ABSTRACT
Context: The number of pediatric anterior cruciate ligament reconstructions (ACLRs) occurring yearly increased almost 6-fold from 2004-2014. We find it interesting that limited recent data exist on rates of ACL injury and reconstruction in children and adolescents, especially in the context of COVID-19. Objective: Given the effect of the COVID-19 pandemic on youth sports seasons and the postponement of many elective surgeries, we sought to examine the changes in rates of ACLR during this period. Design: Retrospective cohort study. Setting: This study used the Pediatric Health Information System (PHIS) database to identify eligible patients at PHIS-participating hospitals nationwide from January 2016-June 2021, with March 1, 2020, considered the start of the COVID-19 pandemic. Patients or other participants: Using Current Procedural Terminology codes, patients 18 years old and younger who underwent ACLR surgery were identified. Main outcome measure(s): Patient demographics and overall rates of surgery prepandemic and intrapandemic were compared. Data were analyzed using bivariate, mixed-model, and time series analyses. Results: A total of 24 843 ACLRs were identified during this time period. In total, 1853 fewer surgeries than expected were performed after March 2020 given prepandemic trends. Intrapandemic demographics revealed an increase in the proportion of patients who identified as White and with private insurance and a decrease in the proportion who identified as Black and with public insurance. Also, the proportion of ACLRs by region shifted, with more surgeries performed in the Midwest and fewer in the Northeast. In the model adjusted for hospital-level variability, only race and insurance status remained significant. Conclusions: Based on prepandemic trends, fewer patients than projected underwent ACLR once the pandemic began, likely due to a combination of decreased rates of injury and delayed surgery.
ABSTRACT
Background: COVID-19 restrictions created a period of disrupted sports participation for youth athletes. The physical conditioning and sports training habits of youth athletes during COVIDrelated sports interruption and upon returning to normal sports activity are currently unknown. The purpose of this study was to determine the extent to which athletes maintained their training levels during the COVID-19 pandemic and understand the strategies that enhanced motivation and adherence to a training regimen while in isolation. A secondary aim was to further understand the manner as to how youth athletes returned to activity and identify any secondary effects of the prolonged sports interruption as they resumed athletic activities. Methods: A two-part survey was designed to determine activity changes, type of organized instruction, and athlete preferences for training support. This was distributed by email using snowball sampling methodology to athletes 14-21 years-old who were involved in competitive sports when pandemic restrictions were enacted. As sports activities resumed, a follow-up survey was distributed to the same respondents to identify feelings of preparedness, training habits, and injuries. This study was reviewed and approved by the Institutional Review Board of the sponsoring organization. Results: Of the 155 subjects (mean age 16.1 ± 2 years, 64.5% female) that completed the initial survey, 98% reported a stoppage of in-person sports participation and 70% decreased their exercise/training volume, with 41% (n=63) reporting > 50% reduction. Most athletes (86%) received instruction from coaches, with written workouts (70%) being most common, however most athletes (70%) preferred instructor-led, group training sessions. Many athletes (73%) reported supplementing team-based training recommendations with independent workouts, primarily jogging (62%), strength training (54%) and sports specific skills (51%). With regards to their feelings of preparedness for returning to normal sports activity, 42% of athletes reported feeling only minimally or somewhat prepared. Of the 43 subjects that completed the follow up survey (34% response rate), 30% reported immediately returning to play for more than one team, and there was a sharp increase in athletic exposures compared to mid-pandemic levels (Figure 1). Despite this increase in structured athletic activity, 63% of the sample reported they still supplemented team-based practices with jogging (51%), sports specific skill work (47%) and strength training (40%) on an individual basis. Interestingly, 25% of athletes reported sustaining a sports-related injury a mean of 79 days after resuming sports activities. Conclusion: Pandemicrelated sports restrictions resulted in a large reduction in youth athlete training and conditioning. Coaches attempted to maintain training via use of written workouts, however athletes preferred instructor-led, group training sessions. There was a rapid resumption of sports activities, which may have contributed to the high rate of injuries seen in this study. Respondents' number of training days per week during remote led instruction and upon return to in-person sports.
ABSTRACT
Background: Recreational swimming/diving is the most common physical activity among US children and a significant cause of preventable morbidity across the United States. There are an estimated 50 million Americans that participate in swimming per year, 16 million of whom are children. Despite the popularity of swimming and diving, there are few up-to-date national divingrelated injury analyses, and no comprehensive injury analysis has been performed since the institution of International Swimming Pool •Spa Code (ISPSC) in 2012, which regulate diving equipment and design. This study offers a much-needed update on the national epidemiology of diving-related orthopedic injuries. Methods: The Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) database was queried for patients aged 0-18 from 2008- 2020 who presented to any of the approximately 100 NEISSparticipating emergency departments (EDs) for a diving-related injury. The patient cohort was identified using a search for consumer product code-1278 (diving). Injuries involving diving accessories, running, hitting, or tripping over the diving board, and injuries resulting from contact between two or more divers, were excluded. Infections were excluded. Dive characteristics such as dive height, dive skill, dive direction, and dive sequence were determined from case narratives. Descriptive statistical analysis was performed using Stata 16. Results: From 2008-2020 there were 1,157 cases of diving-related injury corresponding to a national estimate of 35,648 injuries (CI=28,067 - 43,230;Table 1). Children aged 10-14 accounted for 42% of all injuries, while adolescents aged 15-19 accounted for 38%. Nearly twice as many injuries occurred in boys compared to girls (64.2% vs 35.8% of total injuries, respectively). From 2008-2012, there were an average estimated 3,191 injuries per year. From 2013-2019, the yearly average decreased to 2,633 injuries (Figure 1). Due to the COVID-19 pandemic, there were relatively few (1,261) injuries in 2020. Compared to 2012, there were an estimated 1,081 fewer diving injuries in 2013, the first year the ISPSC codes were widely adopted. Lacerations were the most reported diagnosis for all years (24.9% of injuries). The head and neck were the mostinjured body parts (46.4% of injuries), followed by the face (17.4% of injuries), and lower extremities (16.6% of injuries). Concussions and nerve injury accounted for 6.7% and 0.1% of injuries, respectively. When the mechanism of injury was reported, unintentional contact with the diving board or platform was the most common cause (27.2% of injuries). Conclusion: Diving injuries are common in children and adolescents, especially in boys aged 10-19. Since the 2012 adoption of international safety standards for swimming pool design and operation, the average number of yearly divingrelated injuries has fallen by nearly 600 injuries/year. There was a significant reduction in diving-related injury corresponding with the COVID-19 pandemic.
ABSTRACT
Background: The COVID-19 pandemic has had a tremendous impact on youth sports participation for children and adolescents in the United States. Prior work demonstrated that pandemic-related closures led to a significant reduction in pediatric sports-related injury in the first half of 2020. However, these trends have yet to be evaluated on a national level and during the latter half of the year when organized youth sports began to re-emerge. Purpose: To estimate monthly and annual trends in youth sports-related injury over the last 5 years using a national injury database in order to measure the impact of the COVID-19 pandemic on overall and sport-specific rates of injury. Methods: We retrospectively reviewed data from the National Electronic Injury Surveillance System (NEISS) database identifying children and adolescents (0-18yo) presenting to US emergency departments with sport participation product codes (Table 1). Cases associated with >1 product code were excluded. The monthly and annual frequency of sports-related injuries was estimated. Quasi-experimental interrupted time series analysis was performed using the period of March-December 2020 as a binary variable. Differences in total and sport-specific injury estimates were calculated with pre-and post-trend analysis of the interrupted time series. Results: Our study criteria identified 152,560 youth sports-related injury cases corresponding to a national estimate of 4,582,892 injuries from 2016-2020 (95% CI=4,420,534-4,745,250). The mean yearly estimate from 2016-2019 was 1,041,944 injuries [890,047-1,193,841]. An estimated 415,115 injuries [357,779-480,594] occurred in 2020. Seasonal peaks in September and May were identified. There was a statistically significant decrease in national youth sportsrelated injuries that coincided with the nationwide COVID-19 shutdown in March 2020 (56,945 [33,143-80,747] fewer monthly injuries (P < 0.0001)). From March-December 2020, an estimated 457,221 [388,450-525,992] fewer sportsrelated injuries occurred than would have been expected based on prior trends. Sport-specific analyses (Table 1) demonstrated the greatest reduction of estimated injuries from March-December 2020 occurred in basketball (137,772 fewer injuries [130,192-145,246]), football (123,345 fewer injuries [86,883-159,807]), and soccer (70,383 fewer injuries [65,849-74,919]). Estimates of injuries associated with wrestling, ice hockey, and cheerleading had the greatest proportional reduction during the March-December time period (99%, 93%, and 79% respectively.) Conclusion: There was a significant reduction in youth sports-related injuries in 2020 coinciding with the nationwide COVID-19 shutdowns in March 2020 and persisting throughout the remainder of the year. Reduced injury burden was most notable for contact sports including basketball, football, and soccer.