Surface-Related High School Football Game Injuries on Pad and No Pad Fields (101)

Objectives: Today’s new generations of artificial turf infill systems are increasingly being installed with lighter weight infill systems, which often incorporate interlocking polypropylene or thermoelastomer pad systems under the fiber-infill layers, reportedly to reduce surface shock, decrease concussions, and enhance shoe: surface stability. At this time, however, the effects of pad systems on high school football trauma during game conditions are unknown. With more than one million athletes playing competitive football, the rise in medical costs, and the increasing popularity of base pads being installed today as an alternative to heavier infill weight systems, this study focused on quantifying the potential influence of this practice on the incidence, mechanisms, and severity of game-related, high school varsity football injuries. Methods: Artificial turf playing fields were divided into two groups based on a pad underlayer or a no pad system. Fifty-eight high schools participated across three states over 7 seasons. Outcomes of interest included injury severity, injury category, primary type of injury, injury mechanism, anatomical location of trauma, type of tissue injured, and elective imaging/surgical procedures. Data were subject to multivariate analyses of variance (MANOVA) and Wilks’ λ criteria using general linear model procedures. Data were expressed as injury incidence rates (IIR) per 10 game season. Results: Of 658 varsity games documented, 260 games were played on fields containing pads, and 398 on no-pad fields, with 795 total injuries reported. MANOVA indicated a significant main effect across pad and no pad playing surfaces by injury severity (F3,791 = 11.436; P < .0001), knee trauma (F9,785 = 2.435; P = .045), injury category (F3,791 = 3.073; P < .0001), primary type of injury (F10,785 = 2.660; P < .0001), injury mechanism (F13,781 = 2.053; P < .001), anatomical location of trauma (F16,778 = 1.592; P < .001), type of tissue injured (F4,790 = 4.485; P < .0001), and elective imaging and surgical procedures (F4,790 = 4.248; P < .002). Post hoc analyses indicated significantly higher ( P < .05) substantial injury [10.3, (95% CI, 10.0-10.5) vs 3.0 (2.5-3.4)], player-to turf trauma [6.5, (95% CI, 5.9-7.1) vs 2.0 (1.6-2.4)], patellofemoral syndrome [1.3, (95% CI, 0.9-1.7) vs 0.3 (0.2-0.5)], neck strain [2.0, (95% CI, 1.5-2.5) vs 0.3 (0.2-0.5)], lower leg strain [3.9, (95% CI, 3.3-4.5) vs 1.1 (0.8-1.4)], and a higher number of lower extremity elective imaging and surgical procedures requested [7.2, (95% CI, 6.7-7.7) vs 3.2 (2.8-3.7)] when competing on artificial turf fields with pads as compared to no pad systems, respectively. In regard to reducing the frequency of concussions, there was no significant difference in concussion rate attributed to turf impact [0.3, (95% CI, 0.2-0.6) vs 0.1 (0.1-0.3)] between pad and no pad fields, respectively. Conclusions: The addition of a pad under an artificial turf surface increases injury rates when compared to non-pad fields across most injury categories. At this time, findings do not support the current trend of installing lightweight padded infill systems at the high school level of play. This is the first longitudinal study to investigate the influence of a pad on sport trauma, when integrated with an artificial turf infill system.

Surface-Related High School Football Game Injuries on Pad and No-Pad Fields

Background: Artificial turf fields are increasingly being installed with lighter weight infill systems that incorporate a pad underlayer, which is reported to reduce surface shock and decrease injuries. At this time, the effects of a pad underlayer on football trauma are unknown. Hypothesis: Athletes would not experience differences in surface-related injuries between pad and no-pad fields. Study Design: Cohort study; Level of evidence, 2. Methods: Artificial turf fields were divided into 2 groups based on a pad underlayer or no-pad system, with 58 high schools participating across 3 states over the course of 7 seasons. Outcomes of interest included injury severity, head and knee trauma, injury category, primary type of injury, injury mechanism, anatomic location of trauma, tissue type injured, and elective imaging and surgical procedures. Data underwent multivariate analyses of variance (MANOVA) using general linear model procedures and were expressed as injury incidence rates per 10-game season. Results: Of 658 varsity games, 260 games were played on fields containing pads, and 398 games were played on no-pad fields, with 795 surface-related injuries reported. MANOVA indicated significant main effects by injury severity ( F3,791 = 11.436; P < .0001), knee trauma ( F9,785 = 2.435; P = .045), injury category ( F3,791 = 3.073; P < .0001), primary type of injury ( F10,785 = 2.660; P < .0001), injury mechanism ( F13,781 = 2.053; P < .001), anatomic location ( F16,778 = 1.592; P < .001), type of tissue injured ( F4,790 = 4.485; P < .0001), and elective imaging and surgical procedures ( F4,790 = 4.248; P < .002). Post hoc analyses indicated significantly greater incidences ( P < .05) of substantial and severe injury, player-to-turf trauma, patellofemoral syndrome, neck strain, lower leg strain, and elective imaging and surgical procedures when games were played on padded turf fields. No differences in concussion rate from turf impact between pad and no-pad fields were observed. Conclusion: In contrast to conventional wisdom, the addition of a pad under an artificial turf surface increases injury rates when compared with nonpadded fields across most injury categories. At this time, findings do not support the current trend of installing lightweight padded infill systems at the high school level of play.

A Comparison of Nonhuman Primate Injuries in Horizontal Versus Vertical Sled +Gz (Head-to-Foot) Impact Accelerations

ABSTRACT Introduction Accelerative events commonly expose military pilots to potentially injurious + Gz (axial, caudal to cranial) accelerations. The Naval Biodynamics Laboratory exposed nonhuman primates (NHPs) to + Gz loading in two subject orientations (supine or upright) to assess the effect of orientation and accelerations associated with injury at accelerations unsafe for human participation. Materials and Methods Archived care records, run records, and necropsy and pathology reports were used to identify acceleration-related injuries. Injuries were categorized as central nervous system (CNS), musculoskeletal (MSK) system, or thoracic (THR). The occurrence of injuries relative to corresponding peak sled acceleration (PSA) and subject orientation were compared. A t-test was applied within each injury category to test for a significant difference in mean PSA between orientations. Results For all 63 + Gz runs conducted, PSA ranged between 6 and 86 G. Of these runs, 17 (6 supine, 11 upright) resulted in acceleration-related injury. The lowest PSAs associated with injury for supine and upright were 69.8 G and 39.6 G, respectively. Individual injury occurrences for supine runs (CNS [n = 5], MSK [n = 6], and THR [n = 6]) occurred at/above 75.7 G, 69.8 G, and 69.8 G, respectively. For upright runs, injury occurrences (CNS [n = 3], MSK injuries [n = 9], and THR injuries [n = 6]) occurred at/above 60.1 G, 39.6 G, and 50.5 G, respectively. The applied t-test showed significant difference between the mean orientation accelerations within each category. Injuries to supine NHPs included compression fracture, organ damage, brain hemorrhage, spinal cord hemorrhage, cervical hemorrhage, paresis/paraplegia, and THR bruising, whereas injuries to upright NHPs included compression fracture, organ damage, spinal cord hemorrhage, paresis/paraplegia, THR bruising, and difficulty breathing. Conclusions Axial loading to supine occupants produced more CNS injuries, whereas upright produced more MSK injuries. Both orientations produced equal THR injuries. NHP injuries reported reflected those reported following human + Gz acceleration events, highlighting the importance of orientation during acceleration to mitigate injury for next generation equipment design and testing.

Evidence of Impact of Outdoor Swimming on Health using an Online Survey (Preprint)

BACKGROUND Outdoor swimming has grown in popularity in many countries including the UK. Many anecdotal accounts indicate an improvement in medical conditions which are considered a consequence of outdoor swimming. OBJECTIVE This study aimed to better understand outdoor swimmers’ perceptions of their health and the extent to which participation impacted upon their existing, self-reported symptoms. METHODS A survey was deployed investigating outdoor swimming behaviours and reports of any diagnosed medical conditions, if any. Medical conditions were coded into categories and descriptive statistics generated regarding the outdoor swimmers’ behaviours and about the effect outdoor swimming had on their medical symptoms, if any. The medical categories were clustered in to five larger categories based on their prevalence in the current sample: mental health, musculoskeletal & injury, neurological, cardiovascular & blood disease, ‘Other’ which consists of all conditions not categorised in the four previous groups. RESULTS In total, 722 outdoor swimmers responded, of which 498 (69%) were female. The probability of outdoor swimming having ‘some impact’ on health across all medical categories was 3.57 times higher compared to no impact (B=1.28,95% CI [0.63, 1.91], P<.001), 44.32 times higher for the mental health category (B=3.79, 95% CI [2.28, 5.30], P<.001), 5.25 times higher for Musculoskeletal & injury category (B = 1.66, 95% CI [0.52, 2.79], P=.004) and 4.02 times higher for ‘Other’ category (B = 1.39, 95% CI [0.27, 2.51], P=.015). Overall, outdoor swimming was associated with perceived reductions in symptoms of poor mental health (2(2)=25.099, P<0.001), musculoskeletal and injury (2 (2)=8.242, P=.038), cardiovascular and blood (2(2)=14.685, P=.006) and ‘other’ conditions (2(2)= 18.213, P<.001). CONCLUSIONS Physical activity taken in the form of outdoor swimming is perceived to have positive impacts on health and is associated with perceived symptom reductions in mental health, musculoskeletal, cardiovascular and respiratory conditions. This study cannot provide causal relationships, or provide mechanistic insight. It does, however, provide a starting point for more targeted prospective intervention research into individual conditions or categories of condition to establish the impact in those who choose to start outdoor swimming.

WHIPLASH INJURY MECHANISMS OF CAR REAR OCCUPANTS: A REVIEW

Whiplash injury due to low severity vehicles crash is a global problem. The injury has long-term clinical and biomechanical implications. Since the mid-1960s, injury statistics have continuously revealed that females face a higher risk of suffering the injury category compare to males. Besides, in a frontal crash, the injury measures from the adult rear dummies were mainly higher than the same size dummies located in driver and front occupant seat. However, most regulations and user crash tests have focused on vehicle drivers and front-seat passenger due to high occupancy and mortality rates in the front seat. In this paper, mechanisms of whiplash injury were reviewed to contribute a further inclusive understanding of human impact reaction, variability quantification, validation, and prevention. The objective of this study is to develop a new design of head restraint (HR) for car rear occupants. In order to raise consideration whiplash injury and prevention mechanisms, impacts are simulated with computer modelling (Ls-Dyna simulation) and validated using Matlab. Therefore, a review of these injury mechanisms indicates the development of new anti-whiplash technology in the automotive safety area is necessary.

A study of incidence and outcome of acute kidney injury in common undifferentiated febrile illnesses

Background: Patients presenting with acute undifferentiated febrile illness may have delay in diagnosis due to nonspecific symptoms and signs. Kidney injury in these patients can cause detrimental effect on their prognosis and hence early diagnosis is warranted.Methods: This is an observational prospective study conducted in the Department of Medicine at Christian Medical College and Hospital, Ludhiana for a period of one year from 1st November 2014 till 31st October 2015.Results: Among the 532 patients acute febrile illness included in the study, 437(82.1%) were diagnosed with dengue fever. A total of 190(35.7%) patients were diagnosed to have AKI. The incidence of AKI in specific diseases was found to be the highest in Malaria 8(61.5%) out of 13 patients). In AKI, majority of them were in the risk category with 97(51.0%). A total of 26(13.6%) patients with AKI required Hemodialysis. Among the 190 patients who had AKI 43(22.6%) died.Conclusions: Dengue was the most common acute febrile illness. Among the patients with acute kidney injury majority were in the risk category with 97(18.2%). 326(61.2%) patients were males with a male to female ratio was found to be 1.5: 1. Dengue with acute kidney injury had the most proportion of patients in the risk and injury category and malaria with acute kidney injury having the highest proportion in failure category. The highest incidence of patients with AKI requiring hemodialysis was seen in scrub typhus. Leptospirosis with AKI had the highest proportion of mortality. The failure category had the highest proportion of mortality.

Pattern of road tra!c injuries and disability burden among accident victims

Worldwide road traffic injuries cause more than 1.2 million deaths every year and alarming rise has been observed in road accidents in Bangladesh over the past few years. A cross- sectional study was carried out from January to December 2017 to determine the pattern of road traffic injuries with disability burden among accident victims. 190 respondents were selected from Center for the rehabilitation of the paralyzed (CRP) at Savar and Mirpur in Dhaka by purposive sampling. Data was collected by face to face interview by using semi-structured pre-tested questionnaire. A large number of accident victims in this study were male (79.5%), Muslim (93.2%), married (85.3%) with middle age group (35.8%). Most of the accident victims came from rural area (62.6%) and place of most accident occurred in subway (73.1%). Highest number of accident occurred by motorized two wheels (47.3%). Fracture (48.9%) were most common types of injury among accident victims and affected part were most commonly the extremities (32.9%) and injury category were maximum injury (38.9%). Years of life lived with disability was highest in spinal cord injury (172.36). Among those who were in middle age group, suffered longer than other injury with years of life lived with disability. It found people who were injured from motorized two wheels had suffered longer years lived with disabilities of life than other types of vehicle injury(82.02).The result indicates the pattern of injuries and accident victims who were lived with disability for long time. Bangladesh Med J. 2018 Jan; 47 (1): 28-32

Incidence of Game-Related, High School Football Lower Extremity and Surface Impact Trauma Requiring Elective Imaging and Surgery across Artificial Turf Systems of Various Infill Weight

Objectives: Artificial turf surfaces are developed to duplicate playing characteristics of natural grass. With the newer generations of sand and rubber infill systems, infill weight is a common component that varies between fields. With the increasing concerns of rising medical costs, the potential for long-term articular changes, and perceived higher incidence of articular trauma while playing on artificial turf, infill weight could be a critical factor that could influence sport trauma and subsequent elective medical decisions. Therefore, this study quantified the incidence of game-related, high school football lower extremity and surface impact trauma requiring elective medical procedures across artificial turf systems of various infill weight. Methods: Artificial turf systems were divided into two sand/rubber infill weight groups by lbs per square foot: 6.0 to ≥9.0, and 0.0-5.9. Fifty-seven high schools participated across four states over 5 seasons. Outcomes of interest included elective medical procedures by injury category (player-turf surface impact trauma, trauma from shoe: surface interaction during physical collision/contact, trauma from shoe: surface interaction during physical noncontact). Data were subject to multivariate analyses of variance (MANOVA) and Wilks’ λ criteria using general linear model procedures. Results: Of 1,837 games documented, 1,049 games were played on 6.0 to ≥9.0 lbs infill/sq. ft, and 788 on 0.0-5.9 lbs infill/sq. ft, with 4,655 total injuries reported. MANOVA indicated a significant main effect across elective medical procedures by injury category (F3,3977 = 16.574; P < .0001). Post hoc analyses indicated significantly lower injury incidence rates (IIR per 10 game season) requiring radiography and MRI procedures following player-turf surface impact trauma [1.7, (95% CI, 1.5 -1.9) vs 3.2 (2.9-3.5); P = .001], trauma from shoe: surface interaction during physical collision/contact [2.4, (95% CI, 2.1-2.6) vs 3.2 (2.9-3.5); P = .001], and trauma from shoe: surface interaction during physical noncontact [0.4, (95% CI, 0.3-0.5) vs 0.7 (0.5-0.9); P = .01], while competing on the 6 to ≥9.0 lbs infill/sq. ft when compared to the lighter infill weight systems, respectively. No significant differences in surgical procedures by injury category were observed between infill weight. Conclusion: As the artificial infill surface weight decreased, the incidence of game-related, high school football lower extremity and surface impact trauma, and subsequent elective medical procedures significantly increased. Based on findings, high school football fields should minimally contain 6.0 to ≥9.0 lbs infill/sq. ft. This is the first longitudinal study to investigate the influence of artificial infill weight influence on high school sport trauma and elective medical decisions.

Injuries Depicted in Sport-Related Films

The perception that children and adolescents have of injuries may be influenced by their depiction in sport-related films. The objective of this study was to determine the depiction of injuries in a select number of sport-related films. Forty-four films were analyzed. Injury category, on-the-field management, and long-term management were determined for each injury. Major injuries were defined as injuries requiring prompt intervention and immediate discontinuation of sport participation. A total of 49 injuries were depicted, categorized as fracture (n = 11), contusion (n = 10), brain concussion (n = 8), muscle cramps (n = 5), laceration/abrasion (n = 4), ligamentous knee injury (n = 4), shoulder dislocation (n = 2), rotator cuff injury (n = 2), ankle sprain (n = 2), and unspecified injury (n = 1). Of the 38 (78%) injuries considered major, immediate return to the game was the disposition for 13 injuries (34%). Pediatric health care providers, coaching staff, and parents should stress the importance of injury recognition/disclosure and realistic expectations for rehabilitation to pediatric athletes.

An analogy between socioeconomic deprivation level and loss of health from adverse effects of medical treatment in England

BackgroundThe purpose of this study was to show whether and how levels, trends and patterns obtained from estimates of premature deaths from adverse effects (AEs) of medical treatment depended on the deprivation level in England over the 24-year period, 1990–2013. We provide a report to inform decision-making strategies to reduce the burden of disease arising from AEs of medical treatment in the most deprived areas of the country.MethodsComparative analysis was driven by a single cause-of-injury category—AEs of medical treatment—from the Global Burden of Disease 2013 study. We report the mean values with 95% uncertainty intervals (UIs) for five socioeconomic deprivation areas of England.ResultsIn the most deprived areas of England, the death rate declined from 2.27 (95% UI 1.65 to 2.57) to 1.54 (1.28 to 2.08) deaths (32.16% change). The death rate in the least deprived areas was 1.22 (0.88 to 1.38) in 1990; it was 1.17 (0.97 to 1.59) in 2013 (4.1% change). Regarding disability-adjusted life year (DALY) rates, the same trend is observed. Although the gap between the most deprived and least deprived populations of England narrowed with regards to number of deaths, and rates of deaths and DALYs from AEs of medical treatment, inequalities between marginal levels of deprivation remain.ConclusionsThe study suggests that a relationship between deprivation level and health loss from the AEs of medical treatment across England is possible. This could then be used when devising and prioritising health policies and strategies.