Primary Injury Prevention Research Articles

Major Activity Restriction Following Musculoskeletal Injury In Collegiate Basketball: Findings From The NCAA-ISP Between 2009/10-2018/19

Previous research has examined the epidemiology of musculoskeletal injuries (MSKI) in basketball (BB) generally, but not in the context of restricted activity. MSKI resulting in major activity restriction (MAR) may negatively influence short- and long-term mental and physical health. PURPOSE: To describe and predict MSKI resulting in MAR sustained by collegiate BB players. METHODS: Men’s and women’s BB exposure and injury data collected via the NCAA Injury Surveillance Program from 2009/10-2018/19 were analyzed. MSKI were characterized as MAR if individuals returned to sport ≥30 days after injury or did not return that season. MSKI distributions were examined by body region, mechanism, diagnosis, and player position using frequencies (%) for men’s and women’s BB individually and pooled. Differential odds of MAR between men’s and women’s BB were examined using multivariable logistic regression models parametrized to adjust for body region, mechanism of injury, and injury diagnosis; odds ratios (ORs) with 95% confidence intervals (95%CI) excluding 1.00 were considered statistically significant. RESULTS: Overall, 444 MSK injuries resulted in MAR (men = 184, 41%; women = 260, 59%). MSKI with MAR most commonly affected the knee (n = 192, 43%) and foot (n = 67, 15%). Most MSKI with MAR were sprains/strains (n = 244, 55%) and fractures (n = 130, 29%) and resulted from non-contact (n = 153, 34%) or player contact (n = 133, 30%) mechanisms. Most MSKI with MAR occurred among guards (n = 204, 46%) and forwards (n = 138, 31%). Sex, body region, mechanism, and diagnosis were significant predictors of MAR following MSKI (p < 0.01; Table 1). CONCLUSION: Athletic trainers working with BB players should be aware of the potential impacts of personal and injury-specific characteristics that contribute to longer periods of MAR following MSK injury. Future work should prioritize primary prevention of lower extremity injuries caused by contact in women’s BB, in particular.

Adductor Strengthening Programme is successfully adopted but frequently modified in Norwegian male professional football teams: a cross-sectional study

ObjectivesGroin injuries represent a substantial problem in male football, with the Adductor Strengthening Programme (ASP) being the only exercise programme demonstrated to significantly reduce the risk of groin problems. We...

O8-8 Foundation of Move Healthy: athletic skill development in children from a motor learning perspective

BackgroundIn the European Union, 6.1 million people are being treated in hospital annually for a sports injury. Of this, 31% of these injuries affect young people (15-24 years). Injury incidence, medical and lost productivity costs can be reduced by promoting a healthy and active lifestyle, where attention is paid to primary injury prevention. However, after two decades of initiatives, traditional injury prevention prevention programs seem effective in the short-term and controlled study settings, but have not decreased long-term injury incidence. One reason for this is the content of the exercises, currently being mainly ?closed and static? exercises. These exercises don't reflect real-world situations where unexpected and automatic movements are required involving complicated motor control adaptations. In addition, physical educators (PE) and trainers/coaches (TC) neither experience current exercises as being context specific and contributing to their training goals. To overcome this implementation gap, the purpose of the MoveHealthy project is to create exercise routines PE and TC can use, where children acquire the ability to sustain optimal automatic motor control while engaging in complex athletic, unpredictable environments (e.g. movement of another child, or a ball), whilst minimising their risk to sustain an injury.MethodsExercise routines (3 for primary and 3 for secondary education, 3 for soccer and 3 for basketball) were co-created with the end-users (PE & TC) and their wishes and needs have been incorporated. Furthermore, to train the complex task-person-environmental interaction, real-world aspects such as visual-motor control where quickly processing environmental cues and anticipation and decision is crucial, was included into all conceptual considerations.ResultsTwelve prototype exercises have been developed. Merging theoretical foundations of motor learning and wishes and needs of end-users made it possible to create exercises that serve both needs.ConclusionsThe development of these prototype exercises guides towards further validation and final development of innovative exercise routines where real-world aspects are incorporated. With this, we will better ensure real-world effects of injury reduction.AcknowledgementsThis project is financially co-funded by the Erasmus+ Sport program from the European Union.

Firearms, Physicians, Families, and Kids: Finding Words that Work

Firearms, Physicians, Families, and Kids: Finding Words that Work

Sex Differences in Pre-Season Anthropometric, Balance and Range-of-Motion Characteristics in Elite Youth Soccer Players.

In soccer, injury epidemiology differs between males and females. It is clinically useful to know whether there are between-sex differences in selected characteristics relevant to primary injury risk and injury prevention practices. The purpose of this study was to explore between-sex differences in anthropometric, balance, and range-of-motion characteristics in Spanish elite male and female youth soccer players. This was a pre-season cross-sectional study. Sixty-nine males (age 16.8 ± 0.9 yr; height 175.9 ± 6.8 cm; mass 67.9 ± 6.3 kg) and thirty-seven females (age 17.2 ± 1.7 yr; height 164.0 ± 6.3 cm; mass 59.0 ± 5.8 kg) participated. Anthropometrics (standing/sitting height, bodymass, right/left leg length) and right/left anterior reach test (ART), hip internal/external active range of motion, active knee extension (AKE), and weightbearing lunge test (WBLT) were measured. Between-sex differences were assessed with Bonferroni-corrected Mann–Whitney U tests and Cliff’s delta (d). Between-sex significant differences (p < 0.003, d ≥ 0.50) were observed for anthropometric data and for hip internal rotation. No between-sex significant differences were observed for ART/AKE/WBLT measures. Between-sex significant differences with large effect sizes were identified for anthropometric data and right/left hip internal rotation. The present study adds new data to the literature for young Spanish male and female soccer players. The present findings will help inform clinical reasoning processes and future injury prevention research for elite male and female youth soccer players.

Comparing lab and field agility kinematics in young talented female football players: Implications for ACL injury prevention

ABSTRACT Modifiable (biomechanical and neuromuscular) anterior cruciate ligament (ACL) injury risk factors have been identified in laboratory settings. These risk factors were subsequently used in ACL injury prevention measures. Due to the lack of ecological validity, the use of on-field data in the ACL injury risk screening is increasingly advocated. Though, the kinematic differences between laboratory and on-field settings have never been investigated. The aim of the present study was to investigate the lower-limb kinematics of female footballers during agility movements performed both in laboratory and football field environments. Twenty-eight healthy young female talented football (soccer) players (14.9 ± 0.9 years) participated. Lower-limb joint kinematics was collected through wearable inertial sensors (Xsens Link) in three conditions: (1) laboratory setting during unanticipated sidestep cutting at 40-50°; on the football pitch (2) football-specific exercises (F-EX) and (3) football games (F-GAME). A hierarchical two-level random effect model in Statistical Parametric Mapping was used to compare joint kinematics among the conditions. Waveform consistency was investigated through Pearson’s correlation coefficient and standardized z-score vector. In-lab kinematics differed from the on-field ones, while the latter were similar in overall shape and peaks. Lower sagittal plane range of motion, greater ankle eversion, and pelvic rotation were found for on-field kinematics (p < 0.044). The largest differences were found during landing and weight acceptance. The biomechanical differences between lab and field settings suggest the application of context-related adaptations in female footballers and have implications in ACL injury prevention strategies. Highlights Talented youth female football players showed kinematical differences between the lab condition and the on-field ones, thus adopting a context-related motor strategy. Lower sagittal plane range of motion, greater ankle eversion, and pelvic rotation were found on the field. Such differences pertain to the ACL injury mechanism and prevention strategies. Preventative training should support the adoption of non-linear motor learning to stimulate greater self-organization and adaptability. It is recommended to test football players in an ecological environment to improve subsequent primary ACL injury prevention programmes.

Direct Healthcare Costs of Moderate and Severe Work-Related Injuries: Estimates from the National Trauma Center of Qatar.

Work-related injuries (WRIs) are recognized as a leading cause of admission to the national trauma center of Qatar. A retrospective analysis of trauma registry data and electronic medical records was conducted on a cohort of all WRI patients who were admitted to the Hamad Trauma Center (HTC), in Doha, Qatar, between 2011 and 2017. A total of 3757 WRI patients were treated at the HTC over the 7-year study period. The overall cost for treatment was 124,671,431 USD (18 million USD per year), with a median cost of 19,071 USD. There was a strong positive correlation between the overall cost and hospital-stay cost (r2 = 0.949, p = 0.00001) and between the overall cost and procedure cost (r2 = 0.852, p = 0.00001). Motor vehicle crash (MVC) victims who wore seatbelts had significantly lower injury severity, hospital stay and median total costs. A comparison of patients by quartiles of the costs incurred showed that the proportions of MVC victims, pedestrian injuries and mortality were significantly higher in the fourth quartile when compared to other quartiles (p < 0.05). These findings suggest that investments in the primary prevention of work-related injuries from falls and MVCs, through proven interventions, should be priorities for occupational safety and health in Qatar.

Efficacy of Helmet Use on Head Injury Reduction in Snow Sports: A Critically Appraised Topic

Context: Review articles published in 2010 concluded that there was strong evidence to support the use of helmets as a way to decrease the risk of sustaining a head injury during snow sport participation. However, new research published over the last decade on this relationship warrants revisiting this primary injury prevention approach. Clinical Question: What is the effect of helmet use on the occurrence of head injuries in snow sports? Clinical Bottom Line: The results from the included studies did not consistently find a reduction in head injury occurrence with helmet use in snow sports. Rather, the collective findings were more supportive of a neutral relationship between helmet use and head injuries. Therefore, these heterogeneous findings indicate there is SORT Level B evidence to support the use of helmets as a primary head injury prevention approach in snow sports. Future initiatives should acknowledge the multifaceted nature of injury occurrence and seek to educate the public more clearly on the limitations of helmet use during skiing and snowboarding.

Intenzivno lečenje pacijenata sa kraniocerebralnom traumom - kako nam akronimi mogu pomoći?

Traumatic brain injury (TBI) is considered to be a "silent global epidemic" and is the leading cause of death in young males in developed countries, major cause of disability, morbidity, and mortality worldwide. The classification of TBI severity was performed using the Glasgow coma scale (GCS) into mild (GCS = 15-13), moderate (GCS = 12-9), and severe (GCS = 8-3). Despite developments in modern intensive care, improvements in resuscitation and vital organ support, the management of critically ill patients with traumatic brain injury presents a challenge to all members of the critical care team. Since severe head injury is often associated with poor functional outcomes due to secondary brain insults, the benefits of intensive treatment and care may not become apparent until months or years later during rehabilitation after injury. Due to the complexity and specificity of TBI, implementation of an easy-to-remember mnemonic can significantly help anesthesiologists and clinicians in conducting intensive therapy. Mnemonic GOST CAP was implementing to help with treatment of patients with primary craniocerebral trauma and prevention of secondary brain injury. GOST CAP acronym emphasizes the significance of glycemic control in neurotrauma, maintaining haemoglobin levels, oxygen support, sodium concentration, temperature maintenance, pain and agitation control, arterial blood pressure control in maintaining cerebral perfusion pressure, and partial pressure of CO2 control. The aim of this paper is to display acronyms that address the most important steps in treating patients with TBI.

Оpen globe injury in children: epidemiology and predictors of an adverse outcome

Here we aimed to analyse the prevalence, clinical course, and current approaches to the prevention and treatment of open globe injury in children as well as its complications: hyphema, retinal detachment, traumatic uveitis, and endophthalmitis. Currently, children are responsible for the 10-15% of open globe injuries. In developed countries, open globe injury is the leading cause of monocular blindness in children. Open globe injury mainly affects boys (60−70% cases), yet severe injuries are rare, and closed globe injury is the most common type of eye injury. Most injuries are accidental and occur at home in daily life (50−60%), outdoors (20−35%), at school (1−5%), or while playing sports (1−3%). Open globe injury most often affects cornea and is associated with a high risk of early and late complications and poor outcomes. Wearing of protective glasses during sports and active recreation is recognised as an efficient tool for primary prevention of open globe injury in children. The main problems in prevention of complications of open globe injury are the lack of specialised care in low-income countries and the limited awareness of parents.

The 2021 Joseph St Geme, Jr, Leadership Award Address: The Role of Structural Racism in Injuries to Children and Adolescents.

The 2021 Joseph St Geme, Jr, Leadership Award Address: The Role of Structural Racism in Injuries to Children and Adolescents.

Results of a tri-national online survey on the current status of sportsinjury prevention among members of the German-Speaking Orthopaedic Sports Medicine Society (GOTS).

To assess the current opinions and state of knowledge in primary sports injury prevention among members of the German-Speaking Society for Orthopaedic and Traumatologic Sports Medicine (GOTS). On 21 August 2019, a web-based questionnaire was sent to the members of the tri-national society GOTS (Austria, Germany and Switzerland). The survey was online until 21 November 2019 and included twenty-two questions, which were divided into five sections: 1) general importance of prevention (n = 4), 2) specifications of the study population (n = 3), 3) implementation of prevention (n = 8), 4) improvement opportunities in prevention (n = 4) and 5) future research areas (n = 3). A total of 272 participants completed the survey, representing a total survey participation of 17.7 % of all members. The study population consisted of orthopaedic surgeons (55 % with surgical and 21 % with non-operative orientation), medical students (10 %), physical therapists (8 %) and sports scientists (4 %). Ninety-four percent of all participants stated that they considered the importance of sports injury prevention to be "very high" (68 %) or "high" (26 %). However, almost 70 % of all participants stated that they spend less than one hour per week on injury prevention work. The term "prevention" was clearly defined and practicable for only 40 %, understandable but difficult to implement for 51 %, and unclear and difficult to implement for 9 % of the participants. Seventy-two percent of respondents were aware of existing prevention programs such as "Stop-X" or "FIFA 11 +", whereas 28 % of participants were uninformed regarding these programs. A strong divergence was identified between participants' perception of the importance of sports injury prevention and the existing implementation of preventive measures. Future funding of prevention programs, expansion of research strategies for injury prevention and better financial reimbursement are of utmost importance.

Developing a systematic approach for Population-based Injury Severity Assessment (PISA): a million-person survey in rural Bangladesh

IntroductionThere is currently no defined method for assessing injury severity using population-based data, which limits our understanding of the burden of non-fatal injuries and community-based approaches for primary prevention of...

Access to specialist hospital care and injury survivability: identifying opportunities through an observational study of prehospital trauma fatalities

BackgroundOf the five million injury deaths that occur globally each year, an estimated 70% occur before the injured person reaches hospital. Although reducing the time from injury to definitive care has been shown to achieve better outcomes for patients, the relationship between injury incident location and access to specialist care has been largely unexplored. ObjectiveTo determine the number and distribution of prehospital (on-scene/en route) trauma deaths without timely access to a hospital with surgical and intensive care capabilities, overall and by estimated injury survivability. MethodsNew Zealand's Mortality Collection and Hospital Discharge dataset were used to select prehospital injury deaths in 2009-2012. These records were linked to files held by Australasia's National Coronial Information Service (NCIS) to estimate, for the trauma subset, injury survivability. Using geographical locations of injury for the prehospital trauma fatalities, time from Emergency Medical System call-out to arrival at the closest specialist hospital was estimated. ResultsOf 1,752 prehospital trauma fatalities, 14.7% (95%CI 13.0, 16.4) had potentially survivable injuries that occurred in locations without timely access (prehospital phase >60 minutes). More than half (132 of 257) of the potentially survivable prehospital trauma fatalities without timely access died as a result of a motor vehicle traffic crash. Only 10% (95%CI 5.7, 16.0) of prehospital trauma fatalities from falls were estimated to be potentially survivable and without timely access compared to 24.6% (95%CI 18.5, 31.5) of prehospital firearm fatalities. Through using geospatial techniques, “hot spot” locations of potentially survivable injuries without timely access to specialist major trauma hospitals were apparent. ConclusionApproximately 15% of prehospital trauma fatalities in New Zealand that are potentially survivable occur in locations without timely access to advanced level hospital care. Continued emphasis is required on both improving timely access to advanced trauma care, and on primary prevention of serious injuries. Decisions regarding trauma service delivery, a modifiable system-level factor, should consider the geographic distribution of locations of these injury events alongside the resident population distribution.

Appalachian Caregiver Perspectives on Childhood Gun Safety in the Home.

BackgroundChildhood gun injuries pose a critical public health challenge. For children, unintentional gun injury deaths primarily occur in the home where parents or other adult guardians, referred to as caregivers hereafter, are responsible for safety. While the American Academic of Pediatrics recommends not having guns in areas where children live and play, firearms are often viewed as normative and fill an important role in many homes. This is particularly true in more rural areas, such as Appalachia, where there is a high density of gun ownership. Additional research is needed to understand rural caregivers’ current gun safety practices in the home.PurposeThe purpose of this study was to gain an understanding of Appalachian caregivers’ gun safety practices, perspectives, and attitudes to assist public health professionals develop more effective interventions and targeted messaging.MethodsTen Appalachian caregivers were interviewed for a qualitative, phenomenologic study designed to elicit an in-depth understanding of firearm safety strategies in the home. An inductive analytic approach to coding and analysis was used to identify main themes and ideas.ResultsCurrent attitudes, practices, and perspectives focused on the primary childhood injury prevention strategies of education, environmental change, and supervision. Findings matched and expanded upon previous literature in the field.ImplicationsCross-cutting themes were identified that have practical implications for the development of public health interventions and messaging for this at-risk population.

Pediatric Medical Emergencies and Injury Prevention Practices in the Pediatric Emergency Unit of Kenyatta National Hospital, Nairobi, Kenya.

The epidemiology and presence of pediatric medical emergencies and injury prevention practices in Kenya and resource-limited settings are not well understood. This is a barrier to planning and providing quality emergency care within the local health systems. We performed a prospective, cross-sectional study to describe the epidemiology of case encounters to the pediatric emergency unit (PEU) at Kenyatta National Hospital in Nairobi, Kenya; and to explore injury prevention measures used in the population. Patients were enrolled prospectively using systematic sampling over four weeks in the Kenyatta National Hospital PEU. Demographic data, PEU visit data and lifestyle practices associated with pediatric injury prevention were collected directly from patients or guardians and through chart review. Data were analyzed with descriptive statistics with stratification based on pediatric age groups. Of the 332 patients included, the majority were female (56%) and 76% were under 5 years of age. The most common presenting complaints were cough (40%) fever (34%), and nausea/vomiting (19%). The most common PEU diagnoses were upper respiratory tract infections (27%), gastroenteritis (11%), and pneumonia (8%). The majority of patients (77%) were discharged from the PEU, while 22% were admitted. Regarding injury prevention practices, the majority (68%) of guardians reported their child never used seatbelts or car seats. Of 68 patients that rode bicycles/motorbikes, one reported helmet use. More than half of caregivers cook at potentially dangerous heights; 59% use ground/low level stoves. Chief complaints and diagnoses in the PEU population were congruent with communicable disease burdens seen globally. Measures for primary injury prevention were reported as rarely used in the sample studied. The epidemiology described by this study provides a framework for improving public health education and provider training in resource-limited settings.

Basic research on the primary prevention of boxing-related sports injuries with the development of a quantitative motion analysis software

[Purpose] To develop a quantitative motion analysis software specific to boxing (Fist Tactics Support) and to verify its effectiveness based on the percentage of hits that land on the participants. [Participants and Methods] A total of 24 male professional boxers were divided into two groups: those who used Fist Tactics Support to analyze fight videos and instituted training changes based on the results (Fist Tactics Support group, 12 participants) and those who did not (control group, 12 participants). The overall percentage of hits that landed on the participants in the fights was compared between the two groups and between pre- and post-intervention. [Results] There were no significant differences between the two groups; however, the percentage of hits that landed on the boxers of the Fist Tactics Support group was significantly lower at post-intervention than at pre-intervention. [Conclusion] The use of scientific analysis results in boxing may facilitate the primary prevention of sports injuries.

S0395 Outcomes of Benign Corrosive Esophageal Stricture Dilation—Single Center Experience

INTRODUCTION: The strictures secondary to caustic ingestion is a debilitating condition causing long-term nutritional challenges. This retrospective study investigates the outcomes of endoscopic dilation in patients with benign esophageal strictures secondary to corrosive ingestion. METHODS: A retrospective study that included patients with esophageal strictures due to caustic injury under follow-up was performed at a tertiary care center. These patients at the centre underwent endoscopic dilation by both Endoscopic Balloon Dilation (EBD) and Gilliard Savary (GS) dilators based on endoscopist comfort (P.K.). Symptomatic relief within 2 months of intervention was considered a successful response. RESULTS: The study included 39 patients including 31 patients with acid ingestion and 8 with alkali ingestion (Figure 1). Of patients with acid ingestion, 32.3% (10/31) underwent EBD and 67.7% (21/39) underwent GSD with only 50% (5/10) and 38.1% (8/21) respectively having symptom relief. Of patients with alkali ingestion, 50% (4/8) underwent EBD and 50% (4/8) underwent GSD with 75% (3/4) and 50% (2/4) respectively having symptom relief. Irrespective of caustic etiology, the composite success for EBD and GSD sub-groups were 61.5% and 38.5% respectively. Short stricture length was associated with successful outcomes among patients with acid ingestion (P = .003) but not among patients with alkali ingestion. Patients with failed outcomes had higher percentages of grade 2B and 3 mucosal injury at time of initial caustic exposure and warranted repeated endoscopic dilations for symptom management. This however did not reach significance in patients with either alkali (P = 0.19) or acid ingestion (likelihood ratio; P = 0.14). In the study population, seven patients had concomitant stomach involvement with three (7.7%) developing gastric outlet obstruction (GOO), all of whom underwent surgical intervention. Other than GOO, no other sequelae like achlorhydria, mucosal metaplasia, carcinoma or protein losing enteropathy were diagnosed during follow up. CONCLUSION: Overall success of endoscopic dilation for caustic esophageal stricture is limited and newer modalities like stent placement or endoscopic incision therapy may play a role in management of refractory strictures. Primary prevention of such injuries should be the preferred approach in managing this public health issue.Figure 1.: Flow diagram describing the endoscopic dilations among the patients with benign strictures.

L-type calcium channel blockers decrease the iron overload-mediated oxidative stress in renal epithelial cells by reducing iron accumulation

Iron-mediated oxidative stress has been recognized as one of the leading causes of chronic kidney injury. The effect of L-type calcium channel (LTCC) blocker on iron overload has been shown in cardiomyocytes, liver cells, and nerve cells. So far, few studies have examined whether blockers improve kidney iron-mediated oxidative stress. Yet, the precise mechanism through which blockers regulate kidney iron transport still remains unclear. In the present work, treatment with nifedipine or verapamil decreased oxidative stress and reduced the cell apoptosis-induced by ferric ammonium citrate (P < 0.05), decreased cellular iron contents, and prevented the rising of iron level-induced by ferric ammonium citrate (P > 0.05) in HK-2 and HEK293 cells. Besides, nifedipine and verapamil treatments increased the expression of divalent metal transporter 1, divalent metal transporter ZIP14, and ferroportin1 in HK-2 cells and increased ferroportin1 expression in HEK293 cells. In summary, LTCC blockers alleviate iron overload-induced oxidative stress in renal epithelial cells by blocking the iron uptake and enhancing cellular iron transport and/or iron export, thus synergistically reducing the cellular iron accumulation. Consequently, LTCC blockers may be used as a novel treatment for the prevention of primary or secondary iron overload-kidney injury.

Prevention of sports injuries in Sri Lanka: what do we know about injuries in our athletes?

In terms of safeguarding the health and well-being of athletes in Sri Lanka, a primary focus has always been toward the treatment of injuries after they have occurred and promoting rehabilitation back into sport. There has been little attention towards the primary prevention of injuries in Sri Lankan sports. As a developing sporting nation, the benefits of injury prevention are immense: from a public health and financial perspective, through to individual benefits for athletes’ physical, psychological and social health. Understanding the reasons behind the lack of motive towards sports injury prevention in the country, and challenges in developing and implementing injury prevention measures in the field is useful so that these reasons can be addressed and overcome. Based on recent experience in conducting injury prevention research among Sri Lankan junior cricketers, this article discusses injury prevention principles in sport and provides directions for future sport injury prevention research in Sri Lanka.