Background: The use of artificial turf in American football continues to grow in popularity, and the effect of these playing surfaces on athletic injuries remains controversial. Knee injuries account for a significant portion of injuries in the National Collegiate Athletic Association (NCAA) football league; however, the effect of artificial surfaces on knee injuries remains ill-defined. Hypothesis: There is no difference in the rate or mechanism of knee ligament and meniscal injuries during NCAA football events on natural grass and artificial turf playing surfaces. Study Design: Descriptive epidemiology study. Methods: The NCAA Injury Surveillance System Men’s Football Injury and Exposure Data Sets for the 2004-2005 through 2013-2014 seasons were analyzed to determine the incidence of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), medial meniscus, and lateral meniscal tear injuries. Injury rates were calculated per 10,000 athlete exposures, and rate ratios (RRs) were used to compare injury rates during practices and competitions on natural grass and artificial turf in NCAA football as a whole and by competition level (Divisions I, Divisions II and III). Mechanisms of injury were calculated for each injury on natural grass and artificial turf surfaces. Results: A total of 3,009,205 athlete exposures and 2460 knee injuries were reported from 2004 to 2014: 1389 MCL, 522 ACL, 269 lateral meniscal, 164 medial meniscal, and 116 PCL. Athletes experienced all knee injuries at a significantly higher rate when participating in competitions as compared with practices. Athletes participating in competitions on artificial turf experienced PCL injuries at 2.94 times the rate as those playing on grass (RR = 2.94; 95% CI, 1.61-5.68). When stratified by competition level, Division I athletes participating in competitions on artificial turf experienced PCL injuries at 2.99 times the rate as those playing on grass (RR = 2.99; 95% CI, 1.39-6.99), and athletes in lower NCAA divisions (II and III) experienced ACL injuries at 1.63 times the rate (RR = 1.63; 95% CI, 1.10-2.45) and PCL injuries at 3.13 times the rate (RR = 3.13; 95% CI, 1.14-10.69) on artificial turf as compared with grass. There was no statistically significant difference in the rate of MCL, medial meniscal, or lateral meniscal injuries on artificial turf versus grass when stratified by event type or level of NCAA competition. No difference was found in the mechanisms of knee injuries on natural grass and artificial turf. Conclusion: Artificial turf is an important risk factor for specific knee ligament injuries in NCAA football. Injury rates for PCL tears were significantly increased during competitions played on artificial turf as compared with natural grass. Lower NCAA divisions (II and III) also showed higher rates of ACL injuries during competitions on artificial turf versus natural grass.

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Study Objectives: Elderly patients represent a population at elevated risk for adverse drug events due not only to polypharmacy, but also to physiological changes that decrease metabolism and clearance of individual drugs. This risk is especially pronounced with regard to renally-cleared medications. Studies suggest emergency physicians inappropriately dose 24-46% of renally-cleared prescriptions, often requiring guidance from automated decision support tools or in-department pharmacists to adjust dosages appropriately. The purpose of this study was to analyze our prescribing patterns in an elderly emergency department (ED) population and to determine our accuracy in adjustment for renal impairment.Methods: This is a retrospective observational study conducted at 2 tertiary care EDs between April 15, 2017 -April 30, 2018. Inclusion criteria included all patients age 65 years or older who were discharged with a new prescription. Each new medication counted as one encounter. We sought to determine how many new discharge medications required adjustment for renal function. We then looked at a subset of anti-infective medications (oseltamivir, sulfamethoxazole-trimethoprim, and nitrofurantoin) to determine if ED physicians appropriately adjusted the medication dosage for renal function. Age, weight, serum creatinine and sex were used to calculate the estimated creatinine clearance (CrCl) in milliliters/minute (mL/min). Patients were excluded from final analysis if data was incomplete.Results: During the study period, there were 6674 prescriptions dispensed upon ED discharge, 1256 (19%) of these were for medications in which dosing for renal impairment is recommended. Among these, the majority were anti-infectives (920, 73.2%). The next most common were analgesics (152, 12.1%), anti-hypertensives (104, 8.2%), and anticoagulants (81, 6.4%). For the subset analysis, oseltamivir was dispensed 85 times. 25 prescriptions were given to patients with a CrCl > 30 to 60mL/min. 11/25 (44%) of these prescriptions were not adjusted for renal function. In all cases, the standard treatment dose was prescribed for those with normal CrCl. There were 3 prescriptions given to patients with a CrCl > 10 to 30 mL/min. All 3 prescriptions were appropriately adjusted for CrCl. Sulfamethoxazole-trimethoprim (800-160mg or 400-80mg) was dispensed 148 times. 13 prescriptions were given to patients with a CrCl 15-30ml/min. In 7/13 cases (54%), the dose was not adjusted for renal function. Only one prescription was inappropriately given to a patient with CrCl < 15 mL/min. Nitrofurantoin was prescribed 36 times; only on 1 occasion inappropriately to a patient with a CrCl < 30 mL/min.Conclusions: Medications that necessitate adjustment for renal impairment are commonly prescribed to geriatric patients upon discharge. In our subset analysis, nearly half the prescriptions dispensed to patients with a CrCl < 30mL/min were not appropriately adjusted for renal impairment. Ongoing ED physician education and further endeavors to improve medication safety i...