title: Neurological injuries from car surfing.
abstract: OBJECTIVE
  Trauma secondary to car surfing is a unique mechanism of head and spinal injury in children and adolescents. In this study, the authors present their experience with neurological injuries resulting from car surfing and describe the growing national trend of car-surfing injuries and the increasing portrayal of this activity in the media.
  
  
  METHODS
  A retrospective study of the Rainbow Babies and Children's Hospital trauma database was conducted to identify all cases of neurological injuries secondary to car surfing. Between January 1995 and December 2008, 7 patients <or= 16 years of age, including 6 boys and 1 girl, were identified. The charts of these patients were reviewed. National data on car-surfing fatalities over the same time period in children and adolescents 10-20 years of age were obtained from the National Highway Traffic Safety Administration, and these data were analyzed for national trends in car-surfing fatalities.
  
  
  RESULTS
  All 7 children with injuries due to car surfing suffered traumatic head injuries. Three patients fell from the back of the moving vehicle, 2 fell from the hood, 1 fell from the side of the vehicle, and 1 patient sustained head injuries after intentionally jumping off the moving vehicle. All 7 children suffered intracranial bleeding, and 4 had associated skull fractures. One patient underwent craniotomy to evacuate an acute subdural hematoma. The other 6 patients required nonoperative treatment. Four patients had permanent neurological problems. National statistics have shown a steady rise in car-surfing fatality rates since 2000, especially in California, Florida, and Texas.
  
  
  CONCLUSIONS
  Car surfing is an unusual but serious mechanism of neurological injury in children and adolescents. Despite its dangers, car surfing is becoming a more common pastime in the pediatric population. National statistics have shown a steady rise in car-surfing fatalities since 2000. This national rise in fatalities chronologically overlaps with the introduction of media depictions of the activity since 1995. Increased awareness of the dangers of car surfing may help prevent future head injuries.
authors.affiliation: Division of Pediatric Neurological Surgery and The Neurological Institute, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Wang
authors.forename: Alan R
authors.initials: AR
authors.lastname: Cohen
authors.forename: Shenandoah
authors.initials: S
authors.lastname: Robinson
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000293:Adolescent; D001642:Bicycling / Q000293:injuries; D001930:Brain Injuries / Q000453:epidemiology* / Q000473:pathology* / Q000523:psychology; D002648:Child; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D015541:Off-Road Motor Vehicles; D009820:Ohio / Q000453:epidemiology; D000297:Psychology, Adolescent; D012042:Registries; D012189:Retrospective Studies; D013690:Television; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D018910:Video Games