Youth Injury Research Articles

An Impacted Tibial Plateau Fracture in an Adolescent Diver: A Case Report

The tibial plateau is a critical load-bearing surface in humans. Although tibial plateau fractures represent only 1% of all fractures, proper management by all members of the health care team, including athletic trainers, physicians, and physical therapists, is required for successful patient outcomes. A 14-year-old national-level competitive female diver injured her right knee during the precompetition warm-up period. Upon evaluation by an athletic trainer, the patient was referred for imaging and examination by a physician. She was seen by an orthopedic surgeon for consultation. The patient elected for a surgical repair of the tibial plateau fracture. Following surgery she underwent an 11-week comprehensive therapeutic exercise program with athletic trainers and physical therapists. The patient’s return-to-play progression included dry land activities, platform diving, 1-m springboard diving, and 3-m springboard diving. The patient has successfully returned to competitive diving. Proper identification of tibial fractures can be difficult considering their low occurrence in youth and their similar clinical presentation to more common youth injuries such as anterior cruciate ligament ruptures. Clinicians providing immediate on-site medical care should be thorough in their clinical exam including palpation and axial loading of the joint.

Cortical Thickness Changes and Their Relationship to Dual-Task Performance following Mild Traumatic Brain Injury in Youth.

Mild traumatic brain injury (mTBI) is common in youth, especially in those who participate in sport. Recent investigations from our group have shown that asymptomatic children and adolescents with mTBI continue to exhibit alterations in neural activity and cognitive performance compared with those without a history of mTBI. This is an intriguing finding, given that current return-to-learn and return-to-play protocols rely predominately on subjective symptom reports, which may not be sensitive enough to detect subtle injury-related changes. As a result, youth may be at greater risk for re-injury and long-term consequences if they are cleared for activity while their brains continue to be compromised. It is currently unknown whether mTBI also affects brain microstructure in the developing brain, particularly cortical thickness, and whether such changes are also related to cognitive performance. The present study examined cortical thickness in 13 asymptomatic youth (10-14 years old) who had sustained an mTBI 3-8 months prior to testing compared with 14 age-matched typically developing controls. Cortical thickness was also examined in relation to working memory performance during single and dual task paradigms. The results show that youth who had sustained an mTBI had thinner cortices in the left dorsolateral prefrontal region and right anterior and posterior inferior parietal lobes. Additionally, cortical thinning was associated with slower reaction time during the dual-task condition in the injured youth only. The results also point to a possible relationship between functional and structural alterations as a result of mTBI in youth, and lend evidence for neural changes beyond symptom resolution.

The Youth Throwing Score: Validating Injury Assessment in Young Baseball Players

Background: Epidemic levels of shoulder and elbow injuries have been reported recently in youth and adolescent baseball players. Despite the concerning frequency of these injuries, no instrument has been validated to assess upper extremity injury in this patient population. Purpose/Hypothesis: The purpose of this study was to validate an upper extremity assessment tool specifically designed for young baseball players. We hypothesized that this tool will be both reliable and valid. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The Youth Throwing Score (YTS) was constructed by an interdisciplinary team of providers and coaches as a tool to assess upper extremity injury in youth and adolescent baseball players (age range, 10-18 years). The psychometric properties of the test were then determined. Results: A total of 223 players completed the final survey. The players’ mean age was 14.3 ± 2.7 years. Pilot analysis showed that none of the 14 questions received a mean athlete importance rating less than 3 of 5, and the final survey read at a Flesch-Kincaid level of 4.1, which is appropriate for patients aged 9 years and older. The players self-assigned their injury status, resulting in a mean instrument score of 59.7 ± 8.4 for the 148 players “playing without pain,” 42.0 ± 11.5 for the 60 players “playing with pain,” and 40.4 ± 10.5 for the 15 players “not playing due to pain.” Players playing without pain scored significantly higher than those playing with pain and those not playing due to pain (P < .001). Psychometric analysis showed a test-retest intraclass correlation coefficient of 0.90 and a Cronbach alpha intra-item reliability coefficient of 0.93, indicating excellent reliability and internal consistency. Pearson correlation coefficients of 0.65, 0.62, and 0.31 were calculated between the YTS and the Pediatric Outcomes Data Collection Instrument sports/physical functioning module, the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, respectively. Injured players scored a mean of 9.4 points higher after treatment (P < .001), and players who improved in their self-assigned pain categorization scored 16.5 points higher (P < .001). Conclusion: The YTS is the first valid and reliable instrument for assessing young baseball players’ upper extremity health.

Head injuries in youth are often linked to psychiatric disorders and disability, study finds.

Head injuries in childhood and adolescence are strongly linked with a range of outcomes including psychiatric disorders, low educational attainment, increased risk of disability, and early death, a study of Swedish health and census data has shown. The more severe the injury, the number of times it is repeated, and the older the person is at the time of injury all increase the risks, researchers reported in PLOS Medicine .1 Amir Sariaslan, of the University of Oxford, UK, and colleagues studied the records of more than 1.1 million Swedish people born from 1973 to 1985, of whom 104 000 (9.1%) had a diagnosis of traumatic brain injury before age 25. This means that they had an injury sufficiently serious to cause some alteration of consciousness and warrant a visit to a hospital emergency department. This would include concussion but also lesser symptoms such as feeling dazed. All of those with a diagnosis of traumatic …

Farm Families: Gendered Perceptions of Youth Safety and Injury Vulnerability

Farming is a male-dominated occupation, with gendered responsibilities evident on the family farm. The gendered construction of agricultural work roles carries over into parenting. Farm mothers have primary childcare responsibilities, but fathers usually oversee the most dangerous youth farm work, namely work around large equipment. This study examined mothers’ and fathers’ work and family roles on family commodity farms, as well as risk-taking propensity, safety perceptions, and perceptions of youth injury vulnerability. Participants were 248 farm parents (124 married couples) with a youth aged 9–19 yrs. Mothers were less likely than fathers to operate tractors, less confident and self-efficacious related to keeping their youth safe, and less knowledgeable about farm safety. Off-farm employment of mothers had little effect on their home or farm responsibilities. Fathers, but not mothers, believed boys could safely operate equipment at younger ages than girls. Unexpectedly, mothers perceived less injury vulnerability to youth than did fathers. For mothers and fathers, younger youth age, lower risk-taking, lower safety self-efficacy, and greater knowledge about farm safety predicted higher perceptions of youth injury vulnerability. For mothers, experience operating tractors predicted lower perceptions of youth vulnerability. Mothers often deferred to fathers when making decisions related to youth use of farm equipment. Mothers’ gendered roles and limited opportunity to gain farm safety knowledge may compromise their ability to work jointly with their husbands to keep youth safe on the farm. There is a need for communities to provide farm safety education to women who jointly farm with their husbands.

The elite young athlete: strategies to ensure physical and emotional health.

This article presents a current review of the risk of physical and psychological injury associated with participation in elite youth sport, and suggests strategies to ensure the physical and emotional health of these young athletes. Although there is lack of epidemiological data, especially with regard to psychological injury, preliminary data suggest that the risk of injury is high in this population. While there is lack of incident and follow-up data, there is also concern regarding burnout, disordered eating, and the long-term consequences of injury. Modifiable injury risk factors identified include postural control, competition anxiety, life events, previous injury, and volume of training. There are presently no studies designed to determine the effectiveness of injury prevention measures in elite youth sports. However, there is adequate evidence arising from injury prevention studies of youth sports participants – including neuromuscular training, protective equipment, mental training to enhance self-esteem, and sport rules modification – to prevent injuries in elite youth sports settings. Although not tested, psychosocial prevention strategies such as adoption of task-oriented coping mechanisms, autonomous support from parents, and a proactive organizational approach also show promise in injury prevention.

The complement system, neuronal injury, and cognitive function in horizontally-acquired HIV-infected youth.

The complement system (C1q/C3) is a key mediator of synaptic pruning during normal development. HIV inappropriately induces C1q and C3 production in the brain, and reduces neuronal complement inhibition. HIV may thus alter neural connectivity in the developing brain by excessively targeting synapses for elimination. The resultant pattern of neuronal injury may fundamentally alter neurodevelopmental and cognitive processes differentially across ages. This study aimed to (1) measure the association between the cerebrospinal fluid (CSF) complement factors (C1q/C3) and a marker of neuronal injury (NFL) in HIV+ subjects; (2) quantify the differences in CSF C1q/C3 between HIV+ youth and older adults; and (3) define the relationship between CSF C1q/C3 and cognitive impairment in each age group. We performed a retrospective cross-sectional study of 20 HIV+ 18–24-year-old youth and 20 HIV+ 40–46-year-old adults with varying levels of cognitive impairment enrolled in the CNS Antiretroviral Therapy Effects Research study. We quantified C3, C1q, and NFL by ELISA in paired CSF/plasma specimens. We found that CSF C1q correlates with NFL in all subjects not receiving antiretroviral therapy (n = 16, rho = 0.53, p = 0.035) when extreme NFL outliers were eliminated (n = 1). There was no difference in plasma/CSF C1q or C3 between older adults and youth. In 18–24-year-old youth, a nearly significant (p = 0.052) elevation of CSF C1q expression was observed in cognitively impaired subjects compared to cognitively normal subjects. Further investigation into the role of the CNS complement system in the neuropathogenesis of HIV is warranted and should be considered in a developmentally specific context.

Implementing and Evaluating Comprehensive Evidence-Based Approaches to Prevent Youth Violence: Partnering to Create Communities Where Youth Are Safe From Violence.

Violence, including its occurrence among youth, results in considerable physical, emotional, social, and economic consequences in the U.S. Youth violence prevention work at the Division of Violence Prevention (DVP) at the Centers for Disease Control and Prevention (CDC) emphasizes preventing youth violence-related behaviors, injuries, and deaths by collaborating with academic and community partners and stakeholders. Since 2000, DVP has funded three rounds of CDC’s National Centers of Excellence in Youth Violence Prevention (YVPCs) in 5-year cycles, with the goal of supporting university-community partnerships so that the best science can be utilized in order to prevent youth violence. The current YVPCs focus on: (a) partnering with communities to identify community needs; (b) selecting and implementing the best comprehensive evidence-based programs to meet those needs; and (c) rigorously evaluating whether those efforts have a community-level impact on youth violence rates. The introduction to this special issue on the current YVPCs provides a brief historical overview on the YVPC Program; outlines the YVPCs’ accomplishments to date; and describes the current YVPCs, their community partners, and their activities. The introduction concludes with an overview of the special issue.

MRI defined osteoarthritis is discordant with clinical and functional outcomes associated with post-traumatic osteoarthritis 3–10 years following SPORT-related knee joint injury in youth

MRI defined osteoarthritis is discordant with clinical and functional outcomes associated with post-traumatic osteoarthritis 3–10 years following SPORT-related knee joint injury in youth

The association between intra-articular knee injury in youth and adiposity in individuals at risk of post-traumatic osteoarthritis

The association between intra-articular knee injury in youth and adiposity in individuals at risk of post-traumatic osteoarthritis

The association between serum levels for cartilage oligomeric matrix protein and history of sport-related intra-articular knee injury in youth

The association between serum levels for cartilage oligomeric matrix protein and history of sport-related intra-articular knee injury in youth

Physical fighting, fighting-related injuries and family affluence among Canadian youth.

BackgroundPhysical fighting is an assaultive behaviour that can lead to injury. Family affluence is a health determinant that can influence injury. This study examines the relationship between family affluence and two outcomes: physical fighting and fighting-related injury in Canadian adolescents. Three measurements were used to represent family affluence and assess whether these measures demonstrated different associations with these outcomes.MethodsCanadian data from the 2009/2010 Health Behaviour in School-aged Children Study were used. It consists of a nationally representative sample of 26,078 grade 6–10 students. A subset analysis of 10,429 grade 9–10 students was conducted to account for additional confounders. Modified Poisson regression was used to compare the risk of physical fighting and fighting-related injury in youth from different levels of family affluence. Three indicators were used to represent family affluence: self-perceived affluence, a family affluence scale (FAS), and area-level average household income.ResultsThe overall prevalence was 35.6 % for physical fighting and 2.7 % for fighting-related injuries. Both outcomes were more frequent in males than females. An inverse gradient was present where risk for both outcomes increased with decreasing levels of affluence irrespective of the affluence measurement. The self-perceived affluence variable showed a significantly stronger gradient in girls than boys for both outcomes. For both outcomes, FAS showed a similar inverse gradient within females, but a threshold effect in males where there was a strong effect in the low FAS group, but a null effect in the moderate FAS group. The area-level income variable presented a significantly higher likelihood for physical fighting only in females (p = 0.001–0.075). For fighting-related injury, none of the area-level income models showed significant risk estimates with the exception of the bivariate association where low income females were twice as likely to report a fighting-related injury compared to higher income groups (p = 0.030). Post hoc power calculations indicate that there was not sufficient power to detect injury effects associated with the area level income measure.ConclusionIt appears that a socioeconomic gradient exists where lower affluence is associated with a higher risk of reporting a physical fight and fighting-related injury irrespective of the measure used. While the patterns were generally the same with all three measurements, the strength of this gradient varied across measures. This demonstrates that each indicator may measure different aspects of affluence. Further analyses are needed to explore concepts and mechanisms underlying each affluence measure.

Youth injury prevention in Canada: use of the Delphi method to develop recommendations.

BackgroundThe Health Behaviour in School-aged Children Survey is one of very few cross-national health surveys that includes information on injury occurrence and prevention within adolescent populations. A collaboration to develop a Canadian youth injury report using these data resulted in, Injury among Young Canadians: A national study of contextual determinants. The objective of this study was to develop specific evidence-based, policy-oriented recommendations arising from the national report, using a modified-Delphi process with a panel of expert stakeholders.MethodEight injury prevention experts and a 3-person youth advisory team associated with a Canadian injury prevention organization (Parachute Canada) reviewed, edited and commented on report recommendations through a three-stage iterative modified-Delphi process.ResultsFrom an initial list of 27 draft recommendations, the modified-Delphi process resulted in a final list of 19 specific recommendations, worded to resonate with the group(s) responsible to lead or take the recommended action. Two recommendations were rated as “extremely important” or “very important” by 100 % of the expert panel, two were deleted, a further two recommendations were deleted but the content included as text in the report, and four were merged with other existing recommendations.ConclusionsThe modified-Delphi process was an appropriate method to achieve agreement on 19 specific evidence-based, policy-oriented recommendations to complement the national youth injury report. In providing their input, it is noted that the injury stakeholders each acted as individual experts, unattached to any organizational position or policy. These recommendations will require multidisciplinary collaborations in order to support the proposed policy development, additional research, programming and clear decision-making for youth injury prevention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2600-x) contains supplementary material, which is available to authorized users.

A Comprehensive Prevention Approach to Reducing Assault Offenses and Assault Injuries among Youth.

Since 2011, the CDC-funded Michigan Youth Violence Prevention Center (MI-YVPC), working with community partners, has implemented a comprehensive prevention approach to reducing youth violence in Flint, MI, based on public health principles. MI-YVPC employed an intervention strategy that capitalizes on existing community resources and application of evidence-based programs using a social-ecological approach to change. We evaluated the combined effect of six programs in reducing assaults and injury among 10-24 year olds in the intervention area relative to a matched comparison community. We used generalized linear mixed models to examine change in the intervention area counts of reported assault offenses and assault injury presentation relative to the comparison area over a period 6 years prior- and 30 months post-intervention. Results indicated that youth victimization and assault injuries fell in the intervention area subsequent to the initiation of the interventions and that these reductions were sustained over time. Our evaluation demonstrated that a comprehensive multi-level approach can be effective for reducing youth violence and injury.

A Systematic Review of the Impact of Juvenile Curfew Laws on Public Health and Justice Outcomes.

Automobile crashes cause more than 800,000 youth injuries and deaths each year. Other youth suffer the consequences from being either a perpetrator or victim of a crime. One type of law that has an effect on youth behavior is juvenile curfew laws. These laws restrict the times that youth may occupy public places or streets. We systematically reviewed studies evaluating the effectiveness of these laws to address the question: Can juvenile curfew laws be used to improve youth public health and juvenile justice outcomes? In 2013, we used a standardized set of keywords to search 24 databases for studies that evaluated effectiveness outcome measures of juvenile curfew laws. After applying the exclusion criteria and removing duplicate studies, 14 studies of juvenile curfews remained. Of the six studies examining the effectiveness of juvenile curfew laws on adverse youth health outcomes, five found a positive impact. Of the eight studies examining the effectiveness of curfew laws on juvenile crime and victimization, four found a positive impact. The studies that found that juvenile curfew laws were effective at reducing adverse youth health outcomes (e.g., trauma transports); juvenile crime; and victimization were of higher quality (e.g., stronger methodologic approaches) than those finding no effects. However, given the limited number of studies and concerns with quality, we conclude that more research is needed before conclusions can be drawn about the effectiveness of juvenile curfew laws.

Developmental and gender influences on executive function following concussion in youth hockey players

Background: Concussion is the most common athletic injury in youth who are simultaneously undergoing rapid developmental changes in the brain, specifically the development of executive functions (EF). The developing brain is more vulnerable to concussive injury with a protracted and different trajectory of recovery than that of adults. Thus, there is a critical need to enhance understanding of how concussion affects EF in youth.Objective: To investigate the effects of age, gender and concussion history (i.e. concussion incidence, recency, severity) on EF in youth hockey players.Methods: This 3-year cross-sectional and longitudinal multiple cohort study examined data from 211 hockey players of 8–15 years of age. Mixed-effects modelling was used to examine the influence of age, gender and concussion on EF in youth athletes.Findings: Baseline analyses revealed significant age and gender effects on measures of EF. Multiple effects of concussion history on measures of cognitive flexibility (F = 2.48, p = 0.03) and psychomotor speed (F = 2.59, p = 0.04) were found.Implications: This study highlights the impact of age, gender and concussion on EF in youth. These findings provide foundational knowledge to better manage cognitive sequelae following sports-related concussion.

Relationships between community social capital and injury in Canadian adolescents: a multilevel analysis

BackgroundCharacteristics of social environments are potential risk factors for adolescent injury. Impacts of social capital on the occurrence of such injuries have rarely been explored.MethodsGeneral health questionnaires were completed by...

Farm Activities and Agricultural Injuries in Youth and Young Adult Workers

ABSTRACTYouth and young adults who work in the agricultural sector experience high rates of injury. This study aimed to investigate relations between high-risk farm activities and the occurrence of agricultural injuries in these vulnerable groups. A cross-sectional analysis was conducted using written questionnaire data from 1135 youth and young adults from the Saskatchewan Farm Injury Cohort. The prevalence of agricultural injury was estimated at 4.9%/year (95% confidence interval [CI]: 3.7, 6.2). After adjustment for important covariates, duration of farm work was strongly associated with the occurrence of injury (risk ratio [RR] = 8.0 [95% CI: 1.7, 36.7] for 10–34 vs. <10 hours/week; RR = 10.3 [95% CI: 2.2, 47.5] for those working 35+ hours/week). Tractor maintenance, tractor operation, chores with large animals, herd maintenance activities, and veterinary activities were identified as risk factors for agricultural injury. Risks for agricultural injury among youth and young adults on farms relate directly to the amounts and types of farm work exposures that young people engage in.

Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis

Youth have very high participation and injury rates in sport. Sport is the leading cause of injury in youth. Sport injury reduces future participation in physical activity which adversely affects...

Family impact of acquired brain injury in children and youth.

To assess the parental view on the impact of pediatric traumatic brain injury (TBI) and nontraumatic brain injury (NTBI) on the family and its determinants. Follow-up study including parents of children with a hospital-based diagnosis of acquired brain injury (ABI) aged 4-20 years at onset of ABI. Parents completed the Pediatric Quality of Life Inventory Family Impact Module (PedsQL FIM), which measures Parent Health-Related Quality of Life, Family Functioning, Communication, and Worry. Additional assessments included the Pediatric Stroke Outcome Measure (PSOM), the Child & Family Follow-up Survey (CFFS), PedsQL General Core and Multiple Fatigue Scales, and sociodemographic and disease characteristics. Parents of 108 patients, median age 13 years (range 5-22), completed the questionnaires 24-30 months after diagnosis. There were 81 patients with TBI of whom 11 (14%) with moderate/severe TBI and 27 patients with NTBI of whom 5 (19%) with moderate/severe NTBI. The median PedsQL FIM Total Scale was 80.4 (SD 16.1). The PedsQL FIM Total Scale and 4 out of 5 Subscale Scores were statistically significantly better in the TBI group than in the NTBI group and in patients with severe NTBI than with mild/moderate NTBI. Moreover, in the total group, there were significant univariate associations between the FIM Total Scale and/or one or more Subscale Scores and age, preinjury patient health problems, and the PSOM, CFFS, PedsQL General Core, and Multiple Fatigue Scales. In the multivariable analysis, the FIM Total Scale was significantly associated with type and severity of injury and preinjury patient health problems. Two years after onset, the parent-reported that impact of ABI on the family as measured by the PedsQL FIM was considerable especially in patients with moderate/severe NTBI.