Youth Injury Research Articles

Hair cortisol sampling as a measure of physiological stress in youth with acute musculoskeletal pain

Stress physiology contributes to health outcomes. Hair cortisol concentration (HCC) is an objective measure of cumulative cortisol secretion associated with health, including pain. The aim of the current study was to describe associations between pre-injury stress physiology (as measured by HCC), acute pain characteristics and relevant demographic factors (i.e., BMI, age, sex, days since injury) in youth with an acute musculoskeletal (MSK) injury. Participants were 58 youth aged 11 to 17 with acute MSK pain. Participants completed self-report measures assessing pain intensity, pain catastrophizing, and pain interference. Hair was collected within 1 month after injury using hair cortisol collection procedures adapted from published research protocols. Correlations examining associations among HCC values and clinical/demographic factors revealed that higher HCC was associated with lower body mass index (BMI) and male sex. HCC was not associated with pain variables or age. Additional research is needed to clarify the relation between HCC and psychosocial variables to aid researchers in studying the role of pre-injury stress in acute MSK injury and pain recovery in youth.

Shoulder Injury Incidence and Epidemiology in Youth, High School, and Collegiate Fastpitch Softball Players: A Systematic Review and Future Research Perspectives.

Fastpitch softball is one of the most popular sports in the United States among young female athletes. Softball players regularly subject their shoulders to extreme range of motion and high velocity movements. To date, no systematic review has reported on the epidemiology and incidence of shoulder injuries in softball players. To describe the incidence and epidemiology of softball-related shoulder injuries in youth, high school, and collegiate female softball players. PubMed, Web of Science, and Embase were searched for relevant English language articles from 1980 to 2023. Studies selected based on predefined inclusion criteria. Studies were required to be available full text, in English. Systematic review. Level 4. A preliminary screening was performed based on study title and abstract. In the subsequent screening, the full text versions of the remaining articles were evaluated by 2 reviewers for the fulfillment of the inclusion criteria. A total of 7 articles met criteria for inclusion. All studies evaluated injuries among softball players for at least 1 season. In total, there were 1107 softball-related shoulder injuries reported in the 7 studies included in this systematic review. Of the 3 studies that included a shoulder injury rate, a mean rate of 4.01 shoulder injuries per 10,000 athlete-exposures was calculated. The 2 most common shoulder injuries were shoulder muscle-tendon strains (297) and shoulder/biceps tendinitis (220). High-level prospective studies reporting injury incidence and risk factors among female softball players are extremely limited. Only 2 studies eligible for inclusion in this systematic review were prospective in nature, with neither of these reporting the specific injury rate for shoulder injuries among softball players.

Associations between growth, maturation and injury in youth athletes engaged in elite pathways: a scoping review

ObjectiveTo describe the evidence pertaining to associations between growth, maturation and injury in elite youth athletes.DesignScoping review.Data sourcesElectronic databases (SPORTDiscus, Embase, PubMed, MEDLINE and Web of Science) searched on 30...

Predictors of Anterior Cruciate Ligament Tears in Adolescents and Young Adults

Background: Anterior cruciate ligament (ACL) injury in youth can lead to expensive treatment, lengthy rehabilitation, and long-term impairment. Injuries to the ACL are more common in adolescents who participate in organized sports. Purpose: To examine whether there is an association between age, physical activity patterns, pubertal timing (Tanner stage), or body mass index (obesity/overweight status) and the risk of developing an ACL injury in youth. Study Design: Cohort study; Level of evidence, 2. Methods: Data from the Growing Up Today Study (GUTS), a prospective cohort study of youth throughout the United States, were used in this study. From 1996 to 2003, questionnaires were sent to GUTS participants every 12 to 18 months to assess a variety of self-reported factors; in a related 2004 questionnaire, ACL tears and other diagnoses among the participants were reported. Cox proportional hazard models were run to determine the sex-specific association of activity patterns and pubertal timing with risk of developing an ACL tear. Results: A total of 4519 boys and 5622 girls (age: 9-15 years) were included, with 2.4% and 2.0% sustaining an ACL injury, respectively. Age was found to be a significant risk factor for ACL injury in both sexes (male: hazard ratio [HR] = 1.30 [95% CI, 1.14-1.48]; female: HR = 1.23 [95% CI, 1.10-1.38]). Mean hours per week engaged in vigorous activity was also predictive of a higher risk of ACL injury (male: HR = 1.04 [95% CI, 1.01-1.08]; female: HR = 1.10 [95% CI, 1.07-1.14]). The sports that were the most predictive of injury were running, basketball, soccer, and cheerleading/gymnastics in girls and running, football, and karate/martial arts in boys. Additionally, in boys, overweight/obese status was found to be a significant predictor of ACL injury (HR = 2.61 [95% CI, 1.60-4.26]). Furthermore, among 9- to 13-year-old girls, advanced Tanner stage was a strong predictor of injury risk (HR = 2.43 [95% CI, 1.10-5.36]). Conclusion: Age, time engaged in vigorous activity, overweight/obese status, and advanced Tanner stage were associated with an increased risk of ACL injury in young adults and adolescents. Further research with follow-up data will help complement this study and continue to highlight the risk factors associated with ACL reconstruction in adolescents and young adults.

Advancing youth transportation safety in North Carolina through addressing alcohol-related motor vehicle collisions

The aim of this work is to analyze trends in youth transportation fatalities and injuries in North Carolina (NC), assess the implementation of ignition interlock devices (IIDs) in the United States and abroad, discuss policy implications for IIDs, and highlight health equity considerations related to motor vehicle collisions (MVCs). MVCs cause the highest number of unintentional injury-related deaths for children and teenagers in NC, and policymakers should pay special attention to MVCs related to alcohol consumption. IIDs are effective in reducing collision rates and recidivism for driving under the influence of alcohol (DUI). Ignition interlock device requirements have been increasingly implemented globally over the past three decades. However, the adoption of stricter IID policies after first-time DUI offenses in NC and across the U.S. is a prudent public health measure to enhance transportation safety for both adults and children. Evidence-based interventions such as IIDs must also strive to address inequities in transportation safety, and the framing of proposed policies should reflect the tenets of cultural humility.

Which Types of Providers Have Firearm Discussions in a Pediatric Primary Care Clinic?

ObjectiveSafe firearm storage decreases self-inflicted and unintentional firearm injury in youth. Medical providers are well-positioned to discuss safe firearm storage with families. The primary objective of this study was to determine which providers are most likely to discuss firearms with their patients. Our secondary objective was to determine whether providers were more likely to discuss firearms with patients at elevated suicide risk. MethodsThis was a retrospective chart review of primary care well-child visits occurring January to December 2019 in a large, urban academic clinic. We documented provider type and training level (exposure); any documentation of firearms in the chart (counseling, screening) was considered as having a firearm discussion (outcome). We also collected demographics, patient mental health history, and Patient Health Questionnaire-9 scores and assessed suicide risk. ResultsOf the 743 charts reviewed, firearms were discussed in 9% (n = 66). Medical students were most likely to discuss firearms (15%), and attending physicians were least likely (1%, P < 0.001). Providers did not discuss firearms more frequently among youth at elevated suicide risk. ConclusionsThough providers do not frequently discuss and document firearm discussions overall, the higher rates among medical students are promising. Given the lethality of firearms in a suicide attempt, the lack of firearm safety discussions with those at elevated suicide risk was concerning. Further study should evaluate factors that facilitate discussions in this cohort and identify strategies to improve counseling among more senior providers.

A Multi-Omics Approach to Defining Target Organ Injury in Youth with Primary Hypertension.

Primary hypertension in childhood tracks into adulthood and may be associated with increased cardiovascular risk. Studies conducted in children and adolescents provide an opportunity to explore the early cardiovascular target organ injury (CV-TOI) in a population free from many of the comorbid cardiovascular disease risk factors that confound studies in adults. Youths (n=132, mean age 15.8 years) were stratified by blood pressure (BP) as low, elevated, and high-BP and by left ventricular mass index (LVMI) as low- and high-LVMI. Systemic circulating RNA, miRNA, and methylation profiles in peripheral blood mononuclear cells and deep proteome profiles in serum were determined using high-throughput sequencing techniques. VASH1 gene expression was elevated in youths with high-BP with and without high-LVMI. VASH1 expression levels positively correlated with systolic BP (r=0.3143, p=0.0034). The expression of hsa-miR-335-5p, one of the VASH1-predicted miRNAs, was downregulated in high-BP with high-LVMI youths and was inversely correlated with systolic BP (r=-0.1891, p=0.0489). GSE1 hypermethylation, circulating PROZ upregulation (log2FC=0.61, p=0.0049 and log2FC=0.62, p=0.0064), and SOD3 downregulation (log2FC=-0.70, p=0.0042 and log2FC=-0.64, p=0.010) were observed in youths with elevated BP and high-BP with high-LVMI. Comparing the transcriptomic and proteomic profiles revealed elevated HYAL1 levels in youths displaying high-BP and high-LVMI. The findings are compatible with a novel blood pressure-associated mechanism that may occur through impaired angiogenesis and extracellular matrix degradation through dysregulation of Vasohibin-1 and Hyaluronidase1 was identified as a possible mediator of CV-TOI in youth with high-BP and suggests strategies for ameliorating TOI in adult-onset primary hypertension.

Case identification of non-traumatic brain injury in youth using linked population data

BackgroundPopulation-level administrative data provides a cost-effective means of monitoring health outcomes and service needs of clinical populations. This study aimed to present a method for case identification of non-traumatic brain injury in population-level data and to examine the association with sociodemographic factors.MethodsAn estimated resident population of youth aged 0–24 years was constructed using population-level datasets within the New Zealand Integrated Data Infrastructure. A clinical consensus committee reviewed the International Classification of Diseases Ninth and Tenth Editions codes and Read codes for inclusion in a case definition. Cases were those with at least one non-traumatic brain injury code present in the five years up until 30 June 2018 in one of four databases in the Integrated Data Infrastructure. Rates of non-traumatic brain injury were examined, both including and excluding birth injury codes and across age, sex, ethnicity, and socioeconomic deprivation groups.ResultsOf the 1 579 089 youth aged 0–24 years on 30 June 2018, 8154 (0.52%) were identified as having one of the brain injury codes in the five-years to 30 June 2018. Rates of non-traumatic brain injury were higher in males, children aged 0–4 years, Māori and Pacific young people, and youth living with high levels of social deprivation.ConclusionThis study presents a comprehensive method for case identification of non-traumatic brain injury using national population-level administrative data.

Glycoprotein Acetyls Associate With Intraglomerular Hemodynamic Dysfunction, Albuminuria, Central Adiposity, and Insulin Resistance in Youth With Type 1 Diabetes

ObjectivesGlycoprotein acetyls (GlycA's) are biomarkers of systemic inflammation and cardiovascular disease, yet little is known about their role in type 1 diabetes (T1D). In this study we examined the associations among GlycA's, central adiposity, insulin resistance, and early kidney injury in youth with T1D. MethodsGlomerular filtration rate and renal plasma flow by iohexol and p-aminohippurate clearance, urine albumin-to-creatinine ratio (UACR), central adiposity by dual-energy x-ray absorptiometry, and estimated insulin sensitivity were assessed in 50 youth with T1D (16±3.0 years of age, 50% female, glycated hemoglobin 8.7%±1.3%, T1D duration 5.7±2.6 years). Concentrations of GlycA were quantified by targeted nuclear magnetic resonance spectroscopy. Correlation and multivariable linear regression analyses were performed. ResultsGlycA's were higher in girls vs boys (1.05±0.26 vs 0.84±0.15 mmol/L, p=0.001) and in participants living with overweight/obesity vs normal weight (1.12±0.23 vs 0.87±0.20 mmol/L, p=0.0004). GlycA's correlated positively with estimated intraglomerular pressure (r=0.52, p=0.001), UACR (r=0.53, p<0.0001), and trunk mass (r=0.45, p=0.001), and inversely with estimated insulin sensitivity (r=−0.36, p=0.01). All relationships remained significant after adjustment for age, sex, and glycated hemoglobin. ConclusionsAs biomarkers of inflammation, GlycA's were higher in girls and those with overweight or obese body habitus in T1D. GlycA's associated with parameters of early kidney dysfunction, central adiposity, and insulin resistance.

User-Guided Enhancements to a Technology-Facilitated Resilience Program to Address Opioid Risks Following Traumatic Injury in Youth: Qualitative Interview Study.

Youth with traumatic injury experience elevated risk for behavioral health disorders, yet posthospital monitoring of patients' behavioral health is rare. The Telehealth Resilience and Recovery Program (TRRP), a technology-facilitated and stepped access-to-care program initiated in hospitals and designed to be integrated seamlessly into trauma center operations, is a program that can potentially address this treatment gap. However, the TRRP was originally developed to address this gap for mental health recovery but not substance use. Given the high rates of substance and opioid use disorders among youth with traumatic injury, there is a need to monitor substance use and related symptoms alongside other mental health concerns. This study aimed to use an iterative, user-guided approach to inform substance use adaptations to TRRP content and procedures. We conducted individual semistructured interviews with adolescents (aged 12-17 years) and young adults (aged 18-25 years) who were recently discharged from trauma centers (n=20) and health care providers from two level 1 trauma centers (n=15). Interviews inquired about reactions to and recommendations for expanding TRRP content, features, and functionality; factors related to TRRP implementation and acceptability; and current strategies for monitoring patients' postinjury physical and emotional recovery and opioid and substance use. Interview responses were transcribed and analyzed using thematic analysis to guide new TRRP substance use content and procedures. Themes identified in interviews included gaps in care, task automation, user personalization, privacy concerns, and in-person preferences. Based on these results, a multimedia, web-based mobile education app was developed that included 8 discrete interactive education modules and 6 videos on opioid use disorder, and TRRP procedures were adapted to target opioid and other substance use disorder risk. Substance use adaptations included the development of a set of SMS text messaging-delivered questions that monitor both mental health symptoms and substance use and related symptoms (eg, pain and sleep) and the identification of validated mental health and substance use screening tools to monitor patients' behavioral health in the months after discharge. Patients and health care providers found the TRRP and its expansion to address substance use acceptable. This iterative, user-guided approach yielded novel content and procedures that will be evaluated in a future trial.

Symposium 01: Neuropsychological Outcomes Following Pediatric Stroke: Research Trends and Advances

Summary Abstract:Stroke is an important cause of acquired brain injury in youth and a significant source of childhood disability. Up to 80% of survivors suffer long-term neurological deficits, including impairments across a range of neuropsychological domains. An improved understanding of neuropsychological outcomes is key to optimizing clinical care, improving evaluation of prognosis, and developing effective rehabilitation and intervention strategies. The proposed symposium will begin with a literature review on neuropsychological outcomes following pediatric stroke. Next, four studies will be presented, each posing distinct and complementary research questions regarding predictors of outcomes. The roles of both clinical (e.g., lesion size, motor impairment, inflammatory response) and environmental factors (e.g., socioeconomic status, family functioning) will be explored regarding cognitive, social-emotional, and behavioral outcomes. The symposium will end with a Q&amp;A period.Attendees will leave with an in-depth understanding of recent trends and scientific advances in research on neuropsychological outcomes in pediatric stroke, which should inform clinical practice and research directions. The first presentation examines predictors of neuropsychological outcomes following pediatric stroke. Findings have often conflicted, and more research is needed to disentangle the effects of predictors on specific domains. Explored predictors include: age at stroke; stroke subtype (hemorrhagic vs. ischemic); lesion location; lesion size; time since stroke; neurologic severity; seizure disorder; and socioeconomic status. This study examines the impact of these predictors on distinct neuropsychological domains. The next presentation addresses associations between neuropsychological outcomes and motor functioning following pediatric stroke. The development of cognitive and motor skills is interrelated and they share common neural substrates. In other populations, motor functioning predicts intellectual ability, and brain connectivity underlies this association. This study investigates associations between motor functioning and global neuropsychological outcomes in children with stroke and explores clinical features associated with motor impairments. The third presentation explores mental health outcomes. Neuropsychological deficits can hinder academic advancement and social-emotional development and may place youth at increased risk for psychological concerns. An increased focus on mental health is warranted given that psychosocial and behavioral issues are often the most concerning problems for parents and teachers. This study uses a qualitative paradigm to shed light on lived experience of youth with stroke with a focus on mental health, relationships, and social competence. The fourth presentation consists of a systematic review exploring the association between inflammatory response and neuropsychological outcome. Stroke induces an inflammation in the central and peripheral nervous systems, and high levels of inflammatory markers following stroke have been associated with poorer cognitive outcomes. This study reviews the state of research on this topic with a focus on pro-inflammatory cytokines and c-reactive protein. The symposium topics covered lie at the heart of the INS mission to study brain-behavior relationships using a multidisciplinary lens, with an emphasis on sharing and applying scientific knowledge. The symposium seeks to inform professionals working with youth with stroke about cutting-edge research, clinically applicable and novel insights, and ideas for future research directions. In this way, our symposium contributes to evidence-based care and the advancement of research.

Firearm Injuries In Children And Adolescents: Health And Economic Consequences Among Survivors And Family Members.

More US children and adolescents today die from firearms than any other cause, and many more sustain firearm injuries and survive. The clinical and economic impact of these firearm injuries on survivors and family members remains poorly understood. Using 2007-21 commercial health insurance claims data, we studied 2,052 child and adolescent survivors compared to 9,983 matched controls who did not incur firearm injuries, along with 6,209 family members of survivors compared to 29,877 matched controls, and 265 family members of decedents compared to 1,263 matched controls. Through one year after firearm injury, child and adolescent survivors experienced a 117percent increase in pain disorders, a 68percent increase in psychiatric disorders, and a 144percent increase in substance use disorders relative to the controls. Survivors' health care spending increased by an average of $34,884-a 17.1-fold increase-with 95percent paid by insurers or employers. Parents of survivors experienced a 30-31percent increase in psychiatric disorders, with 75percent more mental health visits by mothers, and 5-14percent reductions in mothers' and siblings' routine medical care. Family members of decedents experienced substantially larger 2.3- to 5.3-fold increases in psychiatric disorders, with at least 15.3-fold more mental health visits among parents. Firearm injuries in youth have notable health implications for the whole family, along with large effects on societal spending.

Trends in firearm production and firearm deaths in U.S. youth

IntroductionFirearms are now the leading cause of death for U.S. children and teens ages 0–19. The U.S. Department of Justice Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) reported data in 2022 on firearm production, for specific firearm types and calibers. We hypothesized there would be a correlation between firearm production and firearm deaths and nonfatal injuries in youth. MethodsAll firearm deaths and nonfatal injury rates for youth ages 0–19 were extracted from the Centers for Disease Control and Prevention from 2001 to 2020. Firearm production from 2001 to 2020 was extracted from the 2022 ATF Firearms in Commerce Report for overall firearm production, production by weapon type and pistol caliber. Relationships between firearm death and injury and firearm production were evaluated using correlational analyses. ResultsFirearm death and nonfatal injury rates for youth increased from 2001 to 2020 by 48.2% and 69.2%, respectively, and firearm production increased 265% overall and 1298% for 9 mm pistols. There was no correlation between total firearm manufacturing and total firearm deaths or nonfatal injury rates from 2001 to 2020 (all r < 0.28). Pistol caliber (25 and 9 mm) was associated with total firearm deaths and nonfatal injuries (all r > 0.55). ConclusionWhile total firearm manufacturing was not related to firearm deaths and injuries, except suicides, there were strong relationships between 9 mm pistol production and firearm deaths and injuries in youth. Firearm injuries are preventable; we must invest in stronger information systems that track details of firearms linked with deaths and injuries.

Linking emergency care and police department data to strengthen timely information on violence-related paediatric injuries

BackgroundCombined ED and police department (PD) data have improved violence surveillance in the UK, enabling significantly improved prevention. We sought to determine if the addition of emergency medical service (EMS)...

Coaches’ experiences of injury prevention in youth elite athletes: An interview study of 10 coaches

IntroductionInjury prevention is important to reduce the high injury risk in youth elite athletes studying at sports high schools. Coaches are considered important in youth elite sports and injury prevention. ObjectivesThe aim was to investigate perceptions and experiences of injury prevention among coaches at sports high schools. MethodsA manifest qualitative content analysis with an inductive approach was used based on ten semi-structured interviews with coaches who work at sports high schools. ResultsAn overarching theme “Coaches of youth athletes value injury prevention but have limited knowledge and support” was identified and five main categories were formed. Coaches perceived themselves to play an important role in injury prevention, yet they described limited time for knowledge acquisition and highlighted the close collaboration with other professions as a key in injury prevention. ConclusionA coach's knowledge and support are critical factors in injury prevention of youth elite athletes. Evidence-based as well as non-evidence-based approaches are used, and the biopsychosocial perspective was not always taken into consideration. A need for more interprofessional collaboration and knowledge acquisition regarding injury prevention is warranted.

Youth sport participation, injury history, and current physical activity among young adults

Objective: To examine the interaction between high school (HS) sports participation and injury history with current moderate-to-vigorous physical activity (MVPA) among young adults. Participants: Participants (N = 236) were 18–25 years old, not currently injured, and reported no physical activity limitations. Methods: Participants completed online demographic, injury history, and physical activity surveys. A two-way analysis of covariance was used to test the interaction between HS athlete status and previous injury severity on current self-reported MVPA. Results: Participants were 22.2 ± 2.1 years, primarily White (81.8%) or Asian (6.4%), and female (77.5%). After including body mass index and race as covariates, there was a statistically significant interaction between HS athlete status and previous injury history such that current MVPA was higher among former HS athletes compared to HS recreational/nonathletes when individuals reported no injuries or mild injury severity. MVPA was similar across athlete status groups when participants reported high levels of injury severity. Conclusions: Future studies should examine whether young adults who have experienced multiple and/or severe injuries as competitive HS athletes have unique physical activity barriers.

Safety guidelines for youth agricultural work in the United States: A description of the development and updating process.

To reduce the prevalence of youth injuries and fatalities in agricultural settings, safety professionals considered developing a guideline-focused intervention for how and when youth should conduct farm chores. In 1996, the process to create guidelines started, which then expanded to include professionals from the United States, Canada, and Mexico. This team used a consensus driven approach to develop the guidelines and launch the North American Guidelines for Children's Agricultural Tasks. By 2015, research related to the published guidelines indicated a need to incorporate new empirical evidence and develop dissemination plans based on new technologies. The process for updating the guidelines was supported by a 16-person steering committee and used content experts and technical advisors. The process yielded updated and new guidelines, now called Agricultural Youth Work Guidelines. This report responds to request for further details on the development and update of the guidelines and describes the genesis of the guidelines as an intervention, the process for creating guidelines, recognition of the need to update guidelines based on research, and the process for updating guidelines to assist in others engaged in similar types of interventions.

Association Between Magnetic Resonance Imaging Findings and Time to Return to Sport After Muscle Injuries in High-Level Youth Athletes.

To describe the relationship between magnetic resonance imaging (MRI) findings and time to return to sport (RTS) from muscle injuries in youth athletes. Prospective collection of injury surveillance data over 6 seasons (2014-2015 to 2019-2020) and reanalysis of MRIs by a radiologist blinded to RTS time after the data collection period. National sports academy and sports medicine hospital. Male youth (11-19 years) athletes participating in the football (soccer) or athletics (track and field) programs with a muscle injury. Magnetic resonance imaging findings (eg, grade and location) in time-loss muscle injuries. Injury incidence, distributions, and RTS time. In total, 353 time-loss muscle injuries were recorded for 1089 athlete-seasons, of which 85 satisfied our inclusion criteria (MRI within 14 days). Return to sport time was significantly longer for reinjuries compared with index injuries. Associations between MRI findings and RTS time were specific to the muscle group, with significant differences in RTS time observed between categories of structure, location, and grade. The largest number of injuries was to the hamstrings (n = 46), where injuries involving the tendon were more severe than those involving the myotendinous junction and muscle, proximal injuries were more severe than mid-portion and distal, and longer RTS time was observed for higher injury grade ( P < 0.05). Muscle injuries in youth are diverse and cannot be treated as a single injury type. Specific injury durations can be expected depending on injury characteristics such as reinjury, location, structure, and grade.

The incidence of anterior cruciate ligament injury in youth and male soccer athletes: an evaluation of 17,108 players over two consecutive seasons with an age-based sub-analysis.

To evaluate the incidence of anterior cruciate ligament (ACL) injuries in male athletes from professional soccer clubs over two consecutive seasons (2018-2019) with a sub-analysis based on age category: under-13 (U-13), under-15 (U-15), under-17 (U-17), and under-20 (U-20) years. A total of 17,108 young male soccer players were retrospectively reviewed from sixty-three professional clubs in the four highest Brazilian soccer divisions. Data regarding the number of athletes and the number of ACL injuries confirmed by magnetic resonance imaging (MRI) exams in the 2018 and 2019 seasons were collected. Incidence of ACL injury were compared by season, age category (under-13; under-15; under 17; and under-20), demographic region, and club division. Clubs from all regions of Brazil participated in the study. A total of 336 primary ACL injuries were diagnosed over the two seasons (8,167 athletes during the 2018 season and 8,941 athletes during the 2019 season) among all athletes, which corresponds to 2% of the included athletes. There were 11 cases (0.3%) in the under-13, 53 cases (1.3%) in the under-15, 107 cases (2.5%) in the under-17, and 165 cases (3.8%) in the under-20 age category. There was a higher incidence of ACL injury in the older age groups (p < 0.001). A total of 336 ACL injuries were identified in 17,108 youth soccer players from 63 professional clubs with an overall incidence of 2% over 2 seasons of competition. ACL injury rate ranged from 0.3% to 3.8% and was higher in the older and more competitive club divisions. IV.

Evaluating the Impact of Youth Early Sport Specialization on Injury: An Evolution in Measurement.

To track youth sports participation and injury occurrence accurately and longitudinally. An online survey tool that captures sports participation, frequency, level of competition, and tracks injury occurrence has been developed. The survey allows for longitudinal tracking of sports participation to evaluate the change from recreational to highly specialized sports participation. To maximize the utility of this research tool we identified swimmer plots which allow for clear visualization of the data as the best method for graphical representation. Longitudinal measurement of sports participation to evaluate the impact of early sports specialization on injury is feasible with this tool and enhanced by the swimmer plots for visualization.