Cha ra c te riza tio n o f Ame ric a n F o o tb a ll I njurie s - PowerPoint PPT Presentation

Cha ra c te riza tio n o f Ame ric a n F o o tb a ll I njurie s in Childre n a nd Ado le sc e nts PAT RI CK J. SMI T H, MD DE RE K M. K E L L Y, MD ANT HONY M. HOL L I NS, MD

Bac kgr ound  Appro xima te ly 2.5 millio n E R visits e a c h ye a r re la te d to pe dia tric spo rts  L a rg e numb e r o f injurie s a sso c ia te d with yo uth fo o tb a ll; fo o tb a ll injury ra te inc re a se d b y 23% fro m 2000-2010  Sub sta ntia l b urde n to the me dic a l syste m  Po te ntia l fo r lo ng te rm se q ue la e fo llo wing se rio us tra uma

Pur pose  Cha ra c te rize the type s a nd se ve rity o f injurie s in pe dia tric ta c kle fo o tb a ll  Que stio ns:  1) Are c e rta in injurie s mo re pre va le nt in spe c ific pa tie nt g ro ups?  2) Ca n pa tie nt c ha ra c te ristic s pre dic t injury se ve rity?

Study De sign  Re tro spe c tive re vie w o f pe dia tric fo o tb a ll injurie s b e twe e n 2010-2014  E MR q ue rie d fo r E -c o de s re la te d to ta c kle fo o tb a ll  Dia g no sis c o de s a nd a sso c ia te d pro c e dure s ide ntifie d  1494 pa tie nts we re inc lude d  Pa tie nts we re divide d into 4 g ro ups b a se d o n a g e a nd le ve l o f pla y  <8, 8-11, 12-14, 15-18 ye a rs

Ove r all Injur ie s  F ra c ture s o ve ra ll we re the mo st c o mmo n fo o tb a ll injury  596 fra c ture s  335 c o ntusio ns  310 spra ins  170 c lo se d he a d injurie s  62 dislo c a tio ns  14 so lid o rg a n injurie s  9 spina l c o rd injurie s  646 pa tie nts e xpe rie nc e d Uppe r E xtre mity tra uma  487 pa tie nts e xpe rie nc e d L o we r E xtre mity T ra uma

F r ac tur e s  Mo st c o mmo n injury in a ll a g e g ro ups  Appe ndic ula r ske le to n  I nc ide nc e b y a g e g ro up:  <8 41.2%  8-11 44.9%  12-14 47.6%  15-18 26.2%  I nc ide nc e de c re a se s sig nific a ntly in the 15-18 ye a r o ld a g e g ro up, a fte r ste a dily c limb ing in yo ung e r a g e g ro ups  E xpla ine d b y de c re a se in inc ide nc e o f physe a l injurie s  Ra te o f so ft tissue injurie s inc re a se s in 15-18 ye a r o lds  Clo se d g ro wth pla te s le a d to mo re lig a me nto us injurie s  Suppo rte d b y inc re a se in dislo c a tio n, c o ntusio n, a nd spra in ra te s in this a g e g ro up

L owe r E xtr e mity F r ac tur e s  I nc re a se no te d in L E tra uma fro m yo ung e st a g e g ro up (26.5%) to the o lde st a g e g ro up (33.6%)  I nc re a se c o nsiste nt a c ro ss g ro ups  E xpe c te d tha t with de ve lo pme nt a nd e xpe rie nc e , ta c kling te c hniq ue s impro ve  De c re a se in “a rm ta c kling ”  Mo re fo c use d fo rc e s to wa rds pro pe r ta c kling te c hniq ue wo uld le a d to inc re a se d ra te s o f injury fro m the wa ist do wn  Uninte nde d c o nse q ue nc e o f the “ta rg e ting ” rule

Close d He ad Injur y  Surprising ly, hig he st ra te o f c lo se d he a d injurie s wa s in <8 ye a r o lds  Clo se d He a d I njury Ra te s  <8 14.7%  8-11 9.1%  12-14 10.2%  15-18 14.2%  Co nc ussio n a wa re ne ss impo rta nt fo r re c o g nitio n, dia g no sis, a nd tre a tme nt o f he a d injurie s  Diffic ult to e xpla in physio lo g ic a lly due to limite d fo rc e a yo ung e r a thle te wo uld b e a b le to pro duc e

Close d He ad Injur y  Our ra te s hig he r tha n pre vio usly re po rte d (3%-11%) ra te s  Pre vio us lite ra ture sta te s yo ung e st fo o tb a ll pla ye rs still susta in a mo de ra te numb e r o f “hig h ma g nitude ” (80-g ) impa c ts pe r se a so n ( Danie l 2014, Wo ng 2014, Yo ung 2014 )  Also po ssib le tha t o lde r a thle te s unde rre po rt the ir he a d injurie s to sta y in the g a me  Ha lf to 70% o f spo rts-re la te d c o nc ussio ns g o unre po rte d ( Baug h 2015, Grie sb ac h 2013, Kro shus 2015 )

Going for war d  Ana lysis o f da ta o ve r a lo ng e r spa n to ide ntify tre nds o ve r time  Mo re in de pth study o f c lo se d he a d injurie s in the yo uth po pula tio n to e va lua te if we a re a de q ua te ly a nd a c c ura te ly dia g no sing the se injurie s  E xa mine lo ng te rm se q ue la e o f c lo se d he a d injury, a nd if e a rly tre a tme nt le a ds to b e tte r ne uro lo g ic a l o utc o me  I nve stig a te po ssib le tra ining a nd c o nditio ning te c hniq ue s to re duc e so ft tissue injurie s in o lde r a g e g ro up  I f inc re a se in c lo se d he a d injurie s in yo ung e st g ro up is re a l, do we ne e d to c ha ng e e q uipme nt sta nda rds fo r yo ung e r a thle te s?

Study L imitations  Sma ll sa mple size  Use o f re tro spe c tive da ta fro m me dic a l c o ding  Co de s re fle c t injurie s se e n in a mb ula to ry c a re fa c ilitie s, so do n’ t c a pture injurie s tha t we re tre a te d o n the fie ld  Co ding ma y no t a c c ura te ly a ffe c t true injury

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