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

Incidence and distribution of injuries associated with e-scooter use: a radiological perspective

OBJECTIVES

To investigate electric scooter (e-scooter)-associated radiological injury incidence and distribution of injuries.

METHODS

Retrospective cross-sectional study of radiological examinations related to e-scooter injuries at a major trauma centre in a small university city. The hospital radiology information system was searched for terms related to e-scooters between January 1, 2015, and October 31, 2022. E-scooter use was confirmed by review of the patients' electronic medical records. Specific injuries were divided based on site of injury using the Injury Severity Scale categorized groups.

RESULTS

A total of 568 radiological studies related to e-scooter injuries were identified on 340 distinct patients (56% male, with an average age of 28 years). Peak incidence of e-scooter-related injuries was seen in the summer months, after a local scooter sharing system was introduced in October 2020. A total of 149 patients had radiologically diagnosed injuries, with extremity injuries being most frequent (80%). Facial (8%), head/neck (8%), and thorax/abdomen (4%) were less common. Radial head fractures were the most common injury (n = 27). Thirteen patients had multiple sites of injury, four of which had both upper limb and facial bone fractures described.

CONCLUSIONS

We report a significant increase in radiological investigations and injuries in the context of e-scooter injuries, particularly since the introduction of an e-scooter sharing scheme. This study informs radiologists on common locations of injuries when reporting studies of patients that have had e-scooter-related injuries.

ADVANCES IN KNOWLEDGE

This is the first UK-based study providing a comprehensive radiological perspective of the impact of e-scooter use and associated distribution of injuries, adding important data for many cities that are currently undertaking review of their e-scooter sharing schemes.

Analysis of dental traumatic patterns in standing electric scooter-related accidents

BACKGROUND

There have been several studies about the increasing accident risks and injuries of standing electric scooters, but there is no study about the dental traumatic injuries related with standing electric scooter so far.

OBJECTIVES

The purpose of this study is to report the overall dental traumatic patterns, and compare the patterns of standing electric scooter-related dental trauma with other traumatic causes. Also, considerations about minimizing the risks of electric scooter-related trauma will be discussed.

METHODS

Data on patients who visited Region Trauma Center of Wonju Severance Christian Hospital with dental emergency from January 2020 to December 2022 were collected.

RESULTS

The crown-root fracture and avulsion occurred significantly higher in electric scooter-related accidents than others. Furthermore, relatively minor dental injuries including concussion and subluxation showed higher percentage to be occurred as combined injuries in electric scooter-related accidents. The prevalence of traumatized posterior teeth was significantly higher in electric scooter-related trauma than others. Most of patients were teenagers and twenties. Also, the electric scooter-related accidents mostly occurred at evening and night. Furthermore, the number of patients wearing a helmet in electric scooter accidents was 1 out of 33.

CONCLUSION

The standing electric scooter-related dental trauma resulted in an increased prevalence of relatively severe dental trauma. Supplementation and reinforcement of the related policies as well as strict enforcement of the laws on electric scooter users will be needed to prevent severe dental and craniofacial trauma.

Consistently High Frequency of Scooter Injuries in Children-Retrospective Data Analysis in a Level I Trauma Centre

The aim of this retrospective study was to present an epidemiological overview of paediatric nonelectric-scooter-related injuries, focusing on changes in injury mechanism and frequency. A retrospective, descriptive data analysis at a Level I trauma centre, including patients aged from 0 to 18 years injured by riding nonelectric scooters, was performed. The observation period ranged from January 2015 to December 2022. The total study population consisted of 983 (mean age: 7.9 ± 4.0 years) children and adolescents, with most patients being male (800/983; 81.4%). The frequency of nonelectric scooter injuries was relatively consistent over the observation period. Patients sustained mostly minor injuries (lacerations, bone contusions, sprains) (527/983; 53.6%), followed by head injuries (238/983; 24.5%), limb fractures (166/983; 16.9%) and trunk injuries (52/983; 5.3%). However, a few patients sustained severe injuries, including skull fractures (7/238; 2.9%), intracranial haematoma (4/238; 1.7%) or lacerations of abdominal organs (4/52; 7.7%). This study presented a consistently high frequency of scooter injuries in children. Children under 15 years were the most affected by scooter-related injuries. Although most injuries were minor, serious injuries occurred that should not be underestimated. Hence, we emphasise the use of protection gear and recommend raising awareness among parents and children.

Non-motorised active mobility device use by children in Singapore: Injury patterns and risk factors for severe injury

INTRODUCTION

Wheeled recreational devices (WRDs) include tricycles, bicycles, scooters, inline skates, skateboards, longboards and waveboards, and can cause significant morbidity and mortality. This study aimed to describe the epidemiology and nature of injuries sustained by children from WRD use, and risk factors for severe injury.

METHOD

We described injuries relating to WRD use in children <18 years who presented to the emergency department of an Asian tertiary hospital between 2016 and 2020. Demographic data, site and nature of the injury, and historical trends were analysed. Risk factors for severe injury (defined as fractures or dislocations), Injury Severity Score ≥9, and injuries resulting in hospitalisation, surgery or death were evaluated.

RESULTS

A total of 5,002 patients with 5,507 WRD-related injuries were attended to over the 5-year study period. Median age was 4.7 years. Injuries related to bicycles (54.6%) and scooters (30.3%) were most frequent, followed by skateboards and waveboards (7.4%), inline skates (4.7%), and tricycles (3.0%). Injuries occurred most frequently in public spaces. Soft tissue injuries (49.3%) and fractures (18.7%) were the most common diagnoses. Upper limb (36.4%) and head and neck (29.0%) regions were the most common sites of injury. Among the patients, 1,910 (38%) had severe injuries with potential morbidity. On multivariate analysis, heavier children of the school-going age who use either scooters, skateboards or inline skates are more prone to severe injuries. Involvement in a vehicular collision was a negative predictor.

CONCLUSION

WRD use in children can result in severe injuries. Wrist and elbow guards, as well as helmets are recommended, along with adequate parental supervision.

Pediatric electric scooter injuries in the UK: Case series and review of literature

OBJECTIVE

Electric scooters are being used worldwide as a new means of transport and e-scooter shared schemes are currently being piloted in cities across the UK. At present, there is no data published looking at pediatric e-scooter injuries within the UK. We aim to assess if e-scooters pose a risk to children and the patterns and severity of orthopedic injuries related to their use.

METHODS

We performed a retrospective review of all orthopedic pediatric referrals relating to e-scooter use from January 1 to December 31, 2020 at two hospitals, including one pediatric Major Trauma Center in central London. Data including patient demographics, mechanism of injury, diagnosis, and treatment were collected.

RESULTS

Ten patients were identified in this series, of which 5 required orthopedic surgery. Four patients required admission to hospital from the emergency department. The median age was 15 (range 13-17 years) and all were male. All e-scooters were privately owned and all sustained a fall whilst riding the e-scooter. No patient was wearing a helmet. Six sustained lower limb injuries and four upper limb injuries. Two patients were trauma called and one patient sustained an open fracture. There were no mortalities at 30 days.

CONCLUSION

E-scooters pose a significant risk to children and can be associated with severe musculoskeletal injury. The risk they pose to the pediatric population should not be overlooked and these findings may inform public policy regarding the restriction of electric scooter use in children.

A Comparison of Motorized and Nonmotorized Scooter Injuries in Pediatric Patients Seen in US Emergency Departments

OBJECTIVES

We sought to characterize and compare trends in pediatric injuries sustained on motorized and nonmotorized scooters across the United States, to assess the use of safety equipment in children presenting with scooter-related injuries, and provide strategies for injury prevention.

METHODS

The National Electronic Injury Surveillance System was queried for motorized and nonmotorized scooter-related pediatric injuries from 2014 to 2018 in patients ages 6 to 12 years. Patient demographics, diagnosis, injury location, and narrative of the incident were collected. Bivariate and regression analyses were used to determine demographic and social associations of injury characteristics.

RESULTS

An estimated 146,000 (11,452 motorized and 134,548 nonmotorized) injuries occurred in children ages 6 to 12 years over the 5 years. Three of 4 injuries occurred in children younger than 10 years, and most injuries occurred in males (56%).From 2014 to 2018, the nationwide estimated incidence of motorized scooter injuries increased by 112.1%, while that of nonmotorized scooter injuries decreased by 40.3%.Upper extremity injuries were most common with nonmotorized scooters (44.4% of all injuries), while lower extremity injuries were most common with motorized scooters (39.5% of all injuries). Head and neck injuries accounted for 27.4% of nonmotorized scooter injuries and 23.4% of motorized scooter injuries. The number of concussions in motorized scooters increased from 0.4% in 2014 to 2.7% in 2018, while concussions in nonmotorized scooters decreased from 3.5% to 2.7%. Helmets were mentioned in the medical record in 6.6% of the cases. Of these, 60.5% reported no use of helmet at the time of injury.

CONCLUSIONS

From 2014 to 2018, the number of motorized scooter injuries increased by 112.1% in the pediatric population ages 6 to 12 years, whereas nonmotorized scooter injuries decreased by 40.3%. In more than 60% of the cases that mentioned a helmet, the child injured was recorded as not wearing a helmet. The rise in pediatric injuries associated with motorized scooters in contrast with the reduction of injuries associated with nonmotorized scooters highlights the need for novel public health policies and interventions promoting helmet use with motorized scooters in the pediatric population.

Analysis of road traffic accidents involving standing electric scooters reported in newspapers in Italy

Objective

As the use of electric scooters increased in Italy in the last years, we aimed to estimate the burden of accidents caused by this micro-mobility vehicle and identify characteristics, severity, and type of injuries.

Methods

We conducted a case series analysis of news reports about electric scooter crashes occurring in Italy from January 1, 2019 to September 30, 2020. Events were included when a road traffic accident involved an electric scooter and caused damages or injuries to the driver or others.

Results

We identified 96 road accidents involving electric scooters in Italy. The mean age of patients was 30 ± 16 years, and 79% (n = 71/90) were male. Of the 96 patients, only two (2%) were driving an electric scooter with a helmet, and three (3%) were driving while intoxicated. In 68% (n = 62/94) of cases, the incident was caused by a collision with another vehicle or a pedestrian, and 30% (n = 18/96) were transported with life-threatening injuries to the emergency department. In 15% (n = 14/96), the emergency medical service physician was dispatched to the scene. Head trauma was the most common injury (60%, n = 32/53). Patients who had life-threatening conditions were more likely to have head trauma than those who did not (82% [n = 9/11] vs. 55% [n = 23/42], P = 0.10). Polytrauma was significantly more common in patients with life-threatening conditions than in patients with no life-threatening conditions (36% [n = 4/11] vs. 5% [n = 2/42], P < 0.01). Fifteen percent of patients (n = 12/81) were admitted to the intensive care unit; only one death was reported.

Conclusion

Road traffic accidents involving electric scooters often result in serious injuries, including head trauma and polytrauma, necessitating the involvement of an emergency medical service physician and intensive care unit admission in a non-negligible percentage of instances.

The Governance of Helmet Safety to Prevent Traumatic Brain Injury in the Caribbean

BACKGROUND

The Caribbean is a unique region of islands and cays home to nearly 43 million people. A significant challenge facing this population is the burden of traumatic brain injury, which disproportionately affects younger individuals and carries a significant economic burden. A preventive measure to reduce this burden is consistent wearing of helmets. This study aims to assess TBI prevention through helmet safety in Caribbean nations in order to demonstrate the regional impact of public health solutions.

METHODS

We assess the member states of the Caribbean Community (CARICOM) and sought to evaluate CARICOM nations' TBI prevention through helmet safety with relation to public health, policy, laws, infrastructure, and regulations. We produced the Rolle Scoring System (RSS) to ascertain the influence of governance around helmet safety for TBI prevention. The RSS aims to provide a quantifiable method of how well a CARICOM nation is performing in efforts to reduce TBI. The RSS is broken down into 2 categories, with scores ranging from 1 (worst) to 5 (best). The range of possible scores a CARICOM nation could receive was 8 to 40.

RESULTS

Fourteen CARICOM nations were ultimately incorporated into our analysis. From the initial cohort, 3 were removed. These nations were Anguilla, Saint Kitts & Nevis, and Montserrat. We analyzed values derived from the RSS, finding a mean Rolle score of 22. We further subdivided the nations into low Rolle score (8-24) and high Rolle score (>24). Trinidad and Tobago had the highest Rolle score at 29. Haiti was found to have the lowest Rolle score at 8.

CONCLUSION

Several Caribbean nations have demonstrated leadership pertaining to TBI prevention through helmet safety. The regional momentum of helmet safety in the Caribbean can serve as a model for other geographical regional blocs that share interests and culture to consider comprehensive approaches to public health challenges.

A retrospective registry analysis of the transport-related health burden of wheeled recreational devices in Queensland, Australia

OBJECTIVE

Evaluate injury patterns from wheeled recreational devices (WRD) in the public space and explore risk factors for hospital admission.

METHOD

A cross-sectional analysis of WRD injury prevalence and risk factors for hospital admissions was conducted using data from the Queensland Injury Surveillance Unit (QISU) database for 2007 to 2017. Descriptive statistics and a log-binomial regression model were used to calculate adjusted relative risk for hospital admission.

RESULTS

Most WRD injury in the public space was related to stand-alone WRD injury events such as falls, with few reported WRD users being hit by vehicles from 2007 to 2017. Stand-alone WRD injury events had a higher independent risk of hospital admissions when injured in the head/neck/face (RR 2.08, 95%CI 1.6 to 2.8, p<0.001), and when the injury was a fracture (RR 2.57, 95%CI 2.1 to 3.3, p<0.001) or a brain injury (RR 3.19, 95%CI 2.5 to 4.1, p<0.001).

CONCLUSION

Head, brain and facial injuries and fractures are leading preventable factors for hospital admissions due to WRD injury. These types of injuries generate a preventable burden to the health system. Implications for public health: The results support the need to consider legislation regarding mandatory helmet use for non-motorised WRD when used on public roads and footpaths, while further research is conducted. This strategy could reduce the long-term health outcomes associated with head, face and brain injury in young commuters.

What to expect? Injury patterns of Electric-Scooter accidents over a period of one year - A prospective monocentric study at a Level 1 Trauma Center

Purpose

E-scooters are a new type of urban transportation utilized in Germany since June 2019, primarily in larger cities in the context of sharing offers. Such electrically operated standing scooters can be driven at a maximum speed of 20 km/h. A helmet is not mandatory. The aim of this prospective study is to document the injury patterns over the period of 1 year and compare our findings with already available data.

Methods

Over a period of 1 year (July 2019–July 2020), data on E-scooter-related accidents treated at a level 1 trauma center of a major German city were prospectively documented. Injury patterns were analyzed, and epidemiological data evaluated.

Results

Fifty-nine (35 female, 24 male) accidents were included in the observation period. Mean age of accident victims was 30.03 years (± 9.32). Alcohol influence at the time of accident was detected in 9 cases (15.25%). Many of the accident victims suffered multiple injuries. Most of the injuries were upper (50.84%) and lower extremity (47.45%) as well as craniofacial injuries (62.71%). A helmet was not worn in any of the cases.

Conclusion

In the year following their introduction, E-scooter-related accidents have led to an additional burden on the emergency capacities of the involved University Hospital, especially in the summer months of 2019. Protective equipment is de facto not worn. Injuries to the extremities, head, and face were most common. None of the accident victims died. This coincides with results from other major cities in national and international comparison. A more intensive education about injury consequences of unprotected E-scooter use and the discussion of a possible obligation to wear a helmet and further protection equipment for the extremities should take place.

Craniofacial and dental injuries associated with stand-up electric scooters

BACKGROUND/AIM

With the recent increased share of stand-up electric scooters (e-scooters), it is common to see people riding e-scooters on the roads in Korea. The aim of this study was to investigate traumatic injuries to the craniofacial region related to e-scooter accidents and to determine the role of dentists (especially oral and maxillofacial surgeons) in the evaluation of patients with trauma at the emergency department due to an e-scooter accident.

MATERIALS AND METHODS

This retrospective study investigated the medical records of patients who visited the Gangnam Severance Hospital Emergency Care Center for trauma related to e-scooter use from January 1, 2017 to March 31, 2020. Medical records were reviewed to determine the injuries sustained to the craniofacial region related to e-scooter use, including location of the injury (eg, cranium, craniofacial bone, teeth, soft tissue) and the type of trauma (eg, fracture, laceration, abrasion, contusion, concussion).

RESULT

A total of 256 patients' medical records were evaluated. Among them, 125 patients (48.8% of all patients) had sustained craniofacial trauma. Laceration (n = 56, 44.8%) was the most common type of craniofacial injury, followed by cerebral concussion (n = 49, 39.2%), dental injury (n = 27, 21.6%), and craniofacial bone fracture (n = 16, 12.8%).

CONCLUSION

Dentists should always consider the possibility of brain trauma and perform a complete craniofacial and oral examination when assessing patients after e-scooter accidents as outlined by the International Association of Dental Traumatology guidelines. Additionally, it is necessary to educate e-scooter riders about the importance of wearing protective devices, such as helmets, to reduce the risk of injuries to the craniofacial region.