KEEPING THE SCORE ON SPORTS: New Trends And Programs Dr. Khaled - - PowerPoint PPT Presentation

• Dr. Khaled Basiouny

Trauma/Acute Care/Surgical Critical Care/Asst. Professor of Surgery George Washington University Karen Liller, Ph.D. Professor and AAAS Fellow University of South Florida

• Dr. Tad Seifert

Director, Norton Healthcare’s Sports Concussion Program University of Kentucky

KEEPING THE SCORE ON SPORTS: New Trends And Programs

Sports Injury Surveillance for High School Athletes in West-Central Florida

 Karen D. Liller, PhD*  Barbara Morris, DHSc**  Siew Wong, MPH*  Siwon Jang, PhD***

• *University of South Florida (USF) College of Public Health, **Florida Hospital

Wesley Chapel, ***USF Center for Urban Transportation Research

ATC TEAM

 SMART ATC Team

 Sharvettye Frazier

Kathryn Hill

 Ian Graulich Morgan Williams  Anna Griffiths Manuel Ozoa  Jennifer Stollery Donnie Schaffer  Tara Mendres  Ashley Ahearn  Kevorey Hartwell  Crista Colaneri  Jordan Poole  Kayla Wilhide

SPORTS INJURY IN ADOLESCENTS

 The literature shows that

there are approximately 1,000,000 sports injuries reported annually to 10-17 year olds.

 Sports injuries lead to

losses of thousands of dollars each year.

 Sports injuries are one of

the leading reasons for school-related hospitalizations.

SPORTS INJURY SURVEILLANCE

 National data do exist on sports injuries, but are NOT

specific to the state of Florida nor include all sports played in high schools.

 There is no comprehensive data source that captures

injury incidence, prevalence, risk factors, and most importantly exposure information for high school athletes in Florida.

SMART INJURY REGISTRY

 To meet the high school sports injury surveillance

needs, the SMART Injury Registry was created in 2007.

 The Registry was part of the initiatives of the Sports

Medicine and Athletic-Related Trauma Institute (SMART) of the University of South Florida College of Medicine.

SMART INJURY REGISTRY

 The SMART leaders hired and trained 10 certified

athletic trainers (ATCs) who were placed in 10 high schools in west-central Florida to serve the medical needs of athletes and to collect the injury data.

 Schools were selected based on willingness to

participate and need for a certified athletic trainer in the school.

SMART INJURY REGISTRY

 The foundation of the Registry was developed

from software (Simtrak™).

 Exposure variables were added and were defined

as the number of athletes at each practice and/or competition each week.

SMART INJURY REGISTRY

 Other added variables (nearly 1,000 changes)

included:

 Demographics;  Level of Play;  Time and Season of injury;  Equipment and Rules Compliance;  Injury Mechanism, Activity, Environmental Conditions,

Field Locations and Positions;

 Concussion Information; and  Injury Outcomes.

SMART INJURY REGISTRY

 Data were collected and entered electronically by the

ATCs and sent by email to the researchers.

 Data were sent blinded to the research team.  The collection of data for injury analysis was approved

by the University of South Florida Institutional Review Board.

SMART INJURY REGISTRY

 Content validity was established by a panel of experts and

the accuracy and reliability of ATC data collection procedures was verified before the ATCs collected data in the schools.

 This system of data collection was used from 2007-2011.  Different tools were reviewed after 2011 to save costs and

the decision was made to join Reporting Information Online or the RIO system for the 2012-2013 academic year until present.

SELECTION OF DATA TOOL

 RIO is a sports-injury surveillance system funded by

the Centers for Disease Control and Prevention and the National Federation of High School Associations.

 Dataset and definitions nearly identical to our original

Simtrak system.

 Internet-based system where ATCs can submit and

update reports when needed.

DEFINITION OF INJURIES

 Injuries that occur as a result of participation in an

• rganized high school competition or practice;

 requires medical attention by a team physician,

certified athletic trainer, personal physician, or emergency department/urgent care facility; and

 results in restriction of the high school athlete’s

participation for one or more days beyond the day of the injury*

 *Any fracture, concussion, or dental injury regardless

• f restriction status is reported.

SPORTS INJURY REGISTRY

 Data were collected on the following sports:

 Football  Baseball  Softball  Cheerleading  Volleyball  Swimming (men and women)  Track (men and women)  Cross-country (men and women)  Soccer (men and women)

SPORTS INJURY REGISTRY

Sports Included:

 Basketball (men and women)  Lacrosse (men and women)  Wrestling  Other sports (largely flag football)

SPORTS INJURY REGISTRY

 Athlete and exposure data collected by the ATCs and

reported in weekly reports submitted by RIO to investigators monthly.

 The 2013-2014 data includes 15 high schools in west-

central Florida.

 Data were analyzed with SAS 9.3.  All data collection and analyses were approved by the

University of South Florida Institutional Review Board.

2013-2014 RESULTS

 ATC Participation in Schools

 Directly supervised approximately 4,694

athletes from enrolled schools.

 Were present at 7,557 practices and 1,492 games  Supervised 24,201 athletes from competing

schools

2013-2014 RESULTS

Exposure Rates:

 Leading rate of injury per

1,000 athletic exposures for practices was for women’s lacrosse at 3.36, followed by

• ther sports at 3.04 and

football at 3.00.

 Leading rate of injury per 1,000 athletic exposures for

competitions was for football at 14.4, followed by other sports at 9.59, and wrestling at 7.72.

2013-2014 RESULTS

 Frequencies:

 Five-hundred-seventy-four injuries were reported by the

ATCs for 2013-2014.

 Greatest number of injuries in football (N=270),

followed by boys’ wrestling (N=33), girls’ soccer (N=33), and boys’ basketball (N=30).

 Most injuries took place during the regular season

(75.6%).

 Injuries occurred during practices mostly during the

first 1-2 hours (58.8%).

2013-2014 RESULTS

 Most injured athletes were juniors (26.9%), followed by

sophomores (26.0%), seniors (24.7%), and freshmen (22.4%).

 Principle body parts injured were the head/face (21.6%),

knee (15.7%), and ankle (14.6%).

 Leading types of injuries were ligament sprains (26.0%),

concussions (19.7%), and muscle strains (13.4%).

 Most injuries did not require surgery (93.3%) and were

new injuries (85.2%).

 Most athletes returned to play in 3-6 days (22.3%)

followed by 10-21 days (19.0%).

2013-2014 RESULTS

Injuries were mostly evaluated by the ATCs

(94.9%) followed by a general physician (41.1%).

Leading assessment methods were

evaluation (95.6%) followed by x-ray (35.5%).

2013-2014 RESULTS

 Overall, boys had significantly greater sports injury

rates (RR 1.82, CI 1.52-2.19) and in competitions (RR 2.87, CI 2.12-3.91) and practices (RR 1.39, CI 1.10-1.75).

 However, in some sports, results differed. For example

in girl’s soccer, girls had greater injury rates overall (RR 2.36, CI 1.33-4.19) than boys and greater rates in soccer competitions (RR 2.13, CI 1.05-4.32).

RESULTS

100 40.5% 57 23.1% 28 11.3% 24 9.7% 38 15.4%

Competition, n=247

Sprain/strain Concussion Contusion Fracture Other 138 42.6% 56 17.3% 29 9.0% 32 9.9% 69 21.3%

Practice, n=324

1 33.3% 1 33.3% 1 33.3%

Performance, n=3 (Cheerleading only) Injury Diagnoses by Type of Exposure Study

Note: Other injury type included subluxation, tendonitis, dislocation, torn cartilage, laceration, heat illness/injury, hyperextension, bursitis, Jersey finger, torn ACL ligament, pathology with previous ORIF, syncope, seizure, dehydration, nerve injury, separation, shin splints, avulsion, stress fracture, torn LCL, impingement, shoulder impingement, & skin infection.

RESULTS

21 8.8% 55 23.0% 32 13.4% 51 21.3% 18 7.5% 62 25.9%

Competition, n=239

1-2 days 3-6 days 7-9 days 10-21 days >21 days Other

Note: Other included season ended before athlete returned to activity, medical disqualification for season, athlete chose not continue (no medical disqualification), unknown due to ATC departure, athlete quit the team without follow up, medical disqualification for career, & returned to activity in <1 day (for fractures, concussions, and/or dental injuries only). Missing data not included in analysis.

54 17.1% 68 21.6% 46 14.6% 54 17.1% 31 9.8% 62 19.7%

Practice, n=315

1 33.3% 1 33.3% 1 33.3%

Performance, n=3 (Cheerleading only) Time Loss By Type of Exposure

RESULTS

216 87.4% 3 1.2% 28 11.3%

Competition, n=247

New Recurrence (this academic year) Recurrence (previous academic year) 270 83.3% 17 5.2% 37 11.4%

Practice, n=324 New and Recurring Injuries by Type of Exposure Surveillance

3 100%

Performance, n=3 (Cheerleading only)

2013-2014 CONCLUSIONS

 Women’s lacrosse emerged as the sport with the

highest injury rate for practice.

 Football, wrestling, soccer and basketball continue to

dominate the number of sports injuries.

 Leading body sites of the head and face, knees, and

ankles correspond to the leading injuries that include ligament sprains, muscle strains, and concussions.

 Boys had greater injury rates overall, however in some

individual sports, girls had higher injury rates.

LIMITATIONS

 Cannot ensure accuracy of injury data supplied by

coaches only.

 Not all injured athletes may have reported injuries to

the ATCs.

 All study schools are in west-central Florida so

generalizations beyond these schools and programs should be done with caution.

NEXT STEPS: THE FUTURE

 Continued data collection with the inclusion of at

least five new high schools in different counties.

 Special studies on the role of helmets for female

lacrosse players.

ULTIMATE GOALS

 Development of targeted injury prevention programs

in high schools that will be efficacious in decreasing athlete morbidity and mortality.

ULTIMATE GOALS

 Funding for all high schools and middle schools to

hire ATCs and witness the decline of sports injuries.

What Can You and Safe Kids do?

 Work with local Universities and Colleges

(Colleges/Schools of Public Health) to develop sports injury surveillance tools.

 Use the surveillance tool in schools in your area.  Develop and evaluate intervention programs based on

the data.

 Support ATCs in your area, statewide, and nationally.

THANK YOU FROM ALL OF US AND ESPECIALLY OUR ATCS!

QUESTIONS??

The Influence of Migraine in High School Football Players, Concussed or Not

Childhood Injury Prevention Convention

Tad Seifert, MD

Director, Sports Concussion Program, Norton Healthcare Clinical Assistant Professor of Neurology, University of Kentucky Member, Kentucky State Boxing Commission Head, NCAA Headache Task Force

Faculty Disclosure

• Consultant, United

States Department of Defense

• Board Member,

Kentucky State Boxing Commission

Headache in the athlete is not uncommon…..

Headache in the Athlete

Not Uncommon

• 30% of adolescents (13-15) w/ exertional HA

– Cephalalgia 2008

• 36% of collegiate athletes

– Br J Sports Med 1994

• 36% of distance runners

– WV Med J 1999

• 50% of cyclists

– Headache 2012

• 2% of population have given up sports participation due to

primary exertional HA

– Cephalalgia 2002

Headache in the adolescent is not uncommon…..

• Prevalence of migraine was 9.1%
• Limitations:

– Lack of population-based studies from low and low-middle income countries – Very little information about the prevalence of probable migraine and chronic migraine – No information about menstrual migraine in the young

Posttraumatic Headache

• Most common symptom after minor head

trauma

• Up to 90% of individuals sustaining mTBI

– Kirk C, et al. “Chronic posttraumatic headache after head injury in children and adolescents.” Dev Med Child Neurol. 2008

• Occurs in approximately 94% of athletes

with sports-related concussion

– Marar M, et al. “Epidemiology of concussions among United States high school athletes in 20 sports.” Am J Sports Med. 2012

Posttraumatic Headache

• Most common symptom after minor head

trauma

• Up to 90% of individuals sustaining mTBI

– Kirk C, et al. “Chronic posttraumatic headache after head injury in children and adolescents.” Dev Med Child Neurol. 2008

• Occurs in approximately 94% of athletes with

sports-related concussion

– Marar M, et al. “Epidemiology of concussions among United States high school athletes in 20 sports.” Am J Sports Med. 2012

Headaches in Student-Athletes

• Quite challenging in the context of contact

and/or collision sports

• Often unclear if HA represents:

– Exacerbation of an underlying HA disorder – New onset HA unrelated to trauma – A genuine concussive injury

• When making return-to-play decisions,

misdiagnosis can be life-threatening

Comprehensive Assessment of Headache in High School Football Players

Parameter n = 74 % History of Headache 58.6 Migraine 25 33.8 Sinus 21 28.4 Tension-type 8 10.8 Other 3 4.1

Seifert T, Shipman V, Meyer K, et al. In preparation.

“I have sinus headaches”

Eross E et al. Headache. 2007;47:213–224.

86% Migraine 3% Sinus-related

Patients self-diagnosing “sinus” headaches

A Migraine with or without aura 52 B Probable migraine 23 C Chronic migraine 11 D Non-classifiable 9 E Rhinosinusitis 3 F Cluster headache 1 G Hemicrania continua 1

Comprehensive Assessment of Headache in High School Football Players

• Of those indicating a prior history of concussion (n=

27): – 37.0% reported a history of migraine – 29.6% indicated a history of sinus headache

• Of those reporting a prior history of multiple

concussions (n= 8): – 50.0% reported a history of migraine – 37.5% indicated a history of sinus headache

Seifert T, Shipman V, Meyer K, et al. In preparation

NCAA Headache Task Force

Comprehensive Assessment of Headache: Experience in Collegiate Student-Athletes

• Subjects (N=834) from 5 Division-I member institutions
• 597 males and 237 females
• Noncontact/Contact sports

A Report by the NCAA Headache Task Force

Seifert T, Cowan R, Kontos A, et al. In press.

Track & Field Tennis Swimming Basketball Volleyball Soccer Football

Contact Exposure

What does it all mean?

Headache history should become a standard portion

• f any preseason screening

evaluation

Concussion

Concussion

Thank You!

tad.seifert@nortonhealthcare.org

Please complete and return the session evaluation.

Thank you!