Alternative diagnoses at paediatric appendicitis MRI.

As the utilization of MRI in the assessment for paediatric appendicitis increases in clinical practice, it is important to recognize alternative diagnoses as the cause of abdominal pain. The purpose of this review is to share our institution's experience using MRI in the evaluation of 510 paediatric patients presenting with suspected appendicitis over a 30 month interval (July 2011 to December 2013). An alternative diagnosis was documented in 98/510 (19.2%) patients; adnexal pathology (6.3%, n = 32), enteritis-colitis (6.3%, n = 32), and mesenteric adenitis (2.2%, n = 11) comprised the majority of cases. These common entities and other less frequent illustrative cases obtained during our overall institutional experience with MRI for suspected appendicitis are reviewed.

A field-test battery for elite, young soccer players.

The validity and reliability of a battery of field-based performance tests was examined. The opinions of coaches, fitness professionals and players (n=170, 172 and 101 respectively) on the importance of performance testing were established using a questionnaire. On 2 occasions, separated by 7 days, 80 elite, young soccer players (mean±SD [and range]: age 13.2±2.6 [8.9-19.1] years; stature 1.59±0.18 m [1.32-1.91]; body mass 50.6±17.1 [26.5-88.7] kg) completed a battery of field-based tests comprised of heart rate response to a submaximal Multi-stage fitness test, 3 types of vertical jump, sprints over 10 and 20 m, and an agility test. Physical performance testing was considered important by coaches (97%), fitness professionals (94%) and players (83%). The systematic bias ratio and the random error components of the 95% ratio limits of agreement for the first and second tests, for the U9-U11 vs. U12-U14 vs. U15-U18 age groups, were [Systematic bias (*/÷ ratio limits)]: Heart rate (Level 5): 0.983 (*/÷ 1.044) vs. 0.969 (*/÷ 1.056) vs. 0.983 (*/÷ 1.055); Rocket jump: 0998 (*/÷ 1.112) vs. 0.999 (*/÷ 1.106) vs. 0.996 (*/÷ 1.093); 10 m sprint: 0.997 (*/÷ 1.038) vs. 0.994 (*/÷ 1.033) vs. 0.994 (*/÷ 1.038); Agility test: 1.010 (*/÷1.050) vs. 1.014 (*/÷1.050) vs. 1.002 (*/÷1.053). All tests, except heart rate recovery from the Multi-stage fitness test, were able to distinguish between different ability and age groups of players (p<0.05). Thus, the field-test battery demonstrated logical and construct validity, and was shown to be a reliable and objective tool for assessing elite, young soccer players.

The Football Association medical research programme: an audit of injuries in academy youth football.

OBJECTIVES: To undertake a prospective epidemiological study of the injuries sustained in English youth academy football over two competitive seasons. METHODS: Player injuries were annotated by medical staff at 38 English football club youth academies. A specific injury audit questionnaire was used together with a weekly return form that documented each club's current injury status. RESULTS: A total of 3805 injuries were reported over two complete seasons (June to May) with an average injury rate of 0.40 per player per season. The mean (SD) number of days absent for each injury was 21.9 (33.63), with an average of 2.31 (3.66) games missed per injury. The total amount of time absent through injury equated to about 6% of the player's development time. Players in the higher age groups (17-19 years) were more likely to receive an injury than those in the younger age groups (9-16 years). Injury incidence varied throughout the season, with training injuries peaking in January (p<0.05) and competition injuries peaking in October (p<0.05). Competition injuries accounted for 50.4% of the total, with 36% of these occurring in the last third of each half. Strains (31%) and sprains (20%) were the main injury types, predominantly affecting the lower limb, with a similar proportion of injuries affecting the thigh (19%), ankle (19%), and knee (18%). Growth related conditions, including Sever's disease and Osgood-Schlatter's disease, accounted for 5% of total injuries, peaking in the under 13 age group for Osgood-Schlatter's disease and the under 11 age group for Sever's disease. The rate of re-injury of exactly the same anatomical structure was 3%. CONCLUSIONS: Footballers are at high risk of injury and there is a need to investigate ways of reducing this risk. Injury incidence at academy level is approximately half that of the professional game. Academy players probably have much less exposure to injury than their full time counterparts. Areas that warrant further attention include the link between musculoskeletal development and the onset of youth related conditions such as Sever's disease and Osgood-Schlatter's disease, the significant number of non-contact injuries that occur in academy football, and the increased rates of injury during preseason training and after the mid season break. This study has highlighted the nature and severity of injuries that occur at academy level, and the third part of the audit process now needs to be undertaken: the implementation of strategies to reduce the number of injuries encountered at this level.

The association football medical research programme: an audit of injuries in professional football.

OBJECTIVES: To undertake a prospective epidemiological study of the injuries sustained in English professional football over two competitive seasons. METHODS: Player injuries were annotated by club medical staff at 91 professional football clubs. A specific injury audit questionnaire was used together with a weekly form that documented each club's current injury status. RESULTS: A total of 6,030 injuries were reported over the two seasons with an average of 1.3 injuries per player per season. The mean (SD) number of days absent for each injury was 24.2 (40.2), with 78% of the injuries leading to a minimum of one competitive match being missed. The injury incidence varied throughout the season, with training injuries peaking during July (p<0.05) and match injuries peaking during August (p<0.05). Competition injuries represented 63% of those reported, significantly (p<0.01) more of these injuries occurring towards the end of both halves. Strains (37%) and sprains (19%) were the major injury types, the lower extremity being the site of 87% of the injuries reported. Most injury mechanisms were classified as being non-contact (58%). Re-injuries accounted for 7% of all injuries, 66% of these being classified as either a strain or a sprain. The severity of re-injuries was greater than the initial injury (p<0.01). CONCLUSIONS: Professional football players are exposed to a high risk of injury and there is a need to investigate ways of reducing this risk. Areas that warrant attention include the training programmes implemented by clubs during various stages of the season, the factors contributing to the pattern of injuries during matches with respect to time, and the rehabilitation protocols employed by clubs.