Pediatric Sports Medicine Injuries

Background: In orthopedics, patient reported outcome measures (PROMs) have become popularized due to an increase in patient-centered research and pay for performance reimbursement models. Most pediatric PROMs have been utilized and validated in paper format. However, the use of a computer-based system may improve patient and physician efficiency, decrease cost, ensure completion, provide instantaneous information, and minimize inconvenience. The purpose of the study is to validate the use, evaluate patient satisfaction, and review differences of electronic compared to paper PROMs in a pediatric sports medicine practice. Methods: New patients between 12 – 19 years of age with a knee-related primary complaint were identified prior to their appointment. Patients were then randomized into two groups to complete standard clinical PROMs; including the Pedi-IKDC, HSS Pedi-FABS, Tegner Activity Scale, Visual Analogue Scale (VAS) and PedsQL-Teen. Group 1 completed paper forms followed by electronic, while Group 2 received the electronic format followed by paper, with a 10-minute break between formats in each group. Following the completion of PROMs, subjects completed a satisfaction survey. A Pearson’s correlation was used to calculate the association between the measures and a paired t-test to compare means between electronic and paper forms. Reliability analysis was conducted using an ICC calculation. Results: 87 subjects were enrolled with one excluded due to incomplete PROMs, for a total of 86. 54 subjects were female and 32 were male with an average age of 14.3 years (range 12-18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC, HSS Pedi-FABS, PedsQL 13-18 and the Tegner activity scale (Figure 1). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 vs 4.6, p<0.001). Excluding the 10-minute break, it took subjects an average of 21.3 minutes to complete the PROMs. Although not significant, electronic PROMs took less time than paper on average (10.0 min vs 11.2 min, p=0.096). All subjects endorsed that PROMs captured on paper were the same as electronic with 69.8% of subjects preferring the electronic PROMs. 67.4% of subjects reported they felt the electronic format was faster, with only 5.8% of patients reporting the electronic forms were hard or confusing. 93.0% stated they would complete forms at home prior to appointments if it were an option and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion/Significance: PROMs captured electronically were reliable and valid when compared to paper, with differences noted only on the VAS. Electronic PROMs may be quicker, will not require manual scoring, and are preferred by patients. Electronic PROMs will improve the clinician’s ability to collect complete and validated data while reducing the burden on the clinical staff and patients. [Figure: see text]

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Pediatric Sports Medicine

Textbook of Clinical Pediatrics ◽

10.1007/978-3-642-02202-9_411 ◽

2012 ◽

pp. 3945-3952

Author(s):

Mary K. Mulcahey ◽

Keith O. Monchik ◽

Michael J. Hulstyn ◽

Paul D. Fadale

Keyword(s):

Sports Medicine ◽

Pediatric Sports Medicine

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Identifying Persistent Postconcussion Symptom Risk in a Pediatric Sports Medicine Clinic

The American Journal of Sports Medicine ◽

10.1177/0363546518796830 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3254-3261 ◽

Cited By ~ 19

Author(s):

David R. Howell ◽

Roger Zemek ◽

Anna N. Brilliant ◽

Rebekah C. Mannix ◽

Christina L. Master ◽

...

Keyword(s):

Risk Score ◽

Sports Medicine ◽

Risk Scores ◽

Secondary Outcome ◽

Symptom Duration ◽

Clinical Risk Score ◽

Symptom Resolution ◽

Sports Concussion ◽

Clinical Risk ◽

Pediatric Sports Medicine

Background: Although most children report symptom resolution within a month of a concussion, some patients experience persistent postconcussion symptoms (PPCS) that continues for more than 1 month. Identifying patients at risk for PPCS soon after an injury can provide useful clinical information. Purpose: To determine if the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department (ED)–derived and validated tool, is associated with developing PPCS when obtained in a primary care sports concussion setting. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a study of patients seen at a pediatric sports medicine concussion clinic between May 1, 2013, and October 1, 2017, who were <19 years of age and evaluated within 10 days of a concussion. The main outcome was PPCS, defined as symptoms lasting >28 days. Nine variables were used to calculate the 5P clinical risk score, and we assessed the association between the 5P clinical risk score and PPCS occurrence. The secondary outcome was total symptom duration. Results: We examined data from 230 children (mean age, 14.8 ± 2.5 years; 50% female; mean time from injury to clinical assessment, 5.6 ± 2.7 days). In univariable analyses, a greater proportion of those who developed PPCS reported feeling slowed down (72% vs 44%, respectively; P < .001), headache (94% vs 72%, respectively; P < .001), sensitivity to noise (71% vs 43%, respectively; P < .001), and fatigue (82% vs 51%, respectively; P < .001) and committed ≥4 errors in tandem stance (33% vs 7%, respectively; P < .001) than those who did not. Higher 5P clinical risk scores were associated with increased odds of developing PPCS (adjusted odds ratio [OR], 1.62 [95% CI, 1.30-2.02]) and longer symptom resolution times (β = 8.40 [95% CI, 3.25-13.50]). Among the individual participants who received a high 5P clinical risk score (9-12), the majority (82%) went on to experience PPCS. The area under the curve for the 5P clinical risk score was 0.75 (95% CI, 0.66-0.84). After adjusting for the effect of covariates, fatigue (adjusted OR, 2.93) and ≥4 errors in tandem stance (adjusted OR, 7.40) were independently associated with PPCS. Conclusion: Our findings extend the potential use for an ED-derived clinical risk score for predicting the PPCS risk into the sports concussion clinic setting. While not all 9 predictor variables of the 5P clinical risk score were independently associated with the PPCS risk in univariable or multivariable analyses, the combination of factors used to calculate the 5P clinical risk score was significantly associated with the odds of developing PPCS. Thus, obtaining clinically pragmatic risk scores soon after a concussion may be useful for early treatments or interventions to mitigate the PPCS risk.

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Decreasing Radiograph Errors in Pediatric Sports Medicine Clinic

Pediatric Quality and Safety ◽

10.1097/pq9.0000000000000089 ◽

2018 ◽

Vol 3 (4) ◽

pp. e089 ◽

Cited By ~ 1

Author(s):

Amy E. Valasek ◽

James Gallup ◽

T. Arthur Wheeler ◽

Jahnavi Valleru

Keyword(s):

Sports Medicine ◽

Medicine Clinic ◽

Pediatric Sports Medicine

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Exercise in the Heat for Children and Adolescents. Statement from the Commission for Pediatric Sports Medicine, German Society for Sports Medicine and Prevention

Deutsche Zeitschrift für Sportmedizin ◽

10.5960/dzsm.2019.400 ◽

2019 ◽

Vol 70 (11) ◽

pp. 265-269

Author(s):

W Lawrenz

Keyword(s):

Children And Adolescents ◽

Sports Medicine ◽

German Society ◽

Pediatric Sports Medicine

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Cases and Current Concepts in Pediatric Sports Medicine

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000000287 ◽

2014 ◽

Vol 34 ◽

pp. S49-S56

Author(s):

Noah Archibald-Seiffer ◽

Jennifer Weiss ◽

Kevin Shea ◽

Eric Edmonds ◽

William Hennrikus ◽

...

Keyword(s):

Sports Medicine ◽

Pediatric Sports Medicine

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ASSESSING PATIENT OUTCOMES FOLLOWING A FRACTURE

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00106 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0010

Author(s):

Emily A. Sweeney ◽

Morgan N. Potter ◽

Alexia G. Gagliardi ◽

David R. Howell ◽

Aaron Provance

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Patient Outcomes ◽

Sports Medicine ◽

Young Patients ◽

Median Score ◽

Orthopedic Surgeon ◽

Pediatric Sports Medicine ◽

Fracture Management ◽

Patient Reported

Background: Both primary care sports medicine physicians and orthopedic surgeons, in conjunction with advanced practice providers, often manage young patients with fractures. To our knowledge, no investigations have evaluated patient outcomes based on the type of provider they see for fracture management. This study examined fracture management, patient outcomes, and patient satisfaction in pediatric and adolescent patients with fibula, tibia, radius and ulna fractures. Specifically, we sought to determine if there were differences between patients seen by a primary care sports medicine physician or orthopedic surgeon/physician assistant (PA) on measures of time to clearance from the injury, patient-reported functional outcomes, and patient satisfaction. Methods: A retrospective chart review was performed for 4-18 year-old patients who were treated by a sports medicine provider (primary care or orthopedic surgeon/PA) for a fracture of the radius, ulna, tibia or fibula over the course of three months. We contacted patients approximately 10 months post-injury. Patients or their parents completed a patient satisfaction survey (Short Assessment of Patient Satisfaction [SPAS]) and an injury location-specific patient reported functional outcome tool: the Foot and Ankle Ability Measure (FAAM) was used for patients with fibular or tibia fractures; the Disabilities of the Arm, Shoulder, and Hand (DASH) Scale was used for patients with radius or ulna fractures. The SPAS is scored from 0-28 with higher scores indicating higher satisfaction. The DASH is scored from 0-110, while the FAAM is scored from 0-140. For the DASH and FAAM, 0 indicates the least disability. Results: 83 of 139 (60%) of patients who were contacted completed the study. 58 (70%) of patients were treated by pediatric primary care sports medicine physicians and 25 (30%) were treated by a pediatric sports medicine orthopedic surgeon or the surgeon’s PA. Both patient groups (Table 1) were of similar age (10.3±3.1 vs. 8.9±3.9 years; p= 0.09), proportion of females (47% vs. 36%; p= 0.47), proportion of upper extremity injuries (67% vs. 80%; p= 0.30), and number of x-rays obtained (3.2±3.5 vs. 3.5±1.8; p= 0.60). The median time from injury to clinically-confirmed healing was similar between the two groups (47 vs 60.5 days; p=0.54), as was the overall patient satisfaction (Table 2) on the SPAS (median score = 26 [range = 19-28] vs 24 [range 9-28]; p = 0.11). In addition, the patient reported outcomes did not differ significantly between the two groups for the DASH (median score=0 [range= 0-11] vs. 0 [range= 0-43], p= 0.47), or the FAAM (median score= 0 [range= 0-47] vs. 0 [range= 0-0], p= 0.36). A greater proportion of patients that were treated by sports medicine primary care physicians reported they would prefer to see a sports medicine primary care physician for future care relative to the pediatric sports medicine surgeon group (Table 3; 74% vs. 20%; p< 0.001). In contrast, those seen by a sports medicine surgeon or PA indicated they would prefer to see a pediatric PA or pediatric nurse practitioner in the future relative to the pediatric sports medicine primary care group (28% vs. 2%; p= 0.001). Conclusion/Significance: Pediatric primary care sports medicine physicians and pediatric sports medicine orthopedic surgeons, with their PAs, have similar outcomes when caring for young patients with fractures of the radius/ulna and tibia/fibula. Patients report equal satisfaction with their care. Patients will likely have favorable outcomes when they are cared for by any of these providers. Tables and Figures: [Table: see text]

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