Headache Characteristics and Psychological Factors Associated with Functional Impairment in Individuals with Persistent Posttraumatic Headache.

OBJECTIVE: Persistent posttraumatic headache (PPTH), one of the most common symptoms following mild traumatic brain injury, is often associated with substantial functional disability. The objective of this study was to assess the contribution of demographics, headache characteristics, and psychological symptoms to disability associated with PPTH. METHODS: Participants completed the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Pain Catastrophizing Scale (PCS), and the Migraine Disability Assessment (MIDAS) questionnaire. Two linear regression models were formulated to interrogate the relationships between 1) demographics and headache characteristics with the MIDAS questionnaire and 2) demographics, headache characteristics, and psychological symptoms with the MIDAS questionnaire. A two-way stepwise regression using the Akaike information criterion was performed to find a parsimonious model describing the relationships between demographics, headache characteristics, and psychological measures with the MIDAS questionnaire. RESULTS: Participants included 58 patients with PPTH and 39 healthy controls (HCs). The median MIDAS score among those with PPTH was 48.0 (first quartile [1Q] = 20.0, third quartile [3Q] = 92.0), indicative of severe disability. Compared with the HCs, those with PPTH had higher scores on the BDI, STAI, and PCS. Older age predicted lower MIDAS scores (age: B=-0.11, P<0.01), whereas higher headache frequency, greater headache intensity, and higher trait anxiety scores predicted higher MIDAS scores in individuals with PPTH (headache frequency: B=0.07, P<0.001; headache intensity: B=0.51, P=0.04; trait anxiety score: B=1.11, P=0.01). CONCLUSIONS: Individuals with PPTH had substantial psychological symptoms and headache-related disability. Disability was partially explained by age, headache frequency and intensity, and trait anxiety. Holistic management of patients with PPTH to address headaches and psychological symptoms might reduce headache-associated disability.

Hand and Wrist Injuries in Men's and Women's National Collegiate Athletic Association Basketball.

BACKGROUND: Hand and wrist injuries (HWIs) are common in National Collegiate Athletic Association (NCAA) basketball players and can negatively affect performance. There is limited literature available on this topic. PURPOSE: To open a discussion on prevention strategies and encourage future research on HWIs in basketball athletes. STUDY DESIGN: Descriptive epidemiology study. METHODS: HWIs sustained by male and female NCAA basketball players during the 2009-2010 through 2013-2014 academic years and reported to the NCAA Injury Surveillance Program (NCAA-ISP) database were utilized to characterize the epidemiology thereof. Rates and distributions of HWIs were identified within the context of mechanism of injury, injury recurrence, and time lost from sport. RESULTS: Over the 5-year period, 81 HWIs in women and 171 HWIs in men were identified through the NCAA-ISP database. These were used to estimate 3515 HWIs nationally in women's basketball athletes and 7574 HWIs nationally in men's basketball athletes. The rate of HWIs in women was 4.20 per 10,000 athlete-exposures (AEs) and in men was 7.76 per 10,000 AEs, making men 1.85 times more likely to sustain HWIs compared with women. In men, HWIs were 3.31 times more likely to occur in competition compared with practice, while in women, HWIs were 2.40 times more likely to occur in competition than in practice. Based on position, guards, both men and women, were the most likely to suffer HWIs. CONCLUSION: HWIs were common in collegiate basketball players. Most injuries were new, and the majority of players were restricted from participation for less than 24 hours. Men were more likely to be injured compared with women, and injuries were most common in the setting of competition for both sexes. The majority of injuries was considered minor and did not extensively limit participation; however, prevention and detection remain important for optimal performance.

Neck and Cervical Spine Injuries in National College Athletic Association Athletes: A 5-Year Epidemiologic Study.

STUDY DESIGN: Descriptive epidemiology study. OBJECTIVE: The purpose of this study was to describe the epidemiology of neck and cervical spine injuries in collegiate athletes over a 5-year period. SUMMARY OF BACKGROUND DATA: The incidence and etiology of neck and cervical spine injuries in National Collegiate Athletic Association (NCAA) athletes has not been well defined in recent years. METHODS: The incidence and characteristics of neck and cervical spine injuries were identified utilizing the NCAA Injury Surveillance Program database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition. RESULTS: Nationally, there were an estimated 11,510 neck and cervical spine injuries over the 5-year period. These occurred at a rate of 7.05 per 100,000 athlete-exposures (AEs). The rate of neck and cervical spine injuries in men was 2.66 per 100,000 AEs, while women suffered injuries at a rate of 1.95 per 100,000 AEs. In sex-comparable sports, men were 1.36 times more likely to suffer a neck or cervical spine injury compared with women. Men's football (29.09 per 100,000 AEs) and women's field hockey (11.51 per 100,000 AEs) were the sports with the highest rates of injuries. These injuries were 3.94 times more likely to occur during competition compared with practice. In-season injury rates were the highest, at 8.18 per 100,000 AEs. CONCLUSION: The vast majority of neck and cervical spine injuries in NCAA athletes are minor and uncommon. Across all sports in both sexes, the majority of injuries were new, and occurred during in-season competitions. Most athletes returned to play within 24 hours of injury. These data can inform players, parents, coaches, athletic trainers, and physicians regarding the prevalence and rates of these injuries and potentially inform decision-making regarding injury prevention, treatment, and rehabilitation. LEVEL OF EVIDENCE: 4.

Epidemiology of Lumbar Spine Injuries in Men's and Women's National Collegiate Athletic Association Basketball Athletes.

BACKGROUND: Lumbar spine injuries (LSIs) are common in both men's and women's National Collegiate Athletic Association (NCAA) basketball players and can frequently lead to reinjuries and persistent pain. PURPOSE: To describe the epidemiology of an LSI in collegiate men's and women's basketball during the 2009-2010 through 2013-2014 academic years. STUDY DESIGN: Descriptive epidemiology study. METHODS: The incidence and characteristics of LSIs were identified utilizing the NCAA Injury Surveillance Program (ISP). Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in 1 NCAA-sanctioned practice or competition. Incidence rate ratios (IRRs) were then calculated to compare the rates of injury between season, event type, mechanism, injury recurrence, and time lost from sport. RESULTS: The NCAA ISP reported 124 LSIs from an average of 28 and 29 men's and women's teams, respectively. These were used via validated weighting methodology to estimate a total of 5197 LSIs nationally. The rate of LSIs in women was 2.16 per 10,000 AEs, while men suffered LSIs at a rate of 3.47 per 10,000 AEs. Men were 1.61 times more likely to suffer an LSI compared with women. In men, an LSI was 3.48 times more likely to occur in competition when compared with practice, while in women, an LSI was 1.36 times more likely to occur in competition than in practice. Women suffered the highest LSI rate during the postseason, while the highest rate in men was during the regular season. The majority of both female (58.9%; n = 1004) and male (73.1%; n = 2353) athletes returned to play within 24 hours of injury. CONCLUSION: To date, this is the largest study to characterize LSIs in NCAA basketball and provides needed information on the prevalence and timing of these injuries. The majority of injuries in both sexes were new, and most athletes returned to play in less than 24 hours. Injury rates were highest during competition in both sexes.

Preperitoneal Pelvic Packing Is Not Associated With an Increased Risk of Surgical Site Infections After Internal Anterior Pelvic Ring Fixation.

OBJECTIVE: To investigate the risk of postoperative surgical site infections after plate fixation of the anterior pelvic ring subsequent to preperitoneal pelvic packing (PPP). DESIGN: Retrospective observational cohort study. SETTING: Level I academic trauma center. PATIENTS: Adult trauma patients with unstable pelvic ring injuries requiring surgical fixation of the anterior pelvic ring. INTERVENTION: Pelvic plate fixation was performed as a staged procedure after external fixation and PPP/depacking (PPP group; n = 25) or as a single-stage primary internal fixation (control group; n = 87). MAIN OUTCOME MEASURE: Incidence of postoperative surgical site infections of the pelvic space. RESULTS: Anterior pelvic plate fixation was performed in 112 patients during a 5-year study period. The PPP group had higher injury severity scores and transfused packed red blood cells than the control group (injury severity score: 46 ± 12.2 vs. 29 ± 1.5; packed red blood cells: 13 ± 10 vs. 5 ± 2; P < 0.05). The mean time until pelvic depacking was 1.7 ± 0.6 days (range: 1-3 days) and 3.4 ± 3.7 days (range: 0-15 days) from depacking until pelvic fracture fixation. Two patients in the PPP group and 8 patients in the control group developed a postoperative infection requiring a surgical revision (8.0% vs. 9.2%; n.s.). Both PPP patients with a pelvic space infection had undergone anterior plate fixation for associated acetabular fractures. CONCLUSIONS: These data support the safety of the PPP protocol for bleeding pelvic ring injuries due to the lack of increased infection rates after fracture fixation. Caution should be applied when considering PPP in patients with associated acetabular fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Ninety-day readmissions following reverse total shoulder arthroplasty.

BACKGROUND: An adequate characterization of 90-day readmissions after primary reverse total shoulder arthroplasty (RTSA) on a national level remains to be undertaken. As bundled payment models become more prevalent, an improved understanding of readmission data will help to predict resource utilization and expenses. METHODS: All adult patients who underwent elective primary RTSA in 2014 in the National Readmission Database were included in the analysis. Two cohorts were created based on 90-day readmission status. Multivariate analysis was then performed to determine predictors of 90-day readmissions. Reasons for 30-, 60-, and 90-day readmissions were identified. Total hospital resource utilization was calculated. RESULTS: An estimated 25,196 patients were identified. The 30-, 60-, and 90-day rates of readmissions were 0.6%, 1.2%, and 1.7%, respectively. Diabetes (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.14-1.78), hypertension (OR, 1.63; 95% CI, 1.28-2.08), paralysis (OR, 3.61; 95% CI, 1.63-7.97), and solid tumor without metastasis (OR, 2.72; 95% CI, 1.21-6.12) were identified as independent predictors of 90-day readmission. Ninety-day readmissions were associated with a significant increase in cost (P = .02). The most common related reason for 90-day readmission was hardware-related complications at all time points. CONCLUSION: Although uncommon, 90-day readmissions after primary RTSA are associated with significant patient morbidity and consequently substantial hospital costs.

Lumbar Spine Injuries in National Collegiate Athletic Association Athletes: A 6-Season Epidemiological Study.

BACKGROUND: Lumbar spine injuries in National Collegiate Athletic Association (NCAA) athletes have not been well studied. PURPOSE: To describe the epidemiology of lumbar spine injuries in NCAA athletes during the 2009/2010 through 2014/2015 academic years utilizing the NCAA Injury Surveillance Program (ISP). STUDY DESIGN: Descriptive epidemiology study. METHODS: A voluntary convenience sample of NCAA varsity teams from 25 sports was examined. Mechanism of injury, injury recurrence, and time lost from sport were recorded. Injury rates were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in 1 NCAA-sanctioned practice or competition. Injury rate ratios and injury proportion ratios were calculated to compare the rates within and between sports by event type, season, patient sex, mechanism, injury recurrence, and time lost from sport. Comparisons between sexes were made utilizing data that had both male and female samples. RESULTS: An estimated 37,435 lumbar spine injuries were identified. The overall rate of injuries was 6.01 per 1000 AEs. The rate of injuries was 4.94 per 1000 AEs in men compared with 3.94 per 1000 AEs in women for sex-comparable sports. Men were 1.25 times more likely than women to suffer a lumbar spine injury. Men's football (24.62 injuries/1000 AEs) and women's gymnastics (11.46 injuries/1000 AEs) had the highest rates of lumbar spine injuries. Athletes were 1.83 and 3.71 times more likely to sustain a lumbar spine injury during the preseason than the regular season or postseason, respectively. Noncontact was the most common mechanism of injury (38%). Injury recurrence was most common in men's outdoor track (58%). Most injuries resulted in less than 24 hours of time loss from event participation (61%). CONCLUSION: The rate of lumbar spine injuries was high in NCAA athletes, and injuries commonly recurred (20%). In general, men were more likely to sustain a lumbar spine injury compared with women. Higher injury rates occurred during competition and via a noncontact mechanism of injury. In addition to prevention programs, reconditioning programs should be considered to prevent these injuries.