Concussions are the leading cause of injury among youth athletes, and antibiotics are the most prescribed pediatric medication in the United States. Antibiotics have shown to exert neuroprotective effects in animal models of traumatic brain injury, but to date, no human studies exist. Between 2009 and 2019, 6,343 adolescent athletes with differential antibiotic use at baseline were administered Immediate Post-concussion Assessment and Cognitive Testing at baseline and twice postinjury. Chronic antibiotic use was associated with a reduced risk for concussion (odds ratio 0.54), increased postconcussive symptomology and neurocognitive burden, and improved recovery by follow-up, a median of 7 days after concussion. This preliminary retrospective analysis suggests antibiotic use may impart neuroprotection up to a certain severity threshold, leading to fewer, yet more severe concussions that tend to recover faster.
Concussion Incidence and Recovery of Neurocognitive Dysfunction Among Youth Athletes Taking Antibiotics: A Preliminary, Multicenter Retrospective Cohort Study
Nek Asghar, Muhammad Ali, Theodore Hannah, Adam Y. Li, Zerubabbel Asfaw, Eugene I. Hrabarchuk, Addison Quinones, Lily McCarthy, Vikram Vasan, Muhammad Murtaza-Ali, Anthony Lin, Husni Alasadi, Zaid Nakadar, Alexander J. Schupper, Alex Gometz, Mark R. Lovell, and Tanvir F. Choudhri
The Efficacy of Dry Needling in Combination With Electrical Stimulation on Pain Reduction and Improved Function in Chronic Plantar Heel Pain: A Critically Appraised Topic
Kelly J. Lumpkin, Eric J. Fuchs, and Jeff N. Lowes
Focused Clinical Question: What is the efficacy of dry needling (DN) in combination with electrical stimulation on pain and function when compared with DN alone, conservative care, or placebo treatments for chronic plantar heel pain? Clinical Bottom Line: Based on a review of three good-quality randomized controlled trials, it appears the lasting effects of utilizing DN in combination with electrical stimulation on chronic plantar heel pain for reduction in pain and an increase in function are superior in some outcome measures but not all outcome measures over time as compared with other treatments. It is unclear whether DN in combination with electrical stimulation is superior to DN alone; however, both are clinically useful when used adjunctively more than four times in a month. Based on conflicting results, needling protocol variations, treatment type comparison variations, and good-quality studies, the grade of a B is assigned to this critically appraised topic.
Readability of Postconcussion Home Care Instructions
Kristen C. Schellhase, Andrew A. McIntosh, Isis I.A. Jennings-Collier, Madison D. Dininny, Richard I. Zraick, and L. Colby Mangum
Patient education materials should be written at or below a fifth grade reading level. Postconcussion home care instructions outline what signs/symptoms warrant a visit to the emergency department and actions that should be taken/not taken by the caregiver. The purpose of this study was to determine the readability of postconcussion home care instructions provided by national organizations seen as setting the standard of care. Readability analyses were performed using the Readability Studio 2019 Standard Edition, by Oleander Software (Oleander Solutions). All postconcussion home care instructions were written above the recommended reading grade level. Poor comprehension of written material may lead to poor health outcomes; therefore, those organizations should consider amending handouts to meet the recommended reading level. Athletic trainers should examine the readability of home care instructions they provide, use both written and verbal instructions, and ensure caregiver understanding by using the skills in the Health Literacy Universal Precautions Toolkit.
Fractures, Glycemic Control, and Bone Mineral Density in Females With Type 1 Diabetes Mellitus: A Critically Appraised Topic
Antoinette Lee, Nancy A. Uriegas, Morgan G. Adams, and Amy F. Hand
Clinical scenarios have risen where females with Type 1 diabetes mellitus (T1-DM), whose demographics are similar to their male counterparts, have sustained bone injuries, whereas the males with T1-DM have not. These scenarios bring into question the effect of T1-DM on various aspects of bone health and injury risk in females. The purpose of this study was to investigate the impact of T1-DM in females on their fracture risk, glycemic control abilities, and bone mineral density when compared to their male counterparts. Results were consistent across all studies, indicating that individuals with T1-DM had poor glycemic control abilities during ages within peak bone accrual, had significantly lower bone mineral density, and had a greater fracture incidence. Given these results, there is a need for future education to emphasize the importance of glycemic management, future research to investigate differences in physically active populations, and for clinicians to recognize their at-risk patients and take the necessary measures to prevent injury.
NATA News & Notes
Continuing Education Assessment
Volume 28 (2023): Issue 4 (Jul 2023)
The Effectiveness of Advanced Cardiac Testing on Identifying Risk for Sudden Cardiac Arrest/Death in Athletes Following COVID-19 Infection During Preparticipation Examination: A Critically Appraised Topic
Sydney Wysmierski, Emily A. Hall, Greg Garofalo, and Rebecca Lopez
Clinical Scenario: Due to the potential side effects in athletes, there is a need to evaluate for cardiac-related side effects due to COVID-19 infection during preparticipation examinations. Clinical Question: Does advanced cardiac testing during preparticipation examinations in athletes who have contracted the COVID-19 virus identify cardiac abnormalities? Summary of Key Findings: The literature was searched based on athletes’ post–COVID-19 infection who were tested for risk of sudden cardiac arrest/death. The initial search yielded 32 studies, but 7 were excluded based on abstract content. Of the remaining 25 studies, 17 were excluded based on patient age or non-athletic populations. Four relevant studies met the inclusion criteria and were included. The need for cardiac screening and advanced cardiac testing was supported to identify risk of sudden cardiac arrest/death during preparticipation examinations in COVID-19–positive patients. Clinical Bottom Line: The use of advanced cardiac testing along with a comprehensive symptom and history questionnaire is essential to reduce cardiac complications due to COVID-19. Symptom-based questionnaires following COVID-19 infection can detect possible COVID-19–related cardiac abnormalities better than the standard cardiac symptom-based questionnaires alone. These combined screening measures for patients with a COVID-19 infection can safely help return athletes to sports. Strength of Recommendation : This recommendation has a strength of B based on Oxford Centre for Evidence-Based Medicine due to consistently lower quality limited evidence that supports the use of advanced cardiac testing in identifying heart-related complications and risk of sudden cardiac arrest/death in COVID-19–positive patients.
Transcranial Direct Current Stimulation for Improving Outcomes in Patients With Chronic Ankle Instability: A Critically Appraised Paper
Tricia L. Majewski-Schrage and Kelli R. Snyder
Focused Clinical Question: Is there evidence to suggest that transcranial direct current stimulation improves clinical and patient-reported outcomes in patients with chronic ankle instability? Clinical Bottom Line: Evidence from two clinical studies supports the use of transcranial direct current stimulation for improving outcomes in patients with chronic ankle instability.