Snowmobile injuries and fatalities in children.
OBJECTIVE
Snowmobiling is a popular form of wintertime recreation but can be associated with significant morbidity and mortality. To better understand snowmobile trauma in children, medical records were reviewed, evaluating the relationships between demographic data, mechanisms, and resultant injuries. In addition, because prior studies of childhood snowmobile fatalities have reviewed only national databases, state and national data were combined to evaluate possible underreporting.


METHODS
Medical records were reviewed of children </=17 years old admitted to one trauma center between 1991 and 2000 with snowmobile-related injuries. Demographics, helmet usage, driver versus passenger, mechanism, injuries, injury severity score (ISS), and outcome data were recorded. Statistical analyses were performed to identify relationships between potential causative factors and ISS. State mortality data were acquired from state agencies and 2 databases of the U.S. Consumer Product Safety Commission (CPSC). Data from the 3 sources were compared, and a single list of fatalities was compiled and evaluated.


RESULTS
Thirty-one children (65% boys; mean age, 12 years) were admitted with snowmobile-related injuries. Fifty-two percent were driving the snowmobile. Helmet usage was 68%. The most common mechanisms were collisions with a fixed object (42%) and with a motor vehicle (35%). The head was the most commonly injured site (71%) followed by the extremities (58%). ISS ranged from 1 to 38 (median, 10). Increased age and the child driving were the only factors associated with increased ISS (P <.05). One child died of a massive head injury. Twenty-two fatalities (70% boys; mean age, 14 years) statewide were identified from state and national databases, only 12 of which were identified by the CPSC Death Certificate file. Head injury was the most common cause of death.


CONCLUSIONS
Reckless snowmobiling leads to significant morbidity and mortality among children. Prior reports based on CPSC data likely underestimated the number of snowmobile-related fatalities. Our findings support previous American Academy of Pediatrics recommendations, including the restriction of snowmobile driving by children under 16, graduated licensing for older children, and universal helmet usage.
Decou
James M
JM
Department of Pediatric Surgery, DeVos Children's Hospital, Grand Rapids, MI, USA.
Fagerman
Lynn E
LE
Ropele
Diana
D
Uitvlugt
Neal D
ND
Schlatter
Marc G
MG
Connors
Robert H
RH
D000059:Accidents / Q000401:mortality* / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008824:Michigan / Q000453:epidemiology; D009104:Multiple Trauma / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D015541:Off-Road Motor Vehicles / Q000706:statistics & numerical data*; D038161:Snow Sports / Q000293:injuries*