Andrea Lynn Kussman

All Publications

• Impact of Scalene Muscle Botulinum Toxin Injection With and Without Surgery in Neurogenic Thoracic Outlet Syndrome. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Fereydooni, A., Ho, V. T., Olson, E. M., Dyrek, P., Harris, T., Kussman, A., Roh, E., Lee, J. T. 2022

  Abstract

  Scalene blocks are part of both the diagnostic and treatment algorithm for patients presenting with symptoms of neurogenic thoracic outlet syndrome (nTOS). However, there is a paucity of data on the utility of scalene botulinum toxin injection (BTI) before surgical decompression. We sought to determine the impact of BTI with and without surgery at a multidisciplinary referral center.Retrospective cohort study.Single institution tertiary academic center, 2011 to 2020.Seventy-seven consecutive patients.Scalene muscle BTI for nTOS with or without surgical decompression.Pain relief and Quick Disability of the Arm, Shoulder and Hand (QDASH) score.Seventy-seven patients, with a mean age of 31.4 years, had BTI for symptoms of nTOS. All patients underwent pretreatment physical therapy through the Edgelow protocol for a mean duration of 3.4 months. However, 72.7% had dynamic vascular compression on duplex ultrasound with provocative maneuvers and 85.7% had a positive physical examination finding. After BTI, 77.9% reported subjective relief, confirmed by an improved QDASH disability score. Thirty-one patients (40.3%) then went on to have further persistent symptoms and proceeded with first rib resection. After BTI + Surgery, 96.8% reported symptomatic relief and had a median QDASH score improvement of 21 (range: 10-40), with all reaching minimal clinically important differences in the QDASH score after combination therapy.In this reported series of chemodenervation in patients with nTOS, BTI is helpful in alleviating symptoms before definitive surgical decompression. BTI followed by first rib resection provides additional symptom improvement over BTI alone.

  View details for DOI 10.1097/JSM.0000000000001094

  View details for PubMedID 36367782

• Prevalence of Positive Rapid Antigen Tests After 7-Day Isolation Following SARS-CoV-2 Infection in College Athletes During Omicron Variant Predominance. JAMA network open Tsao, J., Kussman, A., Segovia, N. A., Abrams, G. D., Boehm, A. B., Hwang, C. E. 2022; 5 (10): e2237149

  Abstract

  Importance: The US Centers for Disease Control and Prevention shortened the recommended isolation period for SARS-CoV-2 infection from 10 days to 5 days in December 2021. It is unknown whether an individual with the infection may still have a positive result to a rapid antigen test and potentially be contagious at the end of this shortened isolation period.Objective: To estimate the proportion of individuals with SARS-CoV-2 infection whose rapid antigen test is still positive starting 7 days postdiagnosis.Design, Setting, and Participants: This case series analyzed student athletes at a National Collegiate Athletic Association Division I university campus who tested positive for SARS-CoV-2 between January 3 and May 6, 2022. Individuals underwent rapid antigen testing starting 7 days postdiagnosis to determine whether they could end their isolation period.Exposures: Rapid antigen testing 7 days after testing positive for SARS-CoV-2.Main Outcomes and Measures: Rapid antigen test results, symptom status, and SARS-CoV-2 variant identification via campus wastewater analysis.Results: A total of 264 student athletes (140 [53%] female; mean [SD] age, 20.1 [1.2] years; range, 18-25 years) representing 268 infections (177 [66%] symptomatic, 91 [34%] asymptomatic) were included in the study. Of the 248 infections in individuals who did a day 7 test, 67 (27%; 95% CI, 21%-33%) tests were still positive. Patients with symptomatic infections were significantly more likely to test positive on day 7 vs those who were asymptomatic (35%; 95% CI, 28%-43% vs 11%; 95% CI, 5%-18%; P<.001). Patients with the BA.2 variant were also significantly more likely to test positive on day 7 compared with those with the BA.1 variant (40%; 95% CI, 29%-51% vs 21%; 95% CI, 15%-27%; P=.007).Conclusions and Relevance: In this case series, rapid antigen tests remained positive in 27% of the individuals after 7 days of isolation, suggesting that the Centers for Disease Control and Prevention-recommended 5-day isolation period may be insufficient in preventing ongoing spread of disease. Further studies are needed to determine whether these findings are present in a more heterogeneous population and in subsequent variants.

  View details for DOI 10.1001/jamanetworkopen.2022.37149

  View details for PubMedID 36255722

• Use of Monospot Testing in the Diagnosis of Infectious Mononucleosis in the Collegiate Student-Athlete Population. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Wang, E. X., Kussman, A., Hwang, C. E. 2022; 32 (5): 467-470

  Abstract

  OBJECTIVE: To determine the utility of monospot testing in the diagnosis of mononucleosis in the collegiate student-athlete clinical setting.DESIGN: Retrospective cohort study.SETTING: National Collegiate Athletic Association Division I sports medicine clinic.PATIENTS: All varsity student athletes who had a monospot test and Epstein-Barr virus (EBV) titers obtained from January 1, 2016, through March 31, 2020, (n = 199) were included.INDEPENDENT VARIABLES: Monospot, EBV antibody titers, and liver transaminase results.MAIN OUTCOME MEASURES: Using EBV titers indicating acute or recent infection as the gold standard for diagnosing infectious mononucleosis (IM), the reliability of a positive monospot test and elevated liver transaminases for the diagnosis of IM were examined.RESULTS: The monospot test had a sensitivity and specificity of 80.0% and 90.6%, respectively, with a positive predictive value of 36.4% and a negative predictive value of 98.5% in this cohort. All athletes diagnosed with IM also had elevated liver transaminases.CONCLUSIONS: The specificity of the monospot test is lower than previously reported in the literature, and a positive test is not sufficient to diagnose mononucleosis in this clinical setting. Positive monospot results should be confirmed with EBV antibody testing. Elevated transaminase levels are highly correlated with acute IM and could play a supporting role in the diagnosis.

  View details for DOI 10.1097/JSM.0000000000000996

  View details for PubMedID 36083325

• Dietary Behaviors Associated With Lower Nutrient Intake In Collegiate Endurance Runners Barrack, M. T., Fredericson, M., Kraus, E., Tenforde, A., Roche, M., Kussman, A., Gravani, K., Ansari, Y., Olson, C., Nattiv, A. LIPPINCOTT WILLIAMS & WILKINS. 2022: 590

  View details for Web of Science ID 000888056602469

• Accuracy of Rapid Antigen vs Reverse Transcriptase-Polymerase Chain Reaction Testing for SARS-CoV-2 Infection in College Athletes During Prevalence of the Omicron Variant. JAMA network open Tsao, J., Kussman, A. L., Costales, C., Pinsky, B. A., Abrams, G. D., Hwang, C. E. 2022; 5 (6): e2217234

  View details for DOI 10.1001/jamanetworkopen.2022.17234

  View details for PubMedID 35704320

• Comparison of SARS-CoV-2 Test Positivity in NCAA Division I Student Athletes vs Nonathletes at 12 Institutions. JAMA network open Schultz, E. A., Kussman, A., Jerome, A., Abrams, G. D., Hwang, C. E. 2022; 5 (2): e2147805

  Abstract

  Importance: The COVID-19 pandemic initially led to the abrupt shutdown of collegiate athletics until guidelines were established for a safe return to play for student athletes. Currently, no literature exists that examines the difference in SARS-CoV-2 test positivity between student athletes and nonathletes at universities across the country.Objective: To identify the difference in risk of COVID-19 infection between student athlete and nonathlete student populations and evaluate the hypothesis that student athletes may display increased SARS-CoV-2 test positivity associated with increased travel, competition, and testing compared with nonathletes at their respective universities.Design, Setting, and Participants: In this cross-sectional analysis, a search of publicly available official university COVID-19 dashboards and press releases was performed for all 65 Power 5 National Collegiate Athletic Association (NCAA) Division I institutions during the 2020 to 2021 academic year. Data were analyzed at the conclusion of the academic year. Schools that released at least 4 months of testing data, including the fall 2020 football season, for student athletes and nonathlete students were included in the analysis. Power 5 NCAA Division I student athletes and their nonathlete student counterparts were included in the analysis.Exposure: Designation as a varsity student athlete.Main Outcomes and Measures: The main outcome was SARS-CoV-2 test positivity for student athletes and nonathlete students at the included institutions for the 2020 to 2021 academic year, measured as a relative risk for student athletes.Results: Among 12 schools with sufficient data available included in the final analysis, 555 372 student athlete tests and 3 482 845 nonathlete student tests were performed. There were 9 schools with decreased test positivity in student athletes compared with nonathlete students (University of Arkansas: 0.01% vs 3.52%; University of Minnesota: 0.63% vs 5.96%; Penn State University: 0.74% vs 6.58%; Clemson University: 0.40% vs 1.88%; University of Louisville: 0.75% vs 3.05%; Purdue University: 0.79% vs 2.97%; University of Michigan: 0.40% vs 1.12%; University of Illinois: 0.17% vs 0.40%; University of Virginia: 0.64% vs 1.04%) (P<.001 for each). The median (range) test positivity in these 9 schools was 0.46% (0.01%-0.79%) for student athletes and 1.04% (0.40%-6.58%) for nonathlete students. In 1 school, test positivity was increased in the student athlete group (Stanford University: 0.20% vs 0.05%; P<.001). Overall, there were 2425 positive tests (0.44%) among student athletes and 30 567 positive tests (0.88%) among nonathlete students, for a relative risk of 0.50 (95% CI, 0.48-0.52; P<.001). There was no statistically significant difference in student athlete test positivity between included schools; however, test positivity among nonathlete students varied considerably between institutions, ranging from 133 of 271 862 tests (0.05%) at Stanford University to 2129 of 32 336 tests (6.58%) at Penn State University.Conclusions and Relevance: This study found that in the setting of SARS-CoV-2 transmission mitigation protocols implemented by the NCAA, participation in intercollegiate athletics was not associated with increased SARS-CoV-2 test positivity. This finding suggests that collegiate athletics may be held without an associated increased risk of infection among student athletes.

  View details for DOI 10.1001/jamanetworkopen.2021.47805

  View details for PubMedID 35138397

• Factors Associated With a Prolonged Time to Return to Play After a Concussion. The American journal of sports medicine Wang, E. X., Hwang, C. E., Nguyen, J. N., Segovia, N. A., Abrams, G. D., Kussman, A. 2022: 3635465221083646

  Abstract

  Prognosticating recovery times for individual athletes with a concussion remains a challenge for health care providers. Several preinjury and postinjury factors have been proposed to be predictive of prolonged return-to-play (RTP) times, but the data in this area are still sparse.This study aimed to identify risk factors associated with prolonged recovery times and determine which are most predictive of prolonged recovery times in a head-to-head comparison.Case-control study; Level of evidence, 3.All concussions occurring between September 2017 and August 2020 at a single National Collegiate Athletic Association Division I institution were reviewed and included in this study. Preinjury modifiers including age, sex, sport, concussion history, and past medical problems were collected from the electronic medical records. Postinjury modifiers analyzed included initial and follow-up Sport Concussion Assessment Tool 5th Edition scores, vestibular evaluation findings, and eye tracking results.A total of 159 athletes and 187 concussion cases were included. Preinjury factors that were correlated with prolonged RTP times included a history of concussions (P = .015), a history of migraines (P = .013), and whether an athlete participated in an individual sport (P = .009). Postinjury factors correlated with prolonged RTP times included the total number (P = .020) and severity (P = .023) of symptoms as well as abnormal Vestibular Ocular Motor Screening findings (P = .002). Overall, 6 different symptoms (balance problems, difficulty concentrating, light sensitivity, drowsiness, fatigue/low energy, and difficulty remembering) were significantly correlated with prolonged RTP times. The study also found that the number and severity of symptoms were additive in a dose-dependent fashion. On multivariable analysis of all these factors, a history of concussions was found to be the most predictive of prolonged RTP times, while participation in an individual sport had the largest effect on recovery times.Several preinjury and postinjury risk factors were identified as being correlated with prolonged recovery times. Many of these risk factors were also found to be additive in nature. This information provides clinicians with a valuable tool in prognosticating and estimating recovery times for athletes. The study also revealed that athletes participating in individual sports had longer RTP times compared with athletes in team sports, which is a novel finding that requires further research.

  View details for DOI 10.1177/03635465221083646

  View details for PubMedID 35316113

• Splenomegaly from Recurrent Infectious Mononucleosis in an NCAA Division I Athlete CURRENT SPORTS MEDICINE REPORTS Bakal, D. R., Kasitinon, D., Kussman, A. L., Hwang, C. E. 2021; 20 (10): 511-513

  View details for Web of Science ID 000756985300005

• Splenomegaly from Recurrent Infectious Mononucleosis in an NCAA Division I Athlete. Current sports medicine reports Bakal, D. R., Kasitinon, D., Kussman, A. L., Hwang, C. E. 2021; 20 (10): 511-513

  View details for DOI 10.1249/JSR.0000000000000887

  View details for PubMedID 34622813

• Impact of Scalene Muscle Botulinum Toxin Injection with and without Surgery in Neurogenic Thoracic Outlet Syndrome Fereydooni, A., Ho, V. T., Olson, E., Dyrek, P., Harris, T., Kussman, A., Roh, E. Y., Lee, J. T. MOSBY-ELSEVIER. 2021: E410

  View details for Web of Science ID 000707158200201

• Predictors Of Relief Following Botulinum Injection For Thoracic Outlet Syndrome Olson, E., Dyrek, P., Fereydooni, A., Harris, T., Lee, J. T., Kussman, A., Roh, E. Y. LIPPINCOTT WILLIAMS & WILKINS. 2021: 377

  View details for Web of Science ID 000693955700413

• Predicting Return To Play In NCAA Division 1 Athletes With Neurogenic Thoracic Outlet Syndrome Dyrek, P., Olson, E., Fereydooni, A., Harris, T., Kussman, A., Roh, E., Lee, J. T., Segovia, N. LIPPINCOTT WILLIAMS & WILKINS. 2021: 390

  View details for Web of Science ID 000693955700448

• Findings From Cardiovascular Evaluation of National Collegiate Athletic Association Division I Collegiate Student-Athletes After Asymptomatic or Mildly Symptomatic SARS-CoV-2 Infection. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Hwang, C. E., Kussman, A., Christle, J. W., Froelicher, V., Wheeler, M. T., Moneghetti, K. J. 2021

  Abstract

  OBJECTIVE: The risk of myocardial damage after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been controversial. The purpose of this study is to report the incidence of abnormal cardiovascular findings in National Collegiate Athletic Association (NCAA) Division I student-athletes with a history of SARS-CoV-2 infection.DESIGN: This is a case series of student-athletes with SARS-CoV-2 infection and their subsequent cardiac work-up, including troponin level, electrocardiogram, and echocardiogram. Additional testing was ordered as clinically indicated.SETTING: This study was conducted at a single NCAA Division I institution.PARTICIPANTS: Student-athletes were included if they tested positive for SARS-CoV-2 by PCR or antibody testing [immunoglobulin G (IgG)] from April 15, 2020 to October 31, 2020.INTERVENTION: Cardiac testing was conducted as part of postinfection screening.MAIN OUTCOME MEASURES: This study was designed to quantify abnormal cardiovascular screening results and cardiac diagnoses after SARS-CoV-2 infection in Division I collegiate athletes.RESULTS: Fifty-five student-athletes tested positive for SARS-CoV-2. Of these, 14 (26%) had a positive IgG and 41 (74%) had a positive PCR test. Eight abnormal cardiovascular screening evaluations necessitated further testing including cardiac magnetic resonance imaging (cMRI). Two athletes received new cardiac diagnoses, one probable early cardiomyopathy and one pericarditis, whereas the remaining 6 had normal cMRIs.CONCLUSIONS: These data support recent publications which recommend the de-escalation of cardiovascular testing such as cardiac MRI or echocardiogram for athletes who have recovered from asymptomatic or mildly symptomatic SARS-CoV-2 infection. Continued follow-up of these athletes for sequelae of SARS-CoV-2 is critical.

  View details for DOI 10.1097/JSM.0000000000000954

  View details for PubMedID 34173780

• The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part 1: Definition and Scientific Basis. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Nattiv, A., De Souza, M. J., Koltun, K. J., Misra, M., Kussman, A., Williams, N. I., Barrack, M. T., Kraus, E., Joy, E., Fredericson, M. 2021

  Abstract

  ABSTRACT: The Male Athlete Triad is a syndrome of 3 interrelated conditions most common in adolescent and young adult male endurance and weight-class athletes and includes the clinically relevant outcomes of (1) energy deficiency/low energy availability (EA) with or without disordered eating/eating disorders, (2) functional hypothalamic hypogonadism, and (3) osteoporosis or low bone mineral density with or without bone stress injury (BSI). The causal role of low EA in the modulation of reproductive function and skeletal health in the male athlete reinforces the notion that skeletal health and reproductive outcomes are the primary clinical concerns. At present, the specific intermediate subclinical outcomes are less clearly defined in male athletes than those in female athletes and are represented as subtle alterations in the hypothalamic-pituitary-gonadal axis and increased risk for BSI. The degree of energy deficiency/low EA associated with such alterations remains unclear. However, available data suggest a more severe energy deficiency/low EA state is needed to affect reproductive and skeletal health in the Male Athlete Triad than in the Female Athlete Triad. Additional research is needed to further clarify and quantify this association. The Female and Male Athlete Triad Coalition Consensus Statements include evidence statements developed after a roundtable of experts held in conjunction with the American College of Sports Medicine 64th Annual Meeting in Denver, Colorado, in 2017 and are in 2 parts-Part I: Definition and Scientific Basis and Part 2: The Male Athlete Triad: Diagnosis, Treatment, and Return-to-Play. In this first article, we discuss the scientific evidence to support the Male Athlete Triad model.

  View details for DOI 10.1097/JSM.0000000000000946

  View details for PubMedID 34091537

• The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part II: Diagnosis, Treatment, and Return-To-Play. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Fredericson, M., Kussman, A., Misra, M., Barrack, M. T., De Souza, M. J., Kraus, E., Koltun, K. J., Williams, N. I., Joy, E., Nattiv, A. 2021

  Abstract

  ABSTRACT: The Male Athlete Triad is a medical syndrome most common in adolescent and young adult male athletes in sports that emphasize a lean physique, especially endurance and weight-class athletes. The 3 interrelated conditions of the Male Athlete Triad occur on spectrums of energy deficiency/low energy availability (EA), suppression of the hypothalamic-pituitary-gonadal axis, and impaired bone health, ranging from optimal health to clinically relevant outcomes of energy deficiency/low EA with or without disordered eating or eating disorder, functional hypogonadotropic hypogonadism, and osteoporosis or low bone mineral density with or without bone stress injury (BSI). Because of the importance of bone mass acquisition and health concerns in adolescence, screening is recommended during this time period in the at-risk male athlete. Diagnosis of the Male Athlete Triad is best accomplished by a multidisciplinary medical team. Clearance and return-to-play guidelines are recommended to optimize prevention and treatment. Evidence-based risk assessment protocols for the male athlete at risk for the Male Athlete Triad have been shown to be predictive for BSI and impaired bone health and should be encouraged. Improving energetic status through optimal fueling is the mainstay of treatment. A Roundtable on the Male Athlete Triad was convened by the Female and Male Athlete Triad Coalition in conjunction with the 64th Annual Meeting of the American College of Sports Medicine in Denver, Colorado, in May of 2017. In this second article, the latest clinical research to support current models of screening, diagnosis, and management for at-risk male athlete is reviewed with evidence-based recommendations.

  View details for DOI 10.1097/JSM.0000000000000948

  View details for PubMedID 34091538

• Dietary Supplement Use According to Sex and Triad Risk Factors in Collegiate Endurance Runners. Journal of strength and conditioning research Barrack, M., Fredericson, M., Dizon, F., Tenforde, A., Kim, B., Kraus, E., Kussman, A., Singh, S., Nattiv, A. 2020

  Abstract

  Barrack, MT, Fredericson, M, Dizon, F, Tenforde, AS, Kim, BY, Kraus, E, Kussman, A, Singh, S, and Nattiv, A. Dietary supplement use according to sex and Triad risk factors in collegiate endurance runners. J Strength Cond Res XX(X): 000-000, 2020-This cross-sectional study evaluated the prevalence in the use of dietary supplements among elite collegiate runners among 2 NCAA Division I cross-country teams. At the start of each season from 2015 to 2017, male and female endurance runners were recruited to complete baseline study measures; the final sample included 135 (male n = 65, female n = 70) runners. Runners completed a health survey, web-based nutrition survey, and Triad risk assessment. The prevalence of dietary supplement use and Triad risk factors, including disordered eating, low bone mass, amenorrhea (in women), low body mass index, and stress fracture history, was assessed. A total of 78.5% (n = 106) runners reported taking 1 or more supplements on ≥4 days per week over the past month, 48% (n = 65) reported use of ≥3 supplements. Products used with highest frequency included multivitamin/minerals 46.7% (n = 63), iron 46.7% (n = 63), vitamin D 34.1% (n = 46), and calcium 33.3% (n = 45). More women, compared with men, used iron (61.4 vs. 30.8%, p < 0.001) and calcium (41.4 vs. 24.6%, p = 0.04); men exhibited higher use of amino acids and beta-alanine (6.2 vs. 0%, p = 0.04). Runners with bone stress injury (BSI) history, vs. no previous BSI, reported more frequent use of ≥3 supplements (61.5 vs. 32.8%, p = 0.001), vitamin D (49.2 vs. 19.4%, p < 0.001), and calcium (47.7 vs. 19.4%, p = 0.001). Low bone mineral density was also associated with higher use of vitamin D and calcium. Most runners reported regular use of 1 or more supplements, with patterns of use varying based on sex, history of BSI, and bone mass.

  View details for DOI 10.1519/JSC.0000000000003848

  View details for PubMedID 33278271

• Food Accessibility And Eating Patterns In Elite Collegiate Endurance Runners Agans, D., Barrack, M., Fredericson, M., Kraus, E., Kussman, A., Gravani, K., Miller, B., Papanos, L., Roche, M., Hernandez, C., Grohmann, E., Brotman, C., Nattiv, A. LIPPINCOTT WILLIAMS & WILKINS. 2020: 757

  View details for Web of Science ID 000590026302610

• Dietary Intake Patterns And Risk Of Energy Deficiency In Ncaa Endurance Athletes Hernandez, C., Fredericson, M., Nattiv, A., Kraus, E., Kussman, A., Gravani, K., Miller, B., Papanos, L., Roche, M., Agans, D., Grohmann, E., Brotman, C., Barrack, M. LIPPINCOTT WILLIAMS & WILKINS. 2020: 753

  View details for Web of Science ID 000590026303111

• Bone stress injuries in male distance runners: higher modified Female Athlete Triad Cumulative Risk Assessment scores predict increased rates of injury BRITISH JOURNAL OF SPORTS MEDICINE Kraus, E., Tenforde, A. S., Nattiv, A., Sainani, K. L., Kussman, A., Deakins-Roche, M., Singh, S., Kim, B., Barrack, M. T., Fredericson, M. 2019; 53 (4): 237–42

  View details for DOI 10.1136/bjsports-2018-099861

  View details for Web of Science ID 000458357900011

• Bone stress injuries in male distance runners: higher modified Female Athlete Triad Cumulative Risk Assessment scores predict increased rates of injury. British journal of sports medicine Kraus, E., Tenforde, A. S., Nattiv, A., Sainani, K. L., Kussman, A., Deakins-Roche, M., Singh, S., Kim, B. Y., Barrack, M. T., Fredericson, M. 2018

  Abstract

  OBJECTIVES: Bone stress injuries (BSI) are common in runners of both sexes. The purpose of this study was to determine if a modified Female Athlete Triad Cumulative Risk Assessment tool would predict BSI in male distance runners.METHODS: 156 male runners at two collegiate programmes were studied using mixed retrospective and prospective design for a total of 7years. Point values were assigned using risk assessment categories including low energy availability, low body mass index (BMI), low bone mineral density (BMD) and prior BSI. The outcome was subsequent development of BSI. Statistical models used a mixed effects Poisson regression model with p<0.05 as threshold for significance. Two regression analyses were performed: (1) baseline risk factors as the independent variable; and (2) annual change in risk factors (longitudinal data) as the independent variable.RESULTS: 42/156 runners (27%) sustained 61 BSIs over an average 1.9 years of follow-up. In the baseline risk factor model, each 1 point increase in prior BSI score was associated with a 57% increased risk for prospective BSI (p=0.0042) and each 1 point increase in cumulative risk score was associated with a 37% increase in prospective BSI risk (p=0.0079). In the longitudinal model, each 1 point increase in cumulative risk score was associated with a 27% increase in prospective BSI risk (p=0.05). BMI (rate ratio (RR)=1.91, p=0.11) and BMD (RR=1.58, p=0.19) risk scores were not associated with BSI.CONCLUSION: A modified cumulative risk assessment tool may help identify male runners at elevated risk for BSI. Identifying risk factors may guide treatment and prevention strategies.

  View details for PubMedID 30580252

• Youth Multi-sport Participation Is Associated With Higher Bone Mineral Density In Female Collegiate Distance Runners Miller, E., Fredericson, M., Kussman, A., Krauss, E., Singh, S., Deakins-Roche, M., Kim, B., Tenforde, A., Sainani, K., Nattiv, A. LIPPINCOTT WILLIAMS & WILKINS. 2018: 490

  View details for Web of Science ID 000456870502137

• Nutrition Goals Prioritized By Elite Endurance Runners Undergoing A Nutrition Education Intervention Barrack, M., Fredericson, M., Adam, T. S., Kraus, E., Kim, B., Singh, S., Kussman, A., Gravani, K., Ansari, Y., Miller, B., Nattiv, A. LIPPINCOTT WILLIAMS & WILKINS. 2017: 852

  View details for DOI 10.1249/01.mss.0000519298.55627.5d

  View details for Web of Science ID 000415216000102

• Preliminary Results from a Prospective Study Using the Female Athlete Triad Cumulative Risk Assessment Kraus, E., Nattiv, A., Tenforde, A., Kussman, A., Barrack, M., Kim, B., Deakins-Roche, M., Mistra, N., Singh, S., Fredericson, M. LIPPINCOTT WILLIAMS & WILKINS. 2017: 1098

  View details for DOI 10.1249/01.mss.0000520026.24336.5f

  View details for Web of Science ID 000415216000792

• Poster 155 Higher Cumulative Risk Assessment Scores Are Associated with Delayed Return to Play in Division I Collegiate Distance Runners. PM & R : the journal of injury, function, and rehabilitation Kraus, E. A., Kim, B., Nattiv, A., Tenforde, A., Barrack, M., Deakins-Roche, M., Kussman, A., Singh, S., Morkos, J., Fredericson, M. 2016; 8 (9S): S212-S213

  View details for DOI 10.1016/j.pmrj.2016.07.196

  View details for PubMedID 27672919

• 2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management BRITISH JOURNAL OF SPORTS MEDICINE Joy, E., Kussman, A., Nattiv, A. 2016; 50 (3): 154-?

  Abstract

  Eating disorders, such as anorexia nervosa and bulimia nervosa, can have devastating effects on both the health and performance of athletes. Compared to non-athletes, both female and male athletes are at higher risk of developing an eating disorder. This is especially true for athletes participating in sports where low body weight or leanness confers a competitive advantage. Screening for disordered eating behaviours, eating disorders and for related health consequences should be a standard component of preparticipation examinations, and team physicians should be knowledgeable of the updated diagnostic criteria for eating disorders in the Diagnostic and Statistical Manual-V. Athletes with eating disorders should undergo thorough evaluation and treatment by an experienced multidisciplinary team. Team physicians play a critical role in decision-making on clearance for participation and return to play. Using evidence-based guidelines for clearance and return to play encourages transparency and accountability between the sports medicine care team and the athlete. Efforts to prevent eating disorders should be aimed at athletes, coaches, parents and athletic administrators, and focused on expanding knowledge of healthy nutrition in support of sport performance and health.

  View details for DOI 10.1136/bjsports-2015-095735

  View details for Web of Science ID 000369998100010

  View details for PubMedID 26782763

• Distribution of Bone Stress Injuries in Elite Male and Female Collegiate Runners Tenforde, A. S., Nattiv, A., Barrack, M., Kraus, E., Kim, B., Kussman, A., Singh, S., Fredericson, M. LIPPINCOTT WILLIAMS & WILKINS. 2015: 905

  View details for DOI 10.1249/01.mss.0000479187.99648.37

  View details for Web of Science ID 000415222200244