Helmets Matter: Kentucky All-Terrain Vehicle Crashes Seen at a Tennessee Trauma Center

All-terrain vehicle (ATV) safety laws, including helmet use, vary by state and are sporadically enforced. Kentucky state laws require safety helmets only for younger riders. We hypothesized that ATV riders injured in Kentucky and seen at a Tennessee trauma center would more likely be unhelmeted, have more severe head injuries, and have higher mortality rates than those injured in Virginia or Tennessee. A Trauma Registry review of 750 injured ATV riders from June 1, 2005, through June 1, 2015 examined state location of accident, helmet use, markers of injury severity, and outcomes. Multiple logistic regression analysis examined predictors of severe head injuries and death with P < 0.05 significant. Unhelmeted ATV rider status predicted more severe head injuries (relative risk 23.5, P < 0.001) and death (relative risk 4.6, P < 0.001). ATV riders injured in the state of Kentucky were twice as numerous. In addition, they were more likely than ATVriders injured in Tennessee or Virginia to be unhelmeted, to have severe head injuries, and to sustain fatal injuries (all P < 0.001). This single trauma center study lends support for maintaining and enforcing current universal helmet laws for ATVriders of all ages in states where they are in effect and highlights the need to upgrade helmet laws that apply only to some riders.

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

The American Surgeon ◽

10.1177/000313480507101107 ◽

2005 ◽

Vol 71 (11) ◽

pp. 937-941 ◽

Cited By ~ 9

Author(s):

A.H. Fonseca ◽

M.G. Ochsner ◽

W.J. Bromberg ◽

D. Gantt

Keyword(s):

Injury Severity ◽

Public Awareness ◽

Head Injuries ◽

Progressive Increase ◽

Helmet Use ◽

Closed Head Injuries ◽

Safety Regulations ◽

Number Of Patients ◽

Closed Head ◽

Level I

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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Equestrian Injury is Costly, Disabling, and Frequently Preventable: The Imperative for Improved Safety Awareness

The American Surgeon ◽

10.1177/000313481307900134 ◽

2013 ◽

Vol 79 (1) ◽

pp. 76-83 ◽

Cited By ~ 11

Author(s):

Kristina Guyton ◽

Emily Houchen-Wise ◽

Ellen Peck ◽

John Mayberry

Keyword(s):

Injury Severity ◽

Head Injuries ◽

Bodily Pain ◽

Hospital Charge ◽

Daily Activities ◽

Equipment Failure ◽

Helmet Use ◽

Physical Problems ◽

Safety Awareness

Horse-related injury can be severe and disabling. We investigated the causes, severity, and costs of equestrian injury with the goal of injury prevention. A retrospective review of horse-related injuries from 2001 to 2008 identified 231 patients with a mean age of 38 years and a mean Injury Severity Score of 11 (range, 1 to 45). Mean length of stay was 5.5 days. Fifty-nine patients (25%) required 84 surgeries. Helmet use was 20 per cent and of the 172 patients not wearing a helmet while mounted, 38 per cent received potentially preventable head injuries. There were three deaths of which two were the result of intracranial hemorrhage in riders not wearing a helmet. Mean hospital charge was $29,800 for a total of $6.9 million. Ninety-one patients completed a survey regarding causation and disability. Thirty-four per cent reported wearing a helmet at the time of injury. Forty per cent reported that poor environmental factors contributed, 30 per cent reported poor horse and rider pairing, and 9 per cent reported equipment failure. Fifty-nine per cent reported long-term disabilities. Compared with the general population, respondents had diminution in their ability to perform usual daily activities associated with physical problems, diminution in social function, and higher bodily pain. We conclude that equestrian injury is costly, disabling, and frequently preventable.

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Injury coding in a national trauma registry: a one-year validation audit in a level 1 trauma centre

BMC Emergency Medicine ◽

10.1186/s12873-019-0276-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Anna Bågenholm ◽

Ina Lundberg ◽

Bjørn Straume ◽

Rune Sundset ◽

Kristian Bartnes ◽

...

Keyword(s):

Injury Severity ◽

Trauma Registry ◽

Improve Patient Safety ◽

Head Injuries ◽

Trauma Team ◽

Trauma Centre ◽

Registry Data ◽

Reference Standard ◽

National Trauma ◽

Level 1

Abstract Background Hospitals must improve patient safety and quality continuously. Clinical quality registries can drive such improvement. Trauma registries code injuries according to the Abbreviated Injury Scale (AIS) and benchmark outcomes based on the Injury Severity Score (ISS) and New ISS (NISS). The primary aim of this study was to validate the injury codes and severities registered in a national trauma registry. Secondarily, we aimed to examine causes for missing and discordant codes, to guide improvement of registry data quality. Methods We conducted an audit and established an expert coder group injury reference standard for patients met with trauma team activation in 2015 in a Level 1 trauma centre. Injuries were coded according to the AIS. The audit included review of all data in the electronic health records (EHR), and new interpretation of all images in the picture archiving system. Validated injury codes were compared with the codes registered in the registry. The expert coder group’s interpretations of reasons for discrepancies were categorised and registered. Inter-rater agreement between registry data and the reference standard was tested with Bland–Altman analysis. Results We validated injury data from 144 patients (male sex 79.2%) with median age 31 (inter quartile range 19–49) years. The total number of registered AIS codes was 582 in the registry and 766 in the reference standard. All injuries were concordantly coded in 62 (43.1%) patients. Most non-registered codes (n = 166 in 71 (49.3%) patients) were AIS 1, and information in the EHR overlooked by registrars was the dominating cause. Discordant coding of head injuries and extremity fractures were the most common causes for 157 discordant AIS codes in 74 (51.4%) patients. Median ISS (9) and NISS (12) for the total population did not differ between the registry and the reference standard. Conclusions Concordance between the codes registered in the trauma registry and the reference standard was moderate, influencing individual patients’ injury codes validity and ISS/NISS reliability. Nevertheless, aggregated median group ISS/NISS reliability was acceptable.

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The G60 Trauma Center: A Future Consideration?

The American Surgeon ◽

10.1177/000313481708300617 ◽

2017 ◽

Vol 83 (6) ◽

pp. 547-553 ◽

Cited By ~ 3

Author(s):

Marko Bukur ◽

Joshua Simon ◽

Joseph Catino ◽

Margaret Crawford ◽

Ivan Puente ◽

...

Keyword(s):

Elderly Patients ◽

Trauma Center ◽

Injury Severity ◽

Head Injuries ◽

Major Complication ◽

The Elderly ◽

Trauma Patients ◽

Trauma Centers ◽

Failure To Rescue ◽

Level I

With a considerably increasing elderly population, we sought to determine whether the volume of elderly trauma patients treated impacted outcomes at two different Level I trauma centers. This is a retrospective review of all elderly patients (>60 years) at two state-verified Level I trauma centers over the past five years. The elderly trauma center (ETC) saw a greater proportion (52%) of elderly patients than the reference trauma center (30%, TC). Demographic and clinical characteristics were abstracted and stratified into ETC and TC groups for comparison. Primary outcomes were overall postinjury complication and mortality rates, as well as death after major complication (failure to rescue). ETC patients were older (78.6 vs 70.5), more likely to be admitted with severe head injuries (head abbreviated injury score ≥ 3, 50.0% vs 32%), had a greater overall injury burden (injury severity score > 16 41.4% vs 21.1%), and required intensive care unit admission (81.3% vs 64%) than the TC group. Need for operative intervention, mechanism of injury, and comorbidities were similar between the two groups. Overall complications were higher in trauma patients admitted to the TC (21.9% vs 14.3%), as well as failure to rescue (4.0% vs 1.8%). Adjusting for confounding factors, ETC had significantly lower chance of developing a postinjury complication (adjusted odds ratios [AOR] = 0.4, 95% confidence interval [CI] = [0.3, 0.5]), failure to rescue (AOR = 0.3, 95% CI = [0.1, 0.5]), and overall mortality (AOR = 0.3, 95% CI = [0.2, 0.4]). Improved outcomes were demonstrated in the Level I center treating a higher proportion of elderly patients. Exact etiology of these benefits should be determined for quality improvement in care of the injured geriatric patient.

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Injuries and helmet use related to non-motorized wheeled activities among pediatric patients

Chronic Diseases and Injuries in Canada ◽

10.24095/hpcdp.34.2/3.02 ◽

2014 ◽

Vol 34 (2/3) ◽

pp. 74-81 ◽

Cited By ~ 3

Author(s):

H Lindsay ◽

M Brussoni

Keyword(s):

Pediatric Patients ◽

Head Injuries ◽

Common Mechanism ◽

Surveillance Program ◽

Helmet Use ◽

Number Of Patients ◽

Unique Source ◽

Injury Reporting ◽

Helmet Laws ◽

Injured Patients

Introduction Patients presenting to emergency departments (ED) for injuries resulting from recreational activities represent a unique source of information on important directions for injury prevention efforts. We describe the epidemiology of non-motorized wheeled activity-related injury in pediatric patients presenting to Canadian EDs as well as patients' helmet use. Methods Data for the years 2004 to 2009 were abstracted from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), a national ED injury surveillance program in fifteen hospitals. Results Most of the 28 618 children aged 1 to 16 years injured during non-motorized wheeled activities were injured while cycling, followed by skateboarding. Most injuries occurred among boys. Children injured on scooters tended to be younger whereas skateboarders were the oldest. On average, the number of all injuries decreased by 6% over the time period. Falls were the most common mechanism of injury; 8.3% of patients had head injuries, which were seen more often among cyclists than other wheeled-activity users. Helmet use was greatest among cyclists (62.2%) and lowest among skateboarders (32.9%). Injured patients presenting to EDs in jurisdictions with legislation mandating helmet use had 2.12 greater odds of helmet use and 0.86 lesser odds of head injury compared with those presenting in jurisdictions without helmet laws. Conclusion These results provide further evidence that legislation mandating helmet use may be an effective way of reducing injury among all wheeled-activity users. The small number of patients who presented with helmet use and protective gear (59.4% overall) suggests that this remains an area for intervention.

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Trauma Surgeon-Led and Funded Injury Prevention Program Decreases Admission for Motorcycle Crash Injuries

The American Surgeon ◽

10.1177/00031348211050837 ◽

2021 ◽

pp. 000313482110508

Author(s):

Matthew F. Holt ◽

George M. Testerman

Keyword(s):

High School Students ◽

Injury Prevention ◽

Trauma Center ◽

Head Injuries ◽

Local Communities ◽

Full Time ◽

Trauma Surgeon ◽

School Students ◽

Helmet Use ◽

Crash Injuries

Background Unhelmeted motorcyclists injured in states with lax or poorly enforced helmet safety laws are frequently seen in rural trauma centers. A trauma surgeon started a comprehensive injury prevention and research fund with outreach to a three-state trauma center catchment area promoting injury prevention at area high schools and local communities. We hypothesized that unhelmeted riders would have more severe head injuries and fatalities than helmeted riders. Methods A trauma registry review of 708 injured motorcycle riders over an 11-year period examined demographics, helmet use, and clinical outcomes of helmeted and unhelmeted riders. A full-time injury prevention coordinator collaborating with law enforcement provided electronic and mechanical simulations with discussions regarding helmet use, alcohol avoidance, and responsible motorcycle riding for area high school students. This program coincided with the second half of our 11-year study. Multiple regression analysis evaluated predictors for head injury and death. Results Unhelmeted motorcyclists suffered worse head injuries, (OR 8.8, CI 1.6-2.4, P < .001), more severe overall injury (OR 10, CI 12.7-18.6, P < .001), and higher mortality (OR 2.7, CI .02-.15, P < .001). Local motorcycle-related trauma center admissions and deaths have stabilized in recent years while statewide motorcycle crashes have increased ( P < .05). Discussion Unhelmeted motorcyclists suffer worse head injuries and mortality rates. Physician-led outreach efforts for injury prevention may be effective. Trauma surgeons have ongoing opportunities to promote responsible motorcycle riding for schools and local communities.

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Pediatric Equestrian Injuries: Assessing The Impact of Helmet Use

PEDIATRICS ◽

10.1542/peds.95.4.487 ◽

1995 ◽

Vol 95 (4) ◽

pp. 487-489

Author(s):

G. Randall Bond ◽

Richard A. Christoph ◽

Bradley M. Rodgers

Keyword(s):

Emergency Department ◽

Prospective Observational Study ◽

Injury Severity ◽

Head Injuries ◽

University Of Virginia ◽

Severity Scale ◽

Helmet Use ◽

The Mean ◽

The University ◽

The Impact

Objective. To assess the impact of helmet use on the pattern, and severity of pediatric equestrian injuries. Design. A prospective observational study of all children less than 15 years of age who were brought to the University of Virginia children's Emergency Department with horse-related injuries. Results. During the two-year period of the study, 32 children were evaluated. Two children were injured when a horse stepped on them. Thirty children fell from or were thrown from a horse. Of these, 20 were wearing a helmet. Head injuries were more frequent in those patients not wearing helmets. The mean Modified Injury Severity Scale (MISS) score for riders without a helmet (12.9) was significantly higher (more severe) than that for helmeted riders (2.8). All three patients with a Glascow Coma Score <15 on arrival were not wearing a helmet at the time of injury. The frequency of hospitalization was significantly higher for those not wearing a helmet. Compared with other common mechanisms of childhood injury the mean Modified Injury Severity Scale score of injured riders was exceeded only by that of pedestrians struck by a car. Conclusion. Equestrian injuries are more severe than those suffered from other common pediatric mechanisms. Helmet use is associated with decreased frequency and severity of central nervous system injury.

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Exploring the Economics of Motorcycle Helmet Laws — Implications for Low and Middle-Income Countries

Asia Pacific Journal of Public Health ◽

10.1177/10105395070190020401 ◽

2007 ◽

Vol 19 (2) ◽

pp. 16-22 ◽

Cited By ~ 38

Author(s):

A.A. Hyder ◽

H. Waters ◽

T. Phillips ◽

J. Rehwinkel

Keyword(s):

Head Injuries ◽

Economic Evaluations ◽

Cost Ratio ◽

Middle Income ◽

Helmet Use ◽

Middle Income Countries ◽

Motorcycle Helmet ◽

The Usa ◽

Helmet Laws ◽

Low And Middle Income

This paper reviews economic evaluations of motorcycle helmet interventions in preventing injuries. A comprehensive literature review focusing on the e fectiveness of motorcycle helmet use, and on mandatory helmet laws and their enforcement was done. When helmet laws were lifted between 1976-80, 48 states within the USA experienced a cost of $342,047 per excess fatality of annual net savings. Helmet laws in the USA had a benefit-cost ratio of 1.33 to 5.07. Taiwan witnessed a 14% decline in motorcycle fatalities and a 22% reduction of head injury fatalities with the introduction of a helmet law. In Thailand, where 70-90% of all crashes involve motorcycle, after enforcement of a helmet law, helmet-use increased five-fold, the number of injured motorcyclists decreased by 33.5%, head injuries decreased by 41.4%, and deaths decreased by 20.8%. There is considerable evidence that mandatory helmet laws with enforcement alleviate the burden of tra fic injuries greatly. For low and middle-income countries with high rates of motorcycle injuries, enforced, mandatory motorcycle helmet laws are potentially one of the most cost-e fective interventions available. Asia Pac J Public Health 2007; 19(2): 16—22.

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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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