High School-aged Athletes Research Articles

National estimates of nonurgent emergency department utilization for sportsrelated injuries in high school-age population.

Athletic trainers (ATs) can manage nonurgent, musculoskeletal emergency department (ED) visits. Little is known about what populations are most likely to use the ED for nonurgent, sports-related musculoskeletal injuries. Our object is to provide national-level evidence on whether high-school age population with public insurance or lower socioeconomic status were more likely to have ED visits for nonurgent injuries. Cross-sectional study. Secondary data analysis of the 2017-2019 Nationwide Emergency Department Sample (NEDS). ED visits for high school-age patients with a sports-related musculoskeletal injury. We used a multi-step process and AT scope of care threshold to classify ED visits for musculoskeletal injuries as urgent and nonurgent. National estimates of the proportions of visit, patient, and hospital characteristics by urgent, nonurgent, and total injury ED visits were reported. Survey weighted logistic regression was used to calculate odds ratios of an ED visit being for a nonurgent injury based on a patient's insurance type and socioeconomic status. For ED visits for musculoskeletal injuries in a high school-age, sports exposed population, 52.93% (95% CI: 51.11, 54.73) were for nonurgent injuries. Patients with public insurance were more likely (OR = 1.39; 95% CI: 1.35, 1.44) to have an ED visit for a nonurgent injury compared to ED visits for patients with private insurance. Patients from the lowest estimated neighborhood income quartiles were more likely (OR = 1.10; 95% CI: 1.02, 1.20) to have an ED visit for a nonurgent injury compared to ED visits for patients in the highest estimated income quartile. Our results suggest opportunities to reduce nonurgent ED use using AT services exist, especially in high school-age athletes from vulnerable populations.

Overuse Injury Definitions and Rates of Overuse Injury in Epidemiology Studies Concerning High School-Aged Athletes: A Critically Appraised Topic

Context: The definition of an “overuse injury” had some ambiguity until recent publications. It is unknown whether the improved definition of “overuse injury” has been applied to epidemiology studies that examine high school-aged athletes. This population may be predisposed to overuse injuries due to several factors. Clinical Question: Is there more consistency in how the term “overuse injury” is being used, and has the rate of overuse injuries in high school-aged athletes’ epidemiology studies changed since Roos and Marshall’s 2014 systematic review on overuse injury definitions? Clinical Bottom Line: Since Roos and Marshall’s systematic review, more studies are recognizing “overuse injuries” as needing a specific mechanism of injury; however, several studies failed to differentiate “overuse injuries” from “noncontact injuries.” The rate of overuse injuries does not appear to have changed significantly.

Do Differences Exist in Impact Test Domains between Youth Athletes with and without an Anterior Cruciate Ligament Injury?

Poor baseline reaction time, as measured via the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), has been associated with anterior cruciate ligament (ACL) injury risk in adult athletes. Our study sought to determine whether the reaction time and impulse control ImPACT test domains differed between ACL injured and uninjured pediatric athletes. A total of 140 high-school aged athletes comprising 70 athletes who went on to sustain an ACL injury between 2012 and 2018 and 70 age- and sex-matched uninjured controls were included in the study. Mean reaction times were similar for the injured (0.67 s) and uninjured (0.66 s) athletes (p = 0.432), and the impulse control scores were also similar for those with (5.67) and without (6.07) an ACL injury (p = 0.611). Therefore, neurocognitive risk factors for sustaining an ACL injury in adults cannot necessarily be extrapolated to adolescent athletes. Further research is needed to understand why differences exist between injury risk in youth and adult athletes.

Athletic Burnout in High School Students: A Social Perspective

An examination of athlete burnout through a social perspective, determining if athlete burnout levels are correlated to levels of social support and social resources in high school student-athletes. According to this framework, high school athletes are likely to experience burnout if they have a low social support network and a lack of autonomy. A sample of 52 female and male high school-aged athletes from New Jersey participated in this study. The Athlete Burnout Questionnaire (ABQ) and Sport Climate Questionnaire (SCQ) and personal interviews were used in this study. The quantitative data was analyzed using Pearson’s r Correlation Calculator. The quantitative results indicated that there was a negative correlation between social support and the development of athlete burnout among high school student-athletes (r=-.6716), which was further triangulated with the qualitative interview results. These findings revealed that increased social support has the ability to mitigate the severity of athlete burnout; thus to decrease the prevalence of burnout in high school athletes, coaches and athletic directors must enhance their athlete's social support network and resources.

A-69 The Impact of Sleep Disturbance on Depression and Anxiety Post-Concussion Among High School Athletes

Abstract Purpose This study aims to explore the relationship between concussion-related sleep symptoms and affective symptoms in high school athlete. Methods A retrospective analysis of the Maine Concussion Management Initiative (MCMI) Immediate Post-concussion Assessment Tool ™ (ImPACT™) database was conducted to investigate the relationship between sleep and affective symptom scores in high school athletes (14-18 years) within 7 days of sustaining a concussion. The Post-Concussion Symptom Scale (PCSS) was completed by each athlete as part of their post-injury ImPACT™ testing battery. Sleep-related symptoms and affective/mood related symptoms from the PCSS were summed to create a sleep and affective symptom score, respectively. Results The final sample included 548 adolescents (M=15.94±1.06 years old; 50.4% female) were evaluated 3.16±1.85 days after injury. The results of a simple linear regression revealed a significant relationship between sleep and affective symptoms (F(1,546)=142.60, p<.001), and the model explained 20.7% of the total variance of affective symptom scores. Additionally, there was an association between gender and affective symptoms (Χ2(1)=6.39, p=.01), with females 1.6 times more likely to report at least one affective symptom. Females (M=3.62±4.33) had significantly higher affective symptom scores compared to their male (M=2.35±3.46) counterparts (t(546)=3.79, p<.001). Conclusions This study provides evidence of a significant relationship between sleep disturbance and affective symptoms in high school-aged athletes following concussion. Female athletes reported higher affective symptom scores.

Comparison of Volleyball-Related Injuries at US Emergency Departments Between High School and Collegiate Athletes: A 10-Year NEISS Database Study

Background: There is a paucity of current data regarding the sport-specific injury patterns and epidemiological trends associated with volleyball. Purpose: To provide an updated, comparative assessment of the epidemiology of volleyball-related injuries among female high school– and college-aged athletes and to characterize the burden of these injuries on emergency departments (EDs) across the United States. Study Design: Descriptive epidemiological study. Methods: Data were obtained from the National Electronic Injury Surveillance System for volleyball-related injuries between 2012 and 2021 in high school–aged (14-18 years) and college-aged (19-23 years) patients. Incidence, injury characteristics, incident locales, and dispositions were analyzed with weighted population statistics based on National Federation of State High School Associations and National Collegiate Athletic Association data as well as incidence rates and incidence rate ratios (IRRs) and 95% CIs. Results: In total, an estimated 214,302 female athletes aged 14 to 23 years were evaluated in EDs across the United States with volleyball-related injuries between 2012 and 2021. Female college-aged athletes were nearly 3 times more likely to be evaluated with these injuries than their high school–aged counterparts, with incidence rates of 12.8 per 100 at-risk individuals among college-aged athletes and 4.3 per 100 at-risk individuals in high school–aged athletes (IRR, 0.338; 95% CI, 0.333-0.342). The ankle, head, and knee were most frequently injured, often involving strains/sprains, contusions, fractures, and concussions. The IRRs of nearly all injuries were higher among collegiate athletes, especially among knee (IRR, 4.56; 95% CI, 4.40-4.72) and shoulder (IRR, 5.07; 95% CI, 4.81-5.35) injuries. Conclusion: Among volleyball-related injuries evaluated in EDs between 2012 and 2021, the incidence rates of injuries in college-aged athletes far surpassed those of their high school–aged peers irrespective of injury type or bodily location. While sprains and strains were the most frequent injuries, head injuries accounted for the second most common diagnosis in both groups, suggesting that clinicians should maintain a high index of suspicion for concussion when evaluating players.

The Effects of Psychological Techniques on the Performance of High School Varsity Tennis Players

Positive psychological techniques have been researched and implemented within professional sports as well as collegiate programs throughout the country. The effectiveness of audio/visual stimuli on high school aged athletes and their athletic performance, however, has not been previously evaluated. An experiment was performed on varsity high school tennis players where their serving accuracy was measured before and after being introduced to an audio/visual stimuli. 8 female and 9 male participants participated in the trails, where they would serve 10 times on each side of the court (20 total serves). Players additionally completed a survey regarding their mindset and positivity before participation. Results were measured both days of experiments and compared. Findings concluded that the male participants decreased their accuracy 16% after watching the video and females increased accuracy by 20%. Due to the higher number of males that were self reported to have a “negative” mindset, that was deduced to likely cause the decrease in performance along with the female-centered stimuli. These findings show a need for an appealing stimuli to males in the high school age group and demonstrate that emotional, female-focused stimuli helps to improve the performance of female high school athletes.

Return to Sport After Bone-Patellar Tendon-Bone Autograft ACL Reconstruction in High School-Aged Athletes.

Background:Anterior cruciate ligament (ACL) injuries are occurring with increasing frequency in the adolescent population. Outcomes after ACL reconstruction (ACLR) are inconsistently reported in homogeneous patient populations.Purpose/Hypothesis:To evaluate outcomes after bone–patellar tendon–bone (BTB) autograft ACLR in competitive high school–aged athletes by examining return to sport (RTS), patient satisfaction, and reinjury rates. Our hypothesis was that RTS rates and satisfaction will be high and reinjury rates will be low.Study Design:Case series; Level of evidence, 4.Methods:An institutional ACL registry was utilized to identify competitive high school–aged athletes (14-18 years old) who underwent primary ACLR using BTB autograft with a minimum 2-year follow-up. A postoperative questionnaire was administered to determine rates and types of RTS, quality of sports performance, reinjury, and satisfaction. Uni- and multivariable analyses were used to identify demographic, sport-specific, and clinical factors related to RTS.Results:A total of 53 patients were included (mean ± SD age at the time of surgery, 16.6 ± 1.34 years). Mean follow-up was 3.78 ± 0.70 years (range, 2.60-4.94 years). The overall ipsilateral ACL retear rate was 7.5% (n = 4). There were 10 subsequent ACL tears to the contralateral knee (19%). Forty-four (83%) patients successfully returned to at least their prior level of sport at a mean 10.5 ± 8.7 months (range, 3-48 months). Overall satisfaction was high, with 91% of patients very satisfied with the outcome. Higher confidence levels regarding performance of the reconstructed knee were associated with increased probability of RTS on multivariate analysis.Conclusion:BTB autograft ACLR results in high rates of RTS and satisfaction and low rates of subsequent ipsilateral ACL injuries in competitive high school–aged athletes. Patients with higher confidence in performance of the reconstructed knee are more likely to return to at least their prior level of sport.

Sex and Age Comparisons in Neuromuscular And Biomechanical Characteristics of the Knee in Young Athletes.

BackgroundThe identification of risk factors for injury is a key step for musculoskeletal injury prevention in youth sports. Not identifying and correcting for injury risk factors may result in lost opportunity for athletic development. Physical maturation and sex affect these characteristics, which may indicate the need for both age and sex-based injury prevention programs.Hypothesis/PurposeThis study examined age and sex differences in knee strength, static balance, jump height, and lower extremity landing biomechanics in school- and high school-age athletes.Study DesignCross-sectionalMethodsForty healthy school aged (10.8±0.8 yrs) and forty high school (16.8±0.8 yrs) athletes completed isokinetic knee flexion and extension strength tests, single-leg static balance and single-leg vertical stop jump tasks.ResultsHigh school athletes were significantly stronger (~67% and 35% stronger for males and females, respectively) and jumped higher (regardless of sex) compared to school age athletes. High school males had worse balance (~28%) compared to their younger counterparts. High school females had lower strength (~23%) compared to males but had better balance (~46%). Conclusion: Maturation had different effects on the variables analyzed and sex differences were mainly observed after maturation. These differences may be minimized through appropriate age and sex specific training programs.Levels of Evidence3aClinical RelevanceNeuromuscular and biomechanical differences between sex and age groups should be accounted for in injury prevention and rehabilitation. Inadequate training may be a primary factor contributing to injuries in a young athletic population. When designing training programs for long term athlete development, programs should be dependent on decrements seen at specific time points throughout maturation.What is known about the subject: Generally, both males and females get stronger and jump higher as they get older but the results comparing balance and biomechanics between genders or across age groups have been mixed.What this study adds to existing knowledge: The current study looks at multiple neuromuscular and biomechanical variables in male and female participants at different maturation statuses. The current data supports the significant changes observed in strength and jump height, as both genders age, but the data also demonstrates significant differences in balance between age groups in males and between genders in balance and knee flexion angles.

Comparison of in-season and off-season wrestling injuries presenting to United States emergency departments: 2000-2018

ABSTRACT Objectives Wrestling is a physically demanding sport with an inherently high risk of injury relative to other sports. Injury risk factors may change dramatically for athletes participating in off-season wrestling, given exposure to new opponents, training methods, and wrestling styles compared with in-season months; however, this has never been elucidated in the literature. This study seeks to characterize the injuries sustained while participating in off-season wrestling and compare them to injuries sustained during the in-season months for middle and high school age athletes. Methods The National Electronic Injury Surveillance System (NEISS) database was queried (2000–2018) to directly compare national estimates and injury characteristics of middle and high school age patients (11–18 years of age) presenting to US emergency departments (EDs) with wrestling-associated injuries, stratified by in-season and off-season months. Results The average annual number of patients 11 to 18 years of age presenting to US EDs with wrestling-associated injuries was 20,157 (95% Confidence Interval [C.I.] 16,622–23,691) during in-season months and 5,321 (C.I. 3,954–6,688) during off-season months between 2000 and 2018. Those sustaining in-season injuries were significantly (p < 0.001) more and less likely to injure their upper trunk (8.0%; C.I. 7.1% – 8.8%) and wrists (3.7%; C.I. 3.2% – 4.2%), respectively, than those presenting with off-season injuries (upper trunk: 5.3%; C.I. 4.2% – 6.5%; wrists: 6.6%; C.I. 5.1% – 8.1%). There were no significant differences with respect to the overall prevalence of injury diagnoses between in-season and off-season patient cohorts, including for fractures and dislocations (p > 0.05). Conclusion These findings may alleviate concerns that off-season wrestling is inherently more dangerous than in-season wrestling due to changes in wrestling styles or opponent skill levels as the prevalence of specific injury diagnoses between the two seasons is similar.

Repetitive Head Impact Exposure and Cerebrovascular Function in Adolescent Athletes.

The purpose of this study was to determine how subconcussive head impact exposure in high school collision sport student-athletes influenced cerebrovascular function. Transcranial Doppler was used to assess pre- to post-season changes in: (1) resting middle (MCA) and posterior cerebral arteries (PCA), (2) cerebrovascular reactivity (CVR) via breath-holding index (BHI), vasomotor reactivity response (VMRr) and overall MCA response curve, and (3) neurovascular coupling (NVC) via NVC response magnitude and overall PCA response curve. Fifty-three high school-aged athletes (age = 15.8 ± 1.2years, height = 175.8 ± 8.1cm, mass = 69.4 ± 13.5kg) were recruited into two groups (collision vs. non-collision sport). All participants completed a pre-season cerebrovascular function assessment. Following a 4- to 5-month window (118.6 ± 12.2 days), 48 athletes from the original sample (age = 16.0 ± 1.2 years, height = 175.5 ± 8.1 cm, mass = 68.6 ± 4.0 kg) repeated the cerebrovascular assessment. There were no group differences in any cerebrovascular measures at pre-season testing (p > 0.05). At post-season testing, collision sport athletes demonstrated greater positive change in BHI (t44 = -2.21, p = 0.03) while non-collision sport athletes demonstrated greater negative change in the NVC response magnitude to the reading task (t44 = 1.98, p = 0.048), and lower overall PCA response curve to the reading task (F1,2710 = 101.54, p < 0.001). All other pre- to post-season change values were non-significant (p > 0.05). Our data indicate that single-season changes in cerebrovascular outcomes may differ between collision and non-collision sport athletes. Although the clinical interpretation is still unclear, our study demonstrates that CVR and NVC assessments may be sensitive to the dynamic cerebrovascular changes occurring in adolescent athletes. Future research should continue to assess these outcomes following both subconcussive head impact exposure and throughout the recovery trajectory following concussion.

Awareness of Concussion-Education Requirements, and -Management Plans and Concussion Knowledge in High School and Club Sport Coaches.

A growing number of high-school-aged athletes participate on club sport teams. Some, but not all, state concussion laws apply to both interscholastic and private sport organizations. However, concussion education, management plans, and knowledge have not been examined in club coaches who coach high school-aged athletes. To determine if differences in concussion education, management plans, and knowledge exist between high school coaches and coaches of club sport teams. Cross-sectional study. Online survey. A total of 769 coaches (497 high school coaches, 272 club coaches coaching high school-aged athletes; 266 women [34.6%], 503 men [65.4%]) completed an anonymous online questionnaire. The questionnaire consisted of demographic and team information, requirements for concussion-education and -management plans, and concussion knowledge. High school coaches were more likely than club coaches to report that their organizing bodies or leagues required them to receive concussion-education information (97.4% versus 80.4%; P < .001) and that their organizing bodies or leagues had a concussion-management plan (94.0% versus 70.2%; P < .001). High school coaches were more likely than club coaches to correctly agree that most concussions resolve in 7 to 10 days (48.6% versus 40.1%; P = .02) and disagree that loss of consciousness is required to diagnose a concussion (87.1% versus 80.9%; P = .02). Club coaches were less likely to be aware of requirements for concussion-education and -management plans from their parent organizations and scored lower on specific concussion-knowledge questions than high school coaches despite the same education requirements across groups under their state concussion laws. These results raise concerns regarding the proper management of concussions in club sports and suggest a need for greater oversight and enforcement of state laws in the club sport setting.

Wrestling-related concussions and closed head injuries predominantly occur in high school age athletes.

Sports-related concussions (SRC) and closed head injuries (CHI) have recently garnered national attention given mounting concern for long-term neurological sequelae resulting from repetitive head trauma. Despite historically dangerous techniques in wrestling that involve impacts to the head, there is a paucity of epidemiologic data in regard to wrestling-related concussions (WRCs) in the United States (USA). The National Electronic Injury Surveillance System (NEISS) database was queried (2000-2018) to report national estimates and demographic characteristics of patients 6-25 years of age presenting to US emergency departments (EDs) with WRCs and CHIs. The average annual number of patients presenting to US EDs with WRCs or CHIs was 3465 (95% confidence interval [CI]: 2489-4441). Over one-third of patients were between 15 (17.7%; 95% CI: 15.8%-19.7%) and 16 (17.0%; 95% CI: 14.9%-19.1%) years of age, which comprised the peak age groups during which such head injuries were sustained. The vast majority of patients were male (96.3%; 95% CI: 94.8%-97.7%). Lastly, 6.2% (95% CI: 4.3-8.2%) of patients did not present to the ED on the same day that the injury was sustained. Due to the unique nature and culture of the sport, wrestlers may be more likely to attribute SRC or CHI symptoms to normal training-related fatigue, which can lead to underreporting or delayed diagnosis. It is therefore imperative that appropriate safety initiatives and concussion awareness campaigns be implemented in youth wrestling to decrease the incidence of SRCs at local and national levels.

Differences In Baseline Concussion Symptom Reporting Across Age And Gender

PURPOSE: Previous studies have identified significant differences across age and gender in post-concussion symptoms reporting, with female and high school aged athletes reporting both a higher number of symptoms and a greater symptom severity. This study evaluates differences in baseline symptom reporting across age group and gender. METHODS AND STUDY DESIGN: Between 2007-2019, concussive symptoms were reported by middle school (MS), high school (HS) and collegiate athletes (CA) utilizing the post-concussion symptom scale at baseline. Excluded athletes included those with invalid testing, age > 24y or < 10y, learning disabilities, ADHD, autism, or a prior history of concussion. ANOVA was performed assessing the total number of symptoms and the total symptom severity score as reported by age group, and gender. Results: (1000)25,694 athletes (60% male and 40% female) were included: 4.6% MS (n=1,179), 89.7% HS (n=23,047) and 5.7% CA (n=1,468). Among the different age groups, there were no significant differences in number of symptoms (p=0.21) or symptom severity score (p=0.48). However, there were significant differences noted between male and female athletes. Males reported fewer symptoms than females (1.75 ± 3.0 vs 2.50 ± 3.6, p<1x10-70). Males also reported a lower baseline symptom severity (3.34 ± 6.7 vs 4.96 ± 8.7, p<1x10-62). This difference between genders held true across age levels with significant differences in the number of baseline symptoms reported (MS p<0.001, HS p<1x10-60, CA p<0.001) and symptom severity score (MS p<0.001, HS p<1x10-51, CA p<0.01). CONCLUSION: This study identifies symptom differences between genders at baseline. These baseline differences may contribute to the post-concussive discrepancies seen previously. In contrast, baseline differences are not present between age groups possibly suggesting a pathophysiologic underpinning to the post-concussive discrepancies of higher total symptoms and higher severity noted in high school athletes. Significance of Findings: Significant differences in concussive symptom reporting by age level, despite comparable baselines shown here, may reflect pathophysiologic, rather than reporting discrepancies, necessitating specific evaluation and management strategies across age levels.

New Zealand secondary school students’ knowledge, attitude and behaviours towards sports-related concussion

Sports-related concussion is a significant problem in New Zealand, with an estimated 21% of all traumatic brain injuries occurring in the sporting environment. The symptoms of sports-related concussion experienced by high school-aged athletes are often associated with a decline in academic performance, and are commonly more severe and persistent then those experienced by adult athletes. A 35-item, multi-choice questionnaire was used to ascertain New Zealand secondary school students’ knowledge, attitudes, and behaviours of sports-related concussion. By comparing results from 2018 to those obtained in 2017, this study investigated the impact that a 2018 Accident Compensation Corporation (ACC) social media campaign may have had on New Zealand secondary school students' knowledge, attitudes, and behaviours regarding sports-related concussion. The main findings of this study show that the ACC social media campaign did not alter students’ knowledge, attitudes, and behaviours toward sports-related concussion. Students were knowledgeable regarding concussion and showed positive attitudes towards correct management of the injury. Students had specific knowledge gaps regarding the onset of symptoms, activities to avoid post-concussion, the possible complications of multiple injuries, and recognition of the less discernible symptoms of concussion. These results suggest that secondary school students would benefit from further education on the possible long-term effects of sports-related concussion and the importance of effective management once a concussion has occurred.

A Comparison of Emergency Preparedness Between High School Coaches and Club Sport Coaches.

Recent studies suggested that a large population of high school-aged athletes participate on club sport teams. Despite attempts to document emergency preparedness in high school athletics, the adherence to emergency and medical coverage standards among club sport teams is unknown. To determine if differences in emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams. Cross-sectional survey. Online questionnaire. A total of 769 coaches (females = 266, 34.6%) completed an anonymous online questionnaire regarding their emergency preparedness and training. The questionnaire consisted of (1) demographics and team information, (2) emergency preparedness factors (automated external defibrillator [AED] availability, emergency action plan [EAP] awareness, medical coverage), and (3) emergency training requirements (cardiopulmonary resuscitation/AED, first aid). High school coaches were more likely than club sport coaches to be aware of the EAP for their practice venue (83.9% versus 54.4%, P < .001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% versus 68.9%, P = .54). High school coaches were more likely to be made aware of the EAP during competitions (47.5% versus 37.1%, P = .02), but the majority of coaches in both categories indicated that they were never made aware of EAPs. High school coaches were more likely than club coaches to (1) have an AED available at practice (87.9% versus 58.8%, P < .001), (2) report that athletic trainers were responsible for medical care at practices (31.2% versus 8.8%, P < .001) and competitions (57.9% versus 31.2%, P < .001), and (3) be required to have cardiopulmonary resuscitation, AED, or first-aid training (P < .001). High school coaches displayed much greater levels of emergency preparedness and training than coaches of high school-aged club teams. Significant attention and effort may be needed to address the lack of emergency preparedness and training observed in club coaches.

A Comparison of Team Sport Volume Surveyed Between High School and Club Sport Coaches.

Background:Club sport participation is increasingly common among high school athletes. Sport participation characteristics may vary widely between the high school and club sport settings. However, there have been no large-scale comparisons of sport participation volume between high school and club teams from similar sports.Purpose/Hypothesis:The purpose of this study was to compare the sport participation characteristics of high school and high school–aged club teams. We hypothesized that club team athletes would participate in more months per year and hours per week and would take more overnight trips than high school athletes and that club team coaches would be less likely to track their athletes’ sport volume than high school coaches.Study Design:Cross-sectional study.Methods:A total of 769 coaches (266 female; 34.6%) from 3 sports (basketball, volleyball, soccer) completed an anonymous online questionnaire regarding their team’s sport volume and their knowledge, attitudes, and beliefs regarding sport specialization. Coaches were eligible to participate if they had served as the head or assistant coach of a high school sport team or high school–aged club sport team in the past 12 months.Results:Overall, 64.6% (n = 497) were coaches of a high school team, and 35.4% (n = 272) were coaches of a club team with high school–aged athletes. Club coaches’ teams played more months out of the year and took more overnight trips for competitions than high school coaches’ teams but participated in fewer hours per week of practices or competitions during their season. There were no differences between club and high school coaches in tracking their athletes’ sport volume, with most coaches in both settings reporting that they do not track the amount of time that their athletes participate in other sports.Conclusion:Significant differences in sport participation volume exist between the teams of high school and club coaches.

LACK OF SLEEP AMONG YOUTH ATHLETES IS ASSOCIATED WITH A HIGHER PREVALENCE OF SELF-REPORTED HISTORY OF ANXIETY AND DEPRESSION

Background: The importance of sleep in children, and the relationship to mental and physical health, is under recognized. The physical and emotional demands of sports participation may contribute positively and negatively to sleep quality and quantity. Aim: To investigate sleep duration, daytime sleepiness, and mental health in youth athletes. Hypotheses: 1. The majority of youth athletes will not meet the current age based recommendations for sleep duration. 2. Athletes not meeting the current sleep recommendation will have an increased prevalence of anxiety/depression, and have greater daytime sleepiness scores. Study Design: Cross-sectional study Methods: Questionnaire data were analyzed from an injury prevention evaluation (IPE) at a sports injury prevention center affiliated with a tertiary level pediatric medical center between April 2013 and February 2018. Reason for playing was coded into thematic categories. Fun related responses include: to have fun, to make friends, to be part of a team, enjoyment/love etc. Goal oriented reasons include: to win a championship, college or scholarship purposes, to compete to control my weight, to be strong etc. BMI was adjusted by age and sex using ranges recommended by the Center for Disease Control. Anxiety and or depression is measured by a clinician diagnoses but was self-reported by the participant. Homework was measured as total hours spent during weeknights and was measured by categories in three hour units; each category composed approximately 25% of participants. Main outcome measures included sleep duration, scores on daytime sleepiness scale, self-reported anxiety and, self-reported depression. Age, sex, BMI, reasons for playing sports (fun related versus goal oriented), hours of homework per week, and internet access were also analyzed. Results: 756 athletes, =18 years old (mean age 13.5±2.5 yrs.) were included; 56% (N=426) were female. Overall 39% (N= 296) of athletes were not getting the age recommended amount of sleep. Among athletes 6-12 years old, 26% were not meeting the sleep recommendation for age, compared to 45% of 13-18-year-old athletes (p&lt;0.01). Female athletes (44% vs. 33%, p&lt;0.01) and athletes with either depression and/or anxiety (62% vs. 37%, p&lt;0.01) were less likely to meet sleep recommendations. Athletes also appeared less likely to meet the current sleep recommendation if they reported a prior sport-related injury (44% vs. 37%, p=0.05), goal-oriented reasons for playing sports (52% vs. 35%, p&lt;0.01), night time internet access (51% vs. 28%, p&lt;0.01), and as number of weeknight homework hours increase (0-3 hours (22%) compared to 11+ hours (64%); p&lt;0.01). After adjusting for age, gender, injury history, nighttime internet access, and hours of homework per week, the odds of not meeting the recommended amount of sleep increased with age (OR=1.29, 95% CI, 1.2 -1.4, p&lt;0.01). Athletes reporting past diagnoses of anxiety and/or depression had higher odds of not meeting the sleep recommendation (OR 1.92, CI 1.0 – 3.6, p&lt;0.05) and increased daytime sleepiness (ß=2.83, 95% SE 0.7, p&lt;0.01). Goal driven athletes had 1.63 the odds of not meeting the sleep recommendation (CI 1.1-2.4, p&lt;0.05), but were not significantly different from their counterparts with regards to daytime sleepiness scale scores. When stratified by age group, the odds of not meeting the recommended amount of sleep increased among older athletes (OR=1.29, 95% CI, 1.2 -1.4, p&lt;0.01). Middle-school athletes with a self reported history of anxiety and/or depression had a greater likelihood of not meeting the sleep recommendation (OR = 4.49,95% CI, 1.2 – 18.1, p&lt;0.05) and also had higher daytime sleepiness scores (OR=3.19, 95% SE, 1.5, p&lt;0.05). Only daytime sleepiness increased among high school aged athletes with anxiety/depression (ß=3.0, 95% SE, 0.8, p&lt;0.01) Conclusions: Female athletes, those who play sports for goal-oriented reasons, and those with a history of anxiety/depression are at increased risk of not meeting current sleep recommendations. Among middle school aged athletes, self reported history of anxiety and or depression has an even larger impact on sleep.

OVERUSE INJURY RISK INCREASES WITH YEAR-ROUND SPORT PARTICIPATION IN MIDDLE SCHOOL AGED ATHLETES

BACKGROUND: Retrospective studies of high school aged athletes have demonstrated that participating in one sport for more than 8 months of the year is a risk factor for overuse musculoskeletal injuries. This research has driven the recommendation that suggests youth athletes should not play a single organized sport for more than 8 months out of the year. However, these recommendations have never been prospectively examined in middle school aged athletes. The purpose of this study is to determine if year-round participation, operationally defined as participating in one sport for more than 8 months of the year, is associated with increased risk of overuse injuries in middle school aged athletes. METHODS: A total of 281 children (female N= 113, 40.2%, age= 12.1±1.2 years; range 10-14 years of age) completed an anonymous online survey with their parents for 39 weeks. A baseline survey was conducted in the first week of September 2017 and then weekly surveys were completed until June 2018. The baseline survey consisted of demographic information, previous injury history, and sport participation volume (months per year in primary sport). The weekly surveys asked participants to report their sleep habits, musculoskeletal injuries, and illnesses. Parents and children were asked to complete the surveys together. Participants were included in the analysis if they completed at least 80% of the total surveys. In the baseline survey, participants identified the previous months for which they played their primary sport. Those who marked more than 8 months out of the past 12 months were classified as “year-round participants.” Logistic regression was used to determine if year-round participation (&gt;8 months/year) was a significant predictor of overuse musculoskeletal injuries during the study period. A second logistic regression model was created using the participant’s total reported months participating in a single sport as a predictor of overuse injuries. RESULTS: 80 (28.5%) participants were identified as participating year-round in a single sport and 49 overuse injuries were reported during the study period. Athletes who participated in a single sport year-round were more than twice as likely to sustain an overuse injury during the study period compared to non-year-round athletes (OR [95%CI]: 2.20[1.10-4.39], p=0.025), even after adjusting for sex, age, and previous injury history. The odds of sustaining an overuse injury increased approximately 17% for every additional month of participating in a single sport (OR [95%CI]: 1.17 [1.04 -1.32], p=0.012) again while controlling for sex, age, and previous injury. CONCLUSION: This is the first prospective study in middle school aged athletes examining year-round participation and overuse musculoskeletal injuries. Middle school aged athletes are at a 2-times increased risk of overuse musculoskeletal injuries when participating in a single sport for more than 8 months of the year compared to middle school aged athletes who participated 8 or less months in a single sport. Sport specialization has been identified as a risk factor for high school aged athletes for overuse injury – and our observations indicate that a similar trend may exist in middle school aged athletes. Recommendations regarding monthly sport participation for adolescents have been supported in the high school aged population and these recommendations may extend to an even younger population.

A COMPARISON OF EMERGENCY PREPAREDNESS AND MEDICAL COVERAGE BETWEEN HIGH SCHOOL AND CLUB SPORT COACHES

BACKGROUND: Recent studies have demonstrated that a large population of high-school aged athletes participate on club sport teams. Studies have documented emergency preparedness and medical coverage standards in the high school athletic setting. However, similar examinations do not exist for youth club sport teams. PURPOSE: To determine if differences in emergency preparedness and medical coverage exist between high school team coaches and high school-aged club team coaches. A secondary purpose was to compare emergency training characteristics between high school and club coaches. METHODS: A total of 769 coaches (female N=266, 34.6%, age: 41.0±11.5 years) completed an anonymous online questionnaire regarding their emergency preparedness and training. Coaches from 3 sports were surveyed (basketball N=290, volleyball N=256, soccer N=223). The questionnaire consisted of 1) demographics and information regarding the teams that the respondent coaches, 2) emergency preparedness factors such as automated external defibrillator (AED) availability, emergency action plan (EAP) awareness, and medical coverage, and 3) emergency care training requirements (CPR, AED, first aid). Chi-square tests were used to compare response frequencies to various emergency preparedness questions between high school and club coaches. RESULTS: Overall, 64.6% (N=497) respondents were coaches of a high school team, and 35.4% (N=272) were coaches of a club team with high school-aged athletes. High school coaches were more likely than club coaches to be aware of the EAP for their practice venue (83.9% vs. 54.4%, p&lt;.001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% vs. 68.9%, p=.54). During competitions, high school coaches were more likely than club coaches to be aware of the EAP (47.5% vs. 37.1%, p=.02). However, the majority of coaches in each category reported that they were never aware of EAPs during competition. High school coaches were more likely than club coaches to 1) have an AED available at practice (87.9% vs. 58.8%, p&lt;.001), 2), to report that athletic trainers were responsible for medical care at practices (31.2% vs. 8.8%, p&lt;.001) and competitions (57.9% vs. 31.2%, p&lt;.001), and 3) to be required to have CPR, AED, or first aid training (p&lt;.001). Nearly all (98.8%) high school coaches were required to have CPR training, and overall, 58.6% of high school coaches were required to have training in all 3 categories (CPR, AED, first aid) compared to 23.9% of club coaches (p&lt;.001). CONCLUSIONS: High school sport coaches displayed greater levels of emergency preparedness and training compared to coaches of high school-aged club teams. Significant attention and effort is needed to improve emergency preparedness and medical coverage at the club sports level among basketball, soccer, and volleyball coaches.