Removal From Activity After Sports- Related Concussion in Sex-Comparable Sports From the Michigan High School Athletic Association

Background: Research has demonstrated that female athletes are more likely to report their sports-related concussion (SRC) symptoms compared with male athletes; however, it is unknown if these reporting behaviors correspond to immediate removal from activity in sex-comparable sports. Purpose: To compare the incidence of high school student-athletes removed and not removed from activity after SRC in sex-comparable sports in Michigan. Study Design: Descriptive epidemiology study. Methods: Participants included student-athletes diagnosed with SRC participating in Michigan High School Athletic Association–sponsored athletic activities (22 sex-comparable sports) between 2016 and 2019. All SRCs were recorded in the association’s Head Injury Reporting System (HIRS) by certified athletic trainers, administrators, or coaches. Removal from activity indicated that the student-athlete was removed from play at the time of an injury event. If the student-athlete reported that his or her suspected injury event occurred earlier during activity or if symptom onset was delayed, “not removed from activity” was entered into the HIRS. Incidence proportions were calculated by dividing SRCs not removed by total SRCs in each sport. Risk ratios were calculated by dividing the incidence proportions of girls not removed by boys not removed in each sport. Results: A total of 4418 (2773 female, 1645 male) SRCs were reported, with the most occurring in female soccer players (n = 1023). Overall, 515 girls and 243 boys were not removed from activity, resulting in incidences of 0.19 (95% CI, 0.17-0.20) and 0.15 (95% CI, 0.13-0.17), respectively. Across all sports, girls were 1.26 (95% CI, 1.09-1.45) times as likely to not be removed from activity compared with boys. Of the sports with the most SRCs—soccer, basketball, baseball/softball, and lacrosse—girls had 1.37 (95% CI, 1.09-1.72), 1.15 (95% CI, 0.89-1.47), 1.19 (95% CI, 0.77-1.84), and 1.35 (95% CI, 0.94-1.95) times the risk of not being removed, respectively. Conclusion: Girls were at greater risk of not being removed from activity compared with boys in sex-comparable sports. Results from this study should be incorporated into SRC education in Michigan and potentially elsewhere to inform affiliated personnel of potential sex differences and protect female student-athletes from further harm.

A - 02 The Epidemiology of Concussion in Middle School Football

Objective Middle school is often the first exposure to American football for many children. However, research examining concussion in football has primarily focused on high school and older athletes. Therefore, we investigated the incidence of concussion and subsequent sport time loss (TL) in MS football. Methods Athlete exposure (AE) and injury rates (IR) were gathered by onsite Certified Athletic Trainers within public middle school for all events across the 2015/16–2019/20 school years. AE was defined as one athlete participating in one practice or game. TL was defined as the number of days between the injury and return to sport dates. Concussion rates per 1000AE with corresponding confidence intervals (CI) were calculated. Injury rate ratios (IRR) with 95% CIs were compared IR between practices and games. CIs excluding 1.0 were considered significant. Results 75 concussions (IR = 1.38/1000AE, 95% CI = 1.06–1.69) occurred across 54,544 AEs. The concussion rate was significantly higher in games (n = 31, IR = 3.51, 95%CI = 2.27–4.75) than practices (n = 44, IR = 0.96, 95%CI = 0.68–1.25; IRR = 3.65, 95%CI = 2.30–5.77). The mean sport TL was 16.50 ± 8.25 days. Conclusions We observed middle school football concussion rates (practices and games) and associated TL from sport to be consistent with prior youth and high school football research. However, the concussion rate for middle school games was more than 3 times that of practices. This is similar to prior middle school football findings, but less than reported in high school football. Continued research evaluating modifiable risk factors for concussion in middle school football games and practices is needed.

A - 09 The Epidemiology of Concussion in Middle School Wrestling

Objective Wrestling has among the highest concussion incidence in all high school and collegiate sports. Many children begin wrestling in middle school (MS), however, research describing concussion incidence in MS wrestling remains limited. Therefore, we sought to describe the incidence of concussion and subsequent sport time loss (TL) sustained by MS wrestlers. Methods Certified athletic trainers collected concussion and athlete exposure (AE) data for all MS wrestling practices and matches in a large metropolitan public-school division between 2015/16 and 2019/20. AE was defined as one athlete participating in one practice or match. Frequencies and proportions were calculated for diagnosed concussions by event type. TL was the number of days from date of injury to return to sport. Concussion injury rates (IR) per 1000 AEs and injury rate ratios (IRR) to compare IR between practice and matches were calculated with 95% Confidence Intervals (CIs). IRRs with 95% CIs excluding 1.0 were statistically significant. Results 43 concussions occurred across 38,297 AEs (IR = 1.12, 95%CI = 0.79–1.46). No significant difference in the concussion IR between practices (n = 33, IR = 1.11, 95%CI = 0.73–1.49) and matches (n = 10, IR = 1.16, CI = 0.44–1.87; IRR = 1.04, 95% CI = 0.51–2.11) was observed. The mean TL was 18.38 ± 8.25 days. Conclusions We observed higher practice and match concussion rates than those previously reported among middle and high school wrestlers. Additionally, our findings showed that MS wrestlers required approximately 5 more days to return to sport than reported among HS wrestlers. Further investigation of concussion risk factors for concussion and prolonged TL in MS wrestling is needed.

Implementation and Assessment of a New Program Requirement to Promote Professional Development

Purpose: Requiring students to complete and record professional development type activities similar to the requirements of certified athletic trainers may help promote the values and behaviors associated with life-long learning in the evolving practice of athletic training, as well as prepare students more practically for the expectations of credential maintenance. We sought to design, implement, assess, and improve a new professional development program requirement in a professional-level athletic training program that closely mirrored the process and re-certification requirements for certified athletic trainers. Methods: a quasi-experimental mixed-methods approach was used. Data were collected over two consecutive years at a private university in the Midwestern United States. A convenience sample of students enrolled in a professional athletic training program participated in the study. Student-rated perception of the new professional development requirement and qualitative student perceptions were mined from various data sources. Results: Participants in the study reported positive, self-reported progress toward achieving program outcomes. Major benefits as identified by the participants included socialization opportunities, exposure to emerging practices and techniques, and appreciation of the process for credential maintenance. Feedback given by students was integrated into the professional development program requirement where appropriate between years one and two of the study, and changes were received well by participants. Conclusions: Athletic training students in the current study benefitted from participation in overt pedagogy in professional development. Establishment and cultivation of a professional development requirement may benefit athletic training programs for the best preparation of athletic trainers before they transition to practice.

Work-Family Guilt: The Perspective of Secondary School Athletic Trainers with Children

Context: Literature in athletic training has consistently demonstrated evidence of work-family-life conflict and the potential consequences of that conflict among athletic trainers employed in the clinical setting. Parental responsibilities, have been suggested to increase the conflict between work-family-life. The emotions that occur as a result of the conflict have received little attention and warrant further investigation. Objective: To investigate perceptions of and antecedents of work-family guilt among athletic trainers with children working in the secondary school setting. Design: Phemenological qualitative study Setting: Athletic Trainers currently employed in the secondary school setting who self-identify as parents. Patients or Other Participants: Twenty (13 women, 7 men) athletic trainers employed in the secondary school setting with children (range 1–3). All but three were married (n=17) at the time of the study. The average age of our participants was 37 ± 11 and they were certified athletic trainers for 14 ± 11 years. Data Collection and Analysis: Participants completed a one-on-one semi structured phone interview. Multiple analyst triangulation and peer review were included as steps to establish data credibility. Results: General inductive analysis revealed that men and women participants are experiencing feelings of work-family guilt despite having supportive work environments. The guilt for both sexes stemmed from work interfering with family and an altruistic mindset. Women indicated that they felt pressure from their husbands that contributed to feelings of guilt. Conclusions: Secondary school athletic trainers are experiencing work family guilt. Trying to balance parental and athletic training duties can cause an emotional response and athletic trainers' giving and caring nature may be a precursor to guilt.

Injury incidence and characteristics for elite, male, artistic USA gymnastics competitions from 2008 to 2018

ObjectivesTo determine the injury incidence and characteristics for elite, male, artistic USA gymnasts during gymnastics competitions, held in the USA, from 2008 to 2018.MethodsInjury documentation performed by lead physician and certified athletic trainers at elite junior and senior USA Gymnastics competitions from 2008 to 2018 were reviewed and compiled into an excel database. Injury incidence was computed per 1000 registered gymnasts by competition setting as well as injury location, type, cause, severity, and setting.ResultsFrom 2008 to 2018, 180 injuries were reported in a total of 2102 gymnasts with injury incidence of 85.6 per 1000 gymnasts (95% CI 73.4 to 97.8). The most common injury site was at the ankle (16.7 per 1000 gymnasts, 95% CI 10.9 to 22.4), and muscle strain/rupture/tear was the most common type of injury (28.5 per 1000 gymnasts, 95% CI 21.2 to 35.9). The most common cause was contact with surface (56.1 per 1000 gymnasts, 95% CI 46.1 to 66.2), and the event where most injuries were sustained was the vault (21.9 per 1000 gymnasts, 95% CI 15.4 to 28.4). Incidence of time loss injuries was 38.5 per 1000 gymnasts (95% CI 30.1 to 47.0). Injury incidence was higher during competition (58.5 per 1000 gymnasts, 95% CI 48.2 to 68.8) than during training (27.1 per 1000 RG, 95% CI 19.9 to 34.3; RR 2.16, 95% CI 1.59 to 2.94, p<0.001); injury incidence was greater at Olympic Trials (RR 3.23, 95% CI 1.24 to 8.47, p=0.017) than at National Qualifier meets. We report concussion incidence in gymnastics (5.7 per 1000 gymnasts, 95% CI 2.3 to 9.2).ConclusionsThis is the largest injury study to date for male artistic gymnasts (180 injuries, 2102 gymnasts, 11 years).