All-Terrain Vehicle Injuries: Are They Dangerous? A 6-Year Experience at a Level I Trauma Center after Legislative Regulations Expired

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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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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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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Select Isolated Pediatric Closed Head Injuries can be safely managed on a Nonsurgical Service

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1146 ◽

2016 ◽

Vol 5 (2) ◽

pp. 65-69

Author(s):

Dan Parrish ◽

Shannon Rosati ◽

Malkit Singh ◽

Andrew Green ◽

Jeffrey Haynes

Keyword(s):

Injury Severity ◽

Social Issues ◽

Head Injuries ◽

Closed Head Injury ◽

Pediatric Neurosurgery ◽

The United States ◽

Inclusion Criteria ◽

Closed Head Injuries ◽

Closed Head ◽

Gcs Score

ABSTRACT Introduction Annually in the United States, there are an estimated 474,000 traumatic brain injury (TBI) related Emergency Department (ED) visits in children under age 15 years. While their evaluation and management are not standardized, guidelines generally include a neurological examination and head computed tomography (CT) with neurosurgical and/or pediatric surgical consultation, and admission generally based on imaging as well as persistent neurological symptoms. The primary purpose of this study was to review our experience with admitted isolated closed head injuries in children. We evaluated the safety of their management on a nonsurgical service after ED pediatric neurosurgical consultation deemed the injuries nonoperative. Study design A retrospective review was conducted of pediatric patients with closed head injuries between 2008 and 2013 (n = 837). Inclusion criteria were isolated closed head injury, discharged within 48 hours of admission, Glasgow Coma Scale (GCS) score greater than 13, and admission to a nonsurgical service. A total 272 patients met the inclusion criteria. These patients were divided into two groups based on whether or not they received a neurosurgical consult. Results Of the 272 patients, 221 received a pediatric neurosurgery consult while 51 did not. Those that received a neurosurgical consult had a higher Injury Severity Score (ISS) (7.5 vs 3.6), younger age (4.4 vs 6.9), longer length of stay, higher admission acuity, and were more likely to receive a repeat head CT. There was no difference in GCS score (14.9 vs 15), and the most common discharge symptom was a headache. With admission to nonsurgical services, no complications, readmissions, or missed injuries occurred. Conclusion As pediatric neurosurgery is a limited resource, we evaluated the safety of admitting patients deemed nonsurgical to a medical service for management and follow-up of the TBI, as well as the social issues which are often present. The practice resulted in no morbidity or mortality with efficient management of ancillary consult services. How to cite this article Parrish D, Rosati S, Singh M, Green A, Haynes J. Select Isolated Pediatric Closed Head Injuries can be safely managed on a Nonsurgical Service. Panam J Trauma Crit Care Emerg Surg 2016;5(2):65-69.

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Equestrian Trauma: Injury Patterns Vary among Age Groups

The American Surgeon ◽

10.1177/000313481408000424 ◽

2014 ◽

Vol 80 (4) ◽

pp. 396-402 ◽

Cited By ~ 11

Author(s):

Jaroslaw W. Bilaniuk ◽

John M. Adams ◽

Louis T. DiFazio ◽

Brian K. Siegel ◽

John R. Allegra ◽

...

Keyword(s):

Injury Severity ◽

Head Injuries ◽

A Priori ◽

Age Groups ◽

Rib Fractures ◽

Body Region ◽

Injury Patterns ◽

Closed Head Injuries ◽

Closed Head ◽

Trauma Injury

Patients with equestrian injuries were identified in the trauma registry from 2004 to 2007. We a priori divided patients into three groups: 0 to 18 years, 19 to 49 years, and 50 years old or older. There were 284 patients identified with equestrian-related trauma. Injury Severity Score for the three major age categories 0 to 18 years, 19 to 49 years, and 50 years or older, were 3.47, 5.09, and 6.27, respectively. The most common body region injured among all patients was the head (26.1%). The most common injuries by age group were: 0 to 18 years, upper extremity fractures; 19 to 49 year olds, concussions; and 50 years or older, rib fractures. Significant differences were observed among the three age groups in terms of percent of patients with rib fractures: percent of patients with rib fractures was 2, 8, and 22 per cent in age groups 0 to 18, 19 to 49, and 50 years or older, respectively. We found different patterns of injuries associated with equestrian accidents by age. Head injuries were commonly seen among participants in equestrian activities and helmet use should be promoted to minimize the severity of closed head injuries. Injury patterns also seem to vary among the various age groups that ride horses. This information could be used to better target injury prevention efforts among these patients.

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P116: Colder, but no less safe: A comparison of bicycle related traumas in winter compared to summer cyclists

CJEM ◽

10.1017/cem.2020.322 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S106-S107

Author(s):

S. Davis ◽

J. Delaney

Keyword(s):

Protective Factor ◽

Injury Severity ◽

Head Injuries ◽

Severity Scale ◽

Chi Square ◽

Helmet Use ◽

Trauma Severity ◽

Significant Difference ◽

Level I ◽

Chi Square Analysis

Introduction: This study aimed to examine difference in trauma injuries between bicycle users in winter months compared to summer months. Behavioral variables were also examined to assess seasonal variability, as well as associations with traumas. Methods: This was a retrospective cohort study of all bicycle related traumas presenting to a level I trauma center between the years 1998-2018. All data was collected through a standardized trauma database. Seasonal differences were examined by comparing trauma severity and behavior patterns between patients arriving in the months May-September (summer) and those arriving in November-March (winter). Outcome measures included: Injury Severity Scale, GCS, type of accident, helmet use, demographics and alcohol level. Groups were compared using t-tests and Chi-square analysis as appropriate. Results: A total of 980 bicycle related traumas were analyzed. There were a significantly greater number of injuries in the summer as compared to winter months (879 in summer vs. 101 in winter). While most injuries in both groups were rated in the severe range of the Injury Severity Scale, there were no differences in injury severity, initial GCS, deaths, or head injuries between the two seasons. There were also no differences in drug, alcohol, or helmet use. The only significant difference between seasons was that winter riders were more likely to be male. Overall, helmet use was associated with lower injury severity, less head trauma, and a higher initial GCS. Use of alcohol was associated with less likelihood of wearing a helmet. Conclusion: In conclusion, bicycle use in winter does not appear to be associated with worse outcomes than summer. Public health interventions can continue to encourage winter bicycle use, with the encouragement of helmet use and avoidance of alcohol when cycling as an important protective factor in both seasons.

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

Journal of Surgical Research ◽

10.1016/j.jss.2011.11.235 ◽

2012 ◽

Vol 172 (2) ◽

pp. 199

Author(s):

K.H. Nagarsheth ◽

S. Kurek

Keyword(s):

Head Injuries ◽

Helmet Use ◽

Closed Head Injuries ◽

Closed Head

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Verbal learning and memory following pediatric closed-head injury

Journal of the International Neuropsychological Society ◽

10.1017/s1355617700000138 ◽

1995 ◽

Vol 1 (1) ◽

pp. 78-87 ◽

Cited By ~ 82

Author(s):

Keith Owen Yeates ◽

Elliot Blumenstein ◽

Carolyn M. Patterson ◽

Dean C. Delis

Keyword(s):

Learning And Memory ◽

Injury Severity ◽

Head Injuries ◽

Verbal Learning ◽

Closed Head Injury ◽

California Verbal Learning Test ◽

Closed Head Injuries ◽

Closed Head ◽

History Of ◽

Learning Test

AbstractIn this study, verbal learning and memory following pediatric closed-head injuries (CHI) using the children's version of the California Verbal Learning Test (CVLT). Participants included 47 children, ages 5–16 yr, with a history of CHI, and 47 matched, noninjured controls. Children with CHI performed more poorly than controls on the CVLT, although their deficits varied qualitatively as a function of injury severity. Those with mild/moderate injuries performed as well as controls on learning trials, but they recalled proportionally fewer words after a delay (although their recognition was intact). Severely injured children demonstrated deficits in learning, delayed recall, and recognition, compared to controls. The groups did not differ in learning characteristics, but children with severe CHI exhibited more intrusions than controls. Pediatric CHI are associated with specific disturbances in verbal learning and memory similar to those of adults with CHI but different from those of children with other developmental and neurological disorders.JINS, 1995,I, 78–87.)

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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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