title: Neurologic injury in snowmobiling.
abstract: BACKGROUND
  Snowmobiles are increasingly popular recreational, all-terrain utility vehicles that require skill and physical strength to operate given their inherent maneuverability, acceleration, and top speed capabilities. These same characteristics increase the risk of injury with the operation of these vehicles, particularly neurological injury. We characterize our series of 107 patients involved in snowmobiling accidents.
  
  
  METHODS
  From January 2004 to January 2012, all snowmobiling-related injuries referred to our regional trauma center were reviewed. Information had been recorded in the hospital's trauma registry and medical records were retrospectively reviewed for data pertaining to the injuries, with particular emphasis on neurological injuries and any associated details.
  
  
  RESULTS
  A total of 107 patients were identified. Ninety percent of injured riders were male. The mean age was 34.4 years (range 10-70), with 7% younger than age 16. The mean Injury Severity Score was 12.0 ± 0.69 (range 1-34). Although not documented in all patients, alcohol use was found in 7.5% of the patients and drug use found in one patient. Documentation of helmet use was available for only 31 of the patients; of which 13% were not helmeted. Causes included being thrown, flipped, or roll-over (33%), striking a stationary object (27%), being struck by a snowmobile (9%), striking another snowmobile (5.5%) or a car, train, or truck (5.5%), being injured by the machine itself (9%), other (2%) or unspecified (18%). Head injuries occurred in 35% patients, including concussion, subarachnoid hemorrhage, subdural hematoma, contusion, and facial/skull fracture. Spinal fractures occurred in 21% of the patients. Fractures to the thoracic spine were the most common (50%), followed by the cervical (41%) and lumbar (36%) spine. There were also three brachial plexus injuries, one tibial nerve injury, and one internal carotid artery dissection. Average length of stay was 4.98 ± 0.56 days. Disposition was home (78%), home with services (12%), rehabilitation placement (9%), and one death. Details regarding other systemic injuries will also be reviewed.
  
  
  CONCLUSIONS
  Snowmobiles are a significant source of multi-trauma, particularly neurological injury. Neurosurgeons can play key roles in advocating for neurological safety in snowmobiling.
authors.affiliation: University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Plog
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 670, Rochester, NY 14642, USA.
authors.forename: Clifford A
authors.initials: CA
authors.lastname: Pierre
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 670, Rochester, NY 14642, USA.
authors.forename: Vasisht
authors.initials: V
authors.lastname: Srinivasan
authors.affiliation: Case Western Reserve University, School of Law, 11075 East Blvd, Cleveland, OH 44106, USA.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Srinivasan
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 670, Rochester, NY 14642, USA.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Petraglia
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 670, Rochester, NY 14642, USA.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Huang
keywords: Brain injury; neurological sports medicine; snowmobile; spine injury; trauma; traumatic brain injury