Time-loss injuries in karate: a prospective cohort study of 4 consecutive world karate championships

[Abstract]: Background: Prospective studies on injuries in martial arts competitions are scarce, especially those involving time-loss injuries. The upsurge of karate athletes competing in top-level karate competitions warrants elucidation of the time-loss injury risk. Purpose: To determine the time-loss injury proportion and incidence rate, describe the injury pattern among elite senior karate athletes, and compare the risk of time-loss injuries in male versus female athletes and in individual (ie, weight categories) versus team competitions (free-weight category). Study Design: Descriptive epidemiology study. Methods: Data were collected at 4 consecutive World Karate Championships (2010, 2012, 2014, and 2016). Injury incidence rates were calculated per 1000 athlete-exposures (IIRAE) and per 1000 minutes of exposure (IIRME), with 95% CIs. Subgroups were compared by calculating their rate ratios with 95% CIs. Results: A total of 506 injuries were recorded, of which 51 were time-loss injuries (10%). The overall time-loss injury rate was significantly lower for female versus male athletes and slightly lower for team versus individual competitions. Overall, 1.4%of all athletes sustained a time-loss injury, and the IIRAE and IIRME were 5.13 (95% CI, 3.82-6.74) and 1.98 (95% CI, 1.47-2.60), respectively. The most common type of time-loss injury was fracture (41%), followed by dislocation (20%) and concussion (12%). Conclusion: The time-loss injury incidence rate for top-level karate competitions found in this prospective study was relatively low. Comprehensive knowledge about the incidence of time-loss injuries during karate competitions represents an essential basis to develop effective strategies for injury prevention. Thus, the introduction of a uniform injury surveillance system in martial arts is of utmost importance

Epidemiology of injuries in Olympic-style karate competitions: systematic review and meta-analysis

This article has been accepted for publication in British Journal of Sports Medicine 2020 following peer review, and the Version of Record can be accessed online at 10.1136/bjsports-2020-101990[Abstract]: Prospective cohort studies published in peer-reviewed journals and reporting injury data (ie, incidence, severity, location, type, mechanism or risk factors) among athletes participating in Olympic-style karate competition. Twenty-eight studies were included. The estimated IIRAE and IIRME were 88.3 (95%CI 66.6 to 117.2) and 39.2 (95%CI 30.6 to 50.2), respectively. The most commonly injured body region was the head and neck (median: 57.9%; range: 33.3% to 96.8%), while contusion (median: 68.3%; range: 54.9% to 95.1%) and laceration (median: 18.6%; range: 0.0% to 29.3%) were the most frequently reported types of injury. Despite inconsistency in classifying injury severity, included studies reported that most injuries were in the least severe category. There was no significant difference in IIRME between male and female karate athletes (rate ratio 1.09; 95%CI 0.88 to 1.36). Conclusion: Karate athletes sustain, on average, 1 injury every 11 exposures (bouts) or approximately 25 min of competition. The large majority of these injuries were minor or mild in severity

Hospital service use for young people with chronic health conditions : a population-based matched retrospective cohort study

Aim: This study aims to identify the hospitalised morbidity associated with three common chronic health conditions among young people using a population-based matched cohort. Methods: A population-level matched case-comparison retrospective cohort study of young people aged ≤18 years hospitalised with asthma, type 1 diabetes (T1D) or epilepsy during 2005–2018 in New South Wales, Australia using linked birth, health and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated by sex and age group. Results: There were 65 055 young people hospitalised with asthma, 6648 with epilepsy, and 2209 with T1D. Young people with epilepsy (ARR 10.95; 95% confidence interval (CI) 9.98–12.02), T1D (ARR 8.64; 95% CI 7.72–9.67) or asthma (ARR 4.39; 95% CI 4.26–4.53) all had a higher risk of hospitalisation than matched peers. Admission risk was highest for males (ARR 11.00; 95% CI 9.64–12.56) and females with epilepsy (ARR 10.83; 95% CI 9.54–12.29) compared to peers. The highest admission risk by age group was for young people aged 10–14 years (ARR 5.50; 95% CI 4.77–6.34) living with asthma, children aged ≤4 years (ARR 12.68; 95% CI 11.35–14.17) for those living with epilepsy, and children aged 5–9 years (ARR 9.12; 95% CI 7.69–10.81) for those living with T1D compared to peers. Conclusions: The results will guide health service planning and highlight opportunities for better management of chronic health conditions, such as further care integration between acute, primary and community health services for young people

Impact of chronic health conditions and injury on school performance and health outcomes in New South Wales, Australia : a retrospective record linkage study protocol

Introduction: Children who have sustained a serious injury or who have a chronic health condition, such as diabetes or epilepsy, may have their school performance adversely impacted by the condition, treatment of the condition and/or time away from school. Examining the potential adverse impact requires the identification of children most likely to be affected and the use of objective measures of education performance. This may highlight educational disparities that could be addressed with learning support. This study aims to examine education performance, school completion and health outcomes of children in New South Wales (NSW), Australia, who were hospitalised with an injury or a chronic health condition compared with children who have not been hospitalised for these conditions. Method and analysis This research will be a retrospective population-level case-comparison study of hospitalised injured or chronically ill children (ie, diabetes, epilepsy, asthma or mental health conditions) aged ≤18 years in NSW, Australia, using linked health and education administrative data collections. It will examine the education performance, school completion and health outcomes of children who have been hospitalised in NSW with an injury or a chronic health condition compared with children randomly drawn from the NSW population (matched on gender, age and residential postcode) who have not been hospitalised for these conditions. Ethics and dissemination The study received ethics approval from the NSW Population Health Services Research Ethics Committee (2018HRE0904). Findings from the research will be published in peer-reviewed journals and presented at scientific conferences

Match injuries in amateur Rugby Union: a prospective cohort study - FICS Biennial Symposium Second Prize Research Award

Background: The majority of Rugby Union (rugby) players participate at the amateur level. Knowledge of player characteristics and injury risks is predominantly ascertained from studies on professional or junior athletes in rugby. The objectives of the current study are to: (1) describe the health-related quality of life (HRQoL) and physical characteristics of a cohort of amateur rugby players; (2) describe the incidence, severity and mechanism of match injuries in amateur rugby, and; (3) explore factors associated with rates of match injury in this population. Methods: Participants (n = 125) from one amateur men’s rugby club were followed in a one-season (2012) prospective cohort study. Match injury and match time exposure data were collected. A participant match exposure log was maintained. Baseline variables collected include: participant’s age, playing experience, position of play, the SF-36v2 health survey, height and weight. Injury incidence rates (IIRs) per 1000 match-hours exposure were calculated. Injury sub-groups were compared by calculating rate ratios of two IIRs. Poisson mixed-effects generalised linear modelling was used to explore relationships between IIRs and baseline predictors. Results: A total of 129 injuries occurred during a combined period of 2465 match-hours of exposure. The overall IIR was 52.3 (43.7–62.2) /1000 match-hours exposure. Moderate-severe injuries (>1 week time-loss from play) comprised 36 % of all injuries. Tackling was the most common mechanism of injury, the head/face was the most common body region of injury and sprain/ligament injuries were the most common injury type. Fewer years of rugby participation, lower BMI and lower SF-36v2 mental component summary score were associated with higher IIR in amateur rugby. Age, player position i.e., backs versus forwards and SF-36v2 physical component summary score were not associated with injury incidence. Conclusion: Amateur rugby players report similar HRQoL as the general population. We found amateur players had a higher rate of injury and lower injury severity than previous amateur studies, but location, type, and mechanism were similar. In this study pre-season HRQoL and BMI were weakly associated with higher injury rate when controlling for other factors; a finding that should be interpreted with caution and clarified with future research

Mental disorders and their impact on academic performance in Australia: a matched population-based cohort study.

Objectives To compare scholastic performance and high school completion of young people hospitalised with a mental disorder compared to young people not hospitalised for a mental disorder by sex. Approach A population-based matched case-comparison cohort study of young people aged ≤18 years hospitalised for a mental disorder during 2005-2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, sex and residential postcode. Generalised linear mixed modelling examined risk of school performance below the national minimum standard (NMS) and generalised linear regression examined risk of not completing high school for young people with a mental disorder compared to matched peers. Results Young males with a mental disorder had over a 1.7 times higher risk of not achieving the NMS for numeracy (ARR: 1.71; 95%CI 1.35-2.15) and reading (ARR: 1.99; 95%CI 1.80-2.20) compared to matched peers. Young females with a mental disorder had around 1.5 times higher risk of not achieving the NMS for numeracy (ARR: 1.50; 95%CI 1.14-1.96) compared to matched peers. Both young males and females with a disorder had around a three times higher risk of not completing high school compared to peers. Young males with multiple disorders had up to a six-fold increased risk and young females with multiple disorders had up to an eight-fold increased risk of not completing high school compared to peers. Conclusions Early recognition and support could improve school performance and educational outcomes for young people who were hospitalised with a mental disorder. This support should be provided in conjunction with access to mental health services and school involvement and assistance

Using the WHO international classification of patient safety framework to identify incident characteristics and contributing factors for medical or surgical complication deaths

This study aimed to operationalise and use the World Health Organisation's International Classification for Patient Safety (ICPS) to identify incident characteristics and contributing factors of deaths involving complications of medical or surgical care in Australia. A sample of 500 coronial findings related to patient deaths following complications of surgical or medical care in Australia were reviewed using a modified-ICPS (mICPS). Over two-thirds (69.0%) of incidents occurred during treatment and 27.4% occurred in the operating theatre. Clinical process and procedures (55.9%), medication/IV fluids (11.2%) and healthcare-associated infection/complications (10.4%) were the most common incident types. Coroners made recommendations in 44.0% of deaths and organisations undertook preventive actions in 40.0% of deaths. This study demonstrated that the ICPS was able to be modified for practical use as a human factors taxonomy to identify sequences of incident types and contributing factors for patient deaths. Further testing of the mICPS is warranted

Implementing large-system, value-based healthcare initiatives: a realist study protocol for seven natural experiments

IntroductionValue-based healthcare delivery models have emerged to address the unprecedented pressure on long-term health system performance and sustainability and to respond to the changing needs and expectations of patients. Implementing and scaling the benefits from these care delivery models to achieve large-system transformation are challenging and require consideration of complexity and context. Realist studies enable researchers to explore factors beyond ‘what works’ towards more nuanced understanding of ‘what tends to work for whom under which circumstances’. This research proposes a realist study of the implementation approach for seven large-system, value-based healthcare initiatives in New South Wales, Australia, to elucidate how different implementation strategies and processes stimulate the uptake, adoption, fidelity and adherence of initiatives to achieve sustainable impacts across a variety of contexts.Methods and analysisThis exploratory, sequential, mixed methods realist study followed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) reporting standards for realist studies. Stage 1 will formulate initial programme theories from review of existing literature, analysis of programme documents and qualitative interviews with programme designers, implementation support staff and evaluators. Stage 2 envisages testing and refining these hypothesised programme theories through qualitative interviews with local hospital network staff running initiatives, and analyses of quantitative data from the programme evaluation, hospital administrative systems and an implementation outcome survey. Stage 3 proposes to produce generalisable middle-range theories by synthesising data from context–mechanism–outcome configurations across initiatives. Qualitative data will be analysed retroductively and quantitative data will be analysed to identify relationships between the implementation strategies and processes, and implementation and programme outcomes. Mixed methods triangulation will be performed.Ethics and disseminationEthical approval has been granted by Macquarie University (Project ID 23816) and Hunter New England (Project ID 2020/ETH02186) Human Research Ethics Committees. The findings will be published in peer-reviewed journals. Results will be fed back to partner organisations and roundtable discussions with other health jurisdictions will be held, to share learnings

Epidemiology of injuries in full-contact combat sports

As in any sport, there is an inherent risk of injury to practitioners of combative martial arts. Notwithstanding the potential for injury, there has not been a concerted effort to clearly elucidate the injury problem in full-contact combat sports. The purpose of this review is to provide an overview of the injury incidence, injury pattern, and injury severity in six popular and commonly practiced full-contact combat sports. Data from a total of 47 observational studies suggest that there is a significant injury problem in full-contact combat sports generally. However, the injury incidence rates and injury patterns vary considerably across different styles, which most likely is a reflection of differences in competition rules. Very little is known about the actual severity of injuries in combat sports. Future studies are strongly encouraged to adopt stronger study methodologies.5 page(s

Concussion injury in Olympic-style Taekwondo : a systematic review

Sports-related concussion is recognized as a major and increasing public health issue. In response to growing concern about sports-related concussion and the potential long-term sequelae of repeated concussions, the sports medicine community has increasingly developed and updated concussion guidelines and consensus statements. The objectives of this review were to systematically review and synthesize the current best available concussion injury data in Taekwondo and to elucidate the recent sports-related concussion guidelines and discuss their implications for evidence-informed safety and injury prevention policy development in Taekwondo. The concussion incidence rate per 1,000 athlete-exposures varied considerably across the included studies (range: 0.0 to 50.2; median: 4.9). This is greater than in other contact and collision sports (e.g., American football and ice hockey), but smaller than in boxing. Young adolescent Taekwondo athletes are at a greater risk of sustaining concussion injury than both younger (children) and older (adult) athletes. There was insufficient evidence to establish any other risk factors for concussion injury in Taekwondo. Taekwondo governing bodies have an ethical obligation to develop and implement sport-specific safety policies that adhere to current concussion guidelines, and, moreover, to adequately educate on-site medical personnel, referees, coaches, athletes, and the athletes’ parents or guardians. It is vital that athletes do not return to play on the day of concussive injury. It is also imperative that concussion diagnosis and fitness to play (i.e., both removal from and return to play) is a medical decision based on sound clinical judgment exercised by independent health care professionals with experience and specific training in concussion evaluation and management.11 page(s