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Youth soccer participation, particularly among females, continues to grow worldwide. With the high incidence of sport-related concussion (SRC) in soccer, it is important to investigate if SRC occurs disproportionally by positions. Our hypothesis was to see no positional differences in SRCs, SRC-related characteristics, and outcomes among in female youth soccer athletes. Data were prospectively collected from participants at a single sports medicine institution between August 2015-April 2021. Female participants aged 8–18 diagnosed with SRC sustained during an organized soccer practice, scrimmage, or game were separated into 4 groups based on position: Forward, Midfielder, Defender, and Goalkeeper. Demographics, medical history, injury-related details, and outcomes were reviewed. A chi-square test or Fisher's exact test was used for categorical variables. Continuous variables were compared with Mann-Whitney or Kruskal-Wallis test. Two hundred fourteen participants were included: 52 Forwards, 65 Midfielders, 63 Defenders, and 34 Goalkeepers. There were no significant differences between the groups in age, race, ethnicity, or previous concussion history. Differences in mechanism existed with Goalkeepers most commonly reporting Head to Body Part. Goalkeepers, which make up 1/11 of the total positions on the field, had a significantly higher proportion of SRCs compared to Field Positions. (9.1% vs 15.9%) At 3-month post-enrollment, there were no significant differences in reported symptoms or return-to-play between the different positions. In youth female soccer players, goalkeepers sustained a higher proportion of sport-related concussions compared to field players based upon the composition of a soccer team. The mechanism of injury also differed among the different soccer positions. However, no differences in concussion characteristics, outcomes, or RTP were seen across the different soccer positions. [ABSTRACT FROM AUTHOR]

Background: A validated clinical risk tool has been developed to identify pediatric and adolescent patients at risk of developing persisting symptoms after concussion, but has not been prospectively investigated within a sample of athletes seen after concussion by primary care sports medicine physicians and/or athletic trainers. Purpose: To determine whether a validated clinical risk prediction tool for persistent postconcussive symptoms (PPCSs) predicted which patients would develop PPCSs when obtained within 14 days of concussion among a multicenter sample of adolescent athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Pediatric and adolescent patients (8-18 years of age) from 7 pediatric medical centers and 6 secondary school athletic training facilities who were diagnosed with a concussion and presented ≤14 days after concussion were enrolled as part of the Sport Concussion Outcomes in Pediatrics (SCOPE) study during their initial visit and were followed until symptom resolution. Clinical risk scores (Predicting and Preventing Post-concussive Problems in Pediatrics [5P]) and total symptom severity were obtained using the Post-Concussion Symptom Inventory at the initial visit (mean, 4.9 ± 2.9 days after concussion). Participants were then compared based on symptom resolution time: PPCS group (≥28 days to symptom resolution) and no-PPCS group (<28 days). The authors assessed the odds of developing PPCSs based on the 5P risk score using a binary logistic regression model and the utility of the clinical risk prediction tool to identify total time to symptom resolution using a Cox proportional hazards model. Results: A total of 184 participants enrolled, underwent initial evaluation, and were followed until symptom resolution (mean age, 15.2 ± 2.1 years; 35% female). The mean time to symptom resolution across the entire sample was 17.6 ± 3.7 days; 16% (n = 30) of participants developed PPCS. Those in the PPCS group had significantly greater mean initial total 5P risk scores than those in the no-PPCS group (7.9 ± 1.7 vs 5.9 ± 2.3, respectively; P <.001). After adjustment for initial symptom severity, time to assessment, and assessment setting, a higher initial total 5P risk score was associated with a significantly greater odds of developing PPCSs (adjusted odds ratio, 1.49; 95% CI, 1.07-2.08; P =.019). Furthermore, a higher 5P risk score was significantly associated with longer total symptom resolution time (hazard ratio, 0.80; 95% CI, 0.74-0.88; P <.001). Conclusion: In a multicenter sample of youth athletes seen in different outpatient health care settings, the 5P risk score accurately predicted which athletes may be at risk for developing PPCSs. [ABSTRACT FROM AUTHOR]

Objective: Persisting concussion symptoms may adversely affect return to work and functioning in daily activities. This study compared adults who were initially evaluated < 30 days versus those evaluated ≥ 30 days following a concussion at a specialty concussion clinic to determine if delayed initial evaluation is associated with persisting symptoms during recovery. Method: Participants (N = 205) 18 years of age and older who sustained a concussion and presented to a North Texas Concussion Registry (ConTex) clinic were evaluated at two time points: initial clinical visit and three-month follow-up. Participants provided medical history, injury related information, and completed the Sport Concussion Assessment Tool-5 Symptom Evaluation, Generalized Anxiety Disorder 7-item scale (GAD-7), and Patient Health Questionnaire (PHQ-8). Participants were divided into two groups: early and delayed evaluation (±30 days post injury). Results: Number and severity of concussion symptoms were similar between both groups at their initial clinical visit. However, linear regression models showed that a delayed clinical evaluation was associated with a greater number and severity of concussion symptoms along with greater aggravation of symptoms from physical and cognitive activity at three-month follow-up. Conclusions: Individuals who sought care at specialty concussion clinics regardless of previous care 30 or more days following their injury reported more serious persisting concussion symptoms at three month follow-up than those who sought care sooner. Education to improve adults' recognition of concussions when they occur and obtaining earlier clinical evaluation may represent important opportunities in promoting better recovery and reducing persisting concussion symptoms. This study found that a delayed presentation to a specialty concussion clinic (30 or more days post-injury) regardless of previous evaluation was associated with poorer recovery outcomes in adults compared to those with an earlier presentation. Time from injury to a formal clinical evaluation of a concussion should be considered at initial evaluation by all providers and incorporated into prognosis and treatment planning. Concussion educational programs should be developed specifically for adults to promote recognition of concussions and importance of seeking prompt evaluation by specialized providers for this injury. [ABSTRACT FROM AUTHOR]

Hurdling is a track event that is unique due to a combination of running and jumping over an apparatus. Since hurdling requires a special skillset with sprinting and jumping, athletes are at risk for various musculoskeletal injuries. However, there has been a paucity of studies describing the epidemiology of pediatric hurdle injuries. To examine hurdle-related injury types, injured body parts, injury mechanisms, and injury settings in children and adolescents. Descriptive epidemiology study. Data from the National Electronic Injury Surveillance System, which represents emergency room visits, was retrospectively reviewed. Injury data involving hurdle injuries was searched during a 10-year period (2008–2017) with hurdlers 18 years old and younger. Injuries were classified based upon injury types, body parts, injury mechanisms, and injury settings. Descriptive statistics were used including mean ± standard deviation, frequency (N), and percentages (%). A total of 749 hurdle-related injuries were found from 333 males (44.5%) and 416 females (55.5%). The top three injury types were fracture (N = 218, 29.1%), joint sprain (N = 191, 25.5%), and contusion/hematoma/bruise (N = 78, 10.4%). The top three injured body parts were ankle (N = 140, 18.7%), knee (N = 120, 16.0%), and wrist (N = 69, 9.2%). The most common injury mechanisms were apparatus-related trips, falls, and landings (N = 594, 79.0%). Finally, injury settings consisted of track and field practices (N = 469, 62.6%), track and field meets (N = 96, 12.8%), and other settings including gym, physical education class, recess, school activities, and camps (N = 49, 6.5%). In pediatric hurdle athletes, the most prevalent injury type seen in the emergency room was fracture. Although most hurdle-related injuries occur in the lower extremity, wrist injuries were the third most commonly injured body location. The most common injury mechanism was apparatus-related trip, fall, and landing, and injuries most commonly occurred during track practices. In pediatric hurdle athletes seen in the emergency room, majority of injuries consisted of traumatic fractures and joint sprains at ankle, knee, and wrist, which frequently occurred with apparatus-related trip, fall, and landing mechanisms during track and field practices. [ABSTRACT FROM AUTHOR]

Background: The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) has demonstrated normally distributed scores in children aged 10 to 18 years. It has been used to evaluate knee injuries; however, there is limited information regarding its use in evaluating other injury types. Purpose: To (1) assess the validity and utility of HSS Pedi-FABS in youth athletes with injuries to different parts of the body and (2) evaluate the association between the HSS Pedi-FABS and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health 7 (PGH), as well as PROMIS–Pain Interference (PGH-PI) and PROMIS-Fatigue (PGH-F) components. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The authors performed a retrospective review of youth athletes aged 10 to 18 years who completed the HSS Pedi-FABS as part of their previsit intake questionnaire between April 2016 and July 2020. HSS Pedi-FABS score distributions were compared and evaluated for ceiling effects in cohorts determined by demographic, injury characteristic, and sports participation variables; a ceiling effect was determined to be present if >15% of respondents received the highest possible score. HSS Pedi-FABS scores were analyzed for a correlation with PGH, PGH-PI, and PGH-F components. Results: Included were 2274 patients (mean age, 14.6 ± 2.1 years; 53.0% female) participating in 21 distinct primary sports for 9.6 ± 7.9 hours per week. The mean HSS Pedi-FABS scores by injury group were as follows: elbow (22.7 ± 6.7), shoulder (21.0 ± 8.7), ankle (20.2 ± 8.8), knee (19.5 ± 9.1), and hip (15.4 ± 10.4) (P <.001). Broad distribution was seen in each cohort, with no floor or ceiling effects. The HSS Pedi-FABS score correlated with patient-reported hours per week (r = 0.33), days per week (r = 0.33), and years of participation (r = 0.21) (P <.001 for all). All 3 PROMIS components correlated with HSS Pedi-FABS: PGH (r = 0.28), PGH-PI (r = –0.11), and PGH-F (r = –0.15) (P <.001). Conclusion: Study findings indicated that the HSS Pedi-FABS is a valid tool for measuring physical activity level in most injured youth athletes, not just those with knee injuries. The correlation of HSS Pedi-FABS with the PGH suggests a positive relationship of childhood physical activity with general health. [ABSTRACT FROM AUTHOR]

The objective was to examine the use of docosahexaenoic acid (DHA) for the treatment of sport-related concussion (SRC) in adolescent athletes. We hypothesize that participants who intake 2 g of DHA daily will not experience differences in recovery compared with participants who take a placebo. This double-blind, randomized controlled pilot trial was performed in a tertiary pediatric sports medicine clinic from 2013 to 2017 in adolescents (14-18 years) presenting with diagnosed SRC within 4 days of injury. Forty participants were randomized into DHA or PLACEBO group and were instructed to take 2 capsules twice daily for 12 weeks. Participants in the DHA group were symptom-free earlier than the PLACEBO group (11.0 vs 16.0 days, P =.08) and were cleared to begin the Return to Sport progression (14.0 vs 19.5 days, P =.12) sooner. The use of 2 g/day of DHA was well-tolerated and did not significantly affect recovery times in adolescent athletes following SRC. Clinical Trial Registration: ClincalTrials.gov, NCT01903525 [ABSTRACT FROM AUTHOR]

Objective: To examine differences in concussion symptom reporting between female and male adults considering current psychological symptoms such as anxiety and depression and pre-injury factors in order to identify sex differences which may guide treatment efforts. Method: This prospective study is part of the North Texas Concussion Registry (ConTex). Subjects (N = 132) age 19 to 78 years had sustained a concussion within 30 days of clinic visit. The independent variable was sex and covariates included age, ethnicity, current anxiety and depression ratings, history of attention deficit disorder, history of headache/migraine, and time to clinic. The dependent variables were 22 post-concussion symptoms as measured by the Sport Concussion Assessment Tool-5 Post-Concussion Symptom Scale. Results: Analysis of covariance and ordinal logistic regression results both revealed that females had a greater likelihood of reporting increased symptom severity for 15/22 concussion symptoms. The largest risk ratios (effect size) in symptom reporting between sexes (higher symptoms in females) included: feeling more emotional 4.05 (0.72), fatigue or low energy 4.05 (0.72), sensitivity to light 3.74 (0.69), headache 3.65 (0.57), balance problems 3.31 (0.53), pressure in head 3.06 (0.51), and neck pain 2.97 (0.60). Conclusions: Adult females in our sample reported higher levels of many concussion symptoms than males and showed an increased risk of developing these same symptoms following concussion. Examination of the magnitude of sex difference in concussion symptom reporting will better inform medical staff to anticipate and address symptoms that may present greater challenges for adult females. [ABSTRACT FROM AUTHOR]

Accurate assessment of balance recovery throughout treatment of a sport-related concussion is imperative. This study examined differences in balance from diagnosis to return-to-play initiation in adolescent patients post-concussion. Second, this study investigated the extent to which the Balance Error Scoring System (BESS) correlated with center-of-pressure (COP) measures. Forty participants performed the BESS while standing on a force platform such that COP data were obtained simultaneously. Spatial and velocity COP-based measures were computed for the double-stance conditions. BESS scores and COP-based measures indicated improved balance performance between visits. Specifically, 62.5/65.0% of participants exhibited improved firm/foam BESS final scores, respectively, and 56.4–71.8% exhibited improved COP-based measures. However, once normative ranges were referenced to identify maintained performance, the percentage of participants who substantially improved differed from initial findings (BESS: 2.5/7.5%, COP: 48.7–69.2%). Additionally, positive correlations between balance measures were primarily found at diagnosis (r=0.33–0.53), while only three correlations were maintained at return-to-play initiation (r=0.34–0.39). BESS scores successfully identified poor balance performance at diagnosis when symptoms were most pronounced, but failed to accurately depict performance once balance impairment, indicated by COP-based measures, became less apparent. Further work is needed to implement more advanced balance assessments into clinical environments. [ABSTRACT FROM AUTHOR]

Lingering concussion symptoms can negatively impact a child's well-being, yet variability in recovery is poorly understood. To aid detection of those at risk for prolonged symptom duration, we explored postconcussion mood and sleep symptoms as predictors of recovery time in adolescent athletes. We utilized analyses designed to control for potentially confounding variables, such as concussion severity indicators and premorbid psychiatric history. Participants included 393 adolescent athletes (aged 12–18 years) evaluated in outpatient concussion clinics within 2 weeks after injury. Provider-documented date of symptom resolution was obtained via medical record review. Survival analysis for recovery time was conducted in the total sample, and separately for males and females using prior medical history (psychiatric disorder, prior concussion), injury-related factors (loss of consciousness, post-traumatic amnesia [PTA], concussion symptom severity), and psychological symptoms (General Anxiety Disorder-7 Item Scale, Patient Health Questionnaire-8 Item Depression Scale, Pittsburgh Sleep Quality Index) collected at initial clinic visit. PTA, concussion symptoms, and sleep quality were associated with recovery in the total sample (HRs = 0.64–0.99, ps <.05). When analyzed by sex, only concussion symptoms were associated with recovery for females (with females reporting greater symptom severity than males), while for males PTA and greater depression symptoms were significant predictors of recovery (HRs = 0.54–0.98, ps <.05). These findings identified differences in symptom presentation between sexes, particularly for mood symptoms, and suggest that assessment of postconcussive symptoms is useful in helping to identify individuals at risk for longer recovery. Continued exploration of post-injury psychological difficulties in athletes is warranted for better concussion management. [ABSTRACT FROM AUTHOR]

Objective: Consideration of individual differences in recovery after concussion has become a focus of concussion research. Sex and racial/ethnic identity as they may affect reporting of concussion symptoms have been studied at single time points but not over time. Our objective was to investigate the factors of self-defined sex and race/ethnicity in reporting of lingering concussion symptoms in a large sample of adolescents. Participants and Methods: Concussed, symptomatic adolescents (n=849; Female=464, Male=385) aged 13-18 years were evaluated within 30 days of injury at a North Texas Concussion Registry (ConTex) clinic. Participants were grouped by self-defined race/ethnicity into three groups: Non-Hispanic Caucasian (n=570), Hispanic Caucasian (n=157), and African American (n=122). Measures collected at the initial visit included medical history, injury related information, and the Sport Concussion Assessment Tool-5 Symptom Evaluation (SCAT-5SE). At a three-month follow-up, participants completed the SCAT-5SE. Pearson's Chi-Square analyses examined differences in categorical measures of demographics, medical history, and injury characteristics. Prior to analysis, statistical assumptions were examined, and log base 10 transformations were performed to address issues of unequal group variances and nonnormal distributions. A three-way repeated measures ANOVA (Sex x Race/Ethnicity x Time) was conducted to examine total severity scores on the SCAT-5SE. Bonferroni post-hoc tests were performed to determine specific group differences. SPSS V28 was used for analysis with p<0.05 for significance. Data reported below has been back transformed. Results: A significant interaction of Time by Race/Ethnicity was found for SCAT-5SE scores reported at initial visit and three-month follow-up (F(2, 843)=7.362, p<0.001). To understand this interaction, at initial visit, Race/Ethnicity groups reported similar levels of severity for concussion symptoms. At three month follow-up, African Americans reported the highest level of severity of lingering symptoms (M= 3.925, 95% CIs [2.938-5.158]) followed by Hispanic Caucasians(M= 2.978, 95% CIs [2.2663.845]) and Non-Hispanic Caucasians who were the lowest(M= 1.915, 95% CIs [1.6262.237]). There were significant main effects for Time, Sex, and Race/Ethnicity. Average symptom levels were higher at initial visit compared to three-month follow-up (F(1, 843)=1531.526, p<0.001). Females had higher average symptom levels compared to males (F(1, 843)=35.58, p<0.001). For Race/Ethnicity (F(2, 843)=9.236, p<0.001), Non-Hispanic Caucasians were significantly different than African Americans (p<0.001) and Hispanic Caucasians (p=0.021) in reported levels of concussion symptom severity. Conclusions: Data from a large sample of concussed adolescents supported a higher level of reported symptoms by females, but there were no significant differences in symptom reporting between sexes across racial/ethnic groups. Overall, at three-months, the African American and Hispanic Caucasians participants reported a higher level of lingering symptoms than Non-Hispanic Caucasians. In order to improve care, the difference between specific racial/ethnic groups during recovery merits exploration into the factors that may influence symptom reporting. [ABSTRACT FROM AUTHOR]

Background: There is limited epidemiologic data on pediatric basketball injuries and the comparison of these injuries before and after adolescence and between male and female athletes. Purpose: To assess common sex- and age-based injury patterns in pediatric basketball players. Study Design: Descriptive epidemiology study. Methods: Injury data from the National Electronic Injury Surveillance System (NEISS) and participation data from the National Sporting Goods Association were used to complete this study. Data on pediatric basketball injuries between January 2012 and December 2018 in patients aged 7 to 11 years (childhood) and 12 to 17 years (adolescence) were extracted and used to calculate national injury incidence rates with 95% CIs. Sex and age group patterns were examined utilizing Pearson chi-square tests. Z tests were conducted for the comparison of injury rates between female and male athletes in each age group and overall injury rate across age groups. Results: An average of 9582 basketball injuries were reported annually in the NEISS, which calculated to an annual national estimate of 294,920 injuries. The most common diagnoses were ankle strain/sprain (17.7%), finger strain/sprain/fracture (12.1%), concussion/head injury (9.4%), knee strain/sprain (4.5%), and facial laceration (3.3%). There was a significant increase in injury prevalence in adolescents (12- to 17-year-old category: 238,678 injuries per year) when compared with childhood (7- to 11-year-old category: 56,242 injuries per year) (P <.0001). Concussions/head injuries occurred at a high rate in childhood, second only to finger strain/sprain/fracture, and at a similar rate in females and males (injuries per 100,000 athlete-days: 4.9 [95% CI, 3.1-6.7] vs. 5.9 [4.3-7.5], respectively; P =.41). From childhood to adolescence, injury prevalence increased for all areas and across both sexes, except for female finger strain/sprain/fracture; however, the rate of increase for concussion/head injuries and knee injuries was significantly higher in female compared with male athletes (P <.0001 for both). In adolescents, ankle injuries were the most common injury overall. Conclusion: Ankle injuries continue to be the most predominant pediatric basketball injury. However, disproportionate rates of both knee and concussion/head injuries in female athletes during adolescent basketball are of concern and have implications for injury prevention. [ABSTRACT FROM AUTHOR]

Recovery and return to play are important milestones for athletes who sustain sport-related concussions (SRC). Several factors have been shown to influence resolution of post-concussion related symptoms (PCS), but resilience, a trait that reflects the ability to overcome adversity, is another factor that may influence recovery. The aim of this study was to determine the relationship of resilience with resolution of symptoms during recovery in adolescents and young adults following SRC. This prospective study is part of the North Texas Concussion Registry (ConTex). Subjects (N = 332) aged 13 to 25 years who sustained a SRC within 10 days of presenting to clinic were evaluated at two time points: initial clinical visit and three-month follow-up. Resilience was measured by the self-report Brief Resilience Survey (BRS) and PCS by the Sport Concussion Assessment Tool-5 Symptom Evaluation Post-Concussion Symptom Scale (PCSS). Recovery was determined by self-reported return to sports/physical activity and percent back to normal. Repeated measures ANCOVA and linear regression models showed that lower resilience ratings at initial visit were associated with a greater number and severity of PCSS symptoms along with higher levels of anxiety and depression symptoms during recovery from SRC. At three months, subjects with lower initial resilience ratings were less likely to report feeling back to normal and had greater aggravation of symptoms from physical and cognitive activity even when they had returned to sports/physical activity. Lower resilience was associated with greater symptoms and delayed recovery from SRC. Results suggest that resilience may be another important factor to address in recovery from SRC. Future research is needed to examine the extent to which resilience measured after SRC reflects pre-injury characteristics and to better inform the development of interventions to promote resilience during recovery. [ABSTRACT FROM AUTHOR]

Background: The HSS Pedi-FABS activity scale has become increasingly used in children age 10-18 since its development in 2013. Research reports on the utility of the measure in general youth athletes with knee injuries, however limited information is available regarding use in evaluating a variety of joint injuries, athletes who participate in sports with disparate biomechanics, or specialized competitive athletes. Hypothesis/Purpose: This study assessed the sensitivity and distribution of Pedi-FABS in an athletic youth population. Secondarily, this study evaluated Pedi-FABS association with PROMIS® Pediatric Global Health 7(PGH7) with Pain Interference(PGHPI) and Fatigue(PGHF) components. Methods: A retrospective review of youth athletes age 10-18 presenting for evaluation at a single pediatric sports medicine clinic between 4/2016-7/2020 was performed. Participants were included if they completed a pre-visit intake questionnaire and Pedi-FABS. Descriptive statistics were used to analyze Pedi-FABS for normal distribution and the presence of a floor or ceiling effect in subgroups determined by demographics, injury characteristics, and sports participation. A floor or ceiling effect was determined to be present if more than 15% of respondents scored the lowest or highest possible score. A Kruskal-Wallis test used to compare average scores in each subgroup. Spearman's Correlations were calculated to assess the association of PGH with Pedi-FABS scores. Results: 2274 sports medicine patients(14.6±2.1 years; 53.0% females) were included. Of these, 2010 youth athletes reported participating in sports for 9.6±7.9 hours per week during 32.3±15.7 weeks per year with 6.2±3.4 years of participation in 21 distinct primary sports. 80.3% of patients reported participation in only one sport. Pedi-FABS Score differences were found across demographic(Table 1) and sport participation(Table 2) subgroups. Broad distribution was seen in each subgroup with no floor or ceiling effects. Pedi-FABS score correlated with hours per week(r=0.20), days per week(r=0.28), weeks per year(r=0.12), and years of participation(r=0.16/p<0.01). An inverse correlation was observed between Pedi-FABS and Days from Injury to Presentation(r=-0.21/p<0.01). An association between general health and activity level was noted as all three PGH components correlated with Pedi-FABS(PGH7: r=0.28/PGHF: r=-0.16/PGHPI: r=-0.12, p<0.01). Conclusion: Correlations with multiple forms of self-reported activity without floor or ceiling effects demonstrates the validity and sensitivity of Pedi-FABS for use in athletes with a variety of primary sports and injury types. Additionally, mean differences between demographic and sport participation subgroups, as well as associations with days to presentation and a commonly used patient reported outcome measure, may demonstrate the utility of Pedi-FABS for sports medicine clinicians. Table 1. HSS Pedi-FABS Score Distributions by Study Cohort Demographics and Injury Characteristics Table 2. HSS Pedi-FABS Score Distributions by Sports Participation Characteristics Among Self-Reported Athletes in Study Cohort [ABSTRACT FROM AUTHOR]

Background: Impairments in balance or postural control are common following sport-related concussion (SRC). The Balance Error Scoring System (BESS) is widely utilized to assess static postural stability, but laboratory-based balance measures have been shown to more accurately detect changes in postural control. Hypothesis/Purpose: To determine whether postural control improved between presentation to the sports medicine clinic and return-to-sport (RTS) initiation, and whether this trend mirrored symptom scores and cognitive performance. A secondary aim was to assess whether changes in postural control were more accurately captured with center of pressure (COP) based measures compared to BESS. Methods: Patients diagnosed with a SRC were tested within 10 days of presentation (V0) and when cleared by a physician to begin a RTS protocol (V1). Clinical measures included Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the King-Devick (K-D) test. The BESS was performed with eyes closed while standing barefoot on a force platform for 6 conditions: double-limb stance, single-limb stance, and tandem stance on both firm and foam surfaces. BESS scores and total balance time were recorded for each condition, and COP-based measures were computed for both double-limb stance conditions (Table 1). Sample entropy was computed to quantify COP regularity over time with increased values indicating improvement in postural control. Wilcoxon signed-rank tests were performed to determine significance between visits (α <0.05). Results: Forty patients (17 males, 13.8±2.0 years) were included for analysis. ImPACT verbal and visual memory scores improved by 10% and 12%, respectively, total symptom score decreased (V0 18.03±13.85, V1 0.97±2.08; p <0.01), and visual motor speed and reaction time were both 11% faster on the K-D test. For postural control, the BESS indicated significant improvement given the reduction in errors on both surfaces (Firm Total: V0 3.23±2.09, V1 2.25±2.11, p =0.01; Foam Total: V0 7.38±2.05, V1 6.08±1.76, p <0.01; Table 1). Similarly, COP-based measures exhibited better overall balance between visits (Figure 1), primarily in the medial-lateral direction on the firm and the anterior-posterior direction on the foam. Lastly, sample entropy improved between visits, indicating more effective postural control. Conclusion: Significant improvement in postural control was observed during the recovery period which mirrored improvement in symptom scores and cognitive performance. Additionally, while COP-based measures showed similar trends to the BESS, they provided more detailed information in regards to balance recovery. Specifically, findings from the double stance condition highlight the utility of a more advanced assessment of postural control for determining RTS readiness following a SRC. Table 1. COP-based measures of balance performance at diagnosis (V0) and clearance (V1) visits Figure 1. Representative stabilograms of double stance balance on firm and foam surfaces at diagnosis (V0) and clearance visits (V1) [ABSTRACT FROM AUTHOR]

Background: CDC and AAP guidelines discourage routine neuroimaging following concussion, as CT scans are only indicated if severe intracranial injury is suspected. Validated prediction rules such as Pediatric Emergency Care Applied Research Network (PECARN) criteria have decreased the number of unnecessary pediatric head CTs; however, are still commonly performed following pediatric sport-related concussion (SRC). Hypothesis/Purpose: To determine differences in injury characteristics and outcomes in athletes who did and did not undergo head CT following SRC. Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015-May 2021. Participants aged 5-18 diagnosed with SRC and presenting within 30 days were included. Participants were separated into 2 groups based on whether they had a CT scan following SRC: CT (negative scan) and no CT. Positive CTs were excluded. Groups were matched in age and time to presentation (≤14, >14-30 days). Demographics, concussion-related details, and 3-month outcome variables were analyzed including days to symptom resolution (≤30 vs >30 days) and return-to-play (RTP). Results: 324 participants were included: 162 in each group. There were no significant differences between the groups in sex, race, ethnicity, or previous concussion history. Differences in injury-related characteristics are reported in Table 1. Participants in the CT group were more likely to be participating in unorganized events (p=0.05), and less likely to continue playing following SRC (p=0.003) than the no CT group. The CT group more frequently reported head to surface mechanism of injury than the no CT group. Significantly higher rates of loss of consciousness (LOC), amnesia, and vomiting following SRC were reported in the CT group. At 3-months post-SRC, the no CT group reported RTP a week sooner than the CT group (28.8±22.3 vs 35.7±27.3 days, p=0.019). However, there was no difference in prolonged recovery (>30 days: 29.6 vs 40.5%, p=0.07) or overall RTP rates (91.9 vs 85.8%, p=0.09) between the no CT and CT groups. Conclusion: Pediatric athletes who underwent CT following SRC exhibited significantly different injury-related characteristics compared to those who did not, but the differences observed did not impact symptom resolution or return-to-play. While LOC and vomiting differences align with the PECARN prediction rules and likely contribute to decision to perform CT, the additional differences of participating in an unorganized event, head-to-surface impact, and amnesia are not part of PECARN criteria. Further research is needed to discover which variables may contribute to unnecessary head CTs following SRC. Table 1. Injury related characteristics between the CT and no CT scan groups [ABSTRACT FROM AUTHOR]

Background: Persistent postconcussive symptoms (PPCS) can negatively impact quality of life, school, and return to sport. The Predicting and Preventing Postconcussive Problems in Pediatrics [5P] clinical risk score has been validated in the Emergency Department setting to predict pediatric patients at risk of PPCS using 9 variables. Hypothesis/Purpose: To determine if the 5P risk score, obtained within 14 days of concussion, predicts which athletes seen in an athletic training or pediatric sports medicine clinic setting develop PPCS in a multi-center sample. Methods: Data were prospectively collected from participants enrolled in the Sport Concussion Outcomes in Pediatrics (SCOPE) study between September 2018-May 2021 across seven sites. Participants aged 6-18 years diagnosed with a concussion who presented within 14 days of injury were included. Demographics, medical history, and the Postconcussion Symptom Inventory (PCSI) were reviewed to calculate the 5P risk score. 5P risk scores were stratified as low (0-3 points), medium (4-8 points), and high risk (9-12 points). Participants were grouped based on symptom resolution time: PPCS (≥28 days) and no PPCS (<28 days). We compared total symptom resolution time among the 5P risk categories using one-way ANOVA and assessed the odds of developing PPCS based on 5P risk score using a binary logistic regression model. Results: We included 117 participants: 23 with PPCS (19.7%). A higher proportion of the PPCS group were female, were seen in a sports medicine clinic setting, and had a longer time to initial presentation (Table 1). Both PCSI symptom severity and 5P risk score were significantly higher in the PPCS group compared to the no PPCS group (p<0.001). Participants with high risk 5P scores had a significantly longer mean symptom resolution time compared to those with low risk scores (Figure 1; 28.4±18.2 vs 7.1±6.8 days, p=0.009). After adjusting for potential confounding variables of initial symptom severity, time to presentation, and assessment setting, each point increase on the 5P risk score was associated with a 1.7x odds of developing PPCS (odds ratio=1.66; 95% CI=1.13, 2.41; p=0.009). Conclusion: In a multi-center sample of youth athletes, the 5P risk score accurately predicted which athletes were at risk for developing PPCS. The odds of developing PPCS increases with each point increase on the risk score. The 5P risk score can help clinicians identify which athletes are likely to develop PPCS, which may aid in educating families on expectations of recovery and/or provide opportunities for targeted intervention to facilitate sooner recovery. Table 1. 5 P Variables and other Patient Characteristics Comparing PPCS and no PPCS groups Figure 1. Symptom resolution time among the three 5P risk categories (Low : n=15; Medium : n=80; High : n=25; p=0.009) [ABSTRACT FROM AUTHOR]

Objective Variability in recovery time following sport-related concussion (SRC) is poorly understood. We explored the utility of brief mood, anxiety, and sleep questionnaires as postinjury predictors of SRC symptom clearance in adolescents. Method At initial visit 0–2 weeks postinjury, concussed athletes aged 12–18 years self-reported injury/medical factors (prior concussion, loss of consciousness, amnesia, and concussion symptom severity) and were administered psychological symptom measures. At 3 months, medical record review determined return-to-play (RTP) date. Subjects were divided into two datasets, with the first utilized for developing cutoff scores and then validated with the second dataset. Results A total of 64% of the 141 participants had early RTP (within 21 days postinjury), and 23% had late RTP (postinjury day 30 or later). The Generalized Anxiety Disorder Screener (GAD-7, M  = 2.1, SD  = 3.1) was the only significant predictor (p  = .001), with a 1.4-fold [95% CI 1.2–1.8] increased risk for every point. No other factors in the full model discriminated recovery groups (p s > .05). Receiver operating characteristic curve analysis derived a GAD-7 cut score ≥3 (sensitivity= 56.7%, specificity = 74.2%, AUCs = 0.63–0.79, p s < .001). Conclusions Postconcussion anxiety symptoms may help identify individuals at increased risk for prolonged recovery. [ABSTRACT FROM AUTHOR]

Background: In young athletes, patient-reported activity level is frequently used to determine return to the same level of sport after treatment. Purpose: To evaluate the validity and score distributions of the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) compared with the Tegner Activity Level Scale (Tegner) in pediatric athletes. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: A retrospective review of 517 consecutive youth athletes who came to a sports medicine specialty clinic for a knee evaluation was performed. Patients completed the HSS Pedi-FABS, Tegner, and a sports participation survey before evaluation. Scores were compared with reported hours, days, and weeks of participation in sports as well as level of competition. Floor or ceiling effects were identified, and finally, the means and distributions of scores in the 8 most common primary sports were analyzed. Results: A total of 398 participants (54.0% female) with an average age of 14.5 years (range, 10.0-18.8 years) were included in the study. The HSS Pedi-FABS demonstrated correlations with hours per week (r = 0.302; P <.001), days per week (r = 0.278; P <.001), and weeks per year (r = 0.136; P =.014) playing a primary sport. The Tegner only demonstrated a correlation with days per week (r = 0.211; P =.001). Additionally, club/select-level athletes scored higher than junior high/high school–level athletes on the HSS Pedi-FABS (23.8 vs 21.0; P =.004), but no difference was observed with the Tegner. No floor or ceiling effect was observed for the HSS Pedi-FABS, but a ceiling effect was present for the Tegner (32.8%). The HSS Pedi-FABS demonstrated a varied score distribution between the 8 most common primary sports (P <.001), with soccer players scoring the highest, on average (23.5). Conclusion: The HSS Pedi-FABS, compared with the Tegner, demonstrated more correlations with an athlete's participation in sport with no floor or ceiling effect and had a wide distribution of scores even among same-sport athletes. The HSS Pedi-FABS may be a more valuable activity measure than the Tegner in pediatric athletes. [ABSTRACT FROM AUTHOR]

Our objective was to determine the association between sleep quality, symptom severity, and recovery following sport-related concussion in pediatric athletes. A review of data from the North Texas Concussion Network Prospective Registry (ConTex) was performed. Participants were diagnosed with a sport-related concussion and were ≤18 years old. Participants were categorized based on their initial clinic visit Pittsburgh Sleep Quality Index composite score (0-21) into good sleep quality (GS≤5) and poor sleep quality (PS>5) groups. The PS group reported higher median total symptom scores at 3-month follow-up (3.0 vs 0.0, P <.01) and took more than a median of 2 weeks longer to recover compared to the GS group (35.0 days vs 20.0 days, P <.01). Poor sleep quality was strongly associated with greater symptom severity and longer time to recovery following sport-related concussion. Early recognition of concussed athletes with poor sleep quality at initial clinic visit may help predict prolonged recovery. [ABSTRACT FROM AUTHOR]

Objective: Resilience has been found to be a factor in concussion recovery, and the Brief Resilience Scale (BRS) has been validated as a measure of resilience in adults. Investigation of the BRS in adolescents with concussion and its relationship with current measures of anxiety, depression, and emotional symptoms may prove beneficial in further understanding emotional response to concussions in adolescents. Method: Participants aged 12–17 who sustained a concussion (n = 1168) were evaluated within 30 days of injury at a North Texas Concussion Registry (ConTex) clinic. Participants completed the Brief Resilience Scale (BRS), the General Anxiety Disorder 7 scale (GAD-7), the Patient Health Questionnaire depression scale (PHQ-8), and the emotional cluster (feeling irritable, sad, nervous, and more emotional) of the Sport Concussion Assessment Tool 5th Edition Symptom Evaluation (SCAT5) at initial visit. Pearson's correlation coefficient (r) was used to determine the relationship between scores on these four measures. Results: Pearson correlations between BRS scores and scores from the other measures were modest but statistically significant: GAD-7 (r = −0.392, p < 0.001), PHQ-8 (r = −0.321, p < 0.001), and the emotional cluster of the SCAT5 (r = −0.301, p < 0.001). Conclusions: Comparison of BRS score with GAD-7, PHQ-8, and the emotional cluster of the SCAT5 indicates that resilience may exhibit a modest inverse correlation with screening measures of anxiety, depression, and emotional symptoms, and thus a discrete factor for use in evaluating initial emotional response to concussion in adolescents. [ABSTRACT FROM AUTHOR]

Background: Recent trends in youth sports demonstrate athletes specializing in a single sport at younger ages in an effort to increase athletic success. Research suggests that increased training volume and early sport specialization are associated with increased injury risk, overuse injury, and athlete burnout. Although the exact threshold to avoid injuries has not been elucidated, some pediatric studies have shown increased risk of overuse injury with training more hours per week than their age in years. Hypothesis/Purpose: To determine if athletes presenting to a pediatric sports medicine clinic are participating in more hours per week than their age in years and associated factors related to sport participation. Methods: Data were prospectively collected from participants who presented to a tertiary sports medicine clinic for injury evaluation between October 2016-May 2021. Participants aged 5-<19 years who reported playing sports and had hours per week in their primary sport documented were included. Demographic and sport-related variables were reviewed. Participants were separated into two groups based on whether number of hours per week in their primary sport exceeded their age: UNDER (chronologic age and under) and OVER. Results: 10,586 total participants: 8846 (83.6%) UNDER and 1740 (16.4%) OVER. There was no difference in age (13.7±2.6 vs 13.6±2.6 years, p=0.27) between the UNDER and OVER group. There were more males (49.7 vs 38.5%, p<0.0001) and more Hispanic or Latinos (20.2 vs 16.4%, p<0.0001) in the UNDER compared to the OVER group. Soccer (23.0%) was the most common primary sport for the UNDER group while gymnastics (27.1%) was for the OVER group. More participants considered themselves single-sport athletes (68.5 vs 54.1%, p<0.0001) and reported their highest level of competition as club/select/travel (52.0 vs 38.2%, p<0.0001) in the OVER group than the UNDER group. The OVER group reported a significantly higher number of sport participation hours per week than the UNDER group (20.5±8.2 vs 6.9±3.7 hours, p<0.0001, Figure 1), an additional year (6.8±3.2 vs 5.6±3.3 years, p<0.0001), and weeks per year participating in their primary sport (41.7±13.4 vs 32.0±15.5 weeks, p<0.0001). Conclusion: About 15% of athletes seen at the sports medicine clinic reported participating in more hours per week than their age. These athletes were more likely to report being single-sport athletes and participating in club-style teams. Understanding this information may aid providers in educating families in the OVER group about potential increased risk for injury due to high weekly participation volumes and sport specialization. Figure 1. Average number of participation hours per week in the OVER compared to the UNDER group [ABSTRACT FROM AUTHOR]

Thyonella gemmata , also known as the Green sea cucumber, is a biomedically and ecologically important species. In this study, the complete mitogenome of T. gemmata (Echinodermata: Holothuroidea) collected from the Florida Panhandle, USA is reported. The mitochondrial genome of T. gemmata consisted of 15,696 base pairs, and was composed of 36.10% A, 28.27% T, 23.18% C, and 12.45% G. There were 13 protein coding genes, 22 tRNA genes, and 2 rRNA genes within the mitogenome of T. gemmata. Mapping out the complete mitochondrial genome of T. gemmata, will help aid in future evolutionary studies and can be applied to future phylogenetic research of holothurians and related species. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence regarding the impact of pre-existing psychological disorders on the initial clinical presentation in pediatric patients following concussion. Hypothesis/Purpose: To examine differences in clinical symptom measures between pediatric patients with a history of depression and/or anxiety and no history of psychological disorder (PD) following a concussion. Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015 and March 2020. Participants aged 5-18 years diagnosed with a concussion were included. Demographic variables and a range of clinical measures from initial presentation were reviewed, including SCAT-5 Symptom Log, Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7) scale, and Brief Resiliency Scale (BRS). Participants were separated into four groups based on self-reported prior diagnosis: depression, anxiety, depression+anxiety, and no PD. Results: A total of 1770 participants were included: 50 with depression, 82 with anxiety, 84 with both, and 1554 with no history of PD. There was no significant difference in age, sex, prior concussion history, or time to presentation between the depression and no PD group, or between the anxiety and no PD group. A significant difference was found between the depression+anxiety group and no PD group in the following variables: age (15.11±1.8 vs 13.68±2.61 years, p<0.001), prior concussion history (40.5% vs 23.9%, p=0.001), and time to presentation (31.47±25.82 vs 19.85±26.33 days, p=0.01). Additionally, there were more females in the depression+anxiety group than the no PD group (71.4% vs 47.8%, p<0.001). The depression, anxiety, and depression+anxiety groups had significantly higher rates of learning disorders than the no PD group (40%, 47.6%, 46.4% vs 16.4%, all p<0.001). A significant difference in SCAT-5 symptom severity scores between the depression, anxiety, and depression+anxiety groups compared to the no PD group was found. The PD groups all reported higher GAD-7 and PHQ-8 scores and lower BRS scores compared to the no PD group. The depression+anxiety group had the highest symptom severity, GAD-7, and PHQ-8 scores along with the lowest BRS score. Table 1.1 summarizes these significant findings. Conclusion: Differences were seen in participants with a history of depression and/or anxiety at initial clinical presentation, including history of learning disability, SCAT-5 symptom severity scores, and common screening tests for depression, anxiety, and resiliency compared to those without a history of PD. Understanding these differences at initial presentation may urge providers to engage multidisciplinary teams early in facilitating patient recovery. [ABSTRACT FROM AUTHOR]

This article derives a series of analytic formulae for various contingent claims under the real-world probability measure using the stylised minimal market model (SMMM). This model provides realistic dynamics for the growth optimal portfolio (GOP) as a well-diversified equity index. It captures both leptokurtic returns with correct tail properties and the leverage effect. Under the SMMM, the discounted GOP takes the form of a time-transformed squared Bessel process of dimension four. From this property, one finds that the SMMM possesses a special and interesting relationship to non-central chi-square random variables with zero degrees of freedom. The analytic formulae derived under the SMMM include options on the GOP, options on exchange prices and options on zero-coupon bonds. For options on zero-coupon bonds, analytic prices facilitate efficient calculation of interest rate caps and floors. [ABSTRACT FROM AUTHOR]

Objective: To understand factors associated with missed academic time after concussion to improve support for patients. Our goal was to assess patient-specific predictors of total school time lost after pediatric/adolescent concussion., Study Design: We performed a prospective cohort study of children and adolescents (8-18 years of age) seen within 14 days of concussion from seven pediatric medical centers across the United States. We collected outcomes via the Concussion Learning Assessment & School Survey (CLASS) and constructed a multivariable predictive model evaluating patient factors associated with school time loss., Results: 167 patients participated (mean age = 14.5 ± 2.2 years; 46% female). Patients were assessed initially at 5.0 ± 3.0 days post-injury and had a final follow-up assessment 24.5 ± 20.0 days post-concussion. Participants missed a median of 2 days of school (IQR = 0.5-4), and 21% reported their grades dropped after concussion. Higher initial symptom severity rating (β = 0.06, 95% CI = 0.03-0.08, p  < 0.001) and perception of grades dropping after concussion (β = 1.37, 95% CI = 0.28-2.45, p  = 0.01) were significantly associated with more days of school time missed after concussion. Those who reported their grades dropping reported missing significantly more school (mean = 5.0, SD = 4.7 days missed of school) than those who reported their grades did not drop (mean = 2.2, SD = 2.6 days missed of school; p  < 0.001; Cohen's d = 0.87)., Conclusions: Children and adolescents reported missing a median of 2 days of school following concussion, and more missed school time after a concussion was associated with more severe concussion symptoms and perception of grades dropping. These findings may support recommendations for minimal delays in return-to-learn after concussion.

Medical guidelines and legislation in the US call for immediate removal from play and prohibit continued play on the same day if a concussion is suspected. However, there is limited literature examining whether these guidelines and laws are being followed in youth soccer. The purpose of this study was to identify the frequency at which youth soccer players continued play on the same day following sport-related concussion and factors that may be associated with this behavior. A retrospective review of youth soccer players diagnosed at the initial clinic visit with a sport-related concussion was performed. Participants were categorized into groups, those who continued play on the same day as their concussion (PLAY) and those who did not (NO PLAY). Records were reviewed for demographics, injury characteristics, SCAT3™ symptoms, mBESS and ImPACT® results, symptom resolution and return to play protocol initiation. Fifty-eight girls (mean age: 14 years, range: 7-18 years) and 29 boys (mean age: 14.4 years, range: 6-18 years) participated in this study. Thirty of 58 girls (51.7%) continued play the same day compared to only 5 of 29 boys (17.2%; p=0.002). The odds of continued play in girls were 5 times as high as the odds of continued play in boys (OR=5.05; 95% CI, 1.59-19.3). Overall, 35 (40.2%) soccer players continued play on the same day following a concussion. In conclusion, approximately 40% of youth soccer players continued play on the same day as their concussion. Girl soccer players demonstrated a significantly higher frequency of continued play than boys.