Injuries and helmet use related to non-motorized wheeled activities among pediatric 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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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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Helmets Matter: Kentucky All-Terrain Vehicle Crashes Seen at a Tennessee Trauma Center

The American Surgeon ◽

10.1177/000313481808400239 ◽

2018 ◽

Vol 84 (2) ◽

pp. 289-293

Author(s):

George M. Testerman ◽

Daniel C. Prior ◽

Tamie D. Wells ◽

Sarah E. Rollins ◽

Stephen L. Oesch

Keyword(s):

Relative Risk ◽

Trauma Center ◽

Injury Severity ◽

Trauma Registry ◽

Head Injuries ◽

Multiple Logistic Regression Analysis ◽

Multiple Logistic Regression ◽

Helmet Use ◽

State Laws ◽

Helmet Laws

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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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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P074: Impact of wearing a helmet on the risk of hospitalization after a sport injury

CJEM ◽

10.1017/cem.2016.250 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S103-S103

Author(s):

N. Le Sage ◽

M. Prévost ◽

B. Batomen Kuimi ◽

A. Gagnon ◽

V. Bergeron-Larose ◽

...

Keyword(s):

Head Injuries ◽

Skull Fracture ◽

Helmet Use ◽

Hospitalization Rates ◽

Confounding Variables ◽

Downhill Skiing ◽

Canadian Provinces ◽

Injury Reporting ◽

Study Participants ◽

The Impact

Introduction: Six Canadian provinces recently made bicycle helmet mandatory and subsequent data concerning hospitalization rates after head injuries in cyclists were controversial. Furthermore, there remains an important proportion of participants who don’t wear a helmet in sporting activity. We thus wanted to estimate the impact of helmet use in sport injuries on the risk of hospitalization. Methods: Study participants were patients of all age presenting at the emergency department of the Hôpital de l’Enfant-Jésus du CHU de Québec for a trauma that occurred in a sport in which it’s possible to wear a helmet. Data were collected from information provided by the patient and from the Canadian Hospitals Injury Reporting and Prevention Program’ (CHIRPP) database. Descriptive and multivariate analyses have been carried out using these data. We performed binomial logistic regression analyzes to estimate the risk adjusted for potentially confounding variables: age, sex and number of injuries. Results: Most patients included in the study (n=169) were males (69.8%) aged between 10 and 30 years (50.3%). Sports most frequently involved in trauma were cycling (31.4%), downhill skiing (18.3%), snowboarding (14.8%), hockey (11.8%), and skateboarding (5.9%). Overall, 70.4% of patients were wearing a helmet at the time of injury. Helmet use in sports was associated with a reduction of 52% of the risk of hospitalization (RR: 0.48 [CI: 95%: 0.25-0.93]) after a trauma. In addition, patients not wearing a helmet had higher proportions of intracranial hemorrhage (10% vs. 1.7%) and skull fracture (8% vs 2.5%). Conclusion: Results suggest that helmet use decreases the risk of hospitalization for trauma sustained in sports in which it’s possible to wear a helmet.

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Tea Cup in the brain, a rare case of penetrating brain injury in pediatric patient

Romanian Neurosurgery ◽

10.1515/romneu-2016-0019 ◽

2016 ◽

Vol 30 (1) ◽

pp. 118-121

Author(s):

Arvind Sharma ◽

S.K. Jain ◽

Sanjeev Chopra

Keyword(s):

Developing Countries ◽

World Literature ◽

Rare Case ◽

Pediatric Patients ◽

Similar Case ◽

Head Injuries ◽

Common Mechanism ◽

Penetrating Injuries ◽

The World ◽

The Brain

Abstract Head injuries are very common in children. All over the world, the most common mechanism is fall. These injuries are more prevalent in developing countries due to lack of education, poverty, lack of standard and scientific ways to child upbringing. Penetrating injuries in pediatric patients is extremely uncommon and usually occur due to sharp objects like knife, screw driver, drills, nails. We are reporting a rare case of a child with penetrating head injury due to tea cup, very commonly used crockery in every house hold. To the best of our knowledge, no similar case has ever been reported in world literature. Our case also emphasized the need for educating people about child care.

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Helmet Use and Risk of Head Injuries in Alpine Skiers and Snowboarders

Yearbook of Sports Medicine ◽

10.1016/s0162-0908(08)70249-6 ◽

2006 ◽

Vol 2006 ◽

pp. 3

Author(s):

R.C. Cantu

Keyword(s):

Head Injuries ◽

Helmet Use ◽

Alpine Skiers

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COVID-19 Changed the Injury Patterns of Hospitalized Patients

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000285 ◽

2021 ◽

Vol 36 (3) ◽

pp. 251-259

Author(s):

Michael Rozenfeld ◽

Kobi Peleg ◽

Adi Givon ◽

Miklosh Bala ◽

Gad Shaked ◽

...

Keyword(s):

Trauma Registry ◽

Road Traffic ◽

Disease Outbreaks ◽

Injury Patterns ◽

Severe Injuries ◽

Study Objective ◽

Major Health ◽

National Trauma ◽

Number Of Patients ◽

Injured Patients

AbstractIntroduction:Injury patterns are closely related to changes in behavior. Pandemics and measures undertaken against them may cause changes in behavior; therefore, changes in injury patterns during the coronavirus disease 2019 (COVID-19) outbreak can be expected when compared to the parallel period in previous years.Study Objective:The aim of this study was to compare injury-related hospitalization patterns during the overall national lockdown period with parallel periods of previous years.Methods:A retrospective study was completed of all patients hospitalized from March 15 through April 30, for years 2016-2020. Data were obtained from 21 hospitals included in the national trauma registry during the study years. Clinical, demographic, and circumstantial parameters were compared amongst the years of the study.Results:The overall volume of injured patients significantly decreased during the lockdown period of the COVID-19 outbreak, with the greatest decrease registered for road traffic collisions (RTCs). Patients’ sex and ethnic compositions did not change, but a smaller proportion of children were hospitalized during the outbreak. Many more injuries were sustained at home during the outbreak, with proportions of injuries in all other localities significantly decreased. Injuries sustained during the COVID-19 outbreak were more severe, specifically due to an increase in severe injuries in RTCs and falls. The proportion of intensive care unit (ICU) hospitalizations did not change, however more surgeries were performed; patients stayed less days in hospital.Conclusions:The lockdown period of the COVID-19 outbreak led to a significant decrease in number of patients hospitalized due to trauma as compared to parallel periods of previous years. Nevertheless, trauma remains a major health care concern even during periods of high-impact disease outbreaks, in particular due to increased proportion of severe injuries and surgeries.

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Benign Paroxysmal Positional Vertigo in Children and Adolescents With Concussion

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120970515 ◽

2021 ◽

pp. 194173812097051

Author(s):

Alicia Wang ◽

Guangwei Zhou ◽

Kosuke Kawai ◽

Michael O’Brien ◽

A. Eliot Shearer ◽

...

Keyword(s):

Benign Paroxysmal Positional Vertigo ◽

Pediatric Patients ◽

Head Injuries ◽

Vestibular Disorder ◽

Symptom Scale ◽

Level Of Evidence ◽

Pediatric Concussion ◽

Positional Vertigo ◽

Level 3 ◽

Paroxysmal Positional Vertigo

Background: Dizziness after concussion is primarily attributed to effects on the brain, but traumatic inner ear disorders can also contribute. Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that can result from minor head trauma and can be easily diagnosed and rapidly treated in an office setting. The role of BPPV in pediatric postconcussive dizziness has not been well-studied. Purpose: To evaluate the prevalence and clinical features of BPPV in a group of pediatric patients with concussion and prolonged dizziness after concussion. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Retrospective review of 102 patients seen within the past 3 years in a pediatric multidisciplinary concussion clinic for evaluation of postconcussive dizziness. Results: BPPV was diagnosed in 29.4% (30/102) of patients with postconcussion syndrome and dizziness. All patients with BPPV were treated with repositioning maneuvers, except for 5 patients who had spontaneous resolution of symptoms. Patients were evaluated at an average of 18.8 weeks (SD, 16.4 weeks) after the injury. BPPV was diagnosed at similar rates regardless of gender or age group (children vs adolescents). The mean Post-Concussion Symptom Scale (PCSS) score did not differ significantly between patients with (58.3 [SD, 22.5]) or without BPPV (55.8 [SD, 29.4]; P = 0.39). The PCSS “balance problems or dizziness” subscore also did not differ between patients with (3.3 [SD, 1.7]) or without BPPV (2.8 [SD, 1.6]; P = 0.13). Conclusion: BPPV is fairly common in pediatric concussion, occurring in one-third of the patients studied. BPPV is often not diagnosed and treated until many weeks after the injury. Increased awareness of the evaluation and management of BPPV among pediatric concussion providers may help expedite resolution of dizziness and hasten overall recovery in affected patients. Clinical Relevance: BPPV is a treatable cause of dizziness caused by minor head injuries and is more common than previously reported in pediatric patients with concussion. Improved awareness of BPPV by concussion providers may expedite recovery.

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