Risk Of Subsequent Injury Research Articles

Rationale and design of a randomized clinical trial evaluating the efficacy of mechanical neuroprotection in reducing the risk of silent brain infarcts associated with percutaneous left atrial appendage closure: study protocol for a LAAC-SBI trial

BackgroundLeft atrial appendage closure (LAAC) procedures prevent cardioembolic stroke in patients with atrial fibrillation who have contraindications to oral anticoagulant medications. However, these procedures carry certain risks of peri-procedural complications. One such complication is silent brain infarcts (SBI), which can lead to cognitive impairment and mood disturbances. The implementation of mechanical neuroprotection systems during LAAC procedures may reduce the risk of SBI and associated cognitive and mood disorders.MethodsThe LAAC-SBI trial is a prospective, multicenter, randomized, and double-blind interventional study. The study aims to enroll a total of 240 patients, with 120 patients allocated to each group. The study group will evaluate the use of the Sentinel CPS during LAAC, while the control group will undergo LAAC procedures without the Sentinel CPS. The primary endpoint of the study is the number of new SBIs or stroke foci detected by diffusion-weighted magnetic resonance imaging (DW MRI). Secondary endpoints include deterioration of cognitive function, development of dementia syndrome, and occurrence of depressive disorders. These endpoints will be assessed using questionnaire tools such as the Montreal Cognitive Assessment (MoCA), Trail Making Test (TMT), Controlled Oral Word Association Test (COWAT), and Hospital Anxiety and Depression Scale (HADS). The observational period for patients in the study is 2 years.DiscussionIf the study demonstrates a favorable outcome with reduced incidence of SBI and improved cognitive and mood outcomes in patients receiving cerebral protection devices during LAAC, it will have significant implications for clinical management standards. This would support the use of neuroprotection devices not only for LAAC but also in procedures such as atrial fibrillation ablation or transcatheter mitral valve interventions, where the risk of embolic events and subsequent brain injury may also be present.Trial registrationClinicalTrials.gov NCT05369195. Registration on 11.05.2022.

Correlation of Joint Space Widening on Valgus Stress Magnetic Resonance Imaging With Level of Play and Innings Pitched in Professional Pitchers.

Previous studies have described various techniques and confirmed the clinical utility of valgus stress radiography and stress ultrasound in overhead athletes. The addition of valgus stress and a high-resolution anatomic assessment of the elbow with magnetic resonance imaging (MRI) in the active throwing position (flexed elbow valgus external rotation [FEVER] view) can add valuable diagnostic or prognostic information in throwing athletes. The purpose of this study was to evaluate findings on MRI and subsequent performance in professional throwing athletes. It was hypothesized that joint space widening in the FEVER view would be predictive of performance and the risk of subsequent injuries. Cross-sectional study; Level of evidence, 3. All pitchers on 2 Major League Baseball teams who consented to participate during their preseason screening in 2019 and 2020 underwent standard and FEVER MRI, and performance data from the following season were recorded, including injuries, mean throwing velocity, number of innings pitched, strikeout percentage, walk percentage, weighted on-base average, and level of play reached (not signed, minor league, or major league). Categorical variables were compared using the Fisher exact test or chi-square test, and continuous variables were compared using the Kruskal-Wallis test, as appropriate. Ordered logistic regression was used to determine the independent factors predicting performance. A total of 91 players underwent preseason imaging, and all players had subsequent performance data available. Multivariate analysis revealed that when controlling for age, mean velocity, history of injuries, presence of symptoms, and history of ulnar collateral ligament reconstruction, increased absolute joint space widening was predictive of a lower level of play (β = -0.63; P = .042). Univariate analysis demonstrated a significant correlation between relative joint space widening and level of play reached (β = -0.54; P = .034). Relative joint space widening remained a significant predictor of level of play (β = -0.87; P = .012) on multivariate analysis. Multivariate analysis also showed that both absolute joint space widening (β = -13.50; P = .012) and relative joint space widening (β = -13.60; P = .026) were predictive of the number of innings pitched in the subsequent season. The present study demonstrates that findings on MRI with valgus stress correlated with the level of play reached and number of innings pitched in professional throwing athletes.

Femur Fractures in 5 Individuals With Pantothenate Kinase-associated Neurodegeneration: The Role of Dystonia and Suggested Management.

Pantothenate kinase-associated neurodegeneration (PKAN) is a rare, neurodegenerative disorder that manifests with progressive loss of ambulation and refractory dystonia, especially in the early-onset classic form. This leads to osteopenia and stress on long bones, which pose an increased risk of atraumatic femur fractures. The purpose of this study is to describe the unique challenges in managing femur fractures in PKAN and the effect of disease manifestations on surgical outcomes. A retrospective case review was conducted on 5 patients (ages 10 to 20y) with PKAN with a femur fracture requiring surgical intervention. Data regarding initial presentation, surgical treatment, complications, and outcomes were obtained. All patients were non-ambulatory, with 4 of 5 patients sustaining an atraumatic femur fracture in the setting of dystonia episode. One patient had an additional contralateral acetabular fracture. Postoperatively, 4 of the 5 patients sustained orthopaedic complications requiring surgical revision, with 3 of these secondary to dystonia. Overall, 4 required prolonged hospitalization in the setting of refractory dystonia. Femur fractures in PKAN present distinct challenges for successful outcomes. A rigid intramedullary rod with proximal and distal interlocking screws is most protective against surgical complications associated with refractory dystonia occurring during the postoperative period. Multidisciplinary planning for postoperative care is essential and may include aggressive sedation and pain management to decrease the risk of subsequent injuries or complications. Level IV.

TCT-764 Left Main Percutaneous or Surgical Revascularization and Subsequent Risk of Acute Kidney Injury: The LUCKY Registry

TCT-764 Left Main Percutaneous or Surgical Revascularization and Subsequent Risk of Acute Kidney Injury: The LUCKY Registry

Concussion injury management, perception, and knowledge in amateur field hockey.

Field hockey has a high risk for sports-related concussion (SRC) injuries due to the speed and intensity of the game, current rules, field surfaces and equipment composition. Head injuries are the second most common reported injury and up to 75% of SRCs go unreported or undetected. This increases the subsequent injury risk, long-term health consequences and prolonged injury recovery. This study aimed to examine the prevalence of SRC in hockey players within the Southern Gauteng Hockey Association (SGHA) premier league. Concussion knowledge and attitudes of hockey players, coaches, umpires, and officials were also investigated. A partially mixed sequential dominant status design (QUANT-qual) was used, divided into two phases. In Phase One hockey players, coaches, umpires, and technical officials (n=119) completed a modified RoCKAS-ST questionnaire. In Phase Two, a focus group discussion with umpires (n=3) and interviews with coaches (n=3) were conducted. Injuries to the shoulder, neck, head, and face were reported from stick use (n=98); ball use (n=102) and collisions (n=187). Only 19% of hockey players were diagnosed with SRC, indicating that many of these injuries were undetected or not reported. Responses from the focus group discussion and interviews indicated that coaches, umpires, and officials felt they had insufficient knowledge of SRC. The recognition and management of on-field injuries require improvement to enhance the injury detection system.

Creatine kinase concentration on the second post-match day is not associated with risk of subsequent muscle injury in professional football players: a four-season cohort study

ABSTRACT Objective The objective of this study was to examine the relationship between creatine kinase (CK) concentration following official matches and the risk of subsequent muscle injury in professional male football (soccer) players. Methods Blood samples were collected on the second post-match day for CK analysis over four consecutive seasons in a professional football club. Players were then followed for five days to observe any occurrence of indirect muscle injury (structural or functional in nature). Players exposed to at least 45 minutes in two consecutive matches within seven days were considered valid cases for analysis. Results Eighty players participated in the study, generating 1,656 cases eligible for analysis, of which 229 resulted in muscle injuries. The hamstrings were the most frequently injured muscle group (54%), followed by the adductor (21%), triceps surae (19%), quadriceps (5%), and psoas (1%). While CK concentration was higher in muscle injury cases [783 ± 507 U/L (95%CI, 717 to 849; min–max, 105–2,800)] compared with uninjured cases [688 ± 446 U/L (95%CI, 665 to 711; min–max, 100–2,950)], it was not an accurate predictor of subsequent muscle injury risk in professional football players (sensitivity = 56%; specificity = 55%; odds ratio = 1.00; area under curve = 0.557). Conclusion CK concentration on the second post-match day cannot be used to effectively screen subsequent muscle injury risk in professional male football players.

Poster 167: Increased Throwing Velocity is Correlated with a Higher Likelihood of Violating Current Pitch Count Recommendations in High School Baseball Pitchers.

Objectives: While pitch count and rest guidelines have been promoted for youth and adolescent baseball players for nearly two decades, compliance with guidelines remains poorly understood. The purpose of this study was to determine the frequency of compliance with Pitch Smart guidelines, as well as the association between compliance and range of motion, strength, velocity, injury, and pitcher utilization. Methods: This study was a prospective, multi-center study of high school pitchers, encompassing each region of the United States. Pre-season pitchers were surveyed about their compliance with current off- season rest-related guidelines and history of injury. Pre-season, pitchers underwent standardized physical examinations and pitch velocity was measured. During the high school season that followed, both pitch counts and injury incidence were collected. Results: One hundred and fifteen pitchers participated. Based upon pre-season data, 84% of pitchers had previously violated current pitch recommendation guidelines. During the season, 14% had at least one instance of a violation of the current pitch counts guidelines. Across both the pre-season survey and in-season pitch counts, 89% of players had at least one violation of the current Pitch Smart guidelines. While there were no significant differences in range of motion or strength, those pitchers who were non-compliant with guidelines in the pre-season had higher max pitch velocity (mean±standard deviation 74±8 miles per hour vs. 69±5 miles per hour, p=0.009). Pitchers self-reported their peak velocity at 7 MPH greater than the actual measured velocity. Only a single injury occurred during the season, precluding a comparison between groups. There were no significant differences in the incidence of a history of injury between those pitchers who were noncompliant with between-season rest guidelines (p=0.285). Conclusions: Most high school pitchers are non-compliant with current Pitch Smart guidelines, and they tend to overestimate their peak velocity by 7 MPH. Pitchers with greater velocity were at the highest risk for violating current pitch count recommendations. Since both increased throwing volume and pitch velocity are known risk factors for injury, these athletes may be at particular risk for subsequent injury. research is necessary to understand whether taking three consecutive month rest between seasons prevents pitching-related injury.

Paper 61: NCAA Football Players are at Higher Risk of Upper Extremity Injury After Concussion

Objectives: Sport related concussion has been repeatedly demonstrated to increase the risk of subsequent lower extremity injury in athletes. The current literature suggests that, for multiple years after a concussion, athletes are at increased risk of lower extremity injury. However, we are unaware of any studies that have demonstrated an increase in risk for upper extremity injuries after sport related concussion. The purpose of this study was to investigate a change in the risk of upper extremity injuries for NCAA football players after return to play from a sport related concussion. Methods: The Sports Injury Research Archive (SIRA) of a single NCAA athletic conference was queried for de-identified injury data on concussions and upper extremity injuries. All football players diagnosed with a concussion and recorded in the database were identified between 2017-2021. Athletes were excluded if their concussion was not sport related, if they had multiple concussions, or if they did not return to previous activity level in their respective sport. Each concussed athlete was then retrospectively followed for the year prior to their concussion as well as for one year after their concussion, beginning at 3 months after the date of their concussion. If the athlete was known to have not returned to play within 3 months they were excluded from the study. All upper extremity injuries were identified in the year prior to concussion and for the previously described year after the concussion. The mean number of concussions per athlete were identified in the pre-concussion and post-concussion groups. The odds ratio, 95% confidence interval, and statistical significance between groups were calculated using Microsoft Excel. Results: After exclusions, 230 de-identified football players from a single conference were identified with concussions from the 2017 through 2021 NCAA football seasons. In these athletes there were a total of 60 upper extremity injuries in the year preceding concussion and a total of 111 in the year they were followed after concussion. The mean number of upper extremity injuries per athlete in the year prior to concussion was 0.26, and in the post-concussion athletes was 0.48. The odds of upper extremity injury in the post-concussion year were 1.85 times higher than in the pre-concussion year (OR = 1.85, 95% CI 1.29 – 2.66, p < 0.001). Conclusions: The data collected in this study demonstrates that collegiate football players are at higher risk of upper extremity injury after concussion. Multiple studies have shown an increased risk of lower extremity injury in athletes after sport related concussion. This study is the first to demonstrate an increased risk of injury specifically in the upper extremities after concussion. The explanation for why these athletes’ injury risk changes after concussion is still not fully understood. Prior research has shown that athletes have alterations in their balance, gait, and landing biomechanics after concussion, which could possibly be causative in upper extremity injuries. Various studies have investigated changes in the coupling between perception and reaction amongst athletes after head injury and have theorized these changes as potential causes of the increase in injury risk. Another consideration is simply that athletes may change the way they approach their sport after sustaining a concussion. Further research on the topic should aim at characterizing the types of injuries that portend the largest increase in risk, exploring different sports, and investigating the magnitude of the risk at longer post-concussion time points. Delineating a clear explanation for why athletes have increased risk of injury after concussion is worthy of future research.

A-29 To report or not to report: A review of adolescent decision-making theories following sports-related concussion

Abstract Purpose Sports-related concussion (SRC) is a prevalent concern among adolescent athletes. If SRC is suspected, athletes are usually removed from play for assessment and symptom monitoring. Return-to-play decisions heavily rely on athlete self-report of SRC and associated symptoms. Social pressures and attitudes related to symptom reporting influence an athlete’s decision of whether to disclose symptoms; not reporting increases risk for subsequent injury and delayed recovery. Therefore, it is important to understand the adolescent decision-making process following SRC. In this review, prevailing theories that explain symptom reporting and decision-making following SRC will be evaluated from a clinical lens. Data Selection Literature was reviewed using Google Scholar, PubMed, and SCOPUS. Search terms included “concussion” AND “sport” AND “symptom reporting” OR “reporting” OR “self-report”. Other terms included “decision-making”, “disclosure”, “adolescent”, “high school”, and “college”. Articles from 2004-2023 were included. Data Synthesis Three prevailing theories have been proposed to explain symptom underreporting among adolescent athletes: the Theory of Reasoned Action and Planned Behavior, the Bandura Social Cognitive Theory, and the Disclosure Decision-Making Model. These theories will be critiqued and the lack of research on neurodevelopmental components of decision-making will be highlighted. Conclusions The decision-making process following SRC is complex, multi-factorial, and state-dependent. While these theories provide critical insights into symptom reporting following SRC, they do not consider important neurodevelopmental factors such as the imbalance between cognitive control and reward processing in adolescence. When educating parents and coaches about symptom reporting following SRC, it will be important for clinicians to consider socioemotional, cultural, environmental, and neurodevelopmental factors.

The impact of concussion on subsequent injury risk in elite junior Australian football athletes.

Concussion increases injury risk. However, this has not been investigated in junior Australian football and it is unknown whether the location, severity, and mechanism of subsequent injuries differ after concussion vs. non-concussion injury. Prospective cohort. 1455 elite adolescent male Australian footballers were tracked across seven seasons to determine whether subsequent injury risk was greater after concussion compared to non-concussion index injury using multilevel survival analysis. Mixed-effects logistic regression compared location and mechanism. Mixed-effects Poisson regression compared severity. Of 1455 athletes, 632 were injured and included in subsequent-injury analysis. There were no differences in injury incidence after a concussion compared to upper- (hazard ratio = 1.0, 0.6 to 1.9, P = 0.892; trivial effect) and lower (hazard ratio = 1.1, 0.6 to 1.9, P = 0.810; trivial effect) index injury, or in location. Subsequent injuries were more likely to be contact-based after a non-concussion injury than concussion (odds ratio = 4.6, 1.3 to 16.0; P = 0.017; large effect). There was no difference in subsequent injury severity after lower- (3.4 ± 3.0 missed matches; incidence rate ratio = 1.4, 0.9 to 2.1; P ≤ 0.117; small effect) and upper-limb injuries (3.4 ± 3.1 missed matches; incidence rate ratio = 1.4, 0.9 to 2.2; P = 0.189; small effect) compared to concussion (2.4 ± 2.0 missed matches). Subsequent injury risk, severity, and location in junior Australian football are similar following concussion compared to non-concussion index injuries, although contact injuries are less likely.

Paper 20: Prior Isolated Meniscus Surgery Significantly Increases the Risk for Future Ipsilateral Anterior Cruciate Ligament Reconstruction up to 5 Years: An Analysis of over 100,000 Patients

Objectives: Meniscus tears in a young population often occur from a traumatic, rotational mechanism of injury, which is similar to that of an ACL tear. However, there is limited evidence regarding the risk of subsequent ACL injury following a surgically treated isolated meniscus tears. The purpose of this study was to investigate the risk of subsequent ipsilateral ACL reconstruction (ACL-R) in patients who were surgically treated for isolated meniscus tears compared to the incidence of ACL-R in the general population. We hypothesized that a prior meniscus tear, more specifically a bucket-handle tear, is indicative of a more severe injury and thus increases the risk of subsequent ipsilateral ACL-R. Methods: The PearlDiver Mariner 91 database was queried for patients aged 10-40 years who were surgically treated for isolated meniscus tears using CPT and ICD-10 codes between 2015 to 2020. Patients with any prior cruciate or ligamentous or meniscus injury of the knee or surgery, other concurrent arthroscopic procedure of the knee apart from meniscus repair or meniscectomy, and any concurrent fractures of the femur, tibia, fibula, or patella were excluded. The population incidence for first time ACL-R was determined in patients with same 10-40 year age range and during the same 2015-2020 time period. Cohorts for meniscal tear pathology (including laterality) and surgical treatment (repair vs. meniscectomy) were formed. Ipsilateral subsequent re-operations for ACL-R were tracked up to 5 years. Multivariate logistic regression was performed to compare the risk of subsequent ipsilateral ACL-R after isolated meniscus tear treated surgically to the general population incidence of ACL-R. Results: In total, 106,185 isolated meniscus tears that underwent repair or meniscectomy were identified (Figure 1). The population incidence for first time ACL-R was ≈ 0.2%. After controlling for demographics, comorbidities, and procedure type, patients that were surgically treated for an isolated BH tear (1.7%) were at significantly higher odds of ACL-R within 5 years compared to population incidence of ACL-R (OR 8.54, P<0.001) (Table 1). Medial BH tears (2.2%) had significantly increased odds of ACL-R up to 5 years (OR 10.87, P < 0.001). Non-BH tears (0.9%) had significant higher odds of ACL-R up to 5 years (OR 3.66, P<0.001). Medial BH tears that were repaired (4.0%) had the highest odds of ACL-R (17.53, P<0.001) up to 5 years relative to the general population. Conclusions: The present study is the first to analyze the odds of ACL-R after suffering a prior meniscus tear treated surgically. We found that patients with surgically treated, isolated BH tears are significantly more likely to require ipsilateral ACL-R surgery compared to those treated for all other types of isolated meniscus injuries. Medial BH tears conferred the greatest odds of requiring subsequent ACL-R, suggesting that a BH meniscus tear, especially a medial sided BH tear, is a possible sign of underlying knee instability. Such findings suggest that for patients who undergo surgical treatment for isolated BH tears, ACL injury prevention should be incorporated into rehabilitation protocols. [Figure: see text][Table: see text]

REFINING CARFREEME, A DRIVING RETIREMENT PROGRAM FOR PERSONS WITH DEMENTIA AND THEIR CARE PARTNERS

Abstract Persons living with dementia (PLWD) are at increased risk for roadway crashes and subsequent injury or death. Navigating driving retirement while respecting the PLWD’s autonomy and supporting continued independence can be challenging. CarFreeMe™, originally developed in Australia, is a driving retirement intervention providing tailored psychoeducational telecoaching modules to PLWD and/or their care partners. Session topics include living with dementia, balancing independence and safety, adjusting to loss and change, exploring others’ experiences with driving retirement, planning for alternative transportation, lifestyle planning, advocacy and support, and problem solving. Phase I enrolled 16 care partners and 11 PLWD. Mixed methods data from Phase I’s 1- and 3-month follow-up surveys and post-intervention interviews demonstrated feasibility and acceptance of CarFreeMe™ with a U.S. audience. Phase I participants found the program valuable and would recommend it to others (96% care partners, 100% PLWD). Care partners and PLWD reported improved Readiness of Mobility Transition scores at the 3-month survey. Several felt the program may be most useful early in the decision making process. The program offered strategies and education that facilitated conversations both during and outside of the intervention sessions to support the PLWD’s agency and acceptance of driving retirement. Participant feedback and lessons learned from Phase I informed Phase II development and deployment. Phase II is enrolling 50 care partners, PLWD, or dyads and includes 3- and 6-month follow-up surveys. Preliminary CarFreeMe™ Phase II utility, acceptance, and driving related outcomes will be discussed as well as next steps for evaluation.

Concussion increases within-player injury risk in male professional rugby union

ObjectivesTo assess within-player change in injury risk and between-player subsequent injury risk associated with concussive and common non-concussive injuries in professional rugby union.MethodsThis prospective cohort study in Welsh professional male...

Influence of fluid balance on postoperative outcomes after hepatic resection in patients with left ventricular diastolic dysfunction.

The maintenance of low central venous pressure (CVP) during hepatic resection is associated with a reduction in estimated blood loss. After completion of the hepatic parenchymal transection, fluid is rapidly administered to replace the surgical blood loss and fluid deficit to prevent subsequent organ injury risk. However, this perioperative fluid strategy may influence on the postoperative outcomes of patients with left ventricular diastolic dysfunction (LVDD) who cannot tolerate volume adjustment. A total of 206 patients with who underwent hepatic resection between March 2015 and February 2021 were evaluated. LVDD was defined according to the American Society of Echocardiography and the European Association of Cardiovascular Imaging 2016 recommendations as LVDD (group A, n = 39), or normal LV diastolic function and indeterminate decision (group B, n = 153). We compared the clinical outcomes of patients between two groups, and then analyzed the risk factors for postoperative complications. Postoperative acute kidney injury (AKI, 10.3% vs. 1.3%, P = 0.004) and pleural effusion or edema (51.3% vs. 30.1%, P = 0.013) were more common in group A than in group B. Further, creatinine levels from postoperative day 1 to day 7 were significantly higher and daily urine outputs at postoperative day 1 (P = 0.038) and day 2 (P = 0.025) were significantly lower in group A than in group B. LVDD was the only significant risk factor for postoperative AKI after hepatic resection (odds ratio, 10.181; 95% confidence interval, 1.570-66.011, P = 0.015). The rates of renal dysfunction and pulmonary complications after hepatic resection are higher in patients with LVDD than in those with normal LV diastolic function. Thus, these patients require individualized fluid management.

S51 Trends in Acute Pancreatitis With Cannabis Use Disorder and Subsequent Acute Kidney Injury in Young Adults: Evidence From Nationwide Cohort

Introduction: Cannabis has been a well-recognized etiology of acute pancreatitis (AP) over last decade with some controversies. With increased availability of cannabis for recreational and medicinal purposes in managing chronic pain, it is essential to evaluate potential risk to multi-organ system. However, there is scarcity of large-scale data on the burden and risk of AP and subsequent acute kidney injury (AKI) among cannabis users. Methods: Using weighted discharges from the National Inpatient Sample (2016-2019), young (18-44 years) patients primarily admitted for AP with concomitant cannabis use disorder (CUD) were identified. Primary endpoints included odds and trends in AP with vs. without CUD, subsequent trends in AKI with associated sex/racial disparities and all-cause mortality. Secondary endpoints included patient disposition, hospital stay, and cost. Results: Of total 395,215 AP admissions, 29,815 (7.5%) were among patients with CUD. Crude rate of AP in CUD cohort was slightly higher vs. non-CUD admissions (n=29,815, 1.4 % vs. n=365,400, 1.1%), however, with slightly lower odds when adjusted for confounders (aOR 0.94, 95%CI:0.90-0.97, p< 0.001). The AP-CUD cohort often consisted of younger (median 33 vs 35 years), male (67.5% vs. 53.9%), blacks (28.9% vs 17.6%), patients from lowest income quartile, Medicaid enrollees vs. non-CUD cohort. Alcohol abuse, smoking, and drug abuse were significant higher in the AP-CUD cohort. Rate of AKI in AP-CUD cohort was 7% vs 6.5 % in non-CUD. Interestingly, among AP-CUD cohort, the rate of AKI was higher in males (8.3%, ptrend =0.092) vs females (4.3%, ptrend =0.104) with steady trends. The burden and trend of AKI in AP-CUD cohort was higher in Hispanics (Hispanic 9.3%, black 8.6%, white 5.6%; H: 9.1% in 2016 to 11.9% in 2017 ptrend< 0.004) (Figure). There was no significant difference in all-cause mortality between CUD and non-CUD cohorts (aOR 0.40; 95%CI:0.16-1.03, p=0.058). Routine discharges and median length of stay were comparable between cohorts (3 days) with an average cost was $25,724 in the AP-CUD cohort. Conclusion: There was a higher crude rate of AP admissions in the young CUD cohort, however, when adjusted for confounders, CUD was not independently associated with higher risk of AP, subsequent inpatient mortality, or rising trends in AKI. Hispanics demonstrated concerning trends in AKI. Future studies are warranted assessing long-term impact of polysubstance use on AP admissions and outcomes.Figure 1.: Trends in Acute Kidney Injury among Acute Pancreatitis admissions with Cannabis users by sex and race.

Postural balance asymmetry and subsequent noncontact lower extremity musculoskeletal injuries among Tunisian soccer players with groin pain: A prospective case control study

BackgroundRecent studies reported postural balance disorders in patients and soccer players with groin pain (GP) compared to controls. Since postural balance asymmetry identified after an initial injury contributes for subsequent injuries, identification of this asymmetry in soccer players with GP may highlight the risk of sustaining subsequent noncontact lower extremity musculoskeletal injuries in these players. Therefore, the aims of this study were to (i) examine static and dynamic unipedal postural balance asymmetry in soccer players with GP compared to healthy ones, and (ii) quantify the risk of subsequent noncontact lower extremity injuries in these players. Research questionDo soccer players with GP exhibit higher static and dynamic unipedal postural balance asymmetry, and higher risk of sustaining subsequent injuries compared to controls? MethodsIn this prospective case control study, 27 soccer players with non-time loss GP (GP group: GPG), and 27 healthy ones (control group: CG) were enrolled. Static and dynamic unipedal postural balance asymmetry were evaluated with a force platform using symmetry index (SI), and Y-balance test (Y-BT), respectively. Additionally, subsequent noncontact lower extremity musculoskeletal injuries were tracked for 10 months. ResultsThe GPG revealed higher (p < 0.01) SI in eyes closed condition, higher (p < 0.001) side-to-side asymmetry in anterior, posteromedial and posterolateral reach distances and in composite Y-BT score compared to CG. They showed lower (p < 0.001) composite score for injured limb and higher (p < 0.001) side-to-side asymmetry in posteromedial reach distance compared to the cut-off values of 89.6 % and 4 cm, respectively. Moreover, GPG exhibited higher odds (OR= 7.48; 95 % CI = 2.15, 26.00; p < 0.01) of sustaining subsequent injuries compared to CG. SignificanceThe Y-BT should be instituted into existing pre-participation physical examinations to screen for soccer players with non-time loss GP at an elevated risk of sustaining subsequent injuries. This could help coaches and clinicians make valid return to play decisions.

TCT-539 Left Main Percutaneous or Surgical Revascularization and Subsequent Risk of Acute Kidney Injury: Insights From the LUCKY Registry

TCT-539 Left Main Percutaneous or Surgical Revascularization and Subsequent Risk of Acute Kidney Injury: Insights From the LUCKY Registry

World Federation of Athletic Training and Therapy World Congress 2022 Peer-Reviewed Track Abstracts, May 5–7, 2022, Winnipeg, Manitoba, Canada

World Federation of Athletic Training and Therapy World Congress 2022 Peer-Reviewed Track Abstracts, May 5–7, 2022, Winnipeg, Manitoba, Canada

Performance of resistive index and semi-quantitative power doppler ultrasound score in predicting acute kidney injury: A meta-analysis of prospective studies.

This study aimed to assess the predictive value of the renal resistive index (RRI) and power Doppler ultrasound (PDU) on subsequent acute kidney injury (AKI) risk using a meta-analytic approach. We searched eligible studies in PubMed, EmBase, and the Cochrane library from inception until August 2021. The parameters included the sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curves (AUC). Twenty-three prospective studies involving 2,400 patients were selected. The pooled sensitivity and specificity of the RRI and PDU were 0.76 and 0.79, and 0.64 and 0.90, respectively. The pooled PLR and NLR were 3.64 and 0.31, and 6.58 and 0.40 for the RRI and PDU, respectively. The DORs of the RRI and PDU for predicting AKI were 11.76, and 16.32, respectively. The AUCs of the RRI and PDU for predicting AKI were 0.83, and 0.86, respectively. There were no significant differences between the RRI and PDU for predicting AKI in terms of sensitivity, PLR, NLR, DOR, and AUC. The specificity of the RRI was lower than that of the PDU for predicting AKI. This study found that the predictive performance of the RRI and PDU from the Doppler ultrasound for AKI was similar, which need to be further verified based on the direct comparison results.

Are 6-Month Functional and Isokinetic Testing Measures Risk Factors for Second Anterior Cruciate Ligament Injuries at Long-T Follow-Up?

Second anterior cruciate ligament (SACL) injuries are a devastating complication following return to sport (RTS). Appropriate and safe RTS criteria that reduce the risk of SACL injuries are needed. The goal of this study was to investigate the relationship between functional and isokinetic testing at 6 months following primary ACL reconstruction (ACLR) as risk factors for SACL injuries. Patients with primary ACLR from 1990 to 2010 were identified. Those with 6-month postoperative functional and isokinetic testing and a minimum of 2-year follow-up were included. Functional testing included vertical jump, single-leg hop, and single-leg triple hop. Isokinetic testing included concentric quadriceps and hamstrings (HSs) strength at 60 and 180 degree/s speeds. Statistical analysis evaluated the significance of the various tests between those with and without a secondary tear. In total, 344 patients with a mean age of 26.0 ± 9.8 years at an average time of 9.1 ± 3.5 years of follow-up were analyzed. Fifty-nine patients (17%) experienced SACL injuries at an average time of 4.8 years following ACLR with 34 (58%) ipsilateral graft ruptures and 25 (43%) contralateral tears. Several isokinetic measures were significantly different between the NO SACL and the SACL groups: quadriceps 60 degree/s limb symmetry index (LSI) (75 vs. 82% p = 0.01), HS 60 degree/s LSI (92 vs. 97%, p = 0.04), quadriceps 180 degree/s involved/body weight (BW) (41 vs. 47%, p = 0.04), and HS 180 degree/s involved/BW (30 vs. 34%, p = 0.04). Patients with involved limb peak quadriceps torque value greater than 65 or 50% of BW (60 and 180 degree/s) had a 2.2 and 3.1 times higher risk of an SACL injury. Patients with certain elevated isokinetic scores in the injured limb at 6 months after ACLR experienced a higher rate of subsequent ACL injuries than those who had lower peak torque. Although a quantitative only analysis may not be sufficient to determine RTS criteria, clinicians should caution high-performing patients about the risk of subsequent ACL injury. Cohort study; 3.