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The optimal screening strategy to prevent sudden cardiac death (SCD) in athletes remains unknown. Pre-participation screening with electrocardiogram (ECG) remains controversial. The utility and accuracy of limb-lead (LL) ECG alone in identifying cardiac abnormalities associated with SCD has not been studied. This study was a comparative secondary data analysis, comparing the interpretation accuracy of 4 physicians evaluating publicly available ECGs of the most common cardiac conditions associated with SCD in athletes. Each physician interpreted a total of 100 ECGs: 50 normal ECGs (25 LL and 25 standard 12L) and 50 abnormal ECGs (25 LL and 25 standard 12L). The agreement between LL ECGs and 12L ECGs was assessed by Cohen's kappa coefficient and the accuracy of identifying an abnormal ECG was compared across LL and 12L ECGs using a chi-squared test. Inter-rater reliability was assessed by estimating the Fleiss's kappa coefficient. The sensitivity of LL ECG and 12L ECG was identical at 86%. The specificity of LL ECG was 75% (95% CI = 65% to 83%) and 12L ECG was 82% (95% CI = 73% to 89%). Substantial agreement was seen between LL ECG and 12L ECG interpretation across all readers (k = 0.63; 95% CI = 0.49 to 0.77). Interpretation accuracy was 81% (95% CI = 74% to 86%) and 84% (95% CI 78% to 89%) using LL ECG and 12L ECG, respectively (p = 0.43). In conclusion, the accuracy, sensitivity, and specificity were high and comparable for both LL ECG and 12L ECG in identifying cardiovascular conditions associated with SCD. Agreement between LL ECG and 12L ECG was substantial.

OBJECTIVES: To test whether 1) concussed athletes demonstrate slower tandem gait times compared to controls and 2) concussed female athletes display greater post-injury deficits than males. DESIGN: Prospective longitudinal METHOD: Fifty concussed collegiate student-athletes (32% female, age= 20.18±1.27 years) completed tandem gait tests during pre-season (Time 1) and acutely (

OBJECTIVE: To evaluate the strength of associations between single-task and dual-task gait measures and Posterior Cingulate Gyrus (PCG) neurochemicals in acutely concussed collegiate athletes. SETTING: Participants were recruited from a NCAA Division 1 University. PARTICIPANTS: Nineteen collegiate athletes acutely (< 4 days) following sports-related concussion. DESIGN: We acquired Magnetic Resonance Spectroscopy (MRS) in the PCG and gait performance measurements in the participants, acutely following concussion. Linear mixed-effects models were constructed in order to measure the effect of gait performance, in the single and dual task settings, and sex on the six neurochemicals quantified with MRS in mmol. Correlation coefficients were also calculated to determine the direction and strength of the relationship between MRS neurochemicals and gait performance, post-concussion symptom score, and number of previous concussions. MAIN MEASURES: Average gait speed, average cadence, N-acetyl aspartate, choline, myo-inositol, glutathione, glutamate plus glutamine, creatine. RESULTS: Single-task gait speed (p=0.0056) and cadence (p=0.0065) had significant effects on myo-Inositol concentrations in the PCG, independent of sex, in concussed collegiate athletes. Single-task cadence (p=0.047) also had a significant effect on glutathione in the PCG. No significant effects were observed between dual-task gait performance and PCG neurochemistry. CONCLUSIONS: These findings indicate that increased concentrations of neuroinflammatory markers in the PCG are associated with slower single-task gait performance within four days of sport-related concussion.

PURPOSE: Few studies have investigated recovery between sexes using objective outcome measures. Our purpose was to examine the independent association between biological sex and recovery of post-concussion gait among collegiate athletes. METHODS: We evaluated participants with a diagnosed concussion 0.56 and >0.50 gait velocity (m·s(−1))/height (m) under single and dual-task conditions, respectively. We used a multivariable Cox proportional hazard model to identify associations between sex and dual-task recovery, controlling for age, concussion history, symptom severity, and loss of consciousness at the time of injury. RESULTS: Ninety-four individuals participated in the study: 47 (50%) were female athletes (mean age=20.1, SD=1.3 years) and 47 (50%) were male athletes (mean age=20.3, SD=1.3 years). Sex was not independently associated with height-adjusted single-task gait velocity recovery after controlling for potential confounders (hazard ratio=1.62, 95% confidence interval=0.87, 3.01). However, male sex was independently associated with longer dual-task gait recovery time after controlling for potential confounders (hazard ratio=2.43, 95% confidence interval=1.11, 5.35). CONCLUSION: Male athletes required a longer duration of time after concussion to achieve dual-task gait recovery than female athletes. Thus, functional dual-task abilities after concussion may be affected differentially by sex, and should be accounted for within individualized concussion management strategies.

ObjectiveWe sought to determine whether male collision sport athletes perform worse on computerised neurocognitive assessments and report higher symptom burdens than athletes in contact (but not collision) sports and athletes in non-contact sports.MethodsThis cross-sectional study used data collected by the Massachusetts Concussion Management Coalition on high school boys who underwent computerised neurocognitive testing between 2009 and 2018. We divided sports participation in three different sport types: (1) collision, (2) contact, non-collision and (3) non-contact. Our outcomes included the four computerised neurocognitive composite scores (verbal memory, visual memory, visual motor speed and reaction time) and the total symptom score. The independent variable was sport type (collision, contact, non-contact), adjusted for age, concussion history and comorbidities.ResultsOf the 92 979 athletes (age: 15.59±2.08 years) included in our study, collision sport athletes performed minimally but significantly worse than other athletes on neurocognitive composite scores (verbal memory: β=−1.64, 95% CI −1.85 to –1.44; visual memory: β=−1.87, 95% CI −2.14 to –1.60; visual motor speed: β=−2.12, 95% CI −2.26 to –1.97; reaction time: β=0.02, 95% CI 0.02 to 0.02). Collision and contact sport athletes also had slightly but significantly lower total symptom scores (collision: 3.99±7.17; contact: 3.78±6.81; non-contact: 4.32±7.51, p2=0.001) than non-contact sport athletes.ConclusionThere are minimal observed differences in performance on neurocognitive assessments between collision sport, contact sport and non-contact sport athletes. The repetitive subconcussive head impacts associated with collision sport participation do not appear to negatively affect self-reported symptoms or neurocognitive functioning in current youth athletes.

Background: Athletes who participate in collision sports may experience more repetitive head impacts than other sport types. These repetitive head impacts have been theorized as a potential catalyst for cognitive problems later in life. It is unknown, however, if sport type influences neurocognitive performance. Hypothesis/Purpose: Our purpose was to investigate the association between sport type and baseline neurocognitive scores in a high school athletic population. We hypothesized that athletes participating in collision sports would demonstrate worse scores on baseline neurocognitive tests compared to those in contact or non-contact sports. Methods: We conducted a cross-sectional, observational study using baseline computerized neurocognitive scores of 186,117 high school student-athletes (age: 15.47±2.28 years, height: 168.53±10.77 cm, weight: 63.02±14.83 kg, 45% female) in the state of Massachusetts. The dependent variables were five composite scores (verbal memory, visual memory, visual motor, reaction time, and impulse control) and total symptom score. The independent variables included sport type (collision, contact, non-contact), age, sex, and concussion history. We used univariable one-way ANOVAS to compare composite scores between sport type. We conducted a series of multivariable regression models, controlling for age, sex, and number of previous concussions, to examine the independent association between sport type and composite scores. Results: There was a minimal but statistically significant association between sport type and composite scores, with collision sport athletes performing slightly worse than other athletes on most composite scores. Collision sport athletes had a slightly lower symptom burden. (Tables 1 and 2) Conclusion: While statistically significant, the differences in neurocognitive function and symptom burden between sport type are of questionable clinical significance. In fact, all of them fall within the reliable change index values of each respective score. As participants were in high school at the time of the study, we cannot determine the potential for associations later in life. Tables/Figures: [Table: see text][Table: see text]

Objective: To describe the evaluation, management and recovery time of hallux sesamoid fractures in young athletes.Methods: A retrospective chart review was performed in a large academic teaching institution over a 5-year period (1/1/2010-12/31/2014). All patients with a sesamoid injury were initially included. Excluded were those patients who: 1) did not receive the diagnosis of hallux sesamoid fracture, had a history of prior foot surgery, or had medical records inadequate for analysis, 2) had missing or unclear diagnostic imaging, 3) were age >21 years, or 4) did not report sports participation. Descriptive statistics were employed to analyze the data.Results: Fifty-eight patients (51 females and 7 males) with a mean age of 15.4 years (range: 9-21) were identified with a total of 59 sesamoid fractures. Dancing (37.9%), running (13.8%), and gymnastics (13.8%) were the most common sports reported among these patients. A greater number of fractures were classified as repetitive stress injuries (83.1%), rather than acute traumatic injuries (16.9%). Fractures were treated conservatively in the majority of cases (89.8%), and only six fractures (10.2%) were treated surgically. Most patients (84.7%) were able to return to sports and activities. The average time from diagnosis/start of treatment to pain-free state/cleared to return to sport was 161.4 days.Conclusion: Diagnosis of sesamoid fractures can be challenging, but overall most patients do well with conservative treatment and are able to return to sports and activities. Providers should keep sesamoid fracture in the differential when evaluating patients with pain in the area around the base of the first toe, especially in dancers, gymnasts, and runners. Understanding that the recovery from a sesamoid fracture can be a prolonged process may help patients develop realistic expectations.

ObjectiveTo investigate the association between acute post-injury scores on the Hospital Anxiety and Depression Scale (HADS) and symptom duration in collegiate student-athletes following a concussion.BackgroundConcussion recovery as measured by symptom resolution generally occurs within a week of injury in most athletes. In some cases, however, symptoms can persist for weeks or months. Time to symptom resolution has been associated with many factors, including psychological health. Athletes with a history of psychiatric or mood disorders prior to injury may be more likely to experience prolonged symptoms. It is unknown, however, whether initial complaints of anxiety or depression following a concussion are associated with subsequent symptom duration.Design/MethodsTwenty NCAA collegiate athletes (55% female, 20.10 ± 1.33 years) completed a HADS assessment within a week of sustaining a concussion. Participants then reported their post-concussion symptom scale daily until being cleared to return to sport. Date of symptom resolution was then collected at a follow-up assessment. Symptom duration was defined as the number of days between the injury and day of symptom resolution. Individual linear regressions were used to examine the relationship between HADS scores and symptom duration.ResultsAthletes were initially assessed at a mean of 2.65 ± 1.04 days. Mean symptom duration was 15.95 ± 17.33 days. There were no independent associations between duration of symptoms and HADS anxiety (β = 0.55, 95% CI = −1.28, 2.38, p = 0.63), HADS depression (β = −0.21, 95% CI = −3.08, 2.67, p = 0.88), or total HADS scores (β = 0.23, 95% CI = −1.07, 1.53, p = 0.71).ConclusionsPost-injury anxiety and depression scores did not appear to influence symptom duration in concussed collegiate student-athletes. While mental health should continue to be monitored during recovery, duration of symptoms is likely influenced by a multifaceted set of factors that are highly variable across collegiate athletes who sustain a concussion.

ObjectiveTo examine sex differences in TG performance among collegiate student-athletes acutely post-concussion relative to pre-injury performance.BackgroundPostural control impairments are common following concussion and traditionally assessed using the Balance Error Scoring System (BESS). Tandem gait (TG) has successfully identified impairments in postural control acutely post-concussion that were undetected by the BESS; thus, TG may be a more robust postural control assessment following concussion. While sex differences in BESS performance after concussion have been explored, there is no literature regarding sex differences in post-concussion TG.Design/MethodsForty-eight concussed collegiate student-athletes (30 females) and twenty-five healthy controls (13 females) completed TG tests during pre-season and again acutely post-concussion. Participants walked heel-to-toe down a 3-meter line, turned, and returned as quickly as possible, completing four single-task (ST) and dual-task (DT) TG trials. During DT trials, they simultaneously answered mini-mental style questions. The best ST and DT times were recorded. A 2 × 2 (group*sex) ANOVA was used to examine TG change between pre-injury and post-injury tests (positive value = slower/worsening; negative value = faster/improving).ResultsThe change in TG time from pre-injury to post-injury was significantly higher for the concussion group relative to the control group during both ST (Concussion: 1.6 ± 2.6 seconds, Controls: −1.1 ± 0.8 seconds, p < 0.001) and DT (Concussion: 2.0 ± 3.8 seconds, Controls: −0.9 ± 1.7 seconds, p < 0.001) TG. There were no significant interactions (ST: p = 0.17, DT: p = 0.23) or main effects for sex (ST: p = 0.63, DT: p = 0.91).ConclusionsThere were no sex-specific differences in TG performance acutely post-concussion. However, all concussed participants, regardless of sex, performed significantly worse on TG than male and female controls after injury relative to baseline, while controls did not demonstrate such a change. These results suggest that TG can appropriately identify postural control impairments following concussion; however, there do not appear to be differences in performance between males and females.

ObjectiveTo investigate differences in Hospital Anxiety and Depression Scale (HADS) scores between acutely concussed collegiate student-athletes and healthy, matched group of collegiate athletes.BackgroundMood disturbances have been documented acutely following concussion. The presence of anxiety and/or depression may complicate and prolong concussion recovery among some athletes. Therefore, it is important to examine acute post-injury anxiety and depression to facilitate proper management decisions.Design/MethodsTwenty-six student-athletes (54% female, 19.92 ± 5.56 years of age) with a diagnosed concussion completed the HADS questionnaire within a week of injury. Twenty-six healthy student-athletes (54% female, 18.82 ± 0.54 years of age) completed the HADS during pre-season baseline testing, individually matched by sex and sport. Independent samples t-tests were used to explore differences in HADS scores between groups.ResultsThere was no significant difference (p = 0.50) between total HADS scores of the concussion group (6.77 ± 6.17) and healthy cohort (5.81 ± 3.85). There were also no significant differences between concussion and uninjured groups on the HADS Anxiety subscale (4.38 ± 4.24 vs. 4.50 ± 2.83; p = 0.91) or HADS Depression subscale (2.38 ± 2.82 vs. 1.31 ± 1.67; p = 0.10).ConclusionsHADS scores obtained among collegiate student athletes acutely following concussion did not significantly differ relative to matched healthy control participants. It is possible that one week post-injury was not enough time to observe measurable effects of anxiety or depression, as those are commonly seen in cases of prolonged recovery.

ObjectiveTo 1) investigate differences in baseline scores on the Hospital Anxiety and Depression Scale (HADS) between male and female athletes and 2) examine the influence of concussion history on baseline HADS scores.BackgroundAlthough post-concussion differences between sexes have been documented, whether male and female athletes differ in reporting mental health outcomes and how concussion history may influence scores remains to be fully investigated. Since athletes may experience anxiety and depression after a concussion, screening prior to the beginning of an athletic season (baseline) may identify those who are prone to post-concussion mental health disturbances.Design/MethodsOne hundred fifty-two collegiate athletes (86 males, 66 females) completed a HADS assessment during baseline testing. Each participant also reported the number of diagnosed concussions he or she previously sustained. We used independent samples t-tests to compare baseline HADS scores between male and female athletes, and a multiple linear regression to examine the relationship between baseline HADS scores, sex, and concussion history.ResultsFemale athletes reported significantly lower HADS depression scores at baseline compared to males (Females: 0.92 ± 1.49, Males: 1.77 ± 2.22, F = 2.78, p = 0.01). There were no significant sex differences in HADS anxiety scores (Females: 4.53 ± 2.80, Males: 4.51 ± 2.84, F = 0.02, p = 0.97), but both sexes had higher anxiety outcomes than depression. There was an independent association between higher HADS depression scores and male sex (β = −0.84, p = 0.01; 95% CI = −1.47, −0.21), but not concussion history (β = −0.09, p = 0.66, 95% CI = −0.51, 0.33). Neither sex nor concussion history were significantly associated with HADS anxiety scores.ConclusionsFemale athletes reported lower levels of depression at baseline than males. Concussion history did not appear to influence anxiety or depression baseline scores. Psychological measures could be evaluated, both at baseline and prior to post-concussion return to play, to help identify those who may need more focused monitoring of mental health.