2022 AMSSM Oral Research Poster Presentations

Training Docs: The Athletic Team Physician

Primary Author/Presenter: Hani M. Annabi, MS, MBA

Colby Genrich, MD, Shravya Kichena, BS, and William Felder, MPH

Affiliation: Texas Tech University Health Sciences Center, El Paso, TX.

Assigned #: R2022-0039

Presentation Type: Poster

Purpose: The purpose of this study is to determine the efficacy of an Athletic Sideline Management Training among Texas Tech University Health Sciences Center El Paso Medical Students who volunteer at Texas High School football games in El Paso, Texas.

Methods: A pre-test was used to establish a baseline understanding of athletic sideline management in a group of medical students (n = 41). Students then watched an instructional video based on best practices according to the 2013 Team Physician Consensus Statement. Upon completion of the training module, students took a post-test assessment to determine the improvement in performance.

Results: The statistical analysis looked at the differences in student performance between the pre- and post-test. Although the minimum and maximum score did not change, there was improvement in the mean, median and quartile range of scores. The mean score increased by 17.32%; the median score improved by 30%; the interquartile range increased by 20% for both the 1st and 3rd quartiles. There were 29 students who scored higher on the post-test, compared to 12 students who scored lower on the post test. To determine the significance of the score improvement, we conducted a paired T- Test for the mean difference between the pre- and post-test for our students. The Paired T-Test showed significance (< 0.05). Upon completion of the training module, student performance on the post-assessment had a statistically significant increase compared to the pre-assessment. Therefore, our hypothesis for the research question was proven to be correct.

Conclusions: Medical students should be trained to treat patients in a wide variety of high-risk settings that require efficient decision-making with limited resources such as the athletic sideline. This study's training module and shadowing program taught students how to apply effective healthcare practices during athletic competition. With this knowledge, students will have skillset to reduce unnecessary injury during athletic competition.

Significance: This study serves as a foundation for further research in athletic sideline management best practices; furthermore, how to implement these practices into a medical curriculum. In addition, specific algorithms can be developed for specific injuries.

Acknowledgements: This project would not have been possible without the contributions from the Texas Tech Physicians of El Paso's Department of Sports Medicine.

Energy Availability and Disordered Eating and Exercise Behaviors in Adolescent Athletes

Primary Author/Presenter: Aubrey Armento, MD

Corrine Seehusen, BA, Amanda McCarthy, RDN, CSSD, Vanessa Sherk, PhD, Karin VanBaak, MD, and David Howell, ATC, PhD

Affiliation: University of Colorado School of Medicine, Aurora, CO.

Assigned #: R2022-0047

Presentation Type: Poster

Purpose: The primary aim of the study was to assess the relationship between energy availability (EA) and health parameters in a group of adolescent athletes. The secondary aim was to evaluate the relationship between EA, disordered eating and compulsive exercise behaviors in the study population.

Methods: Participants completed a health history, the Eating Disorder Examination Questionnaire (EDE-Q), the Compulsive Exercise Test (CET) and a DEXA scan. EA was calculated for participants using collected dietary intake and exercise expenditure data. ANOVA was used to compare health parameters between EA groups and bivariate correlation analyses for the relationship between EA, EDE-Q and CET scores.

Results: A total of 25 participants (age 15.8 ± 2.1 years, 80% female, variety of sports) completed the study. 40% had low EA (< 30 kilocalorie/kilogram fat free mass/day), 36% had suboptimal EA (30-45 kcal/kg FFM/day) and 24% had optimal EA (> 45 kcal/kg FFM/day). The low EA group had significantly higher body mass index (BMI) than the suboptimal and optimal EA groups (p = 0.037, p = 0.009). There were no statistically significant differences in total body fat percentage, total body or lumbar spine z-scores between groups. There was a weak and non-significant correlation between EA and EDE-Q (r = -0.31; p = 0.14) and CET (r = -0.32, p = 0.13) scores. There was a moderate and significant correlation between EDE-Q and CET scores (r = -0.44; p = 0.03).

Conclusions: Most of our study sample demonstrated low or suboptimal EA. The low EA group had higher BMI than the other groups without significant differences in total body fat percentage, demonstrating that BMI may be an insufficient surrogate marker for EA. Increased disordered eating was associated with increased compulsive exercise behaviors, but further evaluation is necessary to determine the relationship between EA and these behaviors.

Significance: There is a need to better understand the prevalence and relationships of EA, disordered eating and compulsive exercise behaviors among young athletes to promote early identification and intervention of relative energy deficiency in sport (RED-S).

Acknowledgements: Thank you to the Center for Children's Surgery at Children's Hospital Colorado Ponzio Research Accelerator Award for providing funding to support this project.

Evaluation of Training in Emergency Action Protocols and Comfort Levels Among Athletic Trainers in High School Settings

Primary Author/Presenter: Dimitrios Avgeropoulos, MD

Korin Hudson, MD, Matthew Sedgley, MD, Amber Radtke, ATC, Andrew Lincoln, ScD, MS, and Sean Huffman

Affiliation: MedStar Health Sports Medicine, Baltimore, MD University of Maryland, Baltimore, MD.

Assigned #: R2022-0021

Presentation Type: Poster

Purpose: To evaluate the presence and use of Emergency Action Protocols (EAPs) in the sports medicine setting and to assess certified athletic trainers' (ATs) understanding and comfort level regarding EAP protocols at their local high schools.

Methods: A 73-item REDCap online survey was completed by 18 MedStar Sports Medicine ATs regarding their coverage of local high school sports. Respondents included 3 males (17%) and 15 females, between 22-50 years old with 0-20 years of experience.

Results: All (100%) ATs reported having EAPs for their schools and 94% reported using them in an emergency situation. 94% review the EAP with school personnel, most commonly on an annual basis (67%). 67% reported some hands-on training, most commonly for heat (61%) and spinal cord (56%) emergencies. Hands-on training for other sport-related emergencies were less common: cardiac-33%, severe orthopedic injury-28%; anaphylaxis/asthma-22%; diabetic emergencies-11%; seizures-6%; acute hemorrhage-6%; psychiatric-0%; acute sickle cell crisis-0%. ATs felt very comfortable with the management of cardiac and acute heat emergencies (94%) and severe head injury (83%). However, fewer reported feeling very comfortable with the management of seizures (50%), acute hemorrhage (44%), diabetic emergencies (28%), psychiatric (28%), sickle cell (22%) or overdose (11%) situations.

Conclusions: ATs are an integral part of the medical team responsible for emergency management. ATs reported very high levels of EAP use and regular review in the high school setting. There was a wide range of hands-on training for life-threatening scenarios and moderate-low levels of comfort managing scenarios such as seizures, acute hemorrhage, psychiatric or overdose situations. ATs reported limited hands-on training in many of these scenarios.

Significance: ATs reported limited hands-on training and low comfort levels in some emergency scenarios. These findings suggest an opportunity for the development of further hands-on training modules related to emergency scenarios and EAP training among ATs.

Acknowledgements: MedStar Health Sports Medicine

Differences in Reaction Time and Dynamic Visuomotor Synchronization in NCAA Division I Baseball and Softball Athletes

Primary Author/Presenter: Fernando Avila-Garibay, MD

Brian Donohoe, MD, Nelson Boland, MD, Calvin Duffaut, MD, and Joshua Goldman, MD, MBA

Affiliation: University of California, Los Angeles, Division of Sports Medicine, Santa Monica, CA.

Assigned #: R2022-0157

Presentation Type: Poster

Purpose: To determine differences in clinical reaction time and dynamic visuomotor synchronization in baseball and softball athletes, compared to athletes in other sports (including basketball, soccer and cross country) in NCAA Division I collegiate athletics.

Methods: This is a cross-sectional study in 90 NCAA division I athletes. A clinical reaction time apparatus was used to measure individual reaction time. Smooth pursuit eye tracking was conducted using EYE-SYNC goggles. Paired T-tests were used to assess for differences in reaction time and visuomotor synchronization between two groups: baseball and softball athletes, compared to athletes in other sports.

Results: Reaction times were compared between athletes in baseball and softball (n = 51) and those in soccer, basketball and cross country (n = 39). Reaction time was calculated for each athlete and the aggregated data were used to calculate the means and standard deviations (SD) within each group. Mean clinical reaction time (reported in seconds ± SD) was 0.1999 ± 0.0224 in baseball/softball and 0.2075 ± 0.0272 (p = 0.1594) in all other sports. Visuomotor synchronization was compared between baseball/softball (n = 51) and all other sports (n = 38), using tangential variability, radial variability and mean phase error (reported in degrees ± SD). Tangential variability was 1.069 ± 0.6410 for baseball/softball and 1.367 ± 0.7207 for all other sports (p = 0.0446). Radial variability was 0.8451 ± 0.3147 for baseball/softball and 1.219 ± 1.739 for all other sports (p = 0.1986). Mean phase error was -0.2421 ± 2.829 for baseball/softball and 1.692 ± 4.928 for all other sports (p = 0.0346).

Conclusions: There was no statistically significant difference in mean clinical reaction time among student athletes in baseball and softball, compared to those in other sports. Athletes in baseball and softball demonstrated superior dynamic visuomotor synchronization, particularly in temporal accuracy (tangential variability) and in sustaining the state of synchronization between the eye and the target (mean phase error).

Significance: Athletes who engage in bat-and-ball sports, which employ a small moving target, demonstrated better visuomotor synchronization than their non-bat-and-ball collegiate athlete peers. Future research could examine strategies to enhance eye tracking.

Acknowledgements: The investigators would like to acknowledge the UCLA athletic trainers and students who assisted with data collection, in addition to the student-athletes who participated in this study.

Michigan Coaches Concussion Knowledge Barriers Decrease With Online Modules

Primary Author/Presenter: Benjamin Beduhn, MD

Missy Pleuge, MA, Kristine Waters-Ray, MD, and Robert Kiningham, MD, MA, FAMSSM

Affiliation: University of Michian.

Assigned #: R2022-0138

Presentation Type: Poster

Purpose: To evaluate the compliance and effect of Michigan Public Acts 343'12 and 342'12 which regulated return to play protocol and concussion education for coaches.

Methods: Michigan high school football coaches were surveyed in 2014 and 2020. Responses were collected on time since the last concussion module and ranked perception of barriers regarding concussion recognition, removal and returning athletes to activity. Chi-square tests were used to compare characteristics of the respondents and responses to survey questions between years.

Results: The 2014 survey resulted in 142 respondents and 241 in 2020. By 2020, 88.3% of respondents were in compliance with Michigan legislation by completing an online module within three years. Taking an online module was the only characteristic associated with choosing lack of knowledge as a barrier to identifying and removing a concussed player. In 2014, 30.5% of respondents that completed a module rated lack of knowledge as a barrier to recognizing a concussion compared to 58.8% of respondents who had not completed a module (p < .003). This trend continued in 2020, where only 17.3% of respondents that completed a module rated lack of knowledge as a barrier to recognizing a concussion compared to 33.3% of respondents who had not completed a module (p < .038).

Conclusions: Recent data suggest about of 11.7% of Michigan Coaches have not completed a concussion module with three-year limit mandated by the state. Coaches in this group are twice as likely to see their knowledge as a barrier to recognizing a concussion.

Significance: This study estimates long-term compliance with concussion legislation to be around 88.3% of Michigan coaches. Furthermore, it demonstrates that non-compliant coaches are twice as likely to see their knowledge as a barrier to recognizing a concussion.

Acknowledgements: Special thanks to the Michigan High School Football Coaches Association Clinic

The Utilization of Strain Elastography for the Evaluation of Rotator Cuff Changes in Injured Versus

Primary Author/Presenter: David Berkoff, MD, FAMSSM

Stephanie Pittman, MD

Affiliation: UNC Chapel Hill, NC.

Assigned #: R2022-0042

Presentation Type: Poster

Purpose: Rotator cuff tears are common. Fatty infiltration of the infraspinatus (IS) muscle has been shown to correlate with failed rotator cuff repairs. Purpose: To use ultrasound elastography to identify differences in stiffness of the IS muscle in patients with and without rotator cuff tear.

Methods: Prospective case/control design. 26 participants were recruited. Participants were divided into 3 groups: those with rotator cuff injuries; a young normal group (18-30) and an age-matched normal group (40-80). Ultrasound and strain elastography were performed to analyze the infraspinatus in the short-axis view. Measurement taken at 4 spots along the IS in short axis using strain elastography.

Results: There was a significant difference in muscle stiffness between those with rotator cuff tears and those with no history of rotator cuff tears, There was no difference between the young normal group and the age-matched normal group Qualitative analysis of the images showed that those with rotator cuff injuries had larger areas of soft tissue in the infraspinatus. This was supported with the quantitative analysis of the strain ratios. The one way ANOVA for 2 of the areas of interest were significant, deep to the tendon and inferior to the tendon, p < 0.05. When the areas of interest were averaged to get a greater picture of the entire infraspinatus, there was also a significant difference, p < 0.05. There was not a statistical difference between the young normal group and the age-matched normal group, p = 0.426.

Conclusions: Ultrasound strain elastography can identify changes in the infraspinatus muscle stiffness for those with rotator cuff tears as compared to age matched normals. Additionally these changes were not age related evidenced by no difference in strain results in the two control groups (Younger and older).

Significance: 1) Identification of patients more likely to have good surgical outcomes from RCR is important and strain elastography may be one simple assessment to add to our decision process. 2) The elasticity of RC tendons does not change with age.

Acknowledgements: UNC CSMRP for sponsoring Dr Pittman for a summer internship. Julie Titter for all her help with IRM and research coordination.

Fibula Stress Fractures Correlation to Pes Planus and Hindfoot Valgus Deformity

Primary Author/Presenter: Greta Bires, MD

Marya Ghazzi, Imana Rhoden, MD, Christopher Mehallo, DO, and Marc Harwood, MD

Affiliation: Thomas Jefferson University Hospital, Philadelphia, PA.

Assigned #: R2022-0105

Presentation Type: Poster

Purpose: Approximately 10% of stress fractures occur in the fibula. The pathogenesis and predisposing characteristics are not completely understood as the largest study is an n = 12 case series. Our hypothesis is that pes planus and hindfoot valgus are significantly associated with fibula stress fractures.

Methods: A retrospective study analyzed fibula stress fracture patients with visits in 2015-2020. Chi square and T-test for categorical and continuous variables respectively assessed pes planus and hindfoot valgus rates using Meary's angle (MA), calcaneal pitch and tibiotalar angle (TTA). Logistic regressions assessed rates of pes planus, MA > 4 and hindfoot valgus, TTA < 90, controlling for covariates.

Results: 62 patients were analyzed. Baseline demographics showed female preponderance (74.2% female vs. 25.8% male), average age = 42.2 (SD 19.4), average BMI = 25.0 (SD 5.47), more non-smokers (59 to 1) and a higher rate of sports injuries than not (40 patients or 64.5% vs. 22 patients or 35.5%). 31 patients (50%) had a Meary's angle < -4 (pes planus), 23 (37.1%) ranged 4 to -4 and 8 (12.9%) ranged > 4 (pes cavus) (p < 0.001). Of the 31 patients with pes planus, 27 (43.5%) ranged -4 to -15 (mild deformity) and 4 (6.45%) ranged -15 to -30 (moderate deformity). 26 patients (41.9%) had calcaneal pitch 10-20 (pes planus), 35 (56.5%) 20-30, 1 (1.61%) 30+ (pes cavus) (p value < 0.001). 39 (62.9%) had tibiotalar angle < 90 degrees compared to 23 (37.1%) with tibiotalar angle > 90 degrees (p = 0.004). There was continued significance of pes planus (p < 0.001) and hindfoot valgus (p = 0.004) rates when controlling for age, sex, BMI and sports injury.

Conclusions: Baseline demographics showed higher rate of fibula stress fractures in women and through sports injuries. There was a higher rate of pes planus and hindfoot valgus among the population. These relationships remained significant when controlling for covariates such as age, sex, BMI and sport injuries, supporting our hypothesis.

Significance: The results suggest the importance of pes planus and hindfoot valgus in those with fibula stress fractures. This study presents the largest study to date with a comprehensive analysis of characteristics and pes planus rates in this population.

Acknowledgements: Statistics were done by statistician Matthew Sherman.

The Impact of Virtual Marathon Training on Adolescents During the COVID-19 Pandemic

Primary Author/Presenter: Nelson Boland, MD

Joshua Goldman, MD, MBA, Summer Runestad, ATC, and Emily Miller, MD

Affiliation: UCLA Department of Family Medicine and Orthopedic Surgery, Santa Monica, CA.

Assigned #: R2022-0161

Presentation Type: Poster

Purpose: The COVID-19 pandemic altered training routines for all sports. Schools shifted to virtual or hybrid models. In this study, we sought to evaluate the impact of various marathon training methods on the well being and social connectedness of participants in a youth distance running program.

Methods: A demographic survey was sent to all participants in middle school and high school during the 2020-21 season. At 3 time points over the training season a well-being survey, with questions adapted from the Social Connectedness Scale and Ryff Scales of Psychological Well Being, was sent out. Questions related to training format were included (virtual vs hybrid/in-person).

Results: 1015 participants completed the demographic survey, 204 (20%) in MS, 811 in HS (80%). They were 42.7% male, 57% female, 0.3% other. This was the first season with the program for 45%, with 27% having completed 1 prior marathon and 27% having completed 2-5 marathons. The most common reasons for participation were making new friends (19.6%), friends were participating (18.9%), community (15.9%) and other sports were canceled (10.7%). For the well-being survey, response rates declined with each survey (1002 survey 1, 621 survey 2, 519 survey 3). Ryff psychological well-being and social connectedness scores range from 10-70, with lower numbers indicating more connectedness and well-being respectively. The mean Social Connectedness score was 22.7 in the virtual training model vs 19.7 in the hybrid model (P < 0.001). The mean Ryff Psychological well-being score was 26.0 in the virtual training model vs 26.1 in the hybrid model (p = 0.76).

Conclusions: Virtual training programs did not negatively affect students' psychological well-being compared to hybrid training, but they did correlate with decreased social connectedness. Both training methods had high raw scores for well-being and connectedness compared to the normalized Ryff scale. Limitations include the lack of a control group which would improve the understanding of virtual team training on adolescents' well-being during the pandemic.

Significance: Our study demonstrates that, even in the face of significant changes in the way adolescents engage and train with their teams, virtual training methods can be used to reap the benefits of team sport while ensuring safety during the COVID-19 pandemic.

Acknowledgements: Students Run Los Angeles Orthopedic Institute for Children

Factors Influencing Women's Selection of Sports Medicine Physicians

Primary Author/Presenter: Haylee Borgstrom, MD, MS

Miho Tanaka, MD, and Kelly McInnis, DO

Affiliation: Massachusetts General Hospital/Spaulding Rehabilitation Hospital, Boston, MA.

Assigned #: R2022-0089

Presentation Type: Poster

Purpose: Identify patient-specific factors that may influence women's selection of sports medicine physicians in an effort to provide more comprehensive and equitable care for women athletes.

Methods: Anonymous survey of women patients seen in an outpatient sports medicine clinic by women physicians (2 physiatrists, 1 orthopedic surgeon). Descriptive statistics were used to evaluate patient demographics (age, activity level), influence of physician gender on selection of a sports medicine physician (1-7 Likert scale), potential contributing factors (binary) and desire for ancillary services.

Results: 137 women (mean age 46.3 ± 17 years; mean weekly exercise 5.7 ± 5 hours) completed the survey over a two-month period. Physician selection was moderately influenced by physician gender (4.3 ± 2.3; "1" not influential, "7" most influential) with 76.2% of patients noting at least some preference for a woman physician ( > 1) & 21.5% noting female physician gender as the most influential factor. Commonly identified reasons included: "I feel more comfortable with a woman physician" (51%), "I feel female physicians will take me more seriously" (34%), & "I prefer communication styles of women" (27%). Desired ancillary services included exercise counseling (50%), injury prevention training (49%), nutrition counseling (36%), sleep (18%) & hormonal (16%) specialists, & sports psychology (7%). Younger patients ( < 40) more frequently desired sports psychology (X2 = 6.54, p = 0.01). There were no other correlations between age or activity level & physician gender preference or desired services.

Conclusions: Women patients who were seen by women sports medicine physicians frequently cited physician gender as a contributing factor in the selection of their specialist. Over 75% of patients noted at least some preference for a woman physician & over 20% felt female physician gender was the most influential factor. Additionally, over 80% of patients preferred access to at least one ancillary service, highlighting the desire for multidisciplinary care.

Significance: Understanding the priorities of women patients is essential for optimizing care and combating gender bias in sports medicine. Sports medicine clinics should prioritize recruitment of women physicians and incorporation of multidisciplinary services.

Concussion in Youth Mountain Biking Athletes: Analysis of Data from the NICA Injury Surveillance System

Primary Author/Presenter: Andrea Carefoot, MD

Meredith Ehn Ehn, DO, Masaru Teramoto, PhD, Daniel M. Cushman, MD, and Stuart Willick, MD

Affiliation: University of Utah, Salt Lake City, UT.

Assigned #: R2022-0028

Presentation Type: Poster

Purpose: To describe characteristics associated with concussion in interscholastic youth cross-country mountain biking student-athletes in the National Interscholastic Cycling Association (NICA) using the NICA injury surveillance system (ISS).

Methods: A prospective longitudinal web-based ISS was designed and implemented with REDCap. A designated reporter on each team collected data weekly during the 2018-2020 seasons. Demographic information, injury characteristics, time-loss due to injury and other factors were reported. Analysis was carried out primarily with descriptive statistics. Sub-analysis of concussion data was carried out using Stata.

Results: 66,588 student-athlete-years of data (79.5% males) were collected during competition years 2018-2020. Riders sustained 2,440 unique injuries in 1,576 injury events. Of the 2,440 unique injuries reported, 373 or 15.3% were concussion, the most common injury sustained by interscholastic youth cross-country mountain bike racers. There was no significant difference in the rate of concussions by sex (291 out of 52,956 male student-athlete-years [0.55%] vs. 82 out of 13,632 [0.60%] female student-athlete-years; p = 0.468). Sophomore riders sustained a significantly higher rate of concussion compared to the mean overall rate (50 out of 5,079 student-athlete-years in sophomore riders [0.98%] vs. 373 out of 66,588 all student-athletes-years [0.56%]; p < 0.05). Downhill crashes were significantly associated with a higher rate of concussion (26.2%), while riding uphill was significantly associated with a lower rate of concussion (13.7%; p = 0.007).

Conclusions: Overall, injury rates in youth cross-country mountain biking student-athletes are relatively low. Concussion is the most common injury sustained by these student-athletes with some rider categories and terrain associated with higher rates of concussion than others. Male and female riders experience similar rates of concussion. To our knowledge, this the largest ISS tracking concussions in student-athlete mountain bikers.

Significance: Youth mountain bike racing is increasingly popular. One student-athlete participating for one year has a 0.5% chance of sustaining a concussion. The NICA ISS will inform injury prevention efforts.

Acknowledgements: We would like to thank NICA and all of the student-athletes, parents and coaches who assisted with data collection.

Learning Curve for Image-guided Diagnostic Aspirations

Primary Author/Presenter: Andrea Carefoot, MD

Heather Roesly, MD, Justin Foley, MD, Justin Provo, MD, A. Michael Henrie, DO, Masaru Teramoto, PhD, MPH, PStat, and Daniel M. Cushman, MD

Affiliation: University of Utah, Division of Physical Medicine & Rehabilitation, Salt Lake City, UT.

Assigned #: R2022-0134

Presentation Type: Poster

Purpose: Prior literature exists on the success rate of certain injections based on experience. As no prior work looked at diagnostic aspirations, this study aimed to determine whether providers had improved aspiration success rates as number of performed aspirations increased.

Methods: This study was a retrospective review of diagnostic joint aspirations from an outpatient orthopedic clinic from a single academic institution. Aspirations were performed by physicians with fellowship training in musculoskeletal radiology, sports medicine, or pain medicine. The primary outcome was successful aspiration of fluid, analyzed by a logarithmic trend line fit.

Results: A total of 814 aspirations from 35 attending physicians were included; of which 433 (53.1%) hips, 206 (25.3%) shoulders and 146 (17.9%) knees were aspirated. There were 528 (64.9%) post-arthroplasty patients with a mean age of 61.4 (13.6) and body mass index of 31.0 (8.1) kg/m2. The logarithmic trend line (y = 7.219ln[x] + 38.47, r2 = 0.041, p = 0.001) showed a steep, upward learning curve up to about 20 procedures performed, followed by a much slower, gradual learning curve with more experience. The calculated first aspiration success rate was 38.5 (95%CI 18.8,58.2)%, increasing to 55.1 (44.9, 65.3)% at 10 aspirations and 71.7 (67.5, 75.9)% at 100 aspirations.

Conclusions: This study suggests that when analyzing fellowship-trained physicians, performing joint aspirations under ultrasound or fluoroscopic guidance, there were improved joint aspiration success rates as the number of performed aspirations increased.

Significance: It appears that experience plays a role in successful attainment of fluid for diagnostic joint aspirations performed with fluoroscopy or ultrasound guidance.

Acknowledgements: We would like to thank all the patients and providers who participated in this study.

Epidemiology of Taekwondo Versus Judo-related Injuries in the United States Emergency Departments 2011-2020

Primary Author/Presenter: Lawrence Chang, DO, MPH

Petra Aboulhosn, MD, and Anusha Lekshminarayanan, MD

Affiliation: Montefiore Medical Center, Bronx, New York.

Assigned #: R2022-0054

Presentation Type: Poster

Purpose: Taekwondo is mainly a lower limb striking based martial art. Judo is a grappling based marital art. Both are known to commonly injure the head and lower extremities. We aim to compare demographics of Taekwondo versus Judo-related injuries among participants presenting to the emergency room.

Methods: Data on 346 Taekwondo and 253 Judo-related injuries contained within the National Electronic Injury Surveillance System over a 10-year period (January 2011-December 2020) were analyzed.

Results: Injuries from Taekwondo were most common in the 0 to 17 age group (71%), while the 0 to 17 group (47%) and 18-44 group (48%) were almost equally represented in Judo. While males were more likely to be injured in both sports (58% due to Taekwondo versus 71% due to Judo), more women participated in Taekwondo. The majority of injured participants in both groups were not classified under any documented race (40% versus 46%), followed by Caucasian race (38% versus 44%). Injuries to the ankle (14.7%), head (11.5%), knee (10.1%) and toe (9.5%) were the most common in Taekwondo. Injuries to the head (13.0%), ankle (11.1%), knee (10.7%) and foot (6.3%) were the most common in Judo. Strains/sprains were the most common type of injury (35 versus 36%) followed by fracture (24% versus 25%) in both sports.

Conclusions: Taekwondo-related injuries were noted among the younger age group of either gender, while Judo-related injuries were noted among males of younger and middle age group. Strains/sprains were the most common diagnosis for both. Ankle injury is most common in Taekwondo compared to head injury in Judo. Both martial arts participants, despite major differences in their fighting techniques, presented predominantly with lower extremity injuries.

Significance: Protective measures should be implemented to prevent lower extremity and head injuries among Taekwondo and Judo participants.

Acknowledgements: Dr. Paul T. Diamond, MD for this inspiration.

Epidemiology of Kickboxing Versus Karate-Related Injuries in the United States Emergency Departments 2011-2020

Primary Author/Presenter: Lawrence Chang, DO, MPH

Anusha Lekshminarayanan, MD, and Petra Aboulhosn, MD

Affiliation: Montefiore Medical Center, Bronx, NY.

Assigned #: R2022-0055

Presentation Type: Poster

Purpose: Karate and kickboxing similarly use both upper and lower extremities for combat sport. Both are striking forms of martial arts which can inflict major bodily injuries. We aim to describe the ten year prevalence of kickboxing versus karate-related injuries presenting to the emergency room.

Methods: Data on 546 kickboxing and 1981 karate martial arts-related injuries contained within the National Electronic Injury Surveillance System over a 10-year period (January 2011-December 2020) were analyzed.

Results: On comparison of kickboxing versus karate, mean age was 30 years versus 17 years, range 7 to 69 years of age versus 2 to 84 years of age, were recorded. Injuries were most common in the 18 to 44-year versus 0 to 17-year age group (73%). Males and females (50% each) were equally represented in kickboxing compared to 66% of male Karate participants. Majority of participants in kickboxing and karate were Caucasian (52% versus 44% respectively). Injuries to the foot (17%), knee (12%), ankle (10%) and head (6%) were the most common in kickboxing. Injuries to the foot (11%), head (10%) and ankle (9%) were the most common in karate. Strains/sprains were the most common type of injury (47% versus 31% respectively) followed by fracture (19% versus 28% respectively). Most injuries were sustained at a "sports" location (76%). Majority of cases (97%) were treated in the emergency department and released.

Conclusions: Kickboxing-related injuries were noted among the middle age regardless of gender, while karate-related injuries were noted among the male pediatric population. Strains/sprains were the most common diagnosis for both. Foot injuries were the most common injuries for both. There was a higher prevalence for karate participants to have a head injury compared to kickboxing participants.

Significance: Protective measures should be implemented to prevent foot and ankle injuries among karate and kickboxing athletes. Karate athletes have a higher chance of head injuries and thus need to use protection and restrict certain head striking techniques.

Acknowledgements: Dr. Paul T. Diamond, MD for his inspiration.

Concussion Trends in Pediatric Athletes Presenting to Outpatient Clinics Pre- and Post-COVID-19 Pandemic Shutdown

Primary Author/Presenter: Jane Chung, MD

Hannah Worrall, MPH, Claire Althoff, BA, Shane Miller, MD, Jacob Jones, MD, Mathew Stokes, MD, Stephanie Tow, MD, and C. Munro Cullum, PhD

Affiliation: Scottish Rite for Children and UT Southwestern Medical Center, Dallas, TX.

Assigned #: R2022-0165

Presentation Type: Poster

Purpose: Social and physical impacts of COVID-19 pandemic on student athletes include shift to remote learning and disruption of sport participation. To evaluate differences in symptom reporting and return to play (RTP) between athletes pre- and post-COVID shutdown following sport-related concussion (SRC).

Methods: Data prospectively collected on athletes 6-18, diagnosed with SRC presenting to sports medicine clinic within 60 days. Participants separated into 2 groups: pre- (January 2019-March 2020) and post-COVID shutdown (July 2020-November 2021). Demographics, medical history, clinical measures of symptom severity, anxiety (GAD-7), depression (PHQ-8), resiliency (BRS) and recovery outcomes were reviewed.

Results: 623 participants included 339 (54.4%) pre-COVID and 284 (45.6%) post-COVID. At initial presentation, athletes post-COVID reported lower scores on 12 of the SCAT-5 symptoms including sensitivity to light and noise, vestibular, oculomotor and cognition symptoms (p < 0.05) as well as having a lower total symptom severity score (25.2 ± 22.2 vs 32.1 ± 26.3, p = 0.005). No differences were observed between groups in GAD-7, PHQ-8 and BRS scores at initial presentation or 3-months post-enrollment. At 3-months, 5 symptoms (sensitivity to light and noise, dizziness, balance problems and blurry vision) were still significantly lower in the post-COVID athletes (p < 0.05) but no significant difference in total symptom score. There was no difference in overall RTP rates (p = 0.82), but more athletes post-COVID reported symptom resolution in < 31 days (77.7 vs 64.7%, p = 0.02) and initiated RTP protocol sooner (27.2 ± 34.4 vs 32.6 ± 23.4 days, p = 0.0001) compared to athletes pre-COVID.

Conclusions: Athletes post-COVID shutdown reported less symptom severity at initial and 3-months post-enrollment and more athletes reported symptom resolution in < 30 days and initiated RTP initiation quicker than pre-COVID athletes. These findings were surprising based on reports of increased mental health issues and coping difficulties during the drastic changes student athletes faced during the COVID-19 pandemic shutdown.

Significance: This information may be useful for providers showing that pediatric athletes presenting to outpatient clinics for concussion following the onset of the COVID-19 pandemic seem to be coping just as well or better than athletes pre-pandemic shutdown.

Acknowledgements: The study group, North Texas Concussion Registry (ConTex), is supported by a grant from the Texas Institute for Brain Injury and Repair at UT Southwestern Medical Center.

Intra-Articular Steroid Hip Injection Response as a Predictor for THA Outcomes

Primary Author/Presenter: Kevin Cipriano, MD

Steven Jow, MD, Justin Chau, BS, and Jared Aida, DO

Affiliation: Medstar/Georgetown-National Rehabilitation Hospital, Washington, DC.

Assigned #: R2022-0198

Presentation Type: Poster

Purpose: Total Hip Arthroplasty (THA) is a very common surgery for end stage osteoarthritis, however, aside from BMI there are not many good predictors of outcomes. This study looks into the reported outcome of THA Patients who had good responses to steroid injection prior to surgery.

Methods: This was a retrospective study via chart review looking at patients who received intra-articular steroid injection to the hip prior to THA. We looked at patient reported outcomes in terms of relief of pain and overall response to the steroid injection as well as overall outcome from their THA surgery.

Results: Of the over 100 charts reviewed, all but 6 (96%) self reported a good surgical outcome after having a steroid injection prior to surgery. Other data points looked at were BMI and number of Physical Therapy visits from surgery to week 6 for subgroup analysis.

Conclusions: It appears from patient reported outcomes that it may be beneficial to perform an intra-articular hip steroid injection prior to recommending THA to see if the patients reports good relief from the injection. This can be one tool used when deciding if a patient would be a good candidate for THA in the future and more research on the topic would be helpful.

Significance: Intra-articular steroid injections are feasible and inexpensive options to try prior to THA that can has the potential to be a good predictor of surgical outcomes and determining who may be a good surgical candiate.

Ankle Fractures among Skiers and Snowboarders at a Colorado Resort

Primary Author/Presenter: Jennifer Cogburn, MD

Kenneth Hunt, MD, Jack Spittler, MD, Lauren Pierpoint, PhD, Anahita Saeedi, MS, and Morteza Khodaee, MD, MPH

Affiliation: University of Colorado Family Medicine Residency, Denver, CO.

Assigned #: R2022-0176

Presentation Type: Poster

Purpose: To assess the most common ankle fractures suffered by skiers and snowboarders at a large ski resort.

Methods: This is a part of a larger study of injuries presenting to the resort's clinic from 2012/13-2016/17 ski season. The charts for all patients with ankle fracture were reviewed and characterized by investigators.

Results: There were 122 ankle fractures (1.9% of all visits) during the study period. The average age was 45.3 years (range 8-74) with the majority being female (53.3%) and mainly as a result of skiing (82.0%). The majority of fractures were sustained among skiers and snowboarders who self-identified as beginner or intermediate skill level (63.3%), on easy (green) or intermediate (blue) runs (63.1%). The most common fractures sustained were lateral malleolar fractures (77.9%) with Danis-Weber type B the most frequent fracture identified (55.6% of total). Medial malleolar (13.9%), posterior malleolar (8.2%), bimalleolar (10.7%) and trimalleolar (4.9%) fractures were much less common.

Conclusions: Skiers are much more likely to sustain ankle fractures compared to snowboarders. Women were slightly more likely than men to sustain ankle fractures. Most fractures were obtained in those in mild or moderately difficult ski runs compared to advanced ski runs. Fractures appear to be more common with advancing age. Mildly displaced Danis-Weber B fractures are the most common fractures sustained in skiers and snowboarders.

Significance: To our knowledge, this is the first study characterizing ankles fractures in skiers and snowboarders. This study describes the most common ankle fractures obtained in a large ski resorts and can serve as a base for future injury prevention measures.

Implementing a Virtual Intensive Lifestyle Intervention Program in a Food Desert

Primary Author/Presenter: Joseph Coppiano, MD, Joseph Coppiano, MD

Colleen Walters, DNP, Chasity Tierney, FNP, Christian Bramwell, MD, Hailie Hayes, and Richard Sams, MD

Affiliation: Medical College of Georgia, Augusta, GA.

Assigned #: R2022-0118

Presentation Type: Poster

Purpose: The goal of this project is to assess the impact of a virtual intensive lifestyle intervention program on the management of chronic conditions in patients who live in a food desert.

Methods: Eight participants from an academic family medicine clinic completed biweekly virtual lifestyle intervention group sessions over a 12 week period. All participants were given pre-session reading and online videos. Patient's body mass index (BMI), systolic blood pressure (SBP) and medication changes were retrospectively reviewed at 3 and 12 months post baseline.

Results: All participants were black females with an average BMI of 49.7 and SBP 145 at baseline. Six participants had Medicaid, 1 had commercial insurance and 1 was uninsured. Subjects had 74% average attendance. At 12 months from baseline, BMI and SBP decreased by 1.7 points and 12 points on average. No significant medication changes were made during this time.

Conclusions: In the setting of a global pandemic, using technology to promote lifestyle change is effective in improving health metrics. Furthermore, these results support that intensive lifestyle counseling is effective in resource limited communities.

Significance: The use of a virtual platform to conduct an intensive lifestyle intervention program is effective in promoting improvement in health metrics in patients living in a food desert.

Acknowledgements: This projected was supported by the Hames Grant from the Family Medicine Department at the Medical College of Georgia.

Emergency Medicine Residency Musculoskeletal Knowledge Assessment Survey—A Pilot Study

Primary Author/Presenter: Logan Danielson, DO

Aaron Thomas, MD, Alex Tomesch, MD, Anna Waterbrook, MD, CAQ-SM, and William Denq, MD, CAQ-SM

Affiliation: University of Arizona, Tucson, AZ.

Assigned #: R2022-0191

Presentation Type: Poster

Purpose: Identify common practices and areas of need in musculoskeletal (MSK) education in Emergency Medicine (EM) residency programs in the United States. To our knowledge, a needs assessment of musculoskeletal education has never been performed for Emergency Medicine.

Methods: We created an electronic survey to collect data on the areas that we believe most significantly affect EM MSK training. This survey was distributed as a pilot study to EM Program Directors (PD) across the United States. Anonymous responses were collected and reviewed to identify shared practices and common areas of need.

Results: 8 of 10 PDs responded to the pilot survey. The importance of MSK education is rated as 4.13/5. The percentage of residency curriculum dedicated to MSK knowledge ranges between 5% and 15%, with an average of 10%. The educational formats most commonly used include lecture (100%), on-shift teaching (100%) and dedicated MSK rotations (75%). The main methods of MSK Knowledge assessment includes faculty evaluation (87.5%) and inservice exam performance (87.5%). Only one PD reported current use of a formal MSK knowledge assessment tool. If a formal MSK tool was available, 2 programs reported being highly likely to use it and 5 programs would be somewhat likely to use it. All PDs felt improvements could be made to their program's MSK education. Time (75%), followed by interdepartmental relations (50%) are felt to be the biggest barriers to improvements in MSK education. All programs felt their residents are highly prepared (50%) or somewhat prepared (50%) to handle MSK issues upon graduation.

Conclusions: MSK knowledge and education is commonly agreed to be an important aspect of EM residency. How this is accomplished is highly variable and does not appear to be broadly standardized. With the large number of MSK complaints that present to the Emergency Department, it is important that graduates of EM residencies have solid foundations for understanding and treating these conditions.

Significance: This pilot study is the first reported needs assessment on MSK education in EM. It serves as a launch point for understanding perception, barriers and targets for improving MS

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