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Ganga A, Kim EJ, Tang OY, Feler JR, Sastry RA, Anderson MN, Keith SE, Fridley JS, Gokaslan ZL, Cielo DJ, Toms SA, Sullivan PZ. The burden of unhelmeted motorcycle injury: A nationwide scoring-based analysis of helmet safety legislation. Injury 2023; 54:848-856. [PMID: 36646531 DOI: 10.1016/j.injury.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Motorcycle collisions comprise a large portion of motor vehicle injuries and fatalities with over 80,000 injuries and 5,500 fatalities per year in the United States. Unhelmeted riders have poor medical outcomes and generate billions in costs. Despite helmet use having been shown to lower the risk of neurological injury and death, helmet compliance is not universal, and legislation concerning helmet use also varies widely across the United States. METHODS In this study, we systematically reviewed helmet-related statutes from all US jurisdictions. We evaluated the stringency of these statutes using a legislative scoring system termed the Helmet Safety Score (HSS) ranging from 0-7 points, with higher scores denoting more stringent statutes. Regression modeling was used to predict unhelmeted mortality using our safety scores. RESULTS The mean score across all jurisdictions was 4.73. We found jurisdictions with higher HSS's generally had lower percentages of unhelmeted fatalities in terms of total fatalities as well as per 100,000 people and 100,000 registered motorcycles. In contrast, some lower-scoring jurisdictions had over 100 times more unhelmeted fatalities than higher-scoring jurisdictions. Our HSS significantly predicted unhelmeted motorcycle fatalities per 100,000 people (β = -0.228 per 1-point increase, 95% CI: -0.288 to -0.169, p < .0001) and per 100,000 registered motorcycles (β = -6.17 per 1-point increase, 95% CI: -8.37 to -3.98, p < .0001) in each state. Aspects of our score concerning helmet exemptions for riders and motorcycle-type vehicles independently predicted higher fatalities (p < .0001). Higher safety scores predicted lower unhelmeted fatalities. CONCLUSION Stringent helmet laws may be an effective mechanism for decreasing unhelmeted mortality. Therefore, universal helmet laws may be one such mechanism to decrease motorcycle-related neurological injury and fatality burden. In states with existing helmet laws, elimination of exemptions for certain riders and motorcycle-type vehicles may also decrease fatalities.
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Affiliation(s)
- Arjun Ganga
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Eric J Kim
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Oliver Y Tang
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Joshua R Feler
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Rahul A Sastry
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Matthew N Anderson
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Sharonda E Keith
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Jared S Fridley
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Ziya L Gokaslan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Deus J Cielo
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Steven A Toms
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States
| | - Patricia Zadnik Sullivan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States.
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Clark A, Zelmanovich R, Hosseini Siyanaki MR, Michel M, Hanna C, Davidson C, Lucke-Wold B. Microbiome and Neurotrauma: Emerging Innovations. NEUROLOGY & NEUROTHERAPY OPEN ACCESS JOURNAL 2022; 7:170. [PMID: 36035066 PMCID: PMC9410620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The gut-brain axis plays an important role in bidirectional communication that exists and can be altered by injury. Neurotrauma provides acute alteration in the GI tract and alters autonomic function. In this focused review, we highlight what is known about GI disruption following neurotrauma. We then delve into how this affects recovery. Areas of innovation and emerging pre-clinical results are addressed. Finally, we address the link between neurotrauma induced GI dysfunction and progression to neurodegenerative disease states.
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Affiliation(s)
- A Clark
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - R Zelmanovich
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | | | - M Michel
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - C Hanna
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - C Davidson
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - B Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
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Podolak OE, Chaudhary S, Haarbauer-Krupa J, Metzger KB, Curry AE, Kessler RS, Pfeiffer MR, Breiding MJ, Master CL, Arbogast KB. Characteristics of Diagnosed Concussions in Children Aged 0 to 4 Years Presenting to a Large Pediatric Healthcare Network. Pediatr Emerg Care 2021; 37:e1652-e1657. [PMID: 32555016 PMCID: PMC7927314 DOI: 10.1097/pec.0000000000002148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of the study was to comprehensively describe the natural history of concussion in early childhood between 0 and 4 years. METHODS Retrospective cohort study of 329 patients aged 0 to 4 years, with an International Classification of Diseases, Ninth Revision, concussion diagnosis in the Children's Hospital of Philadelphia healthcare network from October 1, 2013, to September 30, 2015. Clinical data were abstracted from the Children's Hospital of Philadelphia electronic health record, which captured all clinical care visits and injury characteristics. RESULTS Nearly 9 (86.6%) of 10 patients sought care in the emergency department or urgent care setting, most commonly on the day of injury (56.2%) and as a result of a fall (64.4%). More than two-thirds (64.4%) of patients or their parent/caregiver reported somatic symptoms (ie, vomiting or headache), whereas close to half (49.2%) reported sleep issues. One of 5 patients identified emotional symptoms (21.9%) or visio-vestibular dysfunction (20.4%). Many patients also experienced symptoms not included in standard assessment tools including personality changes (34.0%) and change in appetite (12.8%). CONCLUSIONS These results provide insight into the clinical characteristics of concussion in early childhood up to 4 years of age. Because assessment in this group relies heavily on parent/caregiver symptom reporting, rather than patient self-report, these results will aid clinicians with the challenge of diagnosing concussions in this population. These findings highlight the need to develop additional tools to adequately and systematically assess common signs and symptoms of concussion in early childhood that may not be included in standard assessment scales routinely used in older adolescents and adults.
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Affiliation(s)
- Olivia E. Podolak
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sofia Chaudhary
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Juliet Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kristina B. Metzger
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Allison E. Curry
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Ronni S. Kessler
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Melissa R. Pfeiffer
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Matthew J. Breiding
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Sarmiento K, Daugherty J, Haarbauer-Krupa J. Healthcare Providers' Self-Reported Pediatric Mild Traumatic Brain Injury Diagnosis, Prognosis, and Management Practices: Findings From the 2019 DocStyles Survey. J Head Trauma Rehabil 2021; 36:282-292. [PMID: 33656487 PMCID: PMC8249309 DOI: 10.1097/htr.0000000000000671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess adherence to 5 key recommendations in the Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury, this article presents results from the 2019 DocStyles survey. STUDY DESIGN Cross-sectional, web-based survey of 653 healthcare providers. RESULTS Most healthcare providers reported adhering to the recommendations regarding the use of computed tomography and providing education and reassurance to patients and their families. However, less than half reported routinely examining their patients with mild traumatic brain injury (mTBI) using age-appropriate, validated symptom scales, assessing for risk factors for prolonged recovery, and advising patients to return to noncontact, light aerobic activities within 2 to 3 days. Self-reported mTBI diagnosis, prognosis, and management practices varied by specialty. Only 3.8% of healthcare providers answered all 7 questions in a way that is most consistent with the 5 recommendations examined from the Centers for Disease Control and Prevention Pediatric mTBI Guideline. CONCLUSION This study highlights several important information gaps regarding pediatric mTBI diagnosis and management. Further efforts to improve adoption of guideline recommendations may be beneficial to ensure optimal outcomes for children following an mTBI.
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Affiliation(s)
- Kelly Sarmiento
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA
| | - Jill Daugherty
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA
| | - Juliet Haarbauer-Krupa
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA
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