Assessment of post-concussion emotional symptom load using PCSS and PROMIS instruments in pediatric patients.

OBJECTIVES: The purpose of this study is to evaluate the utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depressive symptom domains in conjunction with the Post-Concussion Symptom Scale (PCSS)for identifying pediatric patients with emotional symptoms following a concussion, and to identify predictors of higher emotional symptom loads. METHODS: We recruited English-speaking patients aged 8-17 years presenting to a tertiary-care concussion clinic from 2014 to 2018 (n = 458). Demographics and clinical data including PCSS, injury date, previous history of anxiety/depression, and Vestibular/Ocular-Motor Screen (VOMS) were collected from patients' electronic medical records. Participants completed surveys in the PROMISTM Pediatric Item Bank v1.1-Anxiety and Depressive Symptoms domains at their initial clinic visit. Multivariable linear regression identified predictors of higher emotional symptom loads. RESULTS: Overall, 425 (92.8%) reported ≥1 emotional symptom on either PROMIS or PCSS. Predictors of higher emotional symptom loads were abnormal VOMS, female sex, history of anxiety or depression, and longer time since injury. CONCLUSION: Our results suggest that adding PROMIS anxiety and depressive symptom surveys to pediatric concussion evaluations may identify more children with emotional symptoms, allowing clinicians to better direct post-concussion treatment and incorporate psychological support for patients if necessary. Future studies should examine whether earlier identification of emotional symptoms with these tools facilitates recovery and improves short- and/or long-term psychological outcomes in pediatric concussion.

Care of the Transgender Athlete.

Transgender individuals identify as a gender different than their sex designated at birth. Transgender athletes, as the name implies, are transgender individuals who participate in sports/athletics. By reviewing the literature relevant to transgender athletes and adding commentary on important considerations, this article acts as a primer for the sports medicine clinician on the care of transgender athletes. We cover terminology, epidemiology, policy, and relevant medical considerations. Literature relevant for medical care specific to transgender athletes is still relatively sparse. We highlight many recommended areas of future research with the potential to make valuable contributions to evidence-based sports medicine practice for this population.

Promotion of Healthy Weight-Control Practices in Young Athletes.

Children and adolescents may participate in sports that favor a particular body type. Some sports, such as gymnastics, dance, and distance running, emphasize a slim or lean physique for aesthetic or performance reasons. Participants in weight-class sports, such as wrestling and martial arts, may attempt weight loss so they can compete at a lower weight class. Other sports, such as football and bodybuilding, highlight a muscular physique; young athletes engaged in these sports may desire to gain weight and muscle mass. This clinical report describes unhealthy methods of weight loss and gain as well as policies and approaches used to curb these practices. The report also reviews healthy strategies for weight loss and weight gain and provides recommendations for pediatricians on how to promote healthy weight control in young athletes.

The Preparticipation Physical Evaluation.

With rising rates of sports participation among children and adolescents, pediatricians are increasingly being called upon to perform preparticipation physical evaluations (PPEs) for young athletes. The purpose of this review article is to discuss the general structure of a comprehensive PPE and how the PPE differs from a typical health maintenance visit. The PPE focuses attention on screening for cardiac conditions that predispose athletes to sudden cardiac death with exercise. This review also addresses the debate over whether electrocardiogram screening should be a routine required part of the PPE. In addition to cardiac screening, evaluation and management of musculoskeletal injury, concussion, and the female athlete triad will be discussed in greater detail. [Pediatr Ann. 2017;46(3):e85-e92.].

Growing Pains.

CONTEXT: The term growing pains describes a common, benign syndrome of recurrent discomfort that occurs in young children. First described in the 1800s, the etiology of this condition remains unclear. The peak incidence does not correspond to a time of rapid growth. Children typically report bilateral pain in the lower extremities that occurs late in the day or at night. EVIDENCE ACQUISITION: The PubMed database was searched using the keywords growing pains, benign nocturnal limb pains of childhood, recurrent limb pain of childhood, and limb pain in childhood. Articles were also found by reviewing references from the initial PubMed search. Only English-language articles published from 1900 through 2016 were included in the review. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 3. RESULTS: When a patient's history is classic for growing pains and physical examination is normal, laboratory and radiographic evaluation are not needed to make the diagnosis. Findings typical for growing pains include bilateral lower extremity pain usually experienced in the early evening or at night. The pain is not caused by activity and will not cause a limp. CONCLUSION: Additional workup is warranted for children with an atypical history, systemic symptoms, or for those individuals with physical examination abnormalities such as allodynia, focal tenderness, joint swelling, or decreased joint range of motion. Management of growing pains generally consists of symptomatic care with massage and over-the-counter analgesics, as well as reassurance to children and parents about the benign, self-limited nature of this condition. This review article summarizes data on the epidemiology, etiology, and management of growing pains and provides a framework for distinguishing this entity from other causes of extremity pain.

The Postconcussion Symptom Scale: utility of a three-factor structure.

PURPOSE: This study aimed to determine the factor structure of a 19-item Postconcussion Symptom Scale and to examine associations between factor scores and sex, previous history of concussion, and length of time since injury. METHODS: This is a retrospective medical record review of pediatric patients with concussion seen in a sports medicine clinic from April 2008 to September 2012. We performed an exploratory factor analysis (EFA) followed by a confirmatory factor analysis (CFA). ANOVA and regression analysis were used to examine associations between factor scores and sex, previous history of concussion, mood disorder, anxiety disorder or attention-deficit disorder, and length of time since injury. RESULTS: EFA supported a three-factor solution for postconcussive symptoms employing 18 of the original 19 scale items. Factor 1 consisted of eight cognition-related items, factor 2 consisted of six somatic-related items, and factor 3 consisted of four emotional-related items. CFA results confirmed the unidimensionality of factors 1 (neurocognitive), 2 (somatic) and 3 (emotional), with factor 3 being considered borderline. Females and patients with anxiety disorders had significantly worse (higher) scores on all three factors. Patients seen >14 d after the concussive injury had worse (higher) factor 3 (emotional) scores than those seen <14 d after the injury. There was no significant difference in postconcussive symptom factor structures between those with and without a previous history of concussion. CONCLUSIONS: Our investigation demonstrates a consistent symptom 3-factor structure of the Postconcussion Symptom Scale in pediatric patients with concussions. Females and patients with anxiety disorders had higher scores than males for all three factors. Patients seen >14 d after concussive injury had higher scores for emotional symptoms, suggesting that prolonged concussion symptoms may affect emotional health.

Pediatricians' knowledge of current sports concussion legislation and guidelines and comfort with sports concussion management: a cross-sectional study.

BACKGROUND: Sports-related concussions disproportionately affect young athletes. The primary objective of our study was to determine Illinois pediatricians' level of familiarity with state concussion legislation and with published consensus guidelines for sports concussion diagnosis and treatment. We also sought to determine pediatricians' knowledge regarding concussion management and comfort treating sports concussion patients. METHODS: This was a cross-sectional survey of pediatrician members of the Illinois Chapter of the American Academy of Pediatrics. RESULTS: Few general pediatricians (26.6%, n = 42) were "very familiar" or "somewhat familiar" with the recently passed Illinois state concussion legislation. Only 14.6% (n = 23) of general pediatrician respondents use concussion consensus guidelines in their practice. Pediatricians were generally very knowledgeable about concussions; only 5 out of 19 knowledge-based items were answered incorrectly by more than 25% of the study participants. CONCLUSIONS: General pediatricians are knowledgeable about concussions but most are not well aware of state concussion legislation and concussion consensus guidelines.

Bilateral osteochondrosis of the primary patellar ossification centers in a young athlete: a case report.

: Osteochondroses are a group of idiopathic self-limited conditions seen in skeletally immature individuals. The term describes disturbances in endochondral ossification affecting either the primary or secondary ossification centers. Osteochondrosis of the tarsal navicular was first described by Köhler in 1908; the eponym "Köhler's disease" is commonly used to refer to this condition. In his original paper, Köhler also described one instance of an osteochondrosis of the primary patellar ossification center, a clinical entity that has since rarely been reported. We present a case of isolated bilateral "Köhler's disease of the patellae" in an approximately 7-year-old male athlete demonstrated clinically and radiographically by both plain radiographs and magnetic resonance imaging.

Isthmic spondylolisthesis in a nonambulatory patient: a case report.

STUDY DESIGN: Case report. OBJECTIVE: We present a case of a nonambulatory patient with an isthmic spondylolisthesis. SUMMARY OF BACKGROUND DATA: Pars defects are thought to be due to repeated mechanical stress on the spine in individuals with bipedal posture. Epidemiologic and mechanical studies have supported the idea that repeated lumbar flexion and extension can lead to stress fractures of the pars interarticularis and subsequent spondylolisthesis. There are no documented cases of isolated pars defects in nonambulatory patients. We present a case report of an isolated isthmic spondylolisthesis in a patient who has never ambulated. METHODS: Discussion of the patient's clinical and radiologic history with a brief review of the relevant background literature. RESULTS: A pars interarticularis lesion was identified on plain radiographs in a 17-year-old girl with mixed spastic-athetoid cerebral palsy who never ambulated. CONCLUSION: Although ambulatory individuals who engage in activities with repeated lumbar flexion have an increased risk of isthmic spondylolisthesis, this condition can occur in those who do not walk as well. This case illustrated that, although repetitive stress on an upright spine can increase an individual's propensity to develop a pars interarticularis defect, bipedal posture is not an absolute requirement for the development of this lesion.