Helmet use: a survey of 4 common childhood leisure activities

Pediatric injury due to wheeled recreational devices: a single-institution retrospective study

BACKGROUND

Injuries are the number one cause of death in children and cause significant morbidity. Common scenarios for injury include wheeled recreational devices (WRDs) that allow children to be mobile and independent (example ATV-all terrain vehicles, dirt bikes, bicycles, skateboards, and scooters). We present a case series review of these external causes of injury. This study aims to evaluate epidemiologic trends in WRD injuries and patterns in usage of protective gear.

RESULTS

A total of 263 patients were identified as meeting criteria for inclusion with the following causes of injuries-103 bicycle, 73 ATV, 27 dirt bike, 14 skateboard, 13 motorcycle, 7 go carts, 3 hover board, 3 roller skates, 1 dune buggy, 1 motor scooter, 1 rip stick, and 1 tractor toy. Ages of patients ranged from 2 to 18 years of age with the greatest range being noted for bicycles (2-17 years) and motorcycles (3-18 years). The mean age was higher for motorcycle and skateboard (12.9 and 11.6, respectively) and lowest for scooter and bicycle (8.3 and 9.2, respectively). The majority of [overall study (97%) and for each mode of transportation] patients were Caucasian, which is in contrast to our overall ED population, which is only 42% Caucasian. The majority of patients were male [190 (72%)]. Over half of the overall patients, 159 of the 263 (60%), were not wearing a helmet (with only 10 charts having no documentation of helmet use). In regard to ATV riders specifically, 58% were not wearing helmets at the time of injury, with an additional 5 patients who reported their helmet came off. The lowest percentage of riders reporting appropriate helmet use was skateboarders with only 21% wearing helmets, and the highest percentage was dirt bike riders with 74% reporting helmet use.

CONCLUSION

Common scenarios for injury include WRDs that allow children to be mobile and independent. Most of these injuries were found in Caucasian males between the ages of 9-12 with low rates of helmet use. This study adds to the literature with a description of the breadth of products children use and are injured while using.

Managing head injury risks in competitive skateboarding: what do we know?

OBJECTIVES

The broad objective of this paper is to inform policy, practice and research regarding the management of head injury risks in competitive skateboarding. The main motivation for the current study was the question of mandating helmet use in competitive skateboarding. The specific aims are to present current knowledge on (A) head injury risks in skateboarding, (B) preliminary biomechanical data on falls and head injury risks in a selection of competitive skateboarding events similar to those planned for the Summer Olympics, (C) standards for skateboard-styled helmets and (D) impact performance of helmets commonly used in skateboarding.

METHODS

A narrative review of the published literature on head injuries in skateboarding was conducted. Videos of skateboarding competitions from Vans Park Professional League, Street League Skateboarding and Dew Tour were reviewed to describe crashes and falls. Standards databases including the International Organization for Standardization (ISO), British Standards Institution (BSI), Snell, United States Consumer Product Safety Commission (CPSC) and American Society for Testing and Materials (ASTM) were searched for skateboarding-styled helmet standards. A sample of helmets considered suitable for skateboarding was tested in standard impact tests.

RESULTS

The majority of previous literature focused on the paediatric population in a recreational setting with little data from competitive skateboarding. Head injuries comprised up to 75% of all injuries and helmet use was less than 35%. Video analysis identified high rates of falls and crashes during competitive skateboarding, but also a capacity for the athletes to control falls and limit head impacts. Less than 5% of competitive skateboarders wore helmets. In addition to dedicated national skateboard helmet standards, there are several national standards for skateboard-styled helmets. All helmets, with the exception of one uncertified helmet, had similar impact attenuation performance; that is, at 0.8 m drop height, 114-148 g; at 1.5 m, 173-220 g; and at 2.0 m, 219-259 g. Impact performance in the second impact was degraded in all helmets tested.

CONCLUSION

Helmets styled for skateboarding are available 'off the shelf' that will offer protection to the head against skull fractures and intracranial injuries in competitive skateboarding. There is an urgent need to commence a programme of research and development to understanding and control head injury risks.

Pediatric and adolescent injury in skateboarding

Skateboarding has become an international action sport attractive to young people. For this reason, skateboarding has been promoted by some researchers as important for encouraging young people to become more physically active. However, skateboarding is also considered to be inherently dangerous by the medical and broader community and as a result skateboarding is banned in many places. This paper reviews scientific literature on the features, outcomes and risk factors related to skateboarding injuries. Findings suggest that while skateboarding injuries can be severe, skateboarding is not as dangerous as it might appear if appropriate risk management steps are taken. Skateboarding should be encouraged as a worthy physical activity and local communities should consider providing specialised, supervised spaces for young people to practice this sport.

Helmet use in bicycles and non-motorised wheeled recreational vehicles in children

AIM

Injuries involving non-motorised wheeled recreational vehicles (NMWRV) and bicycles are a common cause for hospitalisation in children. Studies show that helmet use whilst bicycle riding can decrease mortality and morbidity due to head injury. However, there remains an important proportion of children who are non-helmet users (NHU). This study aims to investigate helmet use and attitudes and injury patterns in children presenting with trauma after riding bicycles and other NMWRVs.

METHODS

A prospective cohort study was undertaken over 8 months of children aged 0-16 years, who presented with injury secondary to bicycle or NMWRV to the emergency department of two tertiary paediatric centres. Demographics, incident, injury severity and attitudes towards helmet use were compared between helmet users and NHU.

RESULTS

A total of 342 children were included - 41% (n = 139) scooter riders, 39% (n = 133) bicyclists, 18% (n = 61) skateboarders and 2% (n = 9) in-line skaters. Of those interviewed (n = 161), 58% (n = 93) wore a helmet, with children riding bicycles significantly more likely to be helmeted than NMWRV (75 vs. 48%, P = 0.01). NHU were more likely to be admitted to hospital (P = 0.05) and to sustain a major head injury (P = 0.009). The main influence on helmet use was parental rules. The biggest factor influencing non-helmet use was perceived low levels of danger.

CONCLUSIONS

Despite legislation mandating this, helmet use is not universal in cyclists, particularly younger riders. Even fewer NMWRV riders use them. To promote helmet use, a multifaceted approach aimed at altering community norms and individual behaviours and attitudes is required.

Helmet use in preventing acute concussive symptoms in recreational vehicle related head trauma

OBJECTIVES

Helmets use has proved effective in reducing head trauma (HT) severity in children riding non-motorised recreational vehicles. Scant data are available on their role in reducing concussive symptoms in children with HT while riding non-motorised recreational vehicles such as bicycles, push scooters and skateboards (BSS). We aimed to investigate whether helmet use is associated with a reduction in acute concussive symptoms in children with BSS-related-HT.

METHODS

Prospective study of children <18 years who presented with a BSS related-HT between April 2011 and January 2014 at a tertiary Paediatric Emergency Department (ED).

RESULTS

We included 190 patients. Median age 9.4 years (IQR 4.8-13.8). 66% were riding a bicycle, 23% a push scooter, and 11% a skateboard. 62% were wearing a helmet and 62% had at least one concussive symptom. Multivariate logistic regression analysis adjusting for age, gender, and type of vehicle showed that patients without a helmet presented more likely with headache (adjusted odds-ratio (aOR) 2.54, 95% CI 1.27-5.06), vomiting (aOR 2.16, 95% CI 1.00-4.66), abnormal behaviour (aOR 2.34, 95% CI 1.08-5.06), or the presence of at least one concussive symptom (aOR 2.39, 95% CI 1.20-4.80).

CONCLUSIONS

In children presenting to the ED following a wheeled BSS-related HT helmet use was associated with less acute concussive symptoms.

ABBREVIATIONS

aOR, adjusted odds ratio; APHIRST, Australasian Paediatric Head Injury Rules Study; BSS, bicycles, push scooters and skateboards; CI, confidence interval; CT, computed tomography; ED, emergency department; HT, head trauma; IQR, interquartile range; OR, odds ratio; RCH, Royal Children's Hospital; RV, recreational vehicle.

Paediatric recreational vehicle-related head injuries presenting to the emergency department of a major paediatric trauma centre in Australia: Is there room for improvement?

OBJECTIVE

This study examines clinical characteristics and helmet use of children presenting to the ED with a recreational vehicle (RV)-related head injury (HI).

METHODS

Observational retrospective study of children <18 years presenting with a RV-related HI to the ED of a state-wide paediatric trauma centre in Australia between April 2011 and January 2014.

RESULTS

In the 647 presentations identified, corresponding to 7.5% (95% CI 7.0-8.1) of all HI presentations, RVs involved were bicycles (36.3%), push scooters (18.5%), motorcycles (18.4%), horses (11.7%), skateboards (11.6%), quadbikes (2.8%) and go-karts (0.6%). Recorded helmet use was the highest in motorcycle, horse and bicycle riders (83.2%, 82.9% and 65.1%, respectively), and the lowest for push scooter (25.8%) and skateboard riders (17.3%). Overall 23% underwent a CT scan, 8.8% had intracranial injuries on CT, 30.6% were admitted, and 2.2% underwent neurosurgery. Push scooter-related HIs were the least severe. Age (in years), riding a motorised vehicle and not wearing a helmet were independently associated with intracranial injuries on CT on multiple logistic regression (OR 1.1, 95% CI 1.0-1.2; OR 2.4, 95% CI 1.3-4.6 and OR 6.0, 95% CI 3.2-11.2, respectively).

CONCLUSIONS

RV-related HIs accounted for a non-negligible proportion of paediatric HIs presenting to the ED and for significant morbidity and use of hospital resources. Interventions such as introduction of mandatory helmet use for off-road motorised vehicle riding and skateboard riding in children, enhanced injury prevention campaigns, and strict adult supervision during motorised vehicle riding may reduce the morbidity and health care costs associated with paediatric RV-related HIs.

Trauma in children due to wheeled recreational devices

AIM

The aim of this study was to describe trauma in children secondary to the use of wheeled recreational devices (WRDs).

METHODS

This study retrospectively described trauma secondary to use of WRDs sustained by children 16 years or younger over a period of 12 months at two tertiary paediatric hospitals in Brisbane, Queensland. Data were analysed from the Paediatric Trauma Registry at these two facilities. Data were also retrieved from The Commission for Children and Young People and Child Guardian to provide information regarding deaths in Queensland from the use of WRDs for the period January 2004 to September 2013. Outcome measures included age, gender, types of injuries, Injury Severity Scores, admission to Intensive Care, and length of hospital stay for all hospital admissions greater than 24 h.

RESULTS

A total number of 45 children were admitted with trauma relating to WRDs during the 12 months, representing 5.3% of all trauma admissions of greater than 24 h during this time period. Of these, 34 were male with a median age of 11.0 years (IQR = 9-13). Limbs accounted for the majority (54.5%) of injuries, with other common injuries being spine/cranial fractures (14.5%), lacerations (12.7%), internal organ injuries (9.1%), and intracranial bleeds (9.1%). There were six admissions to the Paediatric Intensive Care Unit and one death.

CONCLUSIONS

WRDs contribute significantly to injuries sustained by children. A large proportion of these injuries may be preventable, suggesting that mandating the use of protective equipment in Queensland may be of great benefit.

Skateboarding injuries: An updated review

This in-depth literature review shows that skateboarding has experienced intermittent periods of popularity, with an estimated 6-15 million skateboarders in the US currently involved at all levels of recreational play and competition. Head trauma accounts for ∼ 3.5-13.1% of all skateboarding injuries. Injury occurs most often to the upper extremity (55-63%), whereas thoracoabdominal and spine injuries account for 1.5-2.9% of all trauma and lower extremity injuries occur 17-26% of the time. Few fatal injuries (1.1%) have been reported, oftentimes resulting from traumatic head injuries incurred from collisions with motor vehicles. Although skateparks may be perceived as a safer alternative to street skateboarding, injuries still occur when the skateboarder collides with an object or falls from the board. Factors leading to trauma include fatigue and overuse, age and skill level, inadequate medical care, environmental conditions, equipment concerns, lack of fitness and training, and the detrimental behavior of the competitor. Although not all skateboarding injuries are avoidable, numerous opportunities exist to instill safety involving education, instruction, and supervision and the proper use of protective gear to reduce predisposition to trauma. Future research recommendations include a more standardized data collection system, as well as an increased focus on kinetic analysis of the sport. Legislation involving helmet laws and the increased investment in a safer environment for the skateboarder may also assist in reducing injury in this sport.

Parental attitudes and behaviours concerning helmet use in childhood activities: rural focus group interviews

Previous research demonstrates the importance of parents in ensuring that their children practice proper helmet use. Parents encourage helmet use by setting an example when they wear helmets, as well as establishing rules that the children are expected to follow. Research in the area of helmet use predominantly focuses on bicycle helmets, but there are a number of childhood activities for which a helmet is required. The purpose of this research was to examine rural parents' attitudes toward helmet use and investigate when, and for what activities, they require their children to wear helmets. Rural parents were selected as there is evidence that helmet use is less frequent among children in rural settings. Expanding on the literature, an exploratory qualitative methodology was used to gather data. Eight focus groups were held in rural Saskatchewan to explore what influences parents' decisions to wear helmets themselves, and when and why they enforce helmet rules with their children. A thematic analysis was subsequently conducted on the data. The results suggest that parents recognize that their rules and their example influence their children. Participants mentioned being consistent, establishing rules and using positive reinforcement as ways to encourage helmet use among their children. Helmet costs and lack of awareness of helmet necessity in particular activities were barriers to helmet use. Specific barriers to helmet use in rural areas included the difficulty in finding proper helmets, the lack of exposure to helmet promotion initiatives, and the perception that activities in rural areas were safer than in the city. Parents tended to make their own helmet decisions based on personal experience and threat perception of the activity. This reasoning was the basis for when and why they established helmet rules. It is important to raise awareness of the risks of head injury and the benefits of wearing a helmet in other activities besides bicycling. More effort is needed to reach rural populations with information and opportunities to access appropriate and affordable helmets. Legislating mandatory helmet use could be useful in promoting helmet use in adults and children. Alternatively, the use of incentives for children wearing helmets could also serve as a reinforcement mechanism to increase use. A synthesis of the data gathered suggests that a theoretical approach based on increasing predisposing, enabling and reinforcing factors for helmet use may be useful in future interventions.

Epidemiology of nonfatal bicycle injuries presenting to United States emergency departments, 2001-2008

OBJECTIVES

The purpose of this study was to describe the epidemiology of bicycle-related injuries presenting to United States emergency departments (EDs).

METHODS

The National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) database was used to derive national, weighted estimates of nonfatal ED visits for bicycle-related injuries by patient age, sex, diagnosis, injured body part, locale of incident, traffic-relatedness of incident, and month of incident.

RESULTS

Males accounted for 73% of all bicycle-related injury ED visits. Patients aged 10 to 14 years represented the 5-year age interval with the highest rate of bicycle injury visits (488 per 10,000). Fifty-six percent of ED visits for bicycle-related injuries came from cyclists who were riding on the street, with increased street ridership in those who were older than 15 years, and 99.7% of all patient injuries occurring on the street (as opposed to other locations) were related to motor vehicle collisions (MVCs). The head and face were the most injured body parts in the overall population. In addition, the largest proportion of head injuries, relative to total injuries in the age group, occurred in the very young (0 to 4 years) and elderly (65+ years) populations. The leading rider injury diagnoses were contusion, abrasions, and hematomas. The incidence of bicycle-related injuries peaked in the month of July.

CONCLUSIONS

The study identified the characteristics of bicycle-related injuries across various age groups of riders. This information will aid in developing more effective age-appropriate injury prevention strategies. The frequency of MVC-related injuries deserves attention and suggests the need to examine strategies for limiting interactions between moving vehicles and bicyclists.

Health-risk behaviors among a sample of US pre-adolescents: types, frequency, and predictive factors

BACKGROUND

Children as young as 10 years old report curiosity and participation in health-risk behaviors, yet most studies focus upon adolescent samples.

OBJECTIVE

To document the types and frequencies of health risk behavior among pre-adolescents and to examine the child, family, and environment factors that predict them.

METHOD

A sample of 297 pre-adolescents (mean age=10.5, SD=0.6) from two Midwestern US cities and their parents (child-parent dyads) provided data about demographic characteristics, health risk behavior participation, child self-esteem, child pubertal development, child and adult perception of their neighborhood, and parent monitoring. Their participation was at intake to a 5-year clustered randomized controlled trial.

RESULTS

Pre-adolescents participated in an average of 3.7 health-risk behaviors (SD=2.0), primarily those that lead to unintentional (helmet and seatbelt use) and intentional (feeling unsafe, having something stolen, and physical fighting) injury. Factors predictive of unintentional injury risk behavior were self-esteem, pubertal development, parent monitoring, and parent perception of the neighborhood environment. Boys were 1.8 times less likely than girls to use helmets and seatbelts. Pre-adolescents whose parents were not partnered were 2.8 times more likely than pre-adolescents whose parents were partnered to report intentional risk behavior.

RECOMMENDATIONS

These data demonstrate trends that cannot be ignored. We recommend, focused specifically upon boys and non-partnered families that (a) developmentally appropriate, appealing prevention messages be developed and delivered for parents and pre-adolescents and community interventions targeting both parent and pre-adolescent together be provided to help them establish and monitor behavioral expectations and (b) organized nursing endorse policy in the US and globally that assures adequate family environments for children.

Dental injuries with kick-scooters in 6- to 12-year-old children

BACKGROUND/AIM

The objective of this study was to investigate the occurrence of injuries, especially dental trauma, in scooter-related accidents. In addition, children's habits of wearing protective gear were assessed.

MATERIAL AND METHODS

The study was conducted in primary schools in three neighboring towns near Basel, Switzerland, using anonymous multiple-choice questionnaires completed by parents of schoolchildren.

RESULTS

A total of 953 scooter riders were included in the study. The average age was 9.1 years (range 6-12 years). Of riders, 58.3% wore no protective gear, 39.6% wore a helmet, and 2% wore other protective equipment. Twenty-nine percentage of the children have sustained an accident while riding the scooter, of those injuries, 41.4% affected the lower extremities, 37.0% the upper extremities, 21.6% the head, and 11.2% dental injuries; 20.3% of accidents required medical treatment.

CONCLUSIONS

Parents, teachers, and doctors should be aware of the dangers involved in scooter riding. Educational measures, especially concerning use of protective gear, should be implemented to reduce the number and severity of injuries caused by this popular recreational activity.

Injuries among wheeled shoe users: A comparison with other nonmotorized wheeled activities

BACKGROUND AND OBJECTIVE

Nonmotorized wheeled activities are popular among children. However, these activities can result in significant injury if effective injury prevention measures are not taken. Recently, nonmotorized wheeled shoes have become increasingly popular among children. Preliminary research shows that these activities also result in significant injury. The purpose of the present study was to compare the injury profiles of nonmotorized wheeled activities among Canadian children presenting to the emergency department.

METHODS

A two-year retrospective study was conducted using data from the Canadian Hospitals Injury Reporting and Prevention Program database, specific to the Alberta Children's Hospital, Calgary, Alberta. Data were analyzed using cross tabulations of the type and nature of injury, helmet use, age and sex, with type of nonmotorized wheeled activity.

RESULTS

The most common mechanism of injury for a nonmotorized wheeled activity was bicycling (66.9%), while wheeled shoe use produced the fewest injuries (2.7%). The upper extremity was the most frequently injured body region in all groups, comprising more than 75% of the injuries in wheeled shoe users and approximately 50% of the injuries in participants of other nonmotorized wheeled activities. Forearm fractures were the most common type of injury. Wheeled shoe users had the greatest proportion of forearm fractures. Helmet use was most prevalent in bicyclists (84.6%) and least prevalent in wheeled shoe users (4.7%).

DISCUSSION

Nonmotorized wheeled activities can result in significant morbidity. Results from the present study suggest that wheeled shoe and push scooter activities can result in upper extremity injuries. Protective equipment, particularly wrist guards and helmets, should be used when participating in these activities.

Barriers to bicycle helmet use among Dutch paediatricians

BACKGROUND

In the Netherlands, bicycle helmet wearing rates are very low and perceived social barriers to helmet use are important. We aimed to determine why Dutch paediatricians do or do not wear helmets while bicycling and whether their personal behaviour is influencing their position about the promotion of helmet use.

METHODS

Attendants to the annual meeting of the Dutch Paediatric Society (7-9 November 2006) were surveyed about bicycle riding frequency, helmet use, reasons for not wearing a helmet, helmet use among their own children and personal position about the promotion and legislation of bicycle helmet use.

RESULTS

Of the 1110 paediatricians who are active in the Netherlands, 258 answered the survey. Ninety-six per cent of the respondents ride a bicycle (68% more than once a week). Bicycle was used as a mean of transport (32%), as a recreation/sport (11%) or with both purposes (57%). When cycling for transportation, 94% never wear a helmet and 2% always wear it. When cycling for recreation, 70% never wear a helmet and 18% always wear it. The most common reasons given for not wearing a helmet were: 'I never thought about that' (43%), 'Poor appearance' (31%), 'Nobody uses it in the Netherlands' (27%) and 'Uncomfortable' (25%). A majority (91%) of the respondents agreed that bicycle helmets are effective in reducing the rate of head injury to bicyclists and that they should be advised to children (82%) and adolescents (54%).

CONCLUSIONS

Our results indicate that among Dutch paediatricians, cycling rate is high and helmet wearing rate is very low and that they experience numerous personal barriers to bicycle helmet use. This might explain why bicycle helmet promotion campaigns are scarcely supported by Dutch paediatricians.

Use of protective equipment by adolescents in inline skating, skateboarding, and snowboarding

OBJECTIVES

Determine the frequency of personal protective equipment (PPE) use in adolescent inline skaters, skateboarders, and snowboarders; explore factors influencing PPE use; identify factors that would influence use; and examine the association of high-risk behaviors and PPE use.

DESIGN

Cross-sectional survey.

SETTING

Central/southeast Wisconsin.

PARTICIPANTS

Participants 13-18 years-old.

INTERVENTIONS

None. Independent variables = age, gender, sport.

MAIN OUTCOME MEASUREMENTS

None. Dependent variables = PPE use, factors influencing use, and frequency of other high-risk behaviors.

RESULTS

The mean age of 333 participiants was 14.9 years. Adolescents wore considerably less PPE than recommended. Inline skaters wore the most; snowboarders the least. The most common reasons adolescents wore PPE were parents, peers, and rule/requirement. Younger adolescents cited parents more often than older adolescents as a factor for PPE use. Discomfort and lack of perceived need were the most common reasons for nonuse. Sustaining/witnessing an accident was the most common reason that would convince adolescents to wear PPE. Almost half of adolescents reported nothing would convince them to wear PPE. Younger adolescents wore more PPE than older adolescents. An association was seen between PPE use in all sports and bicycle helmets. An inverse relationship was found for tobacco and helmet use among skaters, as well as alcohol and helmet use in skateboarders.

CONCLUSIONS

Adolescents underuse PPE. PPE reinforcement by parents/peers, encouraging bike helmets, manufacturing more comfortable gear, educating adolescents, and instituting PPE requirements in public areas may increase compliance. This could lead to decreased injuries. Physicians should discuss PPE with their patients/families. There may be an association between PPE use in extreme sports and decreased high-risk health behaviors.

Demographic, socioeconomic, and attitudinal associations with children's cycle-helmet use in the absence of legislation

The association of demographic, socioeconomic, and attitudinal factors with children's cycle-helmet use was investigated using self-reported data from 9775 children aged 8-12 in England, where there are currently no legal requirements that cyclists (of any age) wear helmets. The results suggest that demographic factors, socioeconomic status, and attitudes influence whether children wear bicycle helmets but that attitudinal factors are most important.

Using PEACE to target helmet legislation involving nonmotorized wheeled sports in Canada

Current Canadian helmet bylaws focus mainly on bicycle helmet use. In this way, law makers are ignoring head injuries associated with other wheeled sports. Cycling, in-line skating, skateboarding, and scootering can all cause serious injury to participants if proper protective gear is not worn. Legislation has been shown to work in promoting helmet use and decreasing injuries. Nurses, using theory and research to guide practice, can be key players in advocating for healthy public policies and amendments to provincial legislation. Nurses have the opportunity to play an active leadership role that can be guided by PEACE, a philosophy that encompasses praxis, empowerment, awareness, cooperation, and evolvement.

Injuries caused by small wheel devices

We wanted to look for characteristics in injuries caused by rollerblades, skateboards and unmotorized kick scooters in order to recommend more targeted injury prevention. From September 2000 we did a two-year prospective registration of all small wheel device injuries attending Bergen Accident and Emergency Department's surgical unit. We registered a total of 273 injuries, and found an obvious difference in injury pattern between the three. Rollerbladers were more prone to fractures in their hands and arms, especially distal radial fractures, but also scaphoid fractures. This fracture is seldom in children, but not in child injuries caused by small wheel devices. Skateboarders were susceptible to ankle sprains and had the lowest injury severity among the three activities. Kick scooter users got mostly wound injuries, but had a high frequency of distal radial fractures with volar angulation, the Smith-type of fracture. There were also differences in user groups; 2/3 of injured rollerbladers were boys, mostly aged 12, a typical, injured skateboarder was a young male aged 13, and an injured kick scooter user was either an 11-year-old girl or boy. The use of effective wrist braces could have prevented most injuries in both rollerblading and kickscootering. Due to the high susceptibility of small wheel devices to uneven grounds resulting in falls, these activities should be prohibited in traffic and darkness. Preventive advice should preferably reach children aged 11 to 13.

All-terrain vehicle, trampoline and scooter injuries and their prevention in children

PURPOSE

Childhood injuries are the leading cause of death in children and result in significant healthcare utilization. Injuries specifically related to all terrain vehicles, trampolines and scooter usage can be devastating and are often preventable. Our understanding of how and why these injuries occur can aid in preventing morbidity and mortality.

RECENT FINDINGS

The popularity of all-terrain vehicles, nonmotorized scooters and trampolines has soared over recent years. This increased usage has led to a tremendous rise in injuries in children utilizing these recreational activities. Many of the injuries occur in younger children who may not possess the motor and cognitive skills necessary to safely engage in these activities. These activities lead to a number of head and extremity injuries, most of which can be attenuated by the use of protective gear such as helmets and protective padding.

SUMMARY

Understanding the nature of these injuries can lead to advocacy and hopefully legislation to prevent further injuries from occurring.

Bicycle helmets: overcoming barriers to use and increasing effectiveness

Bicycle riding is a popular recreational activity among children, yet it is not without potential severe consequences such as traumatic brain injury and death. Despite available information attesting to the benefits of the use of bicycle safety helmets, many children still do not wear them. There are several promoting and discouraging factors that influence wearing bicycle helmets. The purposes of this article are to (1) explore current research and discuss these promoting and obstructing factors to child bicycle helmet use and to (2) provide recommendations for improving the compliance of bicycle helmet use among children. Results of the literature review have significant implications for improving the safety of children.

A randomized controlled trial of sport helmet interventions in a pediatric emergency department

OBJECTIVE

To evaluate the effectiveness of 3 competing pediatric emergency department (ED) interventions aiming to increase sport helmet use in a state without helmet legislation.

METHODS

A randomized controlled clinical trial was conducted during the 7-month period between April and October 2003 at an urban pediatric ED in a state without current helmet legislation. We enrolled 200 assenting English-speaking children aged 5 to 16 years, admitted to the ED for treatment, and who did not currently own a helmet. Participants were randomized into 3 experimental arms. A control group received usual care, that is, verbal counseling regarding helmet use. Subjects in one treatment arm received a voucher to receive a free helmet that could be redeemed at a different location within the hospital. Subjects in a second treatment arm actually received a free helmet directly in the ED. The main outcome measure was reported helmet use at follow-up, assessed by telephone interviews of both the child and a parent.

RESULTS

Directly receiving a free helmet in the ED significantly increased reported helmet use relative to the control group; the odds that a parent reported helmet use were nearly 16 times higher (P < 0.01), and the odds that a child reported helmet use were nearly 10 times higher (P < 0.01). Receiving a free helmet also significantly increased reported helmet use when compared with the voucher intervention group. Reported use between the control group and the voucher intervention group was not significantly different.

CONCLUSIONS

Directly receiving a free helmet in the pediatric ED appears to be an effective hospital-based strategy to increase pediatric helmet use.

Scooter injuries in children in a midwestern metropolitan area

OBJECTIVES

We describe the use of nonmotorized scooters and utilization of safety equipment in a Midwestern suburb.

METHODS

Schoolchildren in second to sixth grades of a local school district completed a survey distributed by school nurses and teachers in spring 2001, including topics of scooter ownership, riding patterns, and utilization of safety gear.

RESULTS

Three thousand eighty-seven surveys were distributed, with a 74.4% response rate; 93.2% of children had ridden a scooter, and 71.4% owned a scooter. Children rode in many locations, with 93% riding on the sidewalk, 86.5% in the driveway, 35.5% in a parking lot, and 20% in the street. Of those owning scooters, 91.2% reported owning a helmet, 61.2% kneepads, 59.4% elbow pads, 43.8% wrist guards, and 35.5% riding gloves. Among those owning scooters, 54.6% reported wearing helmets while using their scooter, whereas 10% or less wore riding gloves, kneepads, elbow pads, or wrist guards. Helmet use decreased as grade increased; 50.7% of all second graders reported wearing helmets, compared with 22.7% of sixth graders (P < 0.001). Of those owning scooters, 32.2% reported being injured while riding their scooter. Of those injured, 54% reported wearing helmets.

CONCLUSIONS

Many children ride scooters and own safety gear; however, few children wear their safety equipment when riding their scooter. Children wear helmets less frequently as they age. Physicians should continue to educate patients and their parents as to potential injuries on scooters and encourage the use of safety gear, especially helmets, when riding scooters.

Incidence and description of scooter-related injuries among children

OBJECTIVE

To describe trends in scooter-related injuries among US youth and compare scooter injuries to those related to in-line skates and skateboards.

DESIGN

Retrospective review of data for children 1-19 years old from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for 1997-2002.

RESULTS

There were an estimated 190,878 scooter-related injuries (95% confidence interval: 145,984-235,773) among children treated in US emergency departments; 90% were in those 15 years old or younger. There was a marked increase in scooter-related injuries in 2000, injuries peaked in 2001, and declined. In 2002, the number of scooter-related injuries was similar to in-line skates and lower than skateboard-related injuries. Scooter- and in-line skate-associated injuries primarily involved children 5-12 years old: rates of scooter-related injuries were higher than rates of in-line skate-associated injuries among those 1-9 years old. Skateboard-related injuries more often involved teens. Forearm fractures accounted for 56% of fractures related to scooters (vs 74% in-line skates and 49% skateboards, chi-square, P < .01). Five percent of children injured using scooters had a closed head injury or skull fracture, similar to in-line skates and skateboards.

CONCLUSIONS

The annual number of injuries related to scooters, which peaked in 2001, is now similar to the number of injuries related to in-line skates. Injuries related to scooters primarily involve children 5-12 years old, and forearm fractures are common. These data suggest helmets should be used, and protective equipment should be developed to reduce forearm fractures.

Bicycle-related injuries to children and parental attitudes regarding bicycle safety

This study was designed to evaluate bicycle-related injuries among children requiring emergency treatment, assess the use of safety measures before and after injuries, and determine parental attitudes regarding bicycle safety. Six hundred fifty-eight children were treated for bicycle-related injuries during the study period. Follow-up contact with patients' families was made by telephone or mail within 2 months. Use of safety equipment other than brakes and reflectors occurred in less than 7% of cases. Less than 25% of children used hand signals. Sixty-eight percent of children reportedly owned a bicycle helmet before the injury, but only 26.1% "always" and 29.7% "never" wore a helmet. Given the high parental understanding of the importance of bicycle helmet use, more education and warnings alone are unlikely to increase helmet usage. Parents support a mandatory helmet use law, and therefore, local and state bicycle helmet ordinances and laws should be combined with education.