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Masiakos PT, Jatana KR, DelMonte M, Stanford A, Aldrink JH. Day to Day Advocacy by Pediatric Health Care Providers. J Pediatr Surg 2024; 59:1388-1393. [PMID: 38580545 DOI: 10.1016/j.jpedsurg.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 04/07/2024]
Abstract
This manuscript highlights the impressive advocacy work that members of the American Academy of Pediatrics have achieved and serves to inspire pediatric health care providers of all specialties to pursue such efforts beyond the acute physical need of the child. This article represents one of the Symposia presented at the 2023 American Academy of Pediatrics Section on Surgery.
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Affiliation(s)
- Peter T Masiakos
- Division of Pediatric Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kris R Jatana
- Department of Otolaryngology - Head and Neck Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Mark DelMonte
- Chief Executive Officer, Executive Vice President of the American Academy of Pediatrics, Washington, D.C, USA
| | - Ala Stanford
- Founder, Black Doctors Consortium and Center for Health Equity, Philadelphia, PA, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
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Levy BE, Quattrone M, Castle JT, Doud AN, Draus JM, Worhunsky DJ. Injury Pattern and Outcomes Following All-Terrain Vehicle Accidents in Kentucky Children: A Retrospective Study. Am Surg 2023; 89:5874-5880. [PMID: 37203181 DOI: 10.1177/00031348231173955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
PURPOSE All-terrain vehicles (ATVs) pose a significant risk for morbidity and mortality amongst children. We hypothesize that current vague legislation regarding helmet use impacts injury patterns and outcomes in pediatric ATV accidents. METHODS The institutional trauma registry was queried for pediatric patients involved in ATV accidents from 2006 to 2019. Patient demographics and helmet wearing status were identified in addition to patient outcomes, such as injury pattern, injury severity score, mortality, length of stay, and discharge disposition. These elements were analyzed for statistical significance. RESULTS 720 patients presented during the study period, which were predominantly male (71%, n = 511) and less than 16 years old (76%, n = 543). Most patients were not wearing a helmet (82%, n = 589) at time of injury. Notably, there were 7 fatalities. A lack of helmet use is positively associated with head injury (42% vs 23%, P < .01), intracranial hemorrhage (15% vs 7%, P = .03), and associated with lower Glasgow Coma Scale (13.9 vs 14.4, P < .01). Children 16 years and older were least likely to wear a helmet and most likely to incur injuries. Patients over 16 years had longer lengths of stay, higher mortality, and higher need for rehabilitation. CONCLUSION Not wearing a helmet is directly correlated with injury severity and concerning rates of head injury. Children 16 years and older are at greatest risk for injury, but younger children are still at risk. Stricter state laws regarding helmet use are necessary to reduce pediatric ATV-related injury burden. LEVEL OF EVIDENCE level III retrospective comparative study.
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Affiliation(s)
- Brittany E Levy
- Department of Pediatric Surgery, University of KentuckyChildren's Hospital, Lexington, KY, USA
| | - McKell Quattrone
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jennifer T Castle
- Department of Pediatric Surgery, University of KentuckyChildren's Hospital, Lexington, KY, USA
| | - Andrea N Doud
- Department of Pediatric Surgery, University of KentuckyChildren's Hospital, Lexington, KY, USA
| | - John M Draus
- Department of Surgery, Nemours Children's Health, Jacksonville, FL, USA
| | - David J Worhunsky
- Department of Pediatric Surgery, University of KentuckyChildren's Hospital, Lexington, KY, USA
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Mendenhall SD, Graham EM, Memmott S, Frederiksen H, Rioux-Forker D, Wang AA, Hutchinson DT. A New Source of Mutilating Hand Injuries: The Side-by-Side Utility Terrain Vehicle. Plast Reconstr Surg 2023; 152:820-830. [PMID: 36943702 DOI: 10.1097/prs.0000000000010453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Rates of mutilating hand injuries are increasing from accidents caused by all-terrain vehicles (ATVs) and the recently popularized side-by-side utility terrain vehicles (UTVs). Increasing surgeon familiarity with upper extremity (UE) injury patterns, severity, and outcomes following ATV and UTV accidents may improve patient care and advocacy. METHODS Retrospective comparisons of UE injury patterns, severity, hospital and intensive care unit (ICU) admission lengths, and number of operations were made between ATVs and UTVs. Findings were analyzed with Fisher exact tests, multivariate analysis of variance, analyses of variance with post hoc analyses, and multiple linear regressions. RESULTS A total of 154 cases were identified for inclusion (ATV, n = 87; UTV, n = 67). Patient ages ranged from 4 to 89 years. The UTV group contained significantly more hand and finger injuries, and more of the fractures were open ( P = 0.005, P < 0.001, and P < 0.001, respectively). Riders of UTVs had nearly three times as many mutilating hand injuries and a nearly ninefold increase in amputations compared with ATV riders ( P < 0.001 and P < 0.001, respectively). On average, the UTV group spent 2.5 additional days in the hospital, 0.91 additional days in an ICU, and had 1.3 additional operations ( P = 0.001, P = 0.007, and P < 0.001, respectively). Vehicle type was the only variable significantly correlated with days in the hospital, ICU, and number of UE operations ( P = 0.002, P = 0.008, and P < 0.001, respectively). CONCLUSIONS Hand surgeons are in a unique position to serve as forerunners for increasing public awareness of off-road vehicle risks and promoting rider safety. Collaborating with manufacturers and emergency care providers and directing teaching initiatives may improve patient outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Shaun D Mendenhall
- From the Division of Plastic Surgery
- Division of Plastic, Reconstructive, and Oral Surgery, Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Emily M Graham
- School of Medicine
- Division of Plastic, Reconstructive, and Oral Surgery, Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | | | | | | | - Angela A Wang
- Department of Orthopaedic Surgery, University of Utah
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Silva NBD, Rodrigues TLS, Protasio APL, Cavalcanti AL. Profile of Hospitalizations of Children and Adolescents Victims of Transport Accidents: A Retrospective Study. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2023; 23. [DOI: 10.1590/pboci.2023.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
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Xu Y, Chen M, Yang R, Wumaierjiang M, Huang S. Global, Regional, and National Burden of Road Injuries from 1990 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16479. [PMID: 36554366 PMCID: PMC9779128 DOI: 10.3390/ijerph192416479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Understanding occurrence can help formulate effective preventative laws and regulations. However, the most recent global burden and road injuries (RIs) trends have not been reported. This study reports the burden of RIs globally from 1990 to 2019. (2) Methods: RIs data were downloaded from the Global Burden of Disease 2019. Incidence, deaths, and disability-adjusted life years (DALYs) described the trend and burden of RIs. We calculated age-standardized rates (ASRs) and estimated annual percentage change (EAPC) for the above indexes to evaluate the temporal trend of RIs. We evaluated the social-demographic index (SDI) with epidemiological RI parameters and reported proportions of age-standardized rates due to RI. (3) Results: In 2019, the global incidence of RIs reached 103.2 million. The EAPC of RI incidence increased, whereas deaths and DALYs decreased. Age-standardized incident rate (ASIR) was highest in low-middle SDI regions, age-standardized death rate (ASDR) was high in middle SDI regions, and age-standardized DALYs increased in low SDI regions. The highest accident rates were found in those aged 20-24 years old. Cyclist injuries were the leading RIs (34%), though pedestrian and motor vehicle accidents were the leading cause of death (37.4%, 37.6%) and DALYs (35.7%, 32.3%), respectively. (4) Conclusions: Over the past 30 years, RIs incidence increased annually, though death and DALY rates decreased. RIs places a considerable burden on public health in low SDI countries. Data should be used to develop and implement effective measures to reduce the burden of RIs.
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Affiliation(s)
- Yifan Xu
- Department of Orthopedics, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710049, China
| | - Meikai Chen
- Department of Intensive Care Unit, The Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing 210093, China
| | - Ruitong Yang
- Department of Orthopedics, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710049, China
| | - Muhemaiti Wumaierjiang
- Department of Orthopedics, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710049, China
| | - Shengli Huang
- Department of Orthopedics, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710049, China
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Jennissen CA, Denning GM, Aitken ME. A Comprehensive Report on All-Terrain Vehicles and Youth: Continuing Challenges for Injury Prevention. Pediatrics 2022; 150:189564. [PMID: 36180617 DOI: 10.1542/peds.2022-059280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 12/26/2022] Open
Abstract
All-terrain vehicles (ATVs) represent a serious and ongoing public health and safety concern for children and adolescents. Survey studies indicate that high proportions of youth ride ATVs in both rural and nonrural populations. The significant human and economic costs of pediatric ATV-related deaths and injuries result from a number of major risk factors that are highly common in pediatric ATV crashes: operating adult-size vehicles, riding with or as passengers, lack of protective equipment, and riding on public roads. Other less well-studied but potentially significant risk factors are speed, riding at night, alcohol use among older teenagers, and lack of training and supervision. Although potentially safer than adult ATVs, youth models present a number of safety concerns that have not been addressed with rigorous study. The most common ATV crash mechanism is a noncollision event-for example, a rollover. Common injury mechanisms include ejection from the vehicle, resulting in extremity and head injuries, and being pinned or crushed by the vehicle with resulting multiorgan trauma and/or compression asphyxia. Traumatic brain injury and multisystem trauma are the 2 most common causes of death and disabling injury. Taken together, a large multidecade body of evidence is the basis for the American Academy of Pediatrics policy statement recommendation that no child younger than 16 years of age ride on an ATV. Because children continue to be allowed to ride these vehicles, however, efforts to prevent pediatric ATV-related deaths and injuries require multipronged strategies, including education of both youth and parents, safety-based engineering, and enforcement of evidence-based safety laws.
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Affiliation(s)
- Charles A Jennissen
- Departments of Pediatrics.,Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Gerene M Denning
- Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Mary E Aitken
- Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, Texas
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Menon P, El-Deyarbi M, Khan MA, Al-Rifai RH, Grivna M, Östlundh L, Ei-Sadig M. Risk factors associated with quadbike crashes: a systematic review. World J Emerg Surg 2022; 17:27. [PMID: 35619139 PMCID: PMC9137103 DOI: 10.1186/s13017-022-00430-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background Quadbikes or all-terrain vehicles are known for their propensity for crashes resulting in injury, disability, and death. The control of these needless losses resulting from quadbike crashes has become an essential contributor to sustainable development goals. Understanding the risk factors for such injuries is essential for developing preventive policies and strategies. The aim of this review was to identify the risk factors associated with quadbike crashes at multiple levels through a systematic review of a wide range of study designs. Methods The study incorporated a mixed-method systematic review approach and followed the PRISMA 2020 guidelines for reporting systematic reviews, including a peer reviewed protocol. This systematic review included observational studies investigating the risk factors associated with quadbike crashes, injuries, or deaths. Seven electronic databases were searched from inception to October 2021. Studies were screened and extracted by three researchers. Quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). Due to extensive heterogeneity, meta-analysis was not conducted. All the risk factors have been presented in a narrative synthesis for discussion following the guidelines for Synthesis without Meta-analysis (SWiM). Results Thirty-nine studies combining an aggregate of 65,170 participants were included in this systematic review. The results indicate that modifiable risk factors, such as the increasing age of driving initiation, reducing substance use, and the use of organized riding parks, could reduce quadbike injuries. Riding practices such as avoiding passengers, avoiding nighttime riding, and using helmets could significantly reduce crashes and injuries among riders. Vehicle modifications such as increasing the wheelbase and limiting engine displacement could also help reduce crash incidence. Traditional interventional methods, such as legislation and training, had a weak influence on reducing quadbike injuries. Conclusion Multiple risk factors are associated with quadbike injuries, with most of them modifiable. Strengthening policies and awareness to minimize risk factors would help in reducing accidents associated with quadbikes. PROSPERO registration number CRD42020170245
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Affiliation(s)
- Preetha Menon
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marwan El-Deyarbi
- Department of Pharmacology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Moien Ab Khan
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rami H Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Linda Östlundh
- National Medical Library, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohamed Ei-Sadig
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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Vittetoe KL, Allen JH, Unni P, McKay KG, Yengo-Kahn AM, Ghani O, Mummidi P, Greeno AL, Bonfield CM, Lovvorn HNB. Socioeconomic factors associated with helmet use in pediatric ATV and dirt bike trauma. Trauma Surg Acute Care Open 2022; 7:e000876. [PMID: 35372699 PMCID: PMC8928387 DOI: 10.1136/tsaco-2021-000876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/22/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives Recreational off-road vehicle crashes can produce severe injury and death among children, often from head trauma sustained while riding unhelmeted. Although required for competition, recreational riders commonly forego helmets. This study aimed to identify socioeconomic factors associated with unhelmeted injuries among children riding all-terrain vehicles (ATVs) and dirt bikes recreationally, thus informing injury prevention efforts. Methods A retrospective review was completed of patients younger than 18 years who presented after recreational ATV or dirt bike crash to a single American College of Surgeons-verified level 1 pediatric trauma center (2010-2019). Demographic, injury, and outcome data were collected. US Census data regarding median and per capita income, poverty prevalence, and scholastic graduation rates were recorded for each patient's home county. Relationships between helmet use at the time of injury, demographics, and socioeconomic variables were examined. Results The cohort comprised 680 injured recreational ATV (n=510; 75%) and dirt bike (170; 25%) riders. Unhelmeted riders (n=450) were significantly older (median age 13 vs 11 years; p=0.008) and more often rode ATVs (n=399). Significantly greater percentages of females (77.9%; p<0.001) and passengers (89.5%; p<0.001) were unhelmeted at the time of injury. Residents of counties with lower median and per capita income, higher poverty prevalence, and lower high school and college graduation rates were significantly more likely to be unhelmeted at the time of their crash (p=0.003). In multivariable analysis, unhelmeted injuries were independently associated with ATV use (OR=6.757; p<0.0001), passenger status (OR=6.457; p<0.0001), and older age (OR=1.219; p<0.0001). Conclusion In children, ATV use, passenger status, and older age associated independently with unhelmeted riding in recreational vehicle crash. Residence in a county with both lower median income and scholastic graduation rates associated with unhelmeted crashes, and lower median income significantly predicted unhelmeted crashes. This study revealed socioeconomic factors that identify communities with greatest need for injury prevention initiatives. Level of evidence III-retrospective comparative epidemiological study.
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Affiliation(s)
- Kelly L Vittetoe
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Jackson H Allen
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Purnima Unni
- Pediatric Trauma/Injury Prevention Program, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Katlyn G McKay
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Owais Ghani
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pradeep Mummidi
- Director of Business Analytics, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Amber L Greeno
- Pediatric Trauma/Injury Prevention Program, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Christopher M Bonfield
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Harold N Bo Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Allen JH, Yengo-Kahn AM, Vittetoe KL, Greeno A, Owais Abdul Ghani M, Unni P, Lovvorn HN, Bonfield CM. The impact of helmet use on neurosurgical care and outcomes after pediatric all-terrain vehicle and dirt bike crashes: a 10-year single-center experience. J Neurosurg Pediatr 2022; 29:106-114. [PMID: 34638104 DOI: 10.3171/2021.6.peds21225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE All-terrain vehicle (ATV) and dirt bike crashes frequently result in traumatic brain injury. The authors performed a retrospective study to evaluate the role of helmets in the neurosurgical outcomes of pediatric patients involved in ATV and dirt bike crashes who were treated at their institution during the last decade. METHODS The authors analyzed data on all pediatric patients involved in ATV or dirt bike crashes who were evaluated at a single regional level I pediatric trauma center between 2010 and 2019. Patients were excluded if the crash occurred in a competition (n = 70) or if helmet status could not be determined (n = 18). Multivariable logistic regression was used to analyze the association of helmet status with the primary outcomes of 1) neurosurgical consultation, 2) intracranial injury (including skull fracture), and 3) moderate or severe traumatic brain injury (MSTBI) and to control for literature-based, potentially confounding variables. RESULTS In total, 680 patients were included (230 [34%] helmeted patients and 450 [66%] unhelmeted patients). Helmeted patients were more frequently male (81% vs 66%). Drivers were more frequently helmeted (44.3%) than passengers (10.5%, p < 0.001). Head imaging was performed to evaluate 70.9% of unhelmeted patients and 48.3% of helmeted patients (p < 0.001). MSTBI (8.0% vs 1.7%, p = 0.001) and neurosurgical consultation (26.2% vs 9.1%, p < 0.001) were more frequent among unhelmeted patients. Neurosurgical injuries, including intracranial hemorrhage (16% vs 4%, p < 0.001) and skull fracture (18% vs 4%, p < 0.001), were more common in unhelmeted patients. Neurosurgical procedures were required by 2.7% of unhelmeted patients. One helmeted patient (0.4%) required placement of an intracranial pressure monitor, and no other helmeted patients required neurosurgical procedures. After adjustment for age, sex, driver status, vehicle type, and injury mechanism, helmet use significantly reduced the odds of neurosurgical consultation (OR 0.250, 95% CI 0.140-0.447, p < 0.001), intracranial injury (OR 0.172, 95% CI 0.087-0.337, p < 0.001), and MSTBI (OR 0.244, 95% CI 0.079-0.758, p = 0.015). The unadjusted absolute risk reduction provided by helmet use equated to a number-needed-to-helmet of 6 riders to prevent 1 neurosurgical consultation, 4 riders to prevent 1 intracranial injury, and 16 riders to prevent 1 MSTBI. CONCLUSIONS Helmet use remains problematically low among young ATV and dirt bike riders, especially passengers. Expanding helmet use among these children could significantly reduce the rates of intracranial injury and MSTBI, as well as the subsequent need for neurosurgical procedures. Promoting helmet use among recreational ATV and dirt bike riders must remain a priority for neurosurgeons, public health officials, and injury prevention professionals.
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Affiliation(s)
| | | | | | - Amber Greeno
- 3Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Purnima Unni
- 3Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harold N Lovvorn
- 3Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Mulligan CS, Adams S, Soundappan SSV, Albanese B, Brown J. Paediatric off-road vehicle injury in rural and regional Australia. Aust J Rural Health 2021; 29:417-428. [PMID: 34148260 DOI: 10.1111/ajr.12735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Off-road riding of quad bikes and motorcycles is common among children across rural and remote Australia, but is a significant source of injury and hospitalisation. An in-depth analysis of paediatric off-road vehicle crashes was undertaken to inform injury prevention countermeasures by characterising injury patterns and sources of injury. DESIGN This is a prospective in-depth case series. PARTICIPANTS Participants are children aged 16 and under who have been hospitalised due to injury sustained from the use of an off-road motorcycle or quad bike in New South Wales, Australia. INTERVENTIONS Crash investigation techniques (medical data, structured interview, vehicle and crash site inspection) were used to ascertain details of the crash event, protective gear, injury information and contributory factors. RESULTS Thirty children were recruited, 27 boys and 3 girls, ranging in age from 4 to 16 years, having crashed on off-road motorcycles (n = 27) or quads (n = 3). Most (73.3%) were participating in unstructured social riding. A total of 67 separate injuries were observed, with overall Injury Severity Scores between 1 and 35. There were high rates of wearing helmets and motorcycle-specific garments. The most commonly injured areas were the upper and lower extremities. The most common sources of injury were from impacting the ground, obstacles/other riders or the vehicle. CONCLUSION This study demonstrates the patterns of riding and injury in rural paediatric off-road vehicle riders, occurring despite high rates of helmet/protective gear use. This underscores the need for investigation into the injury mitigation and fit properties of protective gear and the inherent risks for physically and developmentally maturing children.
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Affiliation(s)
| | - Susan Adams
- Department of Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Soundappan S V Soundappan
- Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Bianca Albanese
- The George Institute for Global Health, Newtown, NSW, Australia
| | - Julie Brown
- The George Institute for Global Health, Newtown, NSW, Australia
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Weichelt B, Gorucu S, Jennissen C, Denning G, Oesch S. Assessing the Emergent Public Health Concern of All-Terrain Vehicle Injuries in Rural and Agricultural Environments: Initial Review of Available National Datasets in the United States. JMIR Public Health Surveill 2020; 6:e15477. [PMID: 32469319 PMCID: PMC7293057 DOI: 10.2196/15477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/17/2020] [Accepted: 02/15/2020] [Indexed: 02/03/2023] Open
Abstract
Background Injuries related to the operation of off-road vehicles (ORVs), including all-terrain vehicles (ATVs), continue to be a significant public health concern, especially in rural and agricultural environments. In the United States alone, ATVs have played a role in thousands of fatalities and millions of injuries in the recent decades. However, no known centralized federal surveillance system consistently captures these data. Traditional injury data sources include surveys, police reports, trauma registries, emergency department data, newspaper and online media reports, and state and federal agency databases. Objective The objectives of this study paper were to (1) identify published articles on ORV-related injuries and deaths that used large databases and determine the types of datasets that were used, (2) examine and describe several national US-based surveillance systems that capture ORV-related injuries and fatalities, and (3) promote and provide support for the establishment of a federally-funded agricultural injury surveillance system. Methods In this study, we examined several national United States–based injury datasets, including the web-based AgInjuryNews, the Fatality Analysis Reporting System, databases compiled by the US Consumer Product Safety Commission, and the National Fatality Review Case Reporting System. Results Our review found that these data sources cannot provide a complete picture of the incidents or the circumstantial details needed to effectively inform ORV injury prevention efforts. This is particularly true with regard to ORV-related injuries in agricultural production. Conclusions We encourage the establishment of a federally funded national agricultural injury surveillance system. However, in lieu of this, use of multiple data sources will be necessary to provide a more complete picture of ORV- and other agriculture-related injuries and fatalities.
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Affiliation(s)
- Bryan Weichelt
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, United States
| | - Serap Gorucu
- Department of Agricultural and Biological Engineering, Penn State University, University Park, PA, United States
| | - Charles Jennissen
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Gerene Denning
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
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Flaherty MR, Sheridan R. Fire Pit-Related Burn Injuries in Children and Adolescents. J Burn Care Res 2019; 40:943-946. [DOI: 10.1093/jbcr/irz127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Thermal burns are a leading cause of preventable injury in children and adolescents. Fire pits have become increasingly popular outdoor fixtures in U.S. homes. We aimed to identify trends in pediatric burn injuries related to fire pits that presented to a representative sample of United States Emergency Departments (EDs). A retrospective analysis of annual ED visits from the National Electronic Injury Surveillance System (NEISS) from January 1, 2006 through December 31, 2017 using product codes specific to fire pits. U.S. Census population estimates were used to compute rates per 100,000 population. SAS and Joinpoint weighted regression analyses were used to analyze annual estimates and rate trends across the study period. There were 10,951 (95% CI = 8535–13,367) ED visits for burn injuries secondary to outdoor fire pits in patients 19 years of age and younger across the study period. The majority of injuries occurred in children under the age of 5, and were related to falls into or on a hot fire pit. The annual modeled rate change showed an overall significant increase in burn injuries of 7.16 per 100,000 annually from 2006 to 2017 (P = .02). Outdoor fire pits represent an increasing hazard to young children who are particularly susceptible to burn injuries from falls in or around lit recreational fires. Product modifications and public awareness campaigns are necessary to prevent future life-altering injuries in pediatric patients.
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Affiliation(s)
- Michael R Flaherty
- Division of Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Robert Sheridan
- Harvard Medical School, Boston, Massachusetts
- Department of Burn Surgery, Massachusetts General Hospital, Boston
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13
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Abstract
Safety laws are among the most successful means of reducing injuries, but their effectiveness is strongly influenced by the level of enforcement. To characterize enforcement of off-road vehicle (ORV) laws statewide, analyses of citations were performed using Iowa Court Information System data. From 2005–2015, 5173 individuals were charged with 5643 citations issued. Citations averaged <5/county/year, decreased dramatically over time, and varied by county when normalized to registered all-terrain vehicles (ATVs). Over 90% of operators cited were male and Caucasian. One-fifth were <18 years old. The top five violations were: operation on a highway/snowmobile trail (51%), registration/identification number not documented/displayed (19%), prohibited use in a park/preserve (5.5%), and operation with more persons than the vehicle is designed to carry (4.4%). The Department of Natural Resources issued the highest percentage of citations, followed in decreasing order by Sheriff, Police, State Patrol, and Conservation officers. Significant differences were identified when citations were compared by sex, age, race, enforcement agency, disposition (guilty vs. not guilty), and when comparing counties with or without an ORV park. These characteristics suggest limited and variable enforcement of laws statewide that may reduce their potential to prevent deaths and injuries, and that improved strategies to support ORV law enforcement are needed.
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14
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Abstract
All-terrain vehicles (ATVs) remain a significant source of death and injury among youth. The purpose of this review is to provide an overview of the scope of the problem, the risk factors involved, crash-related outcomes and costs, and injury prevention strategies. There are currently more than 100 pediatric ATV-related fatalities each year and over 30,000 emergency department visits, with a potential annual cost for deaths and injuries approaching $1 billion. Major risk factors include lack of training, operating adult-size ATVs, riding as or carrying passengers, riding on the road, and not wearing a helmet. Extremity injuries are highly common, and the leading causes of death include brain injuries and multi-organ trauma. The latter increasingly involves being crushed by or pinned under the ATV. Reducing ATV-related deaths and injuries will require multiple strategies that integrate approaches from education, engineering, and evidence-based safety laws and their enforcement.
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Affiliation(s)
- Gerene M Denning
- a Department of Emergency Medicine , Roy J and Lucille A Carver College of Medicine, University of Iowa , Iowa City , IA , USA
| | - Charles A Jennissen
- a Department of Emergency Medicine , Roy J and Lucille A Carver College of Medicine, University of Iowa , Iowa City , IA , USA
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15
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Mylonas KS, Hemmati P, Tsilimigras DI, Texakalidis P, Economopoulos KP. Preventing pediatric cardiothoracic trauma: Role of policy and legislation. World J Cardiol 2018; 10:49-51. [PMID: 30079150 PMCID: PMC6068736 DOI: 10.4330/wjc.v10.i7.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/11/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
Data from the last 50 years suggest that pediatric patients typically suffer cardiothoracic injuries following blunt traumatic force (70%) in the setting of either motor vehicle crashes (53.5%) or vehicle-pedestrian accidents (18.2%). Penetrating trauma accounts for 30% of pediatric cardiothoracic injuries, half of which are gunshot wounds. Graduated driver licensing programs, gun-control legislation, off-road vehicle regulation, initiatives such as “Prevent the Bleed”, as well as professional society recommendations are key in preventing pediatric cardiothoracic injuries.
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Affiliation(s)
| | - Pouya Hemmati
- Department of Surgery, Mayo Clinic, Rochester, MN 55902, United States
| | - Diamantis I Tsilimigras
- School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
| | - Pavlos Texakalidis
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54621, Greece
| | - Konstantinos P Economopoulos
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
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16
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Engbrecht BW, Baertschiger RM. American Pediatric Surgical Association Trauma Committee Position Statement on the Use of All-Terrain Vehicles by Children and Youth, 2018. J Pediatr Surg 2018; 53:1444-1445. [PMID: 29752137 DOI: 10.1016/j.jpedsurg.2018.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Brett W Engbrecht
- Pediatric Trauma Program, Penn State Children's Hospital, Milton S. Hershey Medical Center, 500 University Drive, H113, Hershey, PA 17033.
| | - Reto M Baertschiger
- Pediatric Trauma Program, Children's Hospital at Dartmouth (CHaD), Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001.
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