Review of Injuries in Youth Soccer

The Committee on Sports Medicine and Fitness of the American Academy of Pediatrics (AAP) has issued a policy statement reviewing the medical literature on the frequency, types and causes of injuries that occur in youth soccer. The statement appears in the March 2000 issue of Pediatrics.

According to the AAP committee, soccer is one of the most popular team sports in the world. The U.S. Consumer Product Safety Commission estimated that there were 146,000 to 160,000 soccer-related injuries each year from 1992 through 1994. About 85 percent of those injuries were experienced by players younger than 23 years, and 45 percent occurred in players younger than 15 years.

To prevent soccer-related injury or death in children and adolescents, the AAP committee makes the following recommendations:

• Players should use protective eyewear and mouth guards to help reduce the number of some nonfatal head and facial injuries.

• Further research is needed to determine if rule changes, equipment modifications or further safety interventions can reduce the number of other injuries.

• Soccer-related fatalities have been strongly linked with head impact on goalposts; therefore, goal-posts should be secured in a manner consistent with guidelines from the manufacturers and the U.S. Consumer Product Safety Commission.

• The potential for permanent cognitive impairment from heading the ball is unknown. While there is insufficient published data to support a recommendation that players refrain from heading the ball, adults who supervise youth soccer should minimize the use of heading the ball until the potential for permanent cognitive impairment is further delineated.

• Violent behavior and aggressive infractions of the rules that tend to decrease broad participation in youth sports should be strongly discouraged. Parents, coaches and soccer organizations should work to promote enforcement of all safety rules and strongly encourage sportsmanship, fair play and maximum enjoyment for the players.

• Physicians should encourage efforts to increase participation in all forms of physical activity, including youth soccer, and should work to make soccer safer for young persons.

FDA Approves Breath Test for Helicobacter pylori

A breath test (the Meretek UBT) has been approved by the U.S. Food and Drug Administration for the diagnosis and post-treatment monitoring of Helicobacter pylori infection. The test uses a patient's breath to detect H. pylori, the main cause of peptic ulcer disease.

The Centers for Disease Control and Prevention reports that more than 25 million adults in the United States will develop an ulcer at some point in their life. Ninety percent of ulcers are caused by H. pylori infection; therefore, accurate detection of H. pylori is important.

The breath test is administered in the physician's office and takes about 30 minutes. The patient gives breath samples before and after drinking a special solution that detects the presence of an active H. pylori infection in the stomach. The test is simple, noninvasive, sensitive and specific, detecting H. pylori infection with the accuracy of endoscopic biopsy. The test is also useful in monitoring the patient's cure after treatment.

Aquatic Programs for Infants and Toddlers

The Committee on Sports Medicine and Fitness and the Committee on Injury and Poison Prevention of the American Academy of Pediatrics (AAP) have issued a policy statement on swimming programs for infants and toddlers. This update of a previous AAP policy statement provides recommendations for physicians on how to reduce the risk of drowning in infants and toddlers by educating parents and caregivers about the false sense of security these aquatic programs may give. The AAP statement appears in the April 2000 issue of Pediatrics.

The AAP committees make the following recommendations about aquatic programs for young children:

• Children younger than four years are generally not developmentally ready for formal swimming lessons.

• Swimming programs for infants and toddlers should not be promoted as a way to decrease the risk of drowning.

• Parents should not feel that their child is safe in water or safe from drowning after participation in such programs.

• Adults should always be within an arm's length of infants or toddlers when they are in or around water to provide “touch supervision.”

• All swimming programs should include information on the cognitive and motor limitations of infants and toddlers, the inherent risks of water, the strategies for prevention of drowning and the role of adults in supervising and monitoring the safety of children in and around water.

• Hypothermia, water intoxication and communicable diseases can be prevented by following existing medical guidelines and do not preclude infants and toddlers from participating in otherwise appropriate aquatic programs.

The AAP committees also recommend that physicians support research and legislation intended to reduce the risk of drowning in young children.

FDA Approval of Argatroban

The U.S. Food and Drug Administration (FDA) has approved the anticoagulant argatroban for the prevention and treatment of thrombosis associated with heparin-induced thrombocytopenia (HIT). HIT is a serious immune disorder that can occur when heparin is used to prevent blood clots. Of the 12 million persons who are treated with heparin annually, as many as 360,000 will develop HIT.

Argatroban works by blocking the activity of thrombin. The drug is the first synthetic direct thrombin inhibitor approved for the prevention and treatment of thrombosis in persons with HIT.

In clinical trials, argatroban provided a 21 percent relative reduction in the risk of death, amputation or new thrombosis and delayed the onset of these events. Use of argatroban led to significantly faster platelet count recovery and resulted in adequate anticoagulation in more than 75 percent of patients within three to five hours of the initiation of therapy.

Side effects associated with argatroban include gastrointestinal and genitourinary bleeding. Argatroban is contraindicated in patients with overt major bleeding or in patients hypersensitive to the drug or any of its components.

AHRQ Report on Hospital Care in the United States

Hospital care in the United States is examined in a report by the Agency for Healthcare Research and Quality (AHRQ). The report, “Hospitalization in the United States, 1997,” is based on 1997 data from the AHRQ's Nationwide Inpatient Sample. The report is the first in a series on U.S. hospital care. According to John M. Eisenberg, M.D., director of the AHRQ, the report addresses key questions about U.S. health care, such as who uses hospitals? for what reasons? who pays for what? and what happens to hospital patients?

According to the report, more than one third of all hospital patients are initially seen in the emergency department before being admitted. This includes 40 percent of all hospitalized children and 55 percent of persons 80 years and older. The number one cause of hospital admission through the emergency department is pneumonia. One half of the other top 10 causes involved heart conditions.

Other findings in the study include the following:

• More than one half of all hospital patients had at least one comorbidity in addition to the illness for which they were admitted.

• High blood pressure was the most common comorbidity. Leading comorbidities among adolescents and adults up to age 44 included drug abuse, psychoses and depression. Alcohol abuse was a leading secondary condition among persons 18 to 64 years of age.

The AHRQ report also includes statistics on the age and gender of hospitalized patients; main reasons for hospital admission overall and by age; hospital charges; lengths of stay; in-hospital mortality; patients who leave against the advice of physicians; and types of locations to which patients are discharged. Charts on how patients are admitted to the hospital are available on the AHRQ Web site athttp://www.ahrq.gov/news/press.

To obtain a copy of “Hospitalization in the United States, 1997,” HCUP Fact Book No. 1 (AHRQ Publication No. 00–0031) free of charge, call 800-358-9295, or write to the AHRQ Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907.

CDC Report on Frequency of Pap Testing

Early detection and treatment of pre-cancerous and cancerous lesions through the use of the Papanicolaou (Pap) test have contributed to the decline in cervical cancer incidence and mortality in the United States since the 1950s. Because guidelines about the frequency of testing in women with a history of normal Pap results are inconsistent, the Centers for Disease Control and Prevention (CDC) has released a report analyzing various screening recommendations. The CDC report appears in the November 10, 2000 issue of Morbidity and Mortality Weekly Report (MMWR).

Data were analyzed at the CDC from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) from 1991 through 1998 to determine the incidence of cervical cytologic abnormalities after normal Pap testing. Findings of the NBCCEDP show that within three years of a normal Pap test, severe cytologic abnormalities are uncommon; incidence rates are similar among women screened one, two and three years after a normal Pap test.

According to the CDC report, recommendations on the frequency of Pap testing are inconsistent. The U.S. Preventive Services Task Force suggests Pap screening at least every three years until the age of 65. The American Cancer Society guidelines state that screening less often than annually may be adequate in women with a history of three negative annual Pap tests. The American College of Obstetricians and Gyne-cologists recommends annual Pap testing for most women.

The CDC is working with state health departments to reach women who have not received screening services for cervical cancer. According to the CDC report, further research is needed to clarify the benefits and harm related to the frequency of Pap screening in women with normal results.

Reduction of Deaths From Residential Fires

Among persons of all ages, fires and burns are the fourth most common cause of unintentional injury-related death, causing more than 4,000 deaths per year. In response, the Committee on Injury and Poison Prevention of the American Academy of Pediatrics (AAP) has issued a statement on reducing the number of deaths and injuries from residential fires. The AAP statement appears in the June 2000 issue of Pediatrics.

The AAP statement reviews important prevention messages and intervention strategies related to residential fires. It also includes recommendations for physicians regarding office anticipatory guidance, work in the community and support of legislation that could result in a decrease in the number of fire-related injuries and deaths.

The AAP committee makes the following recommendations:

• Physicians should counsel parents about fire and burn prevention, including adequate supervision of children, use of smoke alarms, escape plans, safe behavior in fires and initial treatment of burns. Special planning information should be provided for families with special needs children.

• School-aged children or adolescents who set fires are often reaching out for help. They may have experienced a loss or failure, or may be stressed, abused, confused, angry or frustrated and require psychologic help.

• Physicians can work with other members of the community in the following activities: encouraging persons not to smoke; working with media to increase public awareness of fire-related injury and prevention; and working with fire departments and schools to educate persons about fire prevention and to distribute and install smoke alarms.

• Physicians should also promote and support legislation and regulation to decrease the use of cigarettes and other smoking materials, support flame-retardant clothing laws, and improve and enforce fire building codes and laws requiring widespread installation of working smoke alarms and sprinkler systems.