bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Overuse Injuries in U.S. Secondary School Athletics from 2014-2015 to 2018-2019 Using the National Athletic Treatment, Injury, and Outcomes Network Surveillance Program
Authors: Post Eric G. , Simon Janet E. , Robison Hannah , Morris Sarah N. , Bell David R. 
Published: May 2022

Background: Large-scale injury surveillance systems such as the National Athletic Treatment, Injury and Outcomes Network Surveillance Program (NATION-SP) allow for the investigation of injury rates in national samples of high school athletes. The most recent studies examining overuse injury rates in high school sports reported data from 2012-2013 and therefore may not reflect current overuse injury rates in high school sports. Hypothesis/Purpose: To 1) determine overuse time-loss (TL) and non-time-loss (NTL) injury rates among high school student athletes using NATION-SP data collected from 2014-2015 to 2018-2019 and 2) compare overuse injury rates based on student-athlete gender defined by sport, sport, and injury location. We hypothesized that TL overuse injury rates would be greater than those previously reported from earlier data (1.64/10,000 athletic exposures (AEs) and 1.50/10,000 AEs). We also hypothesized that overall overuse rates would be greater in girls’ sports compared to boys’ sports and would differ between injury types (TL vs. NTL) and injury location. Methods: During the 2014-2015 through 2018-2019 school years, NATION-SP documented TL and NTL injuries from 222 high schools. This study included 23 high school sports during preseason, regular season, and post-season competitions and practices. Overuse injuries were identified using a combination of reported injury mechanism and diagnosis. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs). Results: The overall overuse injury rate was 6.6/10,000 AEs (95%CI=6.3, 6.9), the NTL overuse injury rate was 4.0/10,000 AEs (95%CI=3.8, 4.3), and the TL overuse injury rate was 2.6/10,000 AEs (95%CI=2.4, 2.8). The overuse injury rate was greater in girls’ sports compared to boys’ sports (IRR=1.8; 95%CI=1.6, 1.9). The highest rates of overuse injury regardless of sport gender were reported in girls’ cross-country (20.0/10,000 AEs; 95%CI=15.7, 25.1), girls’ field hockey (17.6/10,000 AEs; 95%CI=12.3, 24.5), and girls’ track and field (17.5/10,000 AEs; 95%CI=14.9, 20.4). Overuse injury rates were highest for the lower extremity compared to the upper extremity (IRR=5.45; 95%CI=4.76, 6.27) and for the lower extremity compared to the trunk and spine (IRR=11.08; 95%CI=9.21, 13.45). Conclusions: Using NATION-SP data collected over five consecutive school years, overuse injury rates among high school athletes were much greater than previously reported earlier in the decade. Awareness of overuse injury risk as well as prevention and intervention recommendations are necessary and should be specifically targeted towards cross-country, field hockey, and track and field athletes. [Table: see text][Figure: see text]
Pediatric Tibial Spine Fractures: Exploring Case Burden by Age and Sex
Authors: DeFrancesco Christopher J. , Wilson Lauren , Mackie Alexandra T. , Lebrun Drake , Memtsoudis Stavros G. , Fabricanta Peter D. 
Published: May 2022

Background: Pediatric tibial spine fractures (TSFs) are a well-known clinical entity, but the epidemiology of these injuries is not fully understood. Further, there is limited data on outcomes after TSF treatment, specifically the proportion of patients that go on to require subsequent ACL reconstruction after completing their initial treatment course. Purpose/Hypothesis: To describe the distribution of TSF case burden by age and sex, and to determine the proportion of patients who undergo subsequent ACL reconstruction or develop ACL insufficiency. Methods: The Truven Marketscan database was queried to identify patients aged 7-18 years with TSFs during the time period of 2016-2018. Diagnosis and initial treatment (surgical vs. nonoperative) was recorded based on database coding. Case burden by age and sex was calculated. The database, which includes longitudinal data, was then queried for subsequent diagnoses of ACL insufficiency as well as subsequent ACL reconstruction procedures performed among the subjects. Results: We found 876 cases of TSF, 71.3% of which were treated nonoperatively. The male:female ratio for case burden was 2.2. Cases peaked at age 13-14 for males and age 11-12 for females (Figure 1). Of all cases identified, 3.7% also had either a diagnosis code for ACL laxity entered in a delayed fashion into the database or a later procedure code for ACL reconstruction (considered together to represent subsequent “ACL insufficiency”). Only 15 subsequent ACL reconstructions were found; all of which were among males, and 9 of which were among males 13-14 years old (Figure 2). Conclusion: This longitudinal study is the largest epidemiologic analysis of pediatric TSFs to date. We found low rates of subsequent ACL insufficiency and ACL reconstruction in general, with males aged 13-14 accounting for the most cases and exhibiting the highest rates of subsequent ACL insufficiency and ACL reconstruction. Rates of subsequent ACL reconstruction were lower than previously reported. Males accounted for about twice as many cases as females. [Figure: see text][Figure: see text]
Saccadic Latency Measures on Oculomotor Tracking and King Devick Testing Performance Measures in Pediatric Concussion Patients
Authors: Sarva Saikaashyap , Thirunagari Prem Kumar , Rieiro Hector , Bell Matthew , Streeter Leslie , Minor Jon , Balaji Arvind , Dusenberry Brett , Mortazavi Mo 
Published: May 2022

Background: King-Devick (KD) testing has been a reliable clinical tool used to identify changes in rapid eye movements between fixation points (saccades) after concussion. Other clinical tools such as oculomotor tracking (OMT) devices have been used to assess the extent of visual dysfunction in concussion patients to aid diagnosis, subtyping, and symptom management. Purpose: To compare trends in OMT saccadic motion analysis data to KD times/performance in concussed patients. Methods: Retrospective study of 66 pediatric patients (ages 12 to 21) with concussion. KD testing was conducted using standard 3 card protocol with a series of numbers which the patient reads aloud in a specific pattern as fast and accurately as possible without head movement. The length of time to complete each card was noted and the three KD times were averaged, resulting in one mean KD value for each patient. Patients were categorized into either a “Fast” (average KD time from 0 - 20 seconds), n=56, or “Slow” group (average KD time above 20 seconds), n=10. Each patient underwent testing with an OMT device during the same visit (250 Hz video-eye tracker), which measured vertical and horizontal saccadic latencies. Statistical analysis using a paired two sample t-test assuming equal variances compared the OMT data between the slow and fast groups. Exclusion criteria included history of visual disorders, learning disorders, seizure disorder, or intracranial hemorrhage. Results: The slow KD group had an average vertical saccadic latency of 248.88 ms and a horizontal saccadic latency of 214.66 ms (Table 1). The fast KD group had an average vertical saccadic latency of 217 ms and a horizontal saccadic latency of 196.64 ms. A t-test of vertical latency showed a statistically significant difference between slow and fast groups (p value = 0.002). A T-test of horizontal latency resulted in a p value = 0.069, which may support a statistically significant difference with a larger sample size. Conclusion: A potential relationship between patients with slower KD test times and slower horizontal/ vertical saccadic latencies on OMT saccadic analysis may be present. However, these trends will need more testing under larger sample sizes in order to make definitive conclusions. [Table: see text]
An Analysis of the Increased Risk for Lower Extremity Injury Within 12 Months After Concussion and Utilization of Lower Extremity Measures for Return to Sport
Authors: Switzer Claire , Melfi Nicole , Mitchell Katy , Hofschulte Robert , Vora Purvi 
Published: May 2022

Background: According to the Concussion Clinical Practice Guidelines, the typical recovery timeline post-concussion is about 7-14 days. However, recent research has shown an increased risk for lower extremity (LE) injury as early as 90 days and up to 1 year post-concussion. Purpose: The primary purpose of this study was to determine the prevalence of youth athletes who sustained a LE injury within 1 year post-concussion at Texas Children’s Hospital. The secondary purpose of this study was to describe the prevalence and utilization of LE functional testing performed by Physicians (MDs), Physical Therapists (PTs), and Athletic Trainers (ATs) as part of return to sport (RTS) clearance post-concussion. Methods: A retrospective chart review was completed consisting of patients diagnosed with a concussion by a Sports Medicine Physician from September 2018 to September 2020. The inclusion criteria were as follows: male or female, ages 8-21, and active participation in 1 or more sports. The data was collected in Microsoft Forms. Additionally, a Microsoft Forms survey was sent to Sports Medicine MDs, PTs, and ATs to assess utilization of LE functional tests. SPSS 25.0 was used for analysis with alpha level at .05. A one-sample chi-square test was utilized to compare re-injury rate to the known rate of 1%. Other proportional comparisons were run using two-sample chi-square analyses. Results: A total of 635 charts were reviewed with 527 patients participating in at least 1 sport. 12.7% (N=54) of those who sustained a concussion had either a musculoskeletal injury or another concussion within 1 year, with the highest proportion of injuries being a second concussion (33.3%) or ligament sprain (35.2%). Of the providers polled, 52.8% do not currently use a LE functional measure as part of RTS criteria. The most commonly reported reasons that providers do not use LE measures were as follows: not included in their standard of practice, lack of time, and lack of knowledge. Conclusion: The results suggest a LE test battery may be beneficial to assess LE injury risk post-concussion. Additionally, the majority of providers do not currently use LE functional measures when assessing RTS criteria. Considering the increased risk for LE injury and lack of LE functional testing completed by providers, further education about current, available LE functional testing should be provided to decrease the prevalence of LE injury after concussion. Future studies should analyze the effects of LE strengthening and functional testing on subsequent LE injury risk post-concussion.
Return to Sport Testing After Arthroscopic Shoulder Surgery in Adolescent Patients
Authors: Anderson Kathryn G. , Roman Dylan , Varakitsomboon Shing , Weaver Adam , Saper Michael G. 
Published: May 2022

Background: Readiness for return to sport (RTS) after surgery can be assessed using strength and functional performance testing. However, data regarding RTS testing after arthroscopic shoulder stabilization in adolescent patients is limited. Purpose: To investigate the results of strength and functional RTS testing following arthroscopic stabilization in adolescent patients with shoulder instability. Methods: A retrospective review of medical records was performed to identify adolescent patients who underwent arthroscopic shoulder stabilization and subsequent RTS testing between April 2017 and April 2020. Surgeries were performed by a single sports medicine fellowship-trained surgeon; RTS assessments were performed at the primary institution’s sports rehabilitation clinic by a licensed physical therapist. Patient demographics, operative details, patient-reported outcome measures (PROMs) (VAS, Tegner, ASES, QuickDASH), and RTS testing results were collected. PROMs were obtained at the time of the RTS test. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥90%. Differences between the involved and uninvolved limbs were analyzed. Correlations between RTS testing results and PROMs were examined. Results: 24 patients (62.5% male) were identified with mean age of 15.5 years (range, 13-21 years). Football was the most common primary sport played (33.3%). 58.3% of patients underwent surgery on their dominant shoulder. 21 patients had isolated anterior repairs, two had combined anterior/posterior repairs, and one had an isolated posterior repair. RTS testing was performed at a mean of 6.02 ± 0.64 months postoperatively. All PROMs improved significantly from pre-operative to the time of RTS testing (p<0.0001). All patients (n=24) failed at least one component of the RTS testing (Table 1). Pre-operative Tegner scores were positively correlated with involved isokinetic external rotation symmetry (r=0.383, p<0.05) and with closed kinetic chain upper extremity stability test (CKCUEST) performance (r=0.577, p<0.005). Post-operative Tegner and ASES scores were positively correlated with involved isometric internal rotation LSI (r=0.418, p<0.05) and CKCUEST performance (r=0.383, p<0.05), respectively. Isometric External Rotation LSI was positively correlated with the Isokinetic External Rotation LSI at 180°/sec for the surgical limb (r=0.57, p<0.01). Conclusion: At 6-months postoperative, shoulder strength and stability deficits persist in the surgical limb of adolescent patients. PROMs improve significantly from pre-operative to time of RTS testing. Tegner and ASES scores may be associated with objective shoulder strength and stability measurements. [Table: see text]
Multiple comorbid conditions and healthcare resource utilization among adult patients with hyperkalemia: A retrospective observational cohort study using association rule mining
Authors: Dai Dingwei , Sharma Ajay , Alvarez Paula J , Woods Steven D 
Published: May 2022

Objectives To estimate the prevalence of specific comorbid conditions (CCs) and multiple comorbid conditions (MCCs) among adult patients with hyperkalemia and examine the associations between MCCs and healthcare resource utilization (HRU) and costs. Methods This retrospective observational cohort study was conducted using a large administrative claims database. We identified patients with hyperkalemia (ICD-10-CM: E87.5; or serum potassium >5.0 mEq/L; or NDC codes for either patiromer or sodium polystyrene sulfonate) during the study period (1/1/2016–6/30/2019). The earliest service/claim date with evidence of hyperkalemia was identified as index date. Qualified patients had ≥12 months of enrolment before and after index date, ≥18 years of age. Comorbid conditions were assessed using all data within 12 months prior to the index date. Healthcare resource utilization and costs were estimated using all data within 12 months after the index date. Association rule mining was applied to identify MCCs. Generalized linear models were used to examine the associations between MCCs and HRU and costs. Results Of 22,154 patients with hyperkalemia, 94% had ≥3 CCs. The most common individual CCs were chronic kidney disease (CKD, 85%), hypertension (HTN, 83%), hyperlipidemia (HLD, 81%), and diabetes mellitus (DM, 47%). The most common dyad combination of CCs was CKD+HTN (71%). The most common triad combination was CKD+HTN+HLD (62%). The most common quartet combination was CKD+HTN+HLD+DM (36%). The increased number of CCs were significantly associated with increased ED visits, length of hospital stays, and total healthcare costs (all p-value < 0.0001). Conclusions MCCs are very prevalent among patients with hyperkalemia and are strongly associated with HRU and costs.
Using mobility status as a frailty indicator to improve the accuracy of a computerised five-level triage system among older patients in the emergency department
Authors: Chien Cheng-Yu , Chaou Chung-Hsien , Yeh Chung-Cheng , Hsu Kuang-Hung , Gao Shi-Ying , Ng Chip-Jin 
Published: May 2022

Abstract
Background
Owing to societal ageing, the number of older individuals visiting emergency departments (EDs) has increased in recent years. For this patient population, accurate triage systems are required. This retrospective cohort study assessed the accuracy of a computerised five-level triage system, the Taiwan Triage and Acuity System (TTAS), by determining its ability to predict in-hospital mortality in older adult patients and compare it with the corresponding rate in younger adult patients presenting to EDs. The association between frailty, which the current triage system does not consider, was also investigated.

Methods
The medical records of adult patients admitted to a single ED between 2016 and 2017 were reviewed. Data collected included information on demographics, triage level, frailty status, in-hospital mortality, and medical resource utilisation. The patients were divided into four age groups: two older adult groups (older: 65–84 years and very old: ≥85 years) and two younger adult groups (young: 18–39 and middle-aged: 40–64 years).

Results
Our study included 265,219 ED adult patients, of whom 64,104 and 16,009 were in the older and very old groups, respectively. The in-hospital mortality rate at each triage level increased with age. The ability of the TTAS to predict in-hospital mortality decreased with age (area under the receiver operating characteristic curve [AUROC]: young: 0.86; middle-aged, 0.84; and older and very old: 0.79). Frailty was associated with in-hospital mortality (odds ratio, 2.20; 95% confidence interval, 2.03–2.38). Adding mobility status as a frailty indicator to TTAS only slightly improved its ability to predict in-hospital mortality (AUROC: 0.74–0.77) in patients ≥65 years of age.

Conclusions
The ability of the current triage system to predict in-hospital mortality decreases with age. Although frailty as mobility was associated with in-hospital mortality, its addition to the TTAS only slightly improved the accuracy with which in-hospital mortality in older patients presenting to EDs was predicted.
Coverage and factors associated with completion of continuum of care for maternal health in sub-Saharan Africa: a multicountry analysis
Authors: Alem Adugnaw Zeleke , Shitu Kegnie , Alamneh Tesfa Sewunet 
Published: May 2022

AbstractBackgroundMany maternal and neonatal deaths are largely preventable by expanding the continuum of care (at least four antenatal visits, skilled birth attendance and postnatal care). Even though ensuring the Continuum of Care (CoC) has advantages over separate services, evidence from the globe suggests that completion of the CoC for maternal health is very low. From our search of the literature, there is limited evidence on the completion of the entire CoC and its associated factors in sub-Saharan Africa (sSA). Therefore, this study aimed to assess coverage and associated factors of completion of the CoC for maternal health in sSA.MethodsData for the study were drawn from a recent nationally representative survey of 32 Demographic and Health Surveys (DHS). A total weighted sample of 225,135 women of reproductive-age, who gave birth in the two preceding years were included. Due to the hierarchical nature of DHS data, a multilevel logistic regression model was applied to investigate individual and community-level factors that may influence completion of CoC. Adjusted Odds Ratios (aORs) with 95% Confidence Interval (CI) were reported and variables with 95% CI not including 1 were considered as significant factors of the completion of CoC.ResultsOnly, 56,172 (25.0%; 95% CI, 20.5%, 29.4%) of the women in sSA utilized the CoC for maternal health which varied from 11,908 (17.9.0%) in East Africa to 7,418 (51.5% in Southern Africa. Factors associated with higher odds of CoC were women aged 24–34 years (aOR 1.22, 95% CI: 1.17, 1.25), aged ≥ 35 years (aOR 1.40, 95% CI: 1.35, 1.47), attending primary education (aOR 1.44, 95% CI: 1.41, 1.49), secondary education (aOR 1.95, 95% CI: 1.89, 2.03), higher education (aOR 2.15, 95% CI: 2.01, 2.25), having mass media exposure (aOR 1.35, 95% CI: 1.28, 1.39), women from female-headed households (aOR 1.18, 95% CI: 1.15, 1.21) and women from communities with high maternal education (aOR 1.12, 95% CI: 1.09, 1.16). However, perceiving distance from the health facility as a big problem (aOR 0.88, 95% CI: 0.85, 0.91), residing in rural areas (aOR 0.78, 95% CI: 0.75, 0.81), delayed ANC initiation (aOR 0.43, 95% CI: 0.41, 0.47) and unintended pregnancy (aOR 0.87, 95% CI: 0.84, 0.91) were associated with lower odds of CoC.ConclusionThis study showed a low proportion of women, who utilized the CoC in sSA. Both individual and community-level factors were associated with CoC completion rates among women in sSA. Therefore, policymakers in sSA must consider both individual and community-level factors and undertake multi-sectorial approaches to address barriers of CoC at different levels.
Could radiofrequency echographic multispectrometry (REMS) overcome the overestimation in BMD by dual-energy X-ray absorptiometry (DXA) at the lumbar spine?
Authors: Caffarelli Carla , Tomai Pitinca Maria Dea , Al Refaie Antonella , De Vita Michela , Catapano Simone , Gonnelli Stefano 
Published: May 2022

Abstract
Background
Osteoarthritis (OA) and vertebral fractures at the lumbar spine lead to an overestimation of bone mineral density (BMD). Recently, a new approach for osteoporosis diagnosis, defined as radiofrequency echographic multi-spectrometry (REMS), represents an innovative diagnostic tool that seems to be able to investigate bone quality and provide an estimation of fracture risk independent of BMD.
The aim of this paper was to evaluate whether the use of REMS technology can favor the diagnosis of osteoporosis in subjects with an apparent increase in BMD.

Methods
In a cohort of 159 postmenopausal (66.2 ± 11.6 yrs) women with overestimated BMD by DXA at the lumbar spine, we performed an echographic scan with the REMS technique.

Results
The mean values of BMD at different skeletal sites obtained by the DXA and REMS techniques showed that the BMD T-scores by REMS were significantly lower than those obtained by the DXA technique both at the lumbar spine (p < 0.01) and at all femoral subregions (p < 0.05). In OA subjects, the percentage of women classified as “osteoporotic” on the basis of BMD by REMS was markedly higher with respect to those classified by DXA (35.1% vs 9.3%, respectively). Similarly, the REMS allows a greater number of fractured patients to be classified as osteoporotic than DXA (58.7% vs 23.3%, respectively).

Conclusions
REMS technology by the analysis of native raw unfiltered ultrasound signals appears to be able to overcome the most common artifacts, such as OA and vertebral fracture of the lumbar spine, which affect the value of BMD by DXA.