P0183 - Multidisciplinary Perspective on Controversial Issues in Pediatric Sports Medicine

Purpose: Identify biases on controversial issues in pediatric sports medicine from the perspective of pediatric sports medicine professionals involved in multiple disciplines.

Methods: An online survey on controversial issues in pediatric sports medicine was provided to the active members of the Pediatric Research in Sports Medicine (PRiSM) Society, which is a multidisciplinary organization that includes physicians and non-physicians interested in pediatric sports medicine research. Both the professional background of the respondents and their responses to questions related to personal experiences with youth sports injuries were used to help determine potential factors associated with underlying biases.

Results: Ninety-six of 259 members responded to the survey, with 88 respondents answering all 16 questions. Of respondents, 61% would not let their child participate in American tackle football prior to skeletal maturity, with 46% still not agreeing to participation even after skeletal maturity. Surgeons were much less likely than non-surgeons to agree to allow their child to return to play American tackle football after sustaining a concussion and passing a concussion protocol (48% vs. 76%, p=0.013). Participation year-round in a single sport prior to puberty was agreed to by only 22% of respondents. Whereas 67% would give their child opioid medications following arthroscopic surgery, there was a trend away from agreeing to opioids associated with more years in practice (p=0.0333). Greater than 90% agreed to elective anterior cruciate ligament (ACL) reconstruction surgery prior to skeletal maturity. Surgeons were more likely than non-surgeons to agree to both elective shoulder stabilization after a first-time dislocation and elective drilling of a stable knee osteochondral defect (OCD) prior to conservative treatment (41% vs. 10%, p=0.0003 and 52% vs. 23%, p=0.013, respectively). Having a history of a child who sustained a major sports injury or concussion did not have a significant effect on the survey responses.

Conclusion: Many topics achieved consensus agreement, such as elective ACL reconstruction prior to skeletal maturity and not allowing participation in a year-round sport prior to puberty. However, issues of allowing a child to participate in American tackle football or return to play following a concussion are very controversial. Surgeons were more likely to agree to the decision of elective shoulder stabilization surgery after a first-time dislocation and drilling of a stable knee OCD instead of a course of conservative management.

Significance: This information identifies significant differences between surgeons and non-surgeons on controversial issues in pediatric sports medicine and should be used to help guide further investigation. In addition, the findings will be useful when having difficult conversations with patients and their families regarding issues of safe youth sports participation and treatment options for common youth sports injuries.