Category: Ankle; Sports; Other Introduction/Purpose: In order to monitor student-athlete health, identify risk factors associated with sports injuries, and develop and evaluate injury prevention programs at the collegiate level, it is necessary to implement and utilize high quality sports injury surveillance systems. The Pac-12 Health Analytics Program (HAP) addresses this need by standardizing electronic medical record entries and common data elements across all Pac-12 institutions. The literature suggests that collegiate student-athletes are at higher risk for certain injuries that have chronic effects on their health-related quality of life. Previous investigations utilizing the HAP database found ankle injuries to be the second most prevalent lower extremity injury in this population. This study aims to build upon these previous findings and further characterize below-knee injuries using the HAP database. Methods: We retrospectively reviewed archival data from Pac-12 student-athletes followed in the HAP database, a deidentified Pac-12 conference-wide sports injury surveillance system used to study the epidemiological characteristics of varsity student- athletes from 2017-2020. Data collection is part of the standard of care provided by varsity athletic trainers and entered into the Presagia Sports electronic medical record. This data is then deidentified and automatically sent to the Pac-12 for inclusion in the HAP. Individual authorization forms were obtained from student-athlete participants prior to deidentification and inclusion in the HAP database. Student-athletes who sustained a lower extremity (LE) injury below the knee were included. Data on demographics and injury characteristics were analyzed. Results: Foot and ankle injuries account for 20.3% (6,776/33,432) of all database injuries, representing 23.4% (2,214/9,444) of all student-athletes. Female-athletes (26.8%) had a higher injury rate than male-athletes (20.9%) (p<0.00001). Lower leg injuries were categorized as ankle (43.1%), foot (25.3%), lower leg (18.4%), and ankle/heel (13.2%). Ligament sprain was the most common injury type (38.1%) followed by tendinopathy (14.4%) and inflammation (7.9%). Males were more likely to sustain an acute injury (81.8%) than females (63.7%). Injuries most commonly occurred on synthetic (46.0%). Common mechanisms of injury (MOI) included running (21.6%), contact with another player (18.4%), and contact with a hard object (14.8%). Injuries most commonly occurred during in-season (48.9%) compared to off-season (25.5%) and pre-season (20.9%) segments of the competitive year. Half of injuries (50.0%) resulted in lost time from sport, however only 6.7% of injuries were season ending and only 2 injuries (<0.01%) resulted in medical retirement. Conclusion: Most ankle injuries occurred on synthetic surfaces, suggesting an opportunity for enhanced monitoring and prehabililitation programs for sports that utilize these types of surfaces. Further investigations accounting for covariates and risk factors may inform injury prevention strategies and improve student-athlete wellness. While the Pac-12 HAP database is early in development, this report demonstrates the potential value that injury surveillance systems can provide for student-athlete health. The Pac-12 HAP is a collaborative and effective injury database, setting the standard for other regional conferences.
Category: Ankle; Other Introduction/Purpose: As the American healthcare system evolves into a value-based reimbursement model, emphasis on tracking and reporting healthcare outcomes has expounded. Patient reported outcome Measures (PROMs) are exceedingly valuable to orthopedists as a means to measure improvement and satisfy regulatory requirements. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS) surveys are favored due to their accessibility, efficiency, and minimal floor and ceiling effects. Furthermore, they have been shown to predict outcomes after orthopedic surgeries. Psychosocial factors have also become increasingly important in predicting surgical outcomes. We aim to report the development and implementation of an institutional PRO data collection platform, including PRO completion rates and improvements in PROs for patients undergoing orthopaedic surgery. Methods: We implemented a secure, HIPAA compliant, automated and EHR integrated, institutional platform to collect PROMs using a cloud-based tool. Patients undergoing surgery by sports medicine and foot and ankle surgeons were included and organized into four surgical pathways: (1) foot and ankle, (2) sports-knee, (3) sports-hip, and (4) sports-shoulder. PROMIS Physical Function (PF), PROMIS Pain interference (PI), site-specific (foot and ankle, knee, hip, and shoulder) Single Assessment Numeric Evaluation (SANE), and the brief resiliency scale (BRS) were collected at the patient's pre-operative visit. The PROMIS and SANE surveys were again collected at 3-, 6-, and 12-month post-operative visits. Surveys were disseminated automatically and patients were able to complete PROMs onsite on secure tablets or remotely through their personal device. Primary outcomes included compliance rates, baseline PRO scores, and change in scores at the various post-operative timepoints for patients in the four surgical pathways. Results: More than 6,000 patients were included, with majority of patients from the sports-knee (47%), followed by sports- shoulder (27%), foot and ankle (23%), and sports-hip (4%) pathways. Average completion rate was highest at the pre-operative timepoint for all pathways (81%), with completion rates of 62% at 50% at 6 months and 45% at 12MO. Compliance rates were lowest highest in the foot and ankle pathway at 12 months (62%). Average baseline scores for all patients were 40.8 for PROMIS PF, 61.1 PROMIS PI, 41 SANE, and 3.9 for BRS. Baseline scores didn't significantly vary between the surgical pathways. Scores improved for all patient pathways at all timepoints for PROMIS PF, PI and SANE PROMs (Table 1). No workflow disruptions were noted for survey administration. Conclusion: Tracking PROs using an automated platform is feasible in orthopaedic clinics. Compliance rates are very good and dependent on provider, staff, and patient buy-in. Patients undergoing surgery had an average baseline PROMIS PI scores >=1 standard deviation from the normal population and all scores improved after surgery. Importantly, statistical significance doesn't always reflect minimum clinically important differences (MCIDs). MCIDs for PROMIS PF and PI have been reported to fall between 5-10 points depending on range of values and methods of calculation. Further investigation into outcomes by procedure type and patient factors is warranted to identify predictive factors of surgical outcomes.
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