Prevalence and predictors of burnout among specialty palliative care clinicians in the United States: Results of a national survey.

87 Background: The increasing demand for specialist palliative care (PC) in cancer care requires an available and responsive clinical workforce. But as the volume of work expands, PC providers face an increased risk of burnout, characterized by depersonalization and work-related emotional exhaustion. The prevalence and predictors of burnout among PC providers is poorly understood. Methods: Members of the American Academy of Hospice and Palliative Medicine (e.g. advanced practice provider, registered nurses, chaplains) completed the Maslach Burnout Inventory (MBI) via electronic survey in the second half of 2013; respondents were recruited via e-mail, blog and Facebook posts, and Twitter tweets. The MBI determine burnout severity across two domains, Emotional Exhaustion (EE) and Depersonalization (DP). Severity is reported as “low”, “moderate”, or “high”; “high” is consistent with burnout. Demographic and work-related variables associated with burnout in other studies were determined via stepwise logistic regression. Results: We received surveys from 1,241 clinicians. We estimated a response rate of 30%. 68% of respondents were physicians. Most respondents were over age 50 (57%), female (65%), were married or partnered (82%) and had worked in the field for less than 10 years (67%). 42% took overnight call regularly, 30% reported working 50 hours per week or more, and 57% had at least 4 colleagues. Regarding burnout, 24% reported high DP, 59% reported high EE, and 62% of reported high burnout symptoms on either EE or DP scales. In logistic regression, younger physicians, those working more than 50 hours per work, and those with fewer colleagues within their practice were at greatest risk of burnout (p<0.02). Conclusions: PC clinicians report a burnout rate of 62%. Even with the limitations of our methods and potentially biased sampling, this prevalence is remarkable and higher than data reported in medical oncology (45%). Burnout severity is associated with working in isolation and working longer hours. Further studies on how burnout affects sustainability of the PC workforce are needed, especially since this workforce is so critical to the provision of high quality cancer care.

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Job Satisfaction and Burnout Levels of Home Care Nurses in Turkey

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4325 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Nilgun Yurtsever ◽

Medine Yilmaz

Keyword(s):

Job Satisfaction ◽

Home Care ◽

Emotional Exhaustion ◽

Maslach Burnout Inventory ◽

Personal Accomplishment ◽

Home Healthcare ◽

Satisfaction Scale ◽

Work Related ◽

Related Stress ◽

Home Care Nurses

Owing to the nature of their jobs, nurses all over the world experience burnout. The aim of this descriptive and correlational study was to describe the job characteristics, job satisfaction and burnout levels of home care nurses, and to predict what factors contributed to their job satisfaction and burnout levels. The study population consisted of 80 nurses working in home care units. Of them, 71 participated in the study. A socio-demographic questionnaire, the Minnesota Satisfaction Scale and the Maslach Burnout Inventory were used. Of the participants, 85.9 per cent were female, 56.4 per cent had a bachelor’s degree, and 46.5 per cent were employed in the public sector, 36.6 per cent in municipalities and 16.9 per cent in the private sector. The results revealed that their burnout levels for emotional exhaustion and personal accomplishment were high, and moderate for depersonalisation. Perceived work-related stress was more associated with emotional exhaustion and depersonalisation than with work satisfaction. Home healthcare nurses were suffering from high levels of burnout. Interventions are needed to improve job satisfaction, to reduce the burden of burnout among nurses, and to prevent them from leaving their jobs and retiring earlier.

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Altitude and risk of sudden unexpected infant death in the United States

Scientific Reports ◽

10.1038/s41598-021-81613-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Richard Johnston ◽

Xiaohan Yan ◽

Tatiana M. Anderson ◽

Edwin A. Mitchell

Keyword(s):

United States ◽

Logistic Regression ◽

Infant Death ◽

The United States ◽

Sudden Infant ◽

Data Set ◽

Live Births ◽

Sudden Unexpected Infant Death ◽

Increased Risk ◽

Unexpected Infant Death

AbstractThe effect of altitude on the risk of sudden infant death syndrome (SIDS) has been reported previously, but with conflicting findings. We aimed to examine whether the risk of sudden unexpected infant death (SUID) varies with altitude in the United States. Data from the Centers for Disease Control and Prevention (CDC)’s Cohort Linked Birth/Infant Death Data Set for births between 2005 and 2010 were examined. County of birth was used to estimate altitude. Logistic regression and Generalized Additive Model (GAM) were used, adjusting for year, mother’s race, Hispanic origin, marital status, age, education and smoking, father’s age and race, number of prenatal visits, plurality, live birth order, and infant’s sex, birthweight and gestation. There were 25,305,778 live births over the 6-year study period. The total number of deaths from SUID in this period were 23,673 (rate = 0.94/1000 live births). In the logistic regression model there was a small, but statistically significant, increased risk of SUID associated with birth at > 8000 feet compared with < 6000 feet (aOR = 1.93; 95% CI 1.00–3.71). The GAM showed a similar increased risk over 8000 feet, but this was not statistically significant. Only 9245 (0.037%) of mothers gave birth at > 8000 feet during the study period and 10 deaths (0.042%) were attributed to SUID. The number of SUID deaths at this altitude in the United States is very small (10 deaths in 6 years).

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Radiológiai osztályon dolgozó szakdolgozók kiégési szintje Magyarországon

Orvosi Hetilap ◽

10.1556/650.2019.31442 ◽

2019 ◽

Vol 160 (27) ◽

pp. 1070-1077 ◽

Cited By ~ 1

Author(s):

Dávid Sipos ◽

Veronika Varga ◽

Attila András Pandur ◽

András Kedves ◽

Melinda Petőné Csima ◽

...

Keyword(s):

Healthcare System ◽

Emotional Exhaustion ◽

Negative Impact ◽

Maslach Burnout Inventory ◽

Three Dimensions ◽

Radiology Department ◽

Online Questionnaire ◽

Descriptive Data ◽

Cross Sectional ◽

Work Related

Abstract: Introduction: Burnout can have a wide negative impact on the quality and the effectiveness of the health care system. The aim of our research was to assess the burnout level of the radiology department workers in Hungary. Method: Our quantitative, cross-sectional, descriptive data collection lasted from June to September 2018 using an online questionnaire. Simple, non-random sampling was carried out among radiology department workers in Hungary. In addition to our self-made questionnaire which included socio-demographic and work-related questions, an internationally validated Maslach Burnout Inventory questionnaire was sent out. Results: After data cleaning, a total number of 404 (n = 404) respondents were included in the statistical analysis. The majority of the respondents works in county hospital, the average year spent in the healthcare system was 18.3 (SD 13,7). The sample’s values at the depersonalization and emotional exhaustion dimension were slightly elevated in contrast to the average values. Educational level, age and years spent in the healthcare system had a significant influence on all the three dimensions of burnout (p≤0.05). The group of workers being 31–35 years old and the group of those who spent 16–20 years in the healthcare system are considered to be the most compromised groups in all the three dimensions of burnout. Respondents with master degree had significantly lower emotional exhaustion values than their colleagues. Conclusion: The increased value of the depersonalization and the emotional exhaustion can be an indicator for employers. Our results are similar like described in the international literature. Orv Hetil. 2019; 160(27): 1070–1077.

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An Observational Cohort Study ofClostridium difficileRibotype 027 and Recurrent Infection

mSphere ◽

10.1128/msphere.00033-18 ◽

2018 ◽

Vol 3 (3) ◽

Cited By ~ 10

Author(s):

Krishna Rao ◽

Peter D. R. Higgins ◽

Vincent B. Young

Keyword(s):

Logistic Regression ◽

Independent Predictor ◽

The United States ◽

Public Health Issue ◽

Clinical Microbiology Laboratory ◽

Clinical Predictors ◽

Content Type ◽

Ribotype 027 ◽

Increased Risk ◽

Wide Range

ABSTRACTRecurrentClostridium difficileinfection (rCDI) frequently complicates recovery from CDI. Accurately predicting rCDI would allow judicious allocation of limited resources, but published models have met with limited success. Thus, biomarkers predictive of recurrence have been sought. This study tested whether PCR ribotype independently predicted rCDI. Stool samples from nonpregnant inpatients ≥18 years of age with diarrhea were included from October 2010 to January 2013 after the patients tested positive forC. difficilein the clinical microbiology laboratory. Per guidelines, the rCDI was defined as a positive test forC. difficileat >2 weeks but ≤8 weeks from the index episode. For each sample, a single colony ofC. difficilewas isolated by anaerobic culture, confirmed to be toxigenic by PCR, and ribotyped. Simple logistic regression and multiple logistic regression were used to model the primary outcome of rCDI, incorporating a wide range of clinical parameters. In total, 927 patients with 968 index episodes of CDI were included, with 110 (11.4%) developing rCDI. Age and use of proton pump inhibitors or concurrent antibiotics did not increase the risk of rCDI. Low serum bilirubin levels and ribotype 027 were associated with increased risk of rCDI on unadjusted analysis, with health care-associated CDI being inversely associated. In the final multivariable model, ribotype 027 was the strongest independent predictor of rCDI (odds ratio, 2.17; 95% confidence interval, 1.33 to 3.56;P= 0.002). Ribotype 027 is an independent predictor of rCDI.IMPORTANCECDI is a major public health issue, with over 400,000 cases per year in the United States alone. Recurrent CDI is common, occurring in approximately one in five individuals after a primary episode. Although interventions exist that could reduce the risk of recurrence, deployment in all patients is limited by cost, invasiveness, and/or an undetermined long-term safety profile. Thus, clinicians need risk stratification tools to properly allocate treatments. Because prior research on clinical predictors has failed to yield a reliable, reproducible, and effective predictive model to assist treatment decisions, accurate biomarkers of recurrence would be of great value. This study tested whether PCR ribotype independently predicted rCDI, and the data build upon prior research in showing that ribotype 027 is associated with rCDI.

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Age, Pulse Pressure and Salt Sensitivity of Blood Pressure Increase the Risk of Death in Normal and Hypertensive Humans.

Hypertension ◽

10.1161/hyp.36.suppl_1.684-b ◽

2000 ◽

Vol 36 (suppl_1) ◽

pp. 684-684

Author(s):

Myron H Weinberger ◽

Naomi S Fineberg ◽

Morris Weinberger ◽

S. Edwin Fineberg

Keyword(s):

Logistic Regression ◽

Pulse Pressure ◽

Initial Study ◽

Cardiovascular Death ◽

Salt Sensitivity ◽

Stepwise Logistic Regression ◽

Volume Depletion ◽

Stepwise Logistic Regression Analysis ◽

Risk Of Death ◽

Increased Risk

36 We recently ascertained 376 initially normotensive (N) and 197 initially hypertensive (H) subjects among a group of 544 studied for the assessment of salt sensitivity (SS) at least 25 years ago to identify factors associated with morbidity and mortality. The age range when initially studied was 18-80 years. For this report we analyzed demographic factors as well as pulse pressure (PP), SS and renin status based on the response to sodium and volume depletion. Of the total ascertained, 108 (42 N, 66 H) have died. Stepwise logistic regression analysis revealed that total death was associated with each 1 mmHg increase in PP (odds ratio-OR 1.04,p<0.001) year of age (OR 1.03,p<0.001)and SS (OR 2.17,p<0.003). An inverse relationship between renin levels and deaths were observed, with low renin status associated with an increased risk (p<0.001). When known cardiovascular death was examined separately by stepwise logistic regression, PP (OR 1.06,p<0.001) age (OR 1.06,p<0.001) and gender (female OR 0.34,p<0.005) emerged as important factors. H at the time of initial study also was associated with reduced survival (p<0.003). Renin status was not found to be associated with total or cardiovascular death after adjusting the observations for age. These observations provide confirmation of earlier studies identifying the contribution of age, gender, H and PP to the risk of cardiovascular disease and mortality. A 4% increase in risk of death with each 1 mmHg increase in PP can be identified from these data. The novel finding of an independent contribution of SS to death requires further investigation.

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Accuracy of Antiretroviral Prescribing in a Community Teaching Hospital: A Medication Use Evaluation

Journal of Pharmacy Practice ◽

10.1177/0897190019857842 ◽

2019 ◽

pp. 089719001985784

Author(s):

Jacob Lines ◽

Paul Lewis

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Medication Error ◽

Medication Errors ◽

Retrospective Chart Review ◽

The United States ◽

Error Rates ◽

Transitions Of Care ◽

Hiv Diagnosis ◽

Increased Risk

Background: Medication errors account for nearly 250 000 deaths in the United States annually, with approximately 60% of errors occurring during transitions of care. Previous studies demonstrated that almost 80% of participants with human immunodeficiency virus (HIV) have experienced a medication error related to their antiretroviral therapy (ART). Objective: This retrospective chart review examines propensity and type of ART-related errors and further seeks to identify risk factors associated with higher error rates. Methods: Participants were identified as hospitalized adults ≥18 years old with preexisting HIV diagnosis receiving home ART from July 2015 to June 2017. Medication error categories included delays in therapy, dosing errors, scheduling conflicts, and miscellaneous errors. Logistic regression was used to examine risk factors for medication errors. Results: Mean age was 49 years, 76.5% were men, and 72.1% used hospital-supplied medication. For the primary outcome, 60.3% (41/68) of participants had at least 1 error, with 31.3% attributed to delays in therapy. Logistic regression demonstrated multiple tablet regimens (odds ratio [OR]: 3.40, 95% confidence interval [CI]: 1.22-9.48, P = .019) and serum creatinine (SCr) ≥1.5 mg/dL (OR: 8.87, 95% CI: 1.07-73.45, P = .043) were predictive for risk of medication errors. Regimens with significant drug–drug interactions (eg, cobicistat-containing regimens) were not significantly associated with increased risk of medication errors. Conclusions and Relevance: ART-related medication error rates remain prevalent and exceeded 60%. Independent risk factors for medication errors include use of multiple tablet regimens and SCr ≥1.5 mg/dL.

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717. Cumulative Incidence of Asthma/Wheezing Among Neonates/Infants/Toddlers Clinically Diagnosed with Respiratory Syncytial Virus Infection in the United States: A Retrospective Database Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.724 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S257-S258

Author(s):

Veronique Wyffels ◽

Maartje Smulders ◽

Sandra Gavart ◽

Debasish Mazumder ◽

Rohit Tyagi ◽

...

Keyword(s):

Logistic Regression ◽

Respiratory Syncytial Virus ◽

Cumulative Incidence ◽

The United States ◽

Term Infants ◽

Increased Risk ◽

Study Results ◽

Syncytial Virus ◽

Time Required

Abstract Background The role of respiratory syncytial virus (RSV) in the development of asthma/wheezing (AW) has been evaluated in several studies, mostly among pre-term infants or among infants after developing severe RSV-related disease. We describe the cumulative incidence (CI) of AW among hospitalized/ambulatory neonates/infants/toddlers after RSV/bronchiolitis infection diagnosis, in a large clinical database. Methods Using deidentified Optum Integrated commercial claims and electronic medical records, we identified patients (0–<3 years old) with a first clinical diagnosis of RSV/bronchiolitis infection from 01 January 2008–31 March 2016. Patients with a diagnosis of asthma/wheezing ≤30 days after first RSV/bronchiolitis diagnosis were excluded. Three cohorts were created with 1/3/5 years of follow-up time required, respectively. Patients were grouped by specific high-risk factors (HRF+/−), including pre-term births and predefined pre-existing disease. Descriptive statistics are reported, with comparisons made by logistic regression analyses. Results 9,811/4,524/1,788 patients with RSV/bronchiolitis infection and HRF− were included in the 1/3/5-years follow-up cohorts. 14.9%/28.2%/36.3% had AW events by the end of follow-up in the three cohorts. 6.5%/6.9%/5.8% were hospitalized for RSV/bronchiolitis. 3,030/1,378/552 patients with RSV/bronchiolitis infection and HRF+ were included in the 1/3/5-years follow-up cohorts. 18.1%/32.9%/37.9% had AW events by the end of follow-up in the three cohorts. 11.4%/11.1%/11.6% were hospitalized for RSV/bronchiolitis. The CI rates of AW in the 1/3/5-year HRF+/− cohorts, stratified by hospitalized for RSV/bronchiolitis Y/N, are shown in Figure 1. Logistic regression confirmed that hospitalization for RSV/bronchiolitis was associated with an increased (P < 0.05) likelihood of AW, for HRF+ and HRF− patients at each follow-up year. Conclusion Thirty-eight percent of RSV/bronchiolitis infants/neonates/toddlers HRF+, and 36% among infants/neonates/toddlers HRF−, developed AW in the 5 years after first RSV/bronchiolitis diagnosis. RSV/bronchiolitis hospitalization was associated with a significantly increased risk of AW development in 1/3/5 years of follow-up; confirming previous observational study results. Disclosures V. Wyffels, Janssen: Employee, Salary. M. Smulders, SmaertAnalyst: Consultant, Consulting fee. S. Gavart, Janssen: Employee, Salary. D. Mazumder, SmartAnalyst: Consultant, Consulting fee. R. Tyagi, SmartAnalyst: Consultant, Consulting fee. N. Gupta, SmartAnalyst: Consultant, Consulting fee. R. Fleischhackl, Janssen: Employee, Salary.

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Burnout syndrome: are stroke neurologists at a higher risk?

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190002 ◽

2019 ◽

Vol 77 (2) ◽

pp. 84-90

Author(s):

Viviane Flumignan Zétola ◽

Giovana Memari Pavanelli ◽

Gabriella Ueharo Pereira ◽

Francisco Manoel Branco Germiniani ◽

Marcos Christiano Lange

Keyword(s):

Emotional Exhaustion ◽

Human Services ◽

Care Setting ◽

Maslach Burnout Inventory ◽

Stroke Care ◽

Burnout Syndrome ◽

Work Related ◽

Significant Difference ◽

Proportional Relationship ◽

Professional Accomplishment

ABSTRACT Background: Burnout syndrome is a work-related psychological response, characterized by emotional exhaustion, depersonalization and low professional accomplishment. Objective: The study aimed to evaluate the prevalence of burnout syndrome in neurologists in the State of Paraná, Brazil, dividing them into stroke neurologists and non-stroke neurologists. Methods: We performed a crosssectional observational study, with a quantitative approach, based on the online Maslach Burnout Inventory - Human Services Survey questionnaire. Results: A total of 74 neurologists were evaluated, 44.6% of whom had burnout syndrome, predominantly among females and stroke neurologists. Both the stroke neurologist and non-stroke neurologist groups had medium degrees of emotional exhaustion and depersonalization; however, while stroke neurologists had high professional accomplishment, non-stroke neurologists had mean-to-low scores of professional accomplishment. There was a proportional relationship between age and emotional exhaustion. Female neurologists also reported lower professional accomplishment levels. Conclusion: Burnout is prevalent among the neurologists of Paraná, corroborating the results previously reported in other studies. There seems to be no significant difference between those neurologists who work in the emergency stroke care setting compared with those who don't.

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352. Characteristics Associated with Pre-Frailty in Older People Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.425 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S186-S186

Author(s):

Peter Mazonson ◽

Theoren Loo ◽

Jeff Berko ◽

Sarah-Marie Chan ◽

Ryan Westergaard ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cognitive Function ◽

Older People ◽

Logistic Regression Analysis ◽

The United States ◽

People Living With Hiv ◽

Factors Associated ◽

Increased Risk ◽

Living With Hiv

Abstract Background Frailty is a concern among older people living with HIV (PLHIV). There is a paucity of research characterizing PLHIV who are at risk of becoming frail (pre-frailty). To investigate how HIV impacts older PLHIV in the United States, a new study called Aging with Dignity, Health, Optimism and Community (ADHOC) was launched at ten sites to collect self-reported data. This analysis uses data from ADHOC to identify factors associated with pre-frailty. Methods Pre-frailty was assessed using the Frailty Index for Elders (FIFE), where a score of zero indicated no frailty, 1–3 indicated pre-frailty, and 4–10 indicated frailty. A cross-sectional analysis was performed on 262 PLHIV (age 50+) to determine the association between pre-frailty and self-reported sociodemographic, health, and clinical indicators using bivariate analyses. Factors associated with pre-frailty were then included in a logistic regression analysis using backward selection. Results The average age of ADHOC participants was 59 years. Eighty-two percent were male, 66% were gay or lesbian, and 56% were white. Forty-seven percent were classified with pre-frailty, 26% with frailty, and 27% with no frailty. In bivariate analyses, pre-frailty was associated with depression, low cognitive function, depression, multiple comorbidities, low income, low social support and unemployment (Table 1). In the multiple logistic regression analysis, pre-frailty was associated with having low cognitive function (Odds Ratio [OR] 8.56, 95% Confidence Interval [CI]: 3.24–22.63), 4 or more comorbid conditions (OR 4.00, 95% CI: 2.23–7.06), and an income less than $50,000 (OR 2.70, 95% CI: 1.56–4.68) (Table 2). Conclusion This study shows that commonly collected clinical and sociodemographic metrics can help identify PLWH who are more likely to have pre-frailty. Early recognition of factors associated with pre-frailty among PLHIV may help to prevent progression to frailty. Understanding markers of increased risk for pre-frailty may help clinicians and health systems better target multi-modal interventions to prevent negative health outcomes associated with frailty. Disclosures All authors: No reported disclosures.

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Exceeding Pitch Count Recommendations In Youth Baseball Increases The Elbow Injuries

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00126 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0012

Author(s):

Tetsuya Matsuura ◽

Toshiyuki Iwame ◽

Koichi Sairyo

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Multivariate Analysis ◽

Univariate Analysis ◽

The United States ◽

Injury Incidence ◽

Elbow Pain ◽

Increased Risk ◽

Youth Baseball ◽

Elbow Injuries

Objectives: With the incidence of Little League elbow increasing, pitch limit recommendations for preventing throwing injuries have been developed in the United States and Japan. In 1995, the Japanese Society of Clinical Sports Medicine announced limits of 50 pitches per day and 200 pitches per week to prevent throwing injuries in younger than 12 years old. However the relationship between pitch limit recommendation and elbow injuries among pitchers has not been adequately studied. The aim of our study was to evaluate the association between pitch counts and elbow injuries in youth pitchers. Methods: A total of 149 pitchers without prior elbow pain were observed prospectively for 1 season to study injury incidence in relation to specific risk factors. Average age was 10.1 years (range, 7-11 years). One year later, all pitchers were examined by questionnaire. Subjects were asked whether they had experienced any episodes of elbow pain during the season. The questionnaire was also used to gather data on pitch counts per day and per week, age, number of training days per week, and number of games per year. We investigated the following risk factors for elbow injury: pitch counts, age, position, number of training days per week, and number of games per year. Data were analyzed by multivariate logistic regression models and presented as odds ratio (OR) and profile likelihood 95% confidence interval (CI) values. The likelihood-ratio test was also performed. A two-tailed P value of less than .05 was considered significant. All analysis was done in the SAS software package (version 8.2). Results: Of the 149 subjects, 66 (44.3%) reported episodes of pain in the throwing elbow during the season. 1. Analysis for pitch count per day Univariate analysis showed that elbow pain was significantly associated with more than 50 pitches per day. Multivariate analysis showed that more than 50 pitches per day (OR, 2.44; 95% CI, 1.22-4.94), and more than 70 games per year (OR, 2.47; 95% CI, 1.24-5.02) were risk factors significantly associated with elbow pain. Age and number of training days per week were not significantly associated with elbow pain. 1. Analysis for pitch count per week Univariate analysis showed that elbow pain was significantly associated with more than 200 pitches per week. Multivariate analysis showed that more than 200 pitches per week (OR, 2.04; 95% CI, 1.03-4.10), and more than 70 games per year (OR, 2.41; 95% CI, 1.22-4.87) were risk factors significantly associated with elbow pain. Age was not significantly associated with elbow pain. Conclusion: A total of 44.3% of youth baseball pitchers had elbow pain during the season. Multivariable logistic regression revealed that elbow pain was associated with more than 50 pitches per day, more than 200 pitches per week, and more than 70 games per year. Previous studies have revealed the risk factor with the strongest association to injury is pitcher. Our data suggest that compliance with pitch limit recommendations including limits of 50 pitches per day and 200 pitches per week may be protective against elbow injuries. Those who played more than 70 games per year had a notably increased risk of injury. With increasing demand on youth pitchers to play more, there is less time for repair of bony and soft tissues in the elbow. In conclusion, among youth pitchers, limits of 50 pitches per day, 200 pitches per week, and limits of 70 games per year may protect elbow injuries.

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