Concussions take time — CJSM Blog Post Journal Club

Our Jr. Assoc. Editor Jason Zaremski MD looking for some help from a friend with the newest CJSM Blog Post Journal Club

Our March 2020 issue has just published, and right out of the gate one of the studies that has received the most buzz is one from a team of researchers in New Zealand demonstrating that less than 50% of concussed individuals recover within two weeks of a sports-related concussion.

Jason Zaremski, MD, CJSM’s Jr. Assoc. Editor, explores this new study today in our most recent CJSM Blog post Journal Club.  It is a two year prospective study with some revealing findings. We’re sure you will enjoy the blog post and the study itself!

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Jason Zaremski MD

Kara S, et al. Less Than Half of Patients Recover Within 2 Weeks of Injury After a Sports-Related Mild Traumatic Brain Injury: A 2-Year Prospective Study. Clin J Sport Med 2020;30:96–101. doi.org/10.1097/JSM.0000000000000811.

Introduction:  Sports related concussion (SRC) is a common and significant concern, challenging not only sports medicine practitioners, but also athletes, coaches, family members, and all sports performance team members. While diagnostic skills and research in this area have dramatically improved in the past 10 years, our patients still have several questions, including: How long until I can go back and play? Some data has suggested the majority of SRC patients recover in approximately a 2-4 week recovery time frame. According to the consensus statement in concussion in sport (5th iteration) held in Berlin, Germany, in October 2016—“the expected duration of symptoms in children with SRC is up to 4 weeks.” (McCrory, et al. BJSM 2017).  Kara and colleagues  have looked into the validity of this stated time frame.

Purpose: To describe clinical recovery time and factors that could impact recovery after a sports-related mild traumatic brain injury (SR-mTBI, aka “concussion”).

Methods/Design:  This is a prospective cohort study with level IV evidence. Read more of this post

Good-bye 2019

This CJSM reindeer is resting before her big night on Christmas Eve. While she works, we hope you all have relaxing holidays.

New Year’s day 2020 is just around the corner, and though a year is coming to an end the decade apparently is NOT (I have just read that the ‘teens’ will end on Dec 31 2020 and the new decade will begin Jan 1 2021).

But the end of a year, 2019 in this case, is always a cause for celebration, and for both reflection and anticipation. And so, right now in this blog post, it’s that time to give 2019 a proper send-off.

Reflection

As I look back at the many studies and toher writing that have been published in the six issues of CJSM, it’s hard to pick a favorite (a bit like a parent picking one’s favorite child — it’s simply not done).  But I can say that there are some studies that are perhaps more memorable to me….. Read more of this post

Urine Reagent Strips for Assessing Hypohydration — Do They Work?

Hydrated or not?

Hydration status is an important issue in sports medicine.  Both ends of the spectrum — hypo and hyperhydration — increase risk for morbidity and mortality in the athlete.  As we all know, maintaining euvolemia is an important step in the prevention of heat illness, as the evaporative effect of sweating is one of the body’s mechanisms for heat dissipation.  Conversely, as my colleague and CJSM author Dr. Tamara Hew-Butler has argued on different platforms, a zeal to overhydrate can lead to hyperhydration, hyponatremia, and in extreme cases, death.

There is another way we concern ourselves with hydration status in sports medicine, and that is when assessing athletes who compete in weight classes, or when doing urine drug testing as a screen at a doping control station in competition.  Typically, such assessments are done using different testing modalities on urine specimens.

I am a Medical Delegate for the Federation Internationale de Natation (FINA) and am involved in doping control at long-distance swimming events.  Urine drug screens cannot reliably be done on dilute urine specimens.  In most settings we use refractometry but in some more remote or less developed venues, we may need to use urine reagent strips [WADA has different standards of specific gravity (SG) suitable for urine testing depending on whether refractometry or urine reagent strips are used].

More commonly, here in central Ohio, is the need to assess for hypohydration in the popular sport of wrestling [wrestlers — and other athletes competing in weight classes — will frequently sweat and minimize fluid intake prior to a competitive weigh-in to ‘make weight’ in the class in which they want to compete].  In Ohio high school wrestling, urine reagent strips only are used, and the standard is any sample with SG >1.025 results in a disqualification, with a minimum time period of 48 hours before reassessment.

Having an interest in all these dimensions of testing an athlete’s hydration status, I read with great interest the Brief Report that was published in the November 2019 CJSM: Urine Reagent Strips Are Inaccurate for Assessing Hypohydration: A Brief Report. Read more of this post

Sports Medicine from South Africa — SASMA biennial congress begins this week!

Dr. Pierre Viviers, President of SASMA

It’s been a while since we have invited a sports medicine colleague to a “Five Questions with CJSM” interview.

What better time to catch up with the current President of the South African Medical Association (SASMA) than on the eve of SASMA’s biennial Congress?

My dear friend Dr. Pierre Viviers of Stellenbosch University is a very busy man right now as he places the final touches on what is sure to be one of the premier events of this year’s sports medicine calendar.  Having attended SASMA in 2015  in Johannesburg, I can attest to what an exciting and stimulating event this Congress is.

True to form, Dr. Viviers did not hesitate to volunteer for this interview when I reached out to him, despite his busy schedule.  I hope you enjoy our conversation and that it whets your appetite for what is coming later this week from Cape Town.  If you can’t be there, be sure to follow #SASMA2019 on social media.

And now….Dr. Viviers!

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  1. CJSM: The biennial Congress of SASMA is taking place 10 – 13 October 2019 in Cape Town, the “Mother City.” It is a joint Congress with SASMA and BRICSCESS.  Can you tell us about what you see as the highlights of the program, and for the readers unfamiliar with BRICSCESS can you tell us about that organization?

Pierre Viviers (PV): It is a joint congress which also includes the 6th Annual Congress on Medicine and Science in Ultra-Endurance Sport which will definitely be a highlight. The pre-congress workshops are always popular and well attended. This will include 2 full-day workshops presented by ‘Exercise is Medicine South Africa” (EIM SA) and SAIDS (SA Institute for Drug-free Sport), as well as a half-day workshop by the S.A Sport-Physiotherapy group.

A highlight for me personally, is the integrated participation between scientists and medical professionals throughout the program.

Opening the narrative of social justice and the role which sport can play, especially in a country like S.A, will be one of our most influential South Africans, Prof Thuli Madonsela, activist for social justice and human rights, previous public protector and advocate in the High Court of S.A.  This is definitely a session not to be missed.

The prestigious Noble lecture will be presented by a good friend and colleague, Cheri Blauwet from Harvard Medical School & Spaulding Rehab Hospital, Boston. Cheri’s journey in injury and illness prevention in the elite Paralympic athlete will be a certain highlight. A symposium later in the conference will be another highlight, focusing on “innovations in athletes with disability.”

The sport nutrition colloquium led by Louise Burke (Australia) and other prominent South Africans in the field is another highlight.

The featured science session on player welfare in rugby union as well as the featured clinical symposium on Sport Related Concussion will reveal interesting concepts in injury prevention and management in this popular South African collision sport.

The session on mental health in athletes presented by two leaders in the field will also give new insight in prevalent mental health issues which may influence athlete welfare and performance.

The BRICES countries are Brasilia, Russia, India, China and South Africa and BRICSCESS is the Council of Exercise and Sport Science founded to specifically look into health and wellness of people within these counties. However, this is there second international congress. The council also strives to bring communication together between the BRICS countries on issues influencing health and wellness through universities and other platforms. The Council is also dedicated to leadership development in young scientists within the field.

 

  1. CJSM: You are winding down your term as President of SASMA. What are the fondest memories of your past two years of service?  Who is the incoming President?

Read more of this post

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