Search

In recent years, isolated non-operative management of penetrating liver injuries has become the standard of care for the hemodynamically stable patient. However, when the patient becomes hemodynamically unstable, adjuncts such as resuscitative endovascular balloon occlusion of the aorta (REBOA) deployed in Zone 1 can be used to achieve complete aortic occlusion from the celiac axis down. Unfortunately, hemorrhage control through REBOA comes at the risk of deadly intra-abdominal ischemia. Partial REBOA (pREBOA) introduces the opportunity to make targeted changes in volume and thus titrate the amount of aortic occlusion in real-time to adequately manage hemorrhage while allowing some distal blood flow. This is a novel approach and one which may give providers more time to gain definitive hemorrhage control while minimizing the morbidity of ischemia. Here, we present a case of life-threatening penetrating liver injury that was successfully managed non-operatively with the assistance of p-REBOA. [ABSTRACT FROM AUTHOR]

Introduction: The anterior stove-in chest (ASIC) is a rare form of flail chest involving bilateral rib or sternal fractures resulting in an unstable chest wall that caves into the thoracic cavity. Given ASIC has only been described in a handful of case reports, this study sought to review our institution's experience in the surgical management of ASIC injuries. Methods: A retrospective review of patients with ASIC was conducted at our level I trauma center from 1//2021 to 3//2023. Information pertaining to patient demographics, fracture pattern, operative management, and outcomes was obtained and compared across patients in the case series. Results: 6 patients met inclusion criteria, all males aged 37-78 years. 5 suffered motor vehicle collisions, and 1 was a pedestrian struck by an automobile. The median injury severity score was 28. All received ORIF within 5 days of admission, most commonly for ongoing respiratory distress. Patients 2 and 4 underwent bilateral ORIF of the ribs and sternum while patients 1, 5, and 6 underwent left-sided repair. Patient 3 required ORIF of left ribs and the sternum to stabilize their injuries. 5 of 6 patients were liberated from the ventilator and survived to discharge. Conclusions: This study demonstrates successful operative management of 6 patients with ASIC and suggests that early operative intervention with ORIF for affected segments may improve respiratory mechanics, ability to wean from the ventilator, and overall survival. Further research is needed to generate standardized guidelines for the management of this uncommon and complex thoracic injury. [ABSTRACT FROM AUTHOR]

Purpose: This study: (1) Described the knowledge, attitudes, and reported behavior intentions of young recreational football players' parents toward concussion. (2) Investigated associations of the previous variables with parent demographics. Materials and Methods: A cross-sectional design utilized an online platform to survey parents of children (8–14 yrs.) in three youth football leagues in the southern United States. Demographics collected included items such as sex or concussion history. Knowledge was assessed via true/false items, with higher scores (0–20) representing greater concussion understanding. 4-point Likert scales were used to describe parents attitudes (1 = not at all, 4 = very much), confidence in intended recognition/reporting (1 = not-confident, 4 = extremely confident), and agreement with intended reporting behaviors (1 = strong- disagreement, 4 = strong-agreement). Descriptive statistics were calculated for demographics. Mann–Whitney U test or Kruskal–Wallis Tests examined survey responses across demographics. Results: Respondents (n = 101) were primarily female (64.4%), white (81.2%), and participated in contact sport (83.2%). Parents averaged 15.9 ± 1.4 on concussion knowledge, with only 34.7% (n = 35) of parents scoring > 17/20. Statements that received the lowest average agreement (3.29/4) regarding reporting intent were related to emotional symptoms. Some parents (n = 42, 41.6%) reported low confidence in recognizing symptoms of a concussion in their child. Parent demographics did not have clinically significant associations with survey responses, with 6/7 demographic variables resulting in no statistical significance (p >.05). Conclusions: Although one-third of parents attained high knowledge scores, several reported low confidence in recognizing concussion symptoms in their children. Parents scored lower in agreement with removing their child from play when concussion symptoms were subjective. Youth sports organizations providing concussion education to parents should consider these results when revising their materials. [ABSTRACT FROM AUTHOR]

This study examined parental decision-making factors regarding their child's participation in tackle (TF) versus non-tackle (NTF) youth football leagues (YFLs, n = 91). The study also aimed to determine if these variables differed between parents who allowed their child to participate in TF and those who only allowed their child to participate in NTF. This study was of cross-sectional survey design and included items on parent demographics, child demographics, and factors influencing parent decision-making, divided into two groups: health- and league-related factors. The survey was piloted, housed, and created in a web-based platform. YFL parents rated decision-making factors on a 6-point scale. Descriptive statistics were run for all demographic variables, and non-parametric test were utilized to compare responses between groups. The Mann-Whitney U test was used to compare TF versus NTF, parent sex, parent concussion history, and child's concussion history. The Kruskal-Wallis test was employed to compare parent sport history. Female parents (n = 61) rated injury risk and concussion risk higher than male parents (n = 30). Parents who did not play a sport (n = 14) rated CTE higher than parents who played football (n = 13), another sport (n = 46), or football plus another sport (n = 18). The NTF parents (n = 10) rated injury risk, concussion risk, and CTE risk higher than TF (n = 81), while TF parents rated coach's level of training, league success, and league safety higher than NTF. This study provides insights into parents' decision-making processes and may help YFL programs tailor their approach to address these concerns and provide a safer environment for children participating in YFL. [ABSTRACT FROM AUTHOR]

Injury Severity Score (ISS) has limited utility as a prospective predictor of trauma outcomes as it is currently scored by abstractors post-discharge. This study aimed to determine accuracy of ISS estimation at time of admission. Attending trauma surgeons assessed the Abbreviated Injury Scale of each body region for patients admitted during their call, from which estimated ISS (eISS) was calculated. The eISS was considered concordant to abstracted ISS (aISS) if both were in the same category: mild (<9), moderate (9-15), severe (16-25), or critical (>25). Ten surgeons completed 132 surveys. Overall ISS concordance was 52.2%; 87.5%, 30.8%, 34.8%, and 61.7% for patients with mild, moderate, severe, and critical aISS, respectively; unweighted k =.36, weighted k =.69. This preliminarily supports attending trauma surgeons' ability to predict severity of injury in real time, which has important clinical and research implications. [ABSTRACT FROM AUTHOR]

Best practices to manage cervical spine injury (CSI) in sport have been published, yet knowledge of their use is unknown. To explore adoption of CSI management policies by high school (HS) athletic trainers (ATs) and their associated behaviors, barriers, and facilitators. Cross-sectional study. Online survey platform. Athletic trainers providing medical services to US HSs. The precaution adoption process model was used in an online questionnaire to determine the stage of adoption by ATs for each CSI management policy component. Components obtained from the National Athletic Trainers' Association position statement on acute management of an athlete with a CSI included immediate care, emergency tools to remove equipment, and maintenance of equipment-removal skills. Questions assessed AT demographics, HS characteristics, and facilitators and barriers to policy adoption. Data are presented as proportions and associations determined through χ2 analysis (P <.05). A total of 508 ATs' responses were included. Of these ATs, 33.1% reported adoption of incomplete policies (< 3 components of a CSI management policy, n = 168; 95% CI = 29.0%, 37.1%), and 66.9% reported adoption of comprehensive policies (n = 339; 95% CI = 62.9%, 71.0%). A significant association was found between coordination of CSI policies with emergency medical services (EMS) and adoption of the policy components for comprehensive immediate CSI care (χ21 = 49.56, P <.001), emergency tools for athletic equipment removal (χ21 = 41.49, P <.001), and the practice and maintenance of equipment-removal skills (χ21 = 86.12, P <.001). Approximately two-thirds (66.5%) reported that a positive relationship with EMS (n = 338; 95% CI = 62.4%, 70.7%) was a facilitator, whereas 42.5% reported challenges with local EMS as a barrier (n = 216; 95% CI = 38.2%, 46.9%). Immediate care and emergency tool policy components had the highest rates of adoption. Higher rates of adoption in this project were associated with coordination of CSI policies with local EMS. Athletic trainers also reported challenges in coordinating with EMS. Interventions to improve collaboration, training, and interprofessional respect between ATs and EMS personnel may improve policy adoption. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the effect of Kinesio tape (KT) versus placebo tape (PT) on the isometric shoulder elevation strength of college female athletes. A randomized, single-blind, crossover design divided eleven athletes (18-22 yrs. old) into two groups. Group 1 received the KT first, while Group 2 received the PT first; one week later, the groups were reversed. Each participant performed three isometric shoulder elevation trials, initially without tape, followed 5-10 minutes later by three trials after taping. Participants then wore each tape for three days before being retested in the same manner as before. Statistical analysis found no significant difference (p = 0.37) between the KT and PT trials. Shoulder strength was significantly greater after three days for both tape techniques. It does not appear that KT makes a significant difference in shoulder strength performance in female athletes. [ABSTRACT FROM AUTHOR]

Abstract: Yeargin, SW, Meyer, CM, Hirschhorn, RM, Lane, AD, Arent, SM, and Haggard, CR. Characterization of health and safety resources for athletes with sickle cell trait at NCAA institutions. J Strength Cond Res XX(X): 000-000, 2024-The purpose of this study was to report the prevalence of student-athletes with sickle cell trait (SCT), determine which screening practices are most commonly used, describe the health and human performance services provided to athletes, and ascertain if differences between National Collegiate Athletic Association (NCAA) designations or divisions exist. A cross-sectional survey design was used to query healthcare administrators regarding SCT resources at their institution. The independent variables were designation (historically Black colleges or universities [HBCUs] or non-HBCU) and Division (DI, DII, and DIII). The dependent variables were SCT prevalence, and the health and human performance services provided to athletes. Of the 60 respondents, HBCU ( n = 16) reported 4.9 ± 2.7% of athletes with SCT, which was higher than non-HBCU (1.1 ± 0.8%; p = 0.022). Historically Black colleges or university reported a higher percentage of student-athletes supplying their own screening results than non-HBCU (52.5 ± 39.2 vs. 12.9 ± 24.0%; p = 0.022). Division III reported higher proportions of waivers than DI (68.3 ± 38.4 vs. 16.9 ± 31.0%; p = 0.010). Most schools ( n = 42, 70.0%) reported having policy and procedures regarding exertional sickling, but none ( n = 60, 100.0%) involved strength and conditioning coaches (SCCs) during development. Practically, a greater proportion of DII and DIII institutions do not have supplemental oxygen available compared with DI but not statistically ( p = 0.058). Pragmatically, the prevalence should be considered when ordering and preparing resources annually. NCAA institutions need to create policy and procedure sections beyond screening. Athletic trainers and SCCs need to have a strong collaborative relationship to optimize health and human performance services., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the National Strength and Conditioning Association.)