index (ATRI) database. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major injury journals published within the past 5 years. INCLUSION CRITERIA: Studies were included if they investigated work-related traffic crashes or related injuries or deaths as the outcome, measured any potential risk factor for work-related road traffic crash as an exposure, included a relevant comparison group, and were written in English. METHODS: Included studies were critically appraised using the GATE-lite critical appraisal form (www.epiq.co.nz). Meta-analysis was not attempted because of the heterogeneity of the included studies. FINDINGS: Of 25 studies identified, three of four robust (case-control and case-crossover) studies found an increased injury risk (i) among workers after extended shifts, (ii) for tractor-trailers with brake and steering defects, and (iii) for "double configuration" trucks. The fourth study showed that alcohol and drug use were not risk factors in an industry with a random testing policy. The best cross-sectional studies showed associations between injury and sleepiness, time spent driving, occupational stress, non-insulin-dependent uncomplicated diabetes, and use of narcotics and antihistamines. CONCLUSIONS: Modifiable behavioral and vehicle-related risk factors are likely to contribute to work-related traffic injury. Fatigue and sleepiness-the most commonly researched topics-were consistently associated with increased risk.     

Evaluation of the ThinkFirst Canada, Smart Hockey, brain and spinal cord injury prevention video

OBJECTIVE: The ThinkFirst Canada Smart Hockey program is an educational injury prevention video that teaches the mechanisms, consequences, and prevention of brain and spinal cord injury in ice hockey. This study evaluates knowledge transfer and behavioural outcomes in 11-12 year old hockey players who viewed the video. DESIGN: Randomized controlled design. SETTING: Greater Toronto Minor Hockey League, Toronto Ontario. SUBJECTS: Minor, competitive 11-12 year old male ice hockey players and hockey team coaches. INTERVENTIONS: The Smart Hockey video was shown to experimental teams at mid-season. An interview was conducted with coaches to understand reasons to accept or refuse the injury prevention video. MAIN OUTCOME MEASURES: A test of concussion knowledge was administered before, immediately after, and three months after exposure to the video. The incidence of aggressive penalties was measured before and after viewing the video. RESULTS: The number of causes and mechanisms of concussion named by players increased from 1.13 to 2.47 and from 0.67 to 1.22 respectively. This effect was maintained at three months. There was no significant change in control teams. There was no significant change in total penalties after video exposure; however, specific body checking related penalties were significantly reduced in the experimental group. CONCLUSION: This study showed some improvements in knowledge and behaviours after a single viewing of a video; however, these findings require confirmation with a larger sample to understand the sociobehavioural aspects of sport that determine the effectiveness and acceptance of injury prevention interventions.     

Applicability of Ottawa knee rule for knee injury in children.

OBJECTIVE: Previous studies have shown that the application of the Ottawa knee rule (OKR) reduces the need for radiographs in adults with acute knee injuries. Our objectives were to describe the epidemiology and incidence of knee injuries in children with acute knee trauma and to validate the OKR in a pediatric population. DESIGN: A prospective, consecutive study. SETTINGS: Two urban pediatric emergency departments. METHODS: All children 18 years of age and under who presented with acute traumatic knee injury of less than 1 week's duration, excluding patients with a normal knee examination, superficial skin injuries, prior history of knee injury, underlying bone disease, serious injuries involving two or more organ systems, or altered mental status were enrolled. Physicians assessed each patient for 22 standardized clinical findings prior to radiography. The OKR was applied to each patient by the investigating physician. RESULTS: All 234 patients eligible for the study had radiographs of the affected knee. The median age was 13 years with a range of 2 to 18 years. Using the OKR criteria for obtaining knee radiographs, 12 of 13 patients with fractures were identified (sensitivity 92%; 95% CI= 64-99). The missed case was an 8-year-old male who had sustained a nondisplaced fracture of the proximal tibia after a fall. If the OKR were applied to the pediatric population, it would have reduced the need for radiography in 46% of children. CONCLUSIONS: In the pediatric population studied, the OKR did not identify all patients with knee fractures. Future studies may consider modifying the OKR to accommodate the differences between pediatric and adult patients to improve the sensitivity of the rule while maintaining its specificity, before it can be applied routinely in clinical practice.     

Evaluation and treatment of substance use problems among adolescents in emergency departments

This paper summarizes research on the epidemiology, screening, and brief treatment of adolescent substance abusers in emergency departments (EDs). The admission rate for emergency treatment of substance-related illness and injury for older adolescents is as high or higher than the admission rate for adult patients. Still, compared with adults, there has been less research and fewer systematic attempts to screen for and treat problematic substance use among adolescents presenting to EDs. Brief screening instruments can be quickly and easily administered from memory and recent research has shown that brief screens are effective for differentiating adolescents with substance use problems from their non-substance abusing peers in EDs. While few studies have tested brief interventions with adolescents in the ED, generally positive results have been found for reducing adolescent substance-related risk for injury. The paper concludes by discussing a general approach for establishing rapport with adolescents and conducting an assessment of substance use problems among ED-treated adolescents.     

Rôle du burnout scolaire dans les idées de suicide des adolescents

Background and study aim

Recent previous studies have highlighted the existence of burnout among high-school students. Burnout among high-school students has been described as a continuum between academic stress and severe burnout. Moreover, as for adults, burnout in school context is a three-dimensional concept that includes: exhausting concerning school demands, cynical attitudes towards school and sense of inadequacy as a student (Salmela-Aro et al., 2009). Previous research has shown that burnout can engender depression (Salmela-Aro et al., 2009), and that, depression in turn could lead to suicide ideas among adolescents (Garlow et al., 2008). Therefore, the aim of this study is to explore the determinisms of burnout among French high-school students and to evaluate the mediator effect of depression between burnout and suicidal ideations.

Method

Two hundred and fifty-six high-school students from 11th and 12th grades participated in this study. Among the participants, 135 were boys and 117 were girls, mean age was 16.9 years (SD = 0.88). The participants completed questionnaires about depression, suicidal ideations, burnout, academic stress, perceived pressure and perfectionism.

Results

Regression analyzes were performed in order to determine the predictor variables of school burnout. The results indicates that burnout was predicted by academic stress, perceived pressure provided by parents and provided by peers; perfectionism however appears as a protective factor. In a second step mediation analyses using multiple regressions were performed. As expected, depression was a mediator between burnout and suicidal ideations. Since burnout was a significant predictor of depression and of suicide ideas, when depression and burnout are both associated, depression is the principal predictor (β = 0.64; t = 11, P < 0.0001) and burnout is no longer a significant predictor (β = –0.09; t = –1.6; P = 0.11). The Sobel post-hoc test confirmed these results (z = 8.4, P < 0.0001).

Conclusion

Therefore it seems important to take into account academic stress and burnout for prevention of suicidality in adolescents. Psychotherapy interventions, focused on problem solving or improving feelings of self-efficacy, may be interesting to explore.     

Sickle cell nephropathy: A review of novel biomarkers and their potential roles in early detection of renal involvement

Whether the underlying mutations are homozygous, heterozygous, or co-inherited with other hemoglobinopathies, sickle cell disease is known to afflict the kidneys, leading to the clinical entity known as sickle cell nephropathy (SCN). Although common, SCN remains diagnostically elusive. Conventional studies performed in the context of renal disorders often fail to detect early stage SCN. This makes the quest for early diagnosis and treatment more challenging, and it increases the burden of chronic kidney disease-related morbidity among patients. Novel diagnostic tools have been employed to overcome this limitation. In this study, we discuss various biomarkers of SCN, including those employed in clinical practice and others recently identified in experimental settings, such as markers of vascular injury, endothelial dysfunction, tubulo-glomerular damage, and oxidative stress. These include kidney injury molecule-1, monocyte chemoattractant protein-1, N-acetyl-B-D-glucosaminidase, ceruloplasmin, orosomucoid, nephrin, and cation channels, among others. Furthermore, we explore the potential of novel biomarkers for refining diagnostic and therapeutic approaches and describe some obstacles that still need to be overcome. We highlight the importance of a collaborative approach to standardize the use of promising new biomarkers. Finally, we outline the limitations of conventional markers of renal damage as extensions of the pathogenic process occurring at the level of the organ and its functional subunits, with a discussion of the expected pattern of clinical and biochemical progression among patients with SCN.     

Formes du rapport au savoir chez des apprentis et lycéens professionnels de niveau V : approche comparative

This comparative and qualitative study led to 229 apprentices and 117 high-school students interviewed at the end of their first year of training aims at showing that wage-earner apprentices and pupils of a professional high school (at the fifth level of qualification) form learning groups of people who develop different forms of attitude towards learning. From a corpus consisting of 346 “assessments of knowledge” [13] (Charlot et al., 1992), we conducted a lexicometric analysis using the Alceste software [14] (Reinert, 1993) and Lexico3 [15] (Lebart and Salem, 1994). Results reveal that these young people develop a different relation to the world, to others and to themselves. Apprentices appear to be more committed in a process of self-building in which autonomy; willingness and reflexiveness are the main dimensions. Therefore, the two groups tend to privilege different sorts of knowledge. While high-school pupils rely more on the school world and the family sphere, apprentices are in turn supported knowledge regain their autonomy and independence.     

Echocardiographic evaluation of wheelchair-bound basketball players

BACKGROUND: Cardiopulmonary function in sedentary men whose lower limbs have been immobilized for years has been shown to be markedly lower than normal. However, the cardiopulmonary function of paraplegics who regularly activate their upper limps and trunk has been suggested to be almost normal in a few studies. The purpose of the present study was to evaluate the left ventricular dimensions, left ventricular mass, systolic and diastolic function in adolescent wheelchair-bound basketball players using echocardio-graphy, and to compare the results with those of sedentary adolescents unable to use their lower extremities and the results of able bodied controls. METHODS: The study group consisted of 22 male adolescent high school students who were unable to use their lower extremities: 11 were members of a high school basketball team who had been regularly playing basketball for at least 2 years, and 11 were sedentary adolescents none of whom was engaged in any kind of routine training program. The control group consisted of 11 healthy able-bodied male adolescents of similar age. RESULTS: There were no significant differences in left ventricular dimensions and wall thickness, aortic root, left atrium diameters, or left ventricular filling characteristics between the three groups. Wheelchair-bound basketball players had increased left ventricular ejection fraction and shortening fraction compared with the sedentary unable-bodied individuals. Although left ventricular ejection fractions were significantly lower than in normal adolescents, all ejection fraction values except one were within the normal limits in the unable-bodied basketball players. CONCLUSION: The results of the present study suggest that an upper extremity exercise program and sports such as basketball can improve the cardiac functions and additional echocardiographic functions of people unable to use their lower extremities, potentially to normal levels.     

Weight-training injuries in adolescents

We studied the incidence of injury caused by weight training in junior and senior high school football players. Three hundred fifty-four subjects completed a retrospective injury questionnaire; histories were confirmed for high school athletes. Cumulative incidence and incidence rates were determined for injuries causing more than 7 days of missed participation. The cumulative incidences of injuries were as follows: all athletes, 7.6% (27/354); junior high school athletes, 7.1% (7/98); high school freshman/junior varsity athletes, 9.4% (15/159); and high school varsity athletes, 5.2% (5/97). The total incidence rate was 0.082 injuries per person-year, with 0.11 injuries per person-year in junior high school athletes, 0.091 injuries per person-year in high school freshman/junior varsity players, and 0.051 injuries per person-year in high school varsity players. Differences in the incidence measures among groups were not statistically significant. The most common injury type was a strain (74.1%), and the most common site was the back (59.3%). Certain exercise apparently caused more back injuries in older athletes.     

Adolescent alcohol use and injury. A summary and critical review of the literature

BACKGROUND: Survey research indicates that alcohol use and misuse by adolescents is prevalent worldwide and has been associated with multiple negative health, social, and economic consequences. Physical injury is one of the negative consequences of alcohol use that appears to be on the rise among adolescents. METHODS: A retrospective review was conducted of published data currently available regarding alcohol use and injury among adolescents. Studies were reviewed if 1) the sample included adolescents between the ages of 13 and 19 years, 2) the study site was a medical setting, and 3) data were collected regarding alcohol ingestion. RESULTS: Data indicate that rates of adolescent alcohol use range from 5% among general emergency department (ED) admissions to nearly 50% among trauma admissions. Alcohol-positive adolescents are more likely than alcohol-negative adolescents to be injured, have a prior history of injury, require trauma service care, and have injury complications. One-third to one-half of alcohol-positive adolescents are referred for or receive intervention related to their alcohol use. CONCLUSIONS: Alcohol use by adolescents is associated with increases in severity of injury and cost of medical treatment. Screening of adolescent trauma unit admissions for alcohol use might be justified based on the literature. Optimal methods of screening, identification, and brief intervention for alcohol abusing adolescents within the medical setting are discussed.