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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.

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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.

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NATA News & Notes

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Continuing Education Assessment

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Volume 28 (2023): Issue 3 (May 2023)

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American Football Soft-Shell Helmet Covers Reduce Head Impact Severity: A Critically Appraised Topic

Kayla O’Connell, Christopher Brown, and Patricia M. Tripp

Focused Clinical Question: Do soft-shell helmet covers reduce head impact severity in American football helmets? Clinical Bottom Line: There is consistent SORT level C evidence to support that soft-shell helmet covers reduce measures of head impact severity and measures of linear and rotational acceleration. The impact reductions occurred at magnitudes less than the average reported concussive impact, which limits the application of the evidence with respect to concussion incidence or risk among American football players.

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Policies, Procedures, and Confidence in Managing Pregnancy Among Secondary School Athletic Trainers

Kaylie Simpson, John Goetschius, and Victor Liberi

Adolescent pregnancy rates are higher in the United States than in other developed countries. Clear policies and procedures are necessary for managing pregnancy in the secondary school setting. This study aimed to determine if athletic trainers had a policy for, and their confidence in, managing pregnant athletes in the secondary school setting. Sixteen percent of the participants have previously managed adolescent pregnancy, yet only 4% had a policy. Athletic trainers with pregnancy policies and procedures or previous experience managing pregnancy reported greater confidence in managing pregnancy in adolescent athletes. Participants were only “slightly confident” in managing pregnant adolescent athletes.

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Athletic Trainers’ Proficiency in Evaluating Emergency Action Plans and a Subset of Catastrophic Policies and Procedures

Samantha E. Scarneo-Miller, Christianne M. Eason, Zachary K. Winkelmann, Christina Emrich, and Johna K. Register-Mihalik

Written health and safety policies mitigate catastrophic outcomes resulting from sport injuries. The purpose of this project was to evaluate athletic trainers’ proficiency in evaluating catastrophic policies and procedures alignment with best practices. This study found athletic trainers were not able to identify the majority of policy and procedure components based on evidence-based best practice documents. Furthermore, athletic trainers tended to focus more on aesthetics and feasibility versus alignment with current best practices. Results support the need to enhance education specific to policy and procedure development, evaluation, and implementation in order to improve proficiency of clinicians.

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Twenty-Three-Year-Old Collegiate Soccer Athlete With Bilateral Femoral Head Avascular Necrosis: A Case Report

Allyson K. Folkert, Brady L. Tripp, and Christopher D. Brown

A 23-year-old collegiate club soccer player reported to his athletic trainer right hip flexor pain and no recalled mechanism. Diagnostic imaging revealed bilateral avascular necrosis (AVN) of both femoral heads. Medical intervention included bilateral core decompression surgery. The majority of reported AVN cases are pediatric patients and adults over 50 years old, following trauma (i.e., femoral fracture) being the main risk factor. Although not seen often in athletic populations, athletic trainers should be aware of the possibility of AVN in patients. AVN is a life-altering condition and accurately documenting all patient encounters, and proper interprofessional collaboration is imperative for positive outcomes.

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Clinical Evaluation Findings in Patients Diagnosed With Deltoid Ligament Ankle Sprains: A Report From the Athletic Training Practice-Based Research Network

Alison R. Snyder Valier, Haley Toohill, Kenneth C. Lam, and Kellie C. Huxel Bliven

Objective: To describe clinical presentation and initial management of patients with deltoid ligament ankle sprains. Design: Retrospective. Setting: Practice-based research network. Participants: Athletic trainers (n = 133) from 52 clinics in 19 states. Independent Variable: Deltoid sprains (October 2009–April 2020). Main Outcome Measurements: Clinical findings (e.g., sport, mechanism of injury, severity, range of motion, tests) and initial management. Results: Deltoid sprains (n = 105) were diagnosed within 3.2 ± 4.1 days of injury, mostly in male secondary school athletes (n = 62/105, 59.0%). Common sports were football (n = 29/94, 30.9%) and basketball (n = 28/94, 29.8%). Common mechanism of injuries were twisting (n = 35/94, 37.2%) and contact (n = 28/94, 29.8%). Sprains were mostly mild (n = 59/94, 62.7%) with mild or no edema (n = 85/96, 85.5%) and effusion (n = 90/96, 93.4%). Active (n = 49/96, 51.0%) and passive range of motion (n = 54/96, 56.3%) were mostly normal, and a median of four (interquartile range = 2–5) tests were used, mostly anterior drawer (n = 74/105, 70.5%) and talar tilt-eversion (n = 74/105, 70.5%). Management involved removal from participation (n = 48/94, 51.1%), treatment by athletic trainers (n = 22/40, 55.0%), and referral to physicians (n = 16/40, 40.0%). Conclusions: Deltoid sprains mostly occurred in males playing football or basketball and were caused by twisting with minimal effusion, edema, and range of motion loss. Given the infrequency of deltoid sprains and difficulty diagnosing them, thorough clinical evaluation is necessary for treatment decisions.