Progress in Cheerleading Safety: Update on the Epidemiology of Cheerleading Injuries Presenting to US Emergency Departments, 2010-2019

Background: Although the athleticism required of cheerleaders has increased, the risks of cheerleading have been less studied as compared with other sports. Purpose: To update our understanding of the epidemiology of cheerleading-related injuries. Study Design: Descriptive epidemiology study. Methods: We analyzed the National Electronic Injury Surveillance System (NEISS) for cheerleading-related injuries presenting to nationally representative emergency departments (EDs) in the United States from January 2010 through December 2019. Extracted data included patient age and sex, injury characteristics (diagnosis, body region injured, time of year, and location where injury occurred), and hospital disposition. Using patient narratives, we recorded the cheerleading skills, settings, and mechanisms that led to injury. NEISS sample weights were used to derive national estimates (NEs) from actual case numbers. Results: From 2010 to 2019, a total of 9868 athletes (NE = 350,000; 95% CI, 250,000-450,000) aged 5-25 years presented to US EDs for cheerleading injuries. The annual number of injuries decreased by 15%, from 982 (NE = 35,000; 95% CI, 27,000-44,000) to 897 (NE = 30,000; 95% CI, 18,000-42,000) ( P = .048), corresponding to a 27% decline in the injury rate per 100,000 cheerleaders ( P < .01). The annual number of injuries caused by performing stunts decreased by 24%, from 240 (NE = 8700; 95% CI, 6700-11,000) to 216 (NE = 6600; 95% CI, 4000-9200) ( P = .01), with a 36% decline in the corresponding injury rate per 100,000 cheerleaders ( P < .01). Despite these decreases, annual incidence of concussions/closed head injuries increased by 44%, from 128 (NE = 3800; 95% CI, 2900-4700) to 171 (NE = 5500; 95% CI, 3400-7700) ( P = .02), and patients requiring hospital admission increased by 118%, from 18 (NE = 330; 95% CI, 250-410) to 24 (NE = 720; 95% CI, 440-1000) ( P < .01). The hospital admission rate increased by 9.0% ( P = .02). Conclusion: The number of cheerleading-related injuries presenting to US EDs decreased from 2010 to 2019. However, the incidence of concussions/closed head injuries and hospital admissions increased, suggesting that further measures are needed to improve safety for cheerleaders.

Ultrasound in Detection of Skull Fractures in Children Younger Than Two Years Old with Closed Head Injuries

Background Paediatrics head injuries is a frequent cause of emergency department (ER) visits. The incidence of head traumas in children varies from one country to other with an estimated 47 to 280 per 100,000 children presented to the ER each year due to traumatic brain injury worldwide. Head computed tomography (CT) is the most frequent CT scan performed in paediatrics population, majority of those scans are done to evaluate trauma. Head CT scans increase the risk of developing brain malignancies and leukemia in exposed pediatric patients. Many efforts have been made to limit the use of CT in children with head injuries. Aim of the Work Our aim was to evaluate the role of skull ultrasound in detection of skull fractures children younger than two years old with closed head injuries. Patients and Methods Type of study was a prospective observational study, sampling method was convenient sampling. The study was conducted according to the stipulations of the Ain Shams University (ASU) ethical and scientific committee. The privacy of participants and confidentiality of data was guaranteed during the various phases of the study. The study was conducted at the radiology unit, Emergency Department, ASU Hospital. The main source of data for this study was patients referred to the Emergency department. Children younger than 2 years presenting with closed head injuries and referred to the radiology department, ASU hospital to perform CT brain, Study Period: 6 months, onset in March 2020. Results We found that skull ultrasound examination of pediatric patients with closed head injuries and Glasgow coma scale (GCS) of 14-15 have a high sensitivity and specificity in detecting skull fractures and subsequently prediction of an underlying traumatic brain injury (TBI) in these patients. Ultrasonographic assessment of the whole cranial vault is not always feasible as most of these age group patients are excessively crying and irritable at presentation, applying the ultrasound probe makes them more irritable and are difficult to maintain their head position during the scan. Although head CT is the gold standard diagnostic modality in the setting of head trauma, it exposes patients to significant ionizing radiation, ultrasonography is a safe diagnostic modality and doesn’t expose the patient to ionizing radiation. Conclusion Skull ultrasound in the setting of pediatrics mild closed head injuries is feasible, safe, sensitive and specific. It can play a complementary rule in risk stratification of these patients.

The Complexity of Secondary Cascade Consequent to Traumatic Brain Injury: Pathobiology and Potential Treatments

: According to the World Health Organization, Traumatic brain injury (TBI) is the major cause of death and disability and will surpass the other diseases by the year 2020. Patients who suffer TBI face many difficulties which negatively affect their social and personal life. TBI patients suffer from changes in mood, impulsivity, poor social judgment and memory deficits. Both open and closed head injuries have their own consequences. Open head injury associated problems are specific in nature e.g. loss of motor functions whereas closed head injuries are diffused in nature like poor memory, problems in concentration etc. Brain injury may have a detrimental effect on the biochemical processes responsible for the homeostatic and physiological disturbances in the brain. Although significant research has been done in order to decrease the overall TBI-related mortality, many individuals suffer from a life-long disability. In this article, we have discussed the causes of TBI, its consequence and the pathobiology of secondary injury. We have also tried to discuss the evidence-based strategies which are shown to decline the devastating consequences of TBI.

Progressive midbrain clefts after head trauma and decompressive surgery: a report of two patients

This report describes two patients with acute-onset ptosis, oculomotor dysfunction, ataxia and drowsiness, referable to the midbrain tegmentum. Both patients had previously suffered severe closed head injuries requiring craniotomy for cerebral decompression. Serial brain scans in both cases revealed a newly developing cleft in the midbrain, with features suggestive of abnormal cerebrospinal fluid (CSF) flow across the aqueduct. A trial of acetazolamide was initiated to reduce CSF production, followed by a third ventriculostomy for CSF diversion in one patient, which resulted in arrested disease progression and partial recovery. There are only two previous reports in the literature of midbrain clefts that developed as remote sequelae of head trauma. We postulate that altered CSF flow dynamics in the aqueduct, possibly related to changes in brain compliance, may be contributory. Early recognition and treatment may prevent irreversible structural injury and possible death.

Soccer-related head injuries—analysis of sentinel surveillance data collected by the electronic Canadian Hospitals Injury Reporting and Prevention Program

Background Participating in sports is a great way to gain physical, psychological, and social benefits. However, it also carries the risk of injury. Soccer is one of the most popular sports worldwide, and in recent years, there have been concerns about potential vulnerabilities to head injuries. Objectives To investigate soccer-related head injuries (SRHIs), using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) surveillance system. Specifically, we aim to compare characteristics of SRHI cases to all head injury cases within the eCHIRPP database. Methods Descriptive analyses of emergency department (ED) injury surveillance data (2011 to 2017) for individuals aged 5 to 29 years from all participating eCHIRPP sites. Computation of proportionate injury ratios (PIR) comparing SRHIs to all head injuries reported to eCHIRPP, and 95% confidence intervals (CI). Results A total of 3,970 SRHIs were reported to eCHIRPP. Injuries were from contact with another player, the ball, ground, goal-post, and other causes. Of the injuries caused by contact with the ball, 9% were from purposely directing the ball with the head (heading). A higher proportion of concussions (PIR=1.32, 95% confidence interval [CI]: 1.27 to 1.37) and minor closed head injuries (PIR=1.20, 95% CI: 1.15 to 1.26) were observed in soccer players. Higher proportions of head injuries occurred in organized soccer and soccer played outdoors. However, admission to the ED for a SRHI was rare (PIR=0.40, 95% CI: 0.30 to 0.55). Conclusions Overall, elevated proportions of brain injuries were observed among soccer players, however, these injuries were unlikely to result in a hospital admission. Moreover, purposely heading the ball contributed to few ED visits.

A Retrospective Analysis of Softball-Related Head and Facial Injuries Treated in United States Emergency Departments, 2013-2017

Background: Softball is a popular sport played through both competitive and recreational leagues. While head and facial injuries are a known problem occurring from games, little is known about the frequency or mechanisms by which they occur. Purpose: To analyze head/face injury diagnoses and to identify the mechanisms associated with such injuries. Study Design: Descriptive epidemiological study. Methods: A public database was used to query data related to head/facial injuries sustained in softball. Data including age, sex, race/ethnicity, injury diagnosis, affected body parts, disposition, incident location, and narrative descriptions were collected and analyzed. Results: A total of 3324 head and face injuries were documented in the database over the time span of 2013 to 2017, resulting in a nationwide weighted estimate of 121,802 head/face injuries occurring annually. The mean age of the players was 21.5 ± 14.4 years; 72.1% of injured players were female, while 27.9% were male. The most common injury diagnoses were closed head injuries (22.0%), contusions (18.7%), concussions (17.7%), lacerations (17.1%), and fractures (15.1%). The overwhelming majority of injuries involved being struck by a ball (74.3%), followed by colliding with another player (8.3%), colliding with the ground or a fixed object (5.0%), or being struck by a bat (2.8%). For those injuries caused by a struck-by-ball incident, most occurred from defensive play (83.7% were fielders struck by a hit or thrown ball) as opposed to offensive play (12.3% were players hit by a pitch or runners struck by a ball). Although helmet usage was poorly tracked in the database, female players (1.3%) were significantly more likely to have been wearing a helmet at the time of injury than were male players (0.2%) ( P = .002). Conclusion: The present study demonstrates that a large number of head and face injuries occur annually within the United States as a result of softball play. A variety of injuries were observed, with the majority involving defensive players being struck by the ball, which highlights the need for more focus on player safety by stronger adherence to protective headgear usage and player health monitoring.