Trauma in children due to wheeled recreational devices

Sports-related traumatic brain injuries and acute care costs in children

OBJECTIVE

To estimate traumatic brain injuries (TBIs) and acute care costs due to sports activities.

METHODS

A planned secondary analysis of 7799 children from 5 years old to <18 years old with head injuries enrolled in a prospective multicentre study between 2011 and 2014. Sports-related TBIs were identified by the epidemiology codes for activity, place and injury mechanism. The sports cohort was stratified into two age groups (younger: 5-11 and older: 12-17 years). Acute care costs from the publicly funded Australian health system perspective are presented in 2018 pound sterling (£).

RESULTS

There were 2903 children (37%) with sports-related TBIs. Mean age was 12.0 years (95% CI 11.9 to 12.1 years); 78% were male. Bicycle riding was associated with the most TBIs (14%), with mean per-patient costs of £802 (95% CI £644 to £960) and 17% of acute costs. The highest acute costs (21%) were from motorcycle-related TBIs (3.8% of injuries), with mean per-patient costs of £3795 (95% CI £1850 to £5739). For younger boys and girls, bicycle riding was associated with the highest TBIs and total costs; however, the mean per-patient costs were highest for motorcycle and horse riding, respectively. For older boys, rugby was associated with the most TBIs. However, motorcycle riding had the highest total and mean per-patient acute costs. For older girls, horse riding was associated with the most TBIs and highest total acute costs, and motorcycle riding was associated with the highest mean per-patient costs.

CONCLUSION

Injury prevention strategies should focus on age-related and sex-related sports activities to reduce the burden of TBIs in children.

TRIAL REGISTRATION NUMBER

ACTRN12614000463673.

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.

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.

Balance bike injuries: A retrospective chart review

AIM

To determine the characteristics of balance bike injuries.

METHODS

This study retrospectively identified patients injured while riding a balance bike and treated at one paediatric emergency department in urban Japan, from February 2015 to July 2020. Data extracted were patient age and sex, circumstances and location of the injury occurrence, helmet use, adult supervision, injury type and body site, treatment and emergency department disposition. Based on these data and the balance bike manual instructions, cases were classified as correct and incorrect balance bike use.

RESULTS

The study assessed 78 patients, age 2-6 years (median 3 years; 73% male). Of these 78 patients, 63 did not follow balance bike manual instructions (80.8%); 34 (43.6%) were injured while riding in prohibited places of use; 45 (57.7%) were injured in prohibited situations of use; and 37 (47.4%) were injured despite adult supervision. A total of 124 injuries were noted; the most common injured body site was the face (49 injuries, 39.5%), followed by the head (40 injuries, 32.3%). Most injuries were contusions and abrasions (65 injuries, 52.4%). More serious injuries were intensive care unit admission with intracerebral haemorrhage (1 patient) and lateral condyle fracture with surgical repair (1 patient).

CONCLUSIONS

Most of the 78 balance bike injuries (76 patients) were mild; 2 were more severe and required intensive care unit admission or operation. Parents must be aware of the rules and instructions for balance bike use and ensure that their children can use the balance bike correctly.

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.

Unpowered Scooter Injury in Children at a Korea Level I Trauma Center

Purpose: Unpowered scooters for recreation and transportation are popular among children. However, to date, there have been no studies on scooter-related injuries in Korea. This study aimed to assess the frequency and injury pattern with unpowered scooters and to propose prevention strategies. Methods: Medical records of children aged <16 years with unpowered scooter-related injuries who visited the emergency department (ED) from 2007 to 2018 were retrospectively reviewed. Results: A total of 109 children were included. The majority (78.9%) of injuries occurred during the last 3 years of the study. The mean age was 5.2 years, and 88% of children were <8 years of age. Most injuries (80.7%) occurred from a fall off a scooter. A total of 65.1% (n = 71) of injuries were to the head and face, followed by upper limb, lower limb, and torso injuries. Eight patients had an intracranial injury and skull fracture. Twenty children had limb fractures, and the most common site of fracture was the elbow. None of the patients wore any protective gear. Conclusions: Unpowered scooter-related injuries are on the increase and represent a serious problem among younger children. The head and face, where serious injuries can occur, are the most vulnerable. Public and parental awareness and education regarding protective gear and safety guidelines are essential to prevent injuries.

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.

Push scooter-related injuries in adults: an underestimated threat? Two decades analysed by an emergency department in the capital of Switzerland

Background

The number of people conducting cycling and skating sports in Switzerland is rising; likewise, we notice an increase in patients visiting our emergency department for adults due to push scooter accidents. In 2001, our emergency department published the first article worldwide on push scooter-related injuries. Nearly two decades later, we want to review the interim period-collect data, compare it with other studies and evaluate the current impact of push scooter accidents in our adult patient population.

Objective

To investigate data on the incidence, severity, treatment and approximate costs of push scooter-related injuries in adults who presented to our emergency department from 2000 to 2017.

Materials and methods

For this descriptive retrospective study, data were collected in the Department of Emergency Medicine at Inselspital (University Hospital), Berne, Switzerland, from October 2000 to September 2017. We used two clinical reporting systems during that period: Qualicare from 2000 to April 2012 and Ecare from May 2012 to 2017.

Results

165 patients were included, aged 16-80 years. The accidents were mainly classified as unspecified falls in 139 cases (84.24%). 21 patients (12.73%) were wearing a helmet at the time of the accident, while the remaining 144 (87.27%) were not. The most common injuries suffered were fractures in 73 patients (44.24%). 92 patients (55.76%) sustained an impact to the head. The most common treatment was surgery in the operating theatre (59 patients, 35.76%). The mean total cost per case was SFr7566.65 (emergency room visit, hospital stay and outpatient controls for the initial case).

Conclusion

The incidence of push scooter-related injuries in adults in our patient population is small but rising. Nevertheless, the resulting injuries are potentially life-threatening and can lead to persistent medical impairment.

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.

Injuries Associated with Hoverboard Use: A Case Series of Emergency Department Patients

Introduction

Since hoverboards became available in 2015, 2.5 million have been sold in the US. An increasing number of injuries related to their use have been reported, with limited data on associated injury patterns. We describe a case series of emergency department (ED) visits for hoverboard-related injuries.

Methods

We performed a retrospective chart review on patients presenting to 10 EDs in southeastern Virginia from December 24, 2015, through June 30, 2016. We used a free-text search feature of the electronic medical record to identify patients documented to have the word “hoverboard” in the record. We reported descriptive statistics for patient demographics, types of injuries, body injury location, documented helmet use, injury severity score (ISS), length of stay in the ED, and ED charges.

Results

We identified 83 patients in our study. The average age was 26 years old (18 months to 78 years). Of these patients, 53% were adults; the majority were female (61.4%) and African American (56.6%). The primary cause of injury was falls (91%), with an average ISS of 5.4 (0–10). The majority of injuries were contusions (37.3%) and fractures (36.1%). Pediatric patients tended to have more fractures than adults (46.2% vs 27.3%). Though 20% of patients had head injuries, only one patient reported using a helmet. The mean and median ED charges were $2,292.00 (SD $1,363.64) and $1,808.00, respectively. Head injuries resulted in a significantly higher cost when compared to other injuries; median cost was $2,846.00.

Conclusion

While the overall ISS was low, more pediatric patients suffered fractures compared to adults. Documented helmet use was low, yet 20% of our population had head injuries. Further investigation into proper protective gear and training is warranted.

Recreational Sporting Activity Vehicle-Related Deaths

Deaths occurring in the setting of nonprofessional, vehicle-related, recreational sporting activities occurring on land or in water during warm or winter months represent a diverse group of cases. These deaths tend to involve scenarios where the participants are purposefully attempting to enjoy themselves prior to experiencing sudden, catastrophic accidents resulting in lethal outcomes. Ultimately, many of the deaths are related to the high speed at which these vehicle-related activities normally occur. Three broad categories of factors may play contributory roles in death: human factors, vehicle factors, and environmental factors. A series of selected cases are presented, representing examples of varying activity types, involving motorized and nonmotorized vehicles, land and water activities, and warm weather and cold weather environments. For each case, the various human, vehicle and environmental factors believed to be contributory to the accident are considered, and strategies for prevention of these and similar deaths involving recreational sporting vehicles are presented.