Catastrophic pediatric sports injuries

Selective medical perspectives of pediatric sports medicine are explored in this issue and behavioral perspectives of pediatric sports medicine are discussed in a subsequent journal issue. Concepts are considered now dealing with sports readiness involving the child and adolescent that involve understanding the limits imposed by growth and development at different ages as well as pubertal stages. Specializing in one sport too soon is not recommended. Sports readiness also involves understanding and counseling about proper diet and nutrition for maximum sports activity as well as overall health benefits.

As clinicians understand sports readiness they can provide a beneficial pre-participation sports examination and deal with qualifications for sports play. Various medical conditions arise in dealing with pediatric persons involved in sports and these are considered in this discussion. They include the female athlete triad, iron deficiency anemia, sports anemia, musculoskeletal overuse injuries, obesity, sudden cardiac death, return to learning after sports-related concussion, epilepsy, asthma, diabetes mellitus, gastrointestinal disorders, genitourinary disorders and dermatology disorders in sports. Clinicians can be very helpful to these young athletes and work with them to ensure the full benefits of sport activities.

Commotio Cordis (CC) diagnosis is based on the occurrence of a blunt, non-penetrating blow to the chest preceding cardiovascular collapse and the absence of structural damage that would explain any observed effects. In CC lethal cases, the execution of the autopsy represents a possible diagnostic tool. Nevertheless, to date in the literature no author expresses an opinion about the use of the autopsy. In the light of the above, the authors propose a review of the literature about this topic. The review consents to state that the occurrence of a blunt blow to the chest is a necessary element for a lethal CC diagnosis, but it cannot be considered enough. Indeed, because CC is a recognized cause of sudden cardiac death, the autopsy should be always performed to exclude the presence of structural damage that would explain any observed effects. This approach is fundamental in order to achieve an accurate diagnosis and to distinguish CC from other causes of sudden cardiac death. In addition, the authors sustain that in case of autopsy data’s lack the authors should not identify CC diagnosis as definitive but as possible.

Swimming has been reported as the most common recreational activity among American youths, while diving remains a popular youth activity as well. We characterize the most common facial injuries occurring during these activities and evaluate facial fracture mechanisms and demographic trends, as this information may be helpful in preventative counseling as well as diagnosis.

The National Electronic Injury Surveillance System was assessed for swimming- and diving-related facial injuries in children from 2007 to 2016. Estimates of national injury incidence were recorded, and patient diagnoses, demographics, and injury mechanisms were evaluated.

In the 10-year period assessed, 789 NEISS entries extrapolated to an estimated 27,709 patients nationwide were analyzed. The yearly incidence fluctuated but steadily rose from 2013 to 2016. Males comprised a majority of injuries (58%), and laceration was the most common diagnosis (65%), followed by abrasion/contusion (22%) and fracture (9%). Facial fractures were most likely to involve the nasal bones (87%). Swimming injuries were more numerous overall (74%), but a greater proportion of diving injuries resulted in fracture (12% vs. 7%). Teenagers were also more likely to suffer fractures than were younger children involved in the same activities.

Most analyses of swimming and diving injuries have focused on spinal and orthopedic trauma. Nevertheless, the nature of headfirst diving and swim strokes suggest facial trauma is an underappreciated concern for clinicians. These findings reinforce the need for safer swimming and diving practices and serve as a useful resource for physicians managing pediatric facial injuries.