Helmet Use in Pediatric ATV Accident Victims and Associated Closed Head Injuries

All-terrain vehicles (ATVs) have increased in popularity and sales since 1971. This rise in popularity led to an increase in injuries resulting in voluntary industry rider safety regulations in 1988, which expired without renewal in 1998. Our purpose was twofold, to determine the incidence and severity of ATV injuries in our patient population and what, if any impact the safety regulations had. To further characterize the risk of ATV use, we compared them to a vehicle generally recognized as dangerous, the motorcycle (MC). Our trauma registry was reviewed from January 1998 through August 2004 for ATV or MC injured. Data collected included age, gender, mortality, Injury Severity Score (ISS), helmet use, and injury distribution. These were compared to our data from the decade of regulation. There were 352 MC and 221 ATV patients. ATV injured demonstrated a higher proportion of pediatric and female patients ( P < 0.001 and P < 0.01, respectively), a decrease in helmet use (8.6% vs 64.7%, P < 0.001), and increased closed head injuries (CHI) (54.2% vs 44.9%, P < 0.05) compared with MC injured. ISS and mortality were similar. The average number of patients from 1988 to 1998 was 6.9/yr compared to 31.6/yr ( P < 0.001) during 1998–2004 with equal ISS. Our data show that there has been a dramatic and progressive increase in the number of ATV crashes since expiration of industry regulations. ATVs are as dangerous as MCs based on patient ISS and mortality. There are significantly more children and women injured on ATVs. The lower rate of helmet use in ATVs may account for the significantly greater incidence of CHI. These data mandate the need for injury prevention efforts for ATV riders, in particular children, through increased public awareness and new legislation.

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Analysis of All-Terrain Vehicle Trauma Data: Implications for Increased Regulation and Injury Prevention

The American Surgeon ◽

10.1177/000313481708300420 ◽

2017 ◽

Vol 83 (4) ◽

pp. 348-353

Author(s):

Cathy V. Ho ◽

James R. Dunne ◽

Wesley R. Stroud ◽

Alvaro H. Fonseca ◽

Frank E. Davis ◽

...

Keyword(s):

Injury Prevention ◽

Pediatric Patients ◽

Head Injuries ◽

Prospective Data ◽

Helmet Use ◽

Closed Head Injuries ◽

Closed Head ◽

Recreational Vehicles ◽

Injured Patients ◽

Motorcycle Crashes

To determine the incidence and severity of all-terrain vehicle crashes (ATVCs) compared with motorcycle crashes (MCCs) in all critically injured patients. Prospective data were retrospectively reviewed on 1840 patients involved in ATVCs and MCCs admitted to a rural level one trauma center over 16 years. ATVC patients (n = 655) were younger (25 vs 38, P < 0.0001), more likely female (20% vs 11%, P < 0.001), less severely injured (13.5 vs 16, P < 0.0001), had similar Glasgow Coma Score (13.3 vs 13.4, p = NS), less helmet use (6% vs 69%, P < 0.0001), more closed head injuries (59.7% vs 54.3%, P < 0.05), more facial injuries (16.9% vs 12.5%, P < 0.05), and lower mortality rate (2.8% vs 5.9%, P < 0.01) compared with MCC patients (n = 1172). Pediatric patients involved in ATVC were more common (29.8% vs 4.8%, P < 0.001), had decreased helmet use (12% vs 59%, P < 0.001) and decreased mortality (3.5% vs 14.3%, P < 0.01). Further injury prevention efforts regarding helmet use and increased regulations regarding ATVCs are needed to decrease the morbidity associated with these recreational vehicles.

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Closed Head Injuries in Athletes

Clinics in Sports Medicine ◽

10.1016/s0278-5919(20)30730-4 ◽

1990 ◽

Vol 9 (2) ◽

pp. 247-261 ◽

Cited By ~ 2

Author(s):

Lawrence B. Lehman ◽

Steven J. Ravich

Keyword(s):

Head Injuries ◽

Closed Head Injuries ◽

Closed Head

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A Retrospective Analysis of Softball-Related Head and Facial Injuries Treated in United States Emergency Departments, 2013-2017

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119825660 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711982566 ◽

Cited By ~ 1

Author(s):

John S. Strickland ◽

Marie Crandall ◽

Grant R. Bevill

Keyword(s):

United States ◽

Head Injuries ◽

The United States ◽

Weighted Estimate ◽

Body Parts ◽

Facial Injuries ◽

Closed Head Injuries ◽

Closed Head ◽

The Mean ◽

Race Ethnicity

Background: Softball is a popular sport played through both competitive and recreational leagues. While head and facial injuries are a known problem occurring from games, little is known about the frequency or mechanisms by which they occur. Purpose: To analyze head/face injury diagnoses and to identify the mechanisms associated with such injuries. Study Design: Descriptive epidemiological study. Methods: A public database was used to query data related to head/facial injuries sustained in softball. Data including age, sex, race/ethnicity, injury diagnosis, affected body parts, disposition, incident location, and narrative descriptions were collected and analyzed. Results: A total of 3324 head and face injuries were documented in the database over the time span of 2013 to 2017, resulting in a nationwide weighted estimate of 121,802 head/face injuries occurring annually. The mean age of the players was 21.5 ± 14.4 years; 72.1% of injured players were female, while 27.9% were male. The most common injury diagnoses were closed head injuries (22.0%), contusions (18.7%), concussions (17.7%), lacerations (17.1%), and fractures (15.1%). The overwhelming majority of injuries involved being struck by a ball (74.3%), followed by colliding with another player (8.3%), colliding with the ground or a fixed object (5.0%), or being struck by a bat (2.8%). For those injuries caused by a struck-by-ball incident, most occurred from defensive play (83.7% were fielders struck by a hit or thrown ball) as opposed to offensive play (12.3% were players hit by a pitch or runners struck by a ball). Although helmet usage was poorly tracked in the database, female players (1.3%) were significantly more likely to have been wearing a helmet at the time of injury than were male players (0.2%) ( P = .002). Conclusion: The present study demonstrates that a large number of head and face injuries occur annually within the United States as a result of softball play. A variety of injuries were observed, with the majority involving defensive players being struck by the ball, which highlights the need for more focus on player safety by stronger adherence to protective headgear usage and player health monitoring.

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The glial reaction in closed head injuries

Neuropathology and Applied Neurobiology ◽

10.1111/j.1365-2990.1991.tb00740.x ◽

1991 ◽

Vol 17 (5) ◽

pp. 407-414 ◽

Cited By ~ 9

Author(s):

D. A. CROOKS ◽

C. L. SCHOLTZ ◽

G. VOWLES ◽

S. GREENWALD ◽

S. EVANS

Keyword(s):

Head Injuries ◽

Closed Head Injuries ◽

Glial Reaction ◽

Closed Head

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Airway complications in patients with closed-head injuries

American Journal of Otolaryngology ◽

10.1016/s0196-0709(87)80030-3 ◽

1987 ◽

Vol 8 (2) ◽

pp. 91-96 ◽

Cited By ~ 25

Author(s):

Peggyann Nowak ◽

Arnold M. Cohn ◽

Mary Ann Guidice

Keyword(s):

Head Injuries ◽

Closed Head Injuries ◽

Airway Complications ◽

Closed Head

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Inappropriate Discharge Instructions for Youth Athletes Hospitalized for Concussion

PEDIATRICS ◽

10.1542/peds.95.2.216 ◽

1995 ◽

Vol 95 (2) ◽

pp. 216-218

Author(s):

Frank J. Genuardi ◽

William D. King

Keyword(s):

Head Injury ◽

Injury Severity ◽

Head Injuries ◽

Closed Head Injury ◽

Medical Society ◽

Discharge Instructions ◽

Youth Athletes ◽

Closed Head Injuries ◽

Closed Head ◽

Grade 3

Objective. To evaluate the medical care, especially the discharge instructions regarding return to participation, received by youth athletes hospitalized for a closed head injury. Methods. We examined the records of all patients admitted over a 5-year period (1987 through 1991) to The Children's Hospital of Alabama for a sports-related closed head injury. Descriptive information was recorded and discharge instructions reviewed. Injury severity was graded according to guidelines current during the study period, as well as those outlined most recently by the Colorado Medical Society, which have been endorsed by a number of organizations including the American Academy of Pediatrics. Discharge instructions recorded for each patient were then compared with those recommended in the guidelines. Results. We identified 33 patients with sports-related closed head injuries. Grade 1 concussions (least severe) occurred in 8 patients (24.2%), grade 2 in 10 (30.3%), and grade 3 (most severe) in 15 (45.4%). Overall, discharge instructions were appropriate for only 10 patients (30.3%), including all with grade 1 concussions, but only 2 with a grade 2 (20.0%) and none with a grade 3 concussion. Conclusion. All who care for youth athletes must become familiar with the guidelines for management of concussion to provide appropriate care and counseling and to avoid a tragic outcome.

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