title: Helmet use among Alaskan children involved in off-road motorized vehicle crashes.
abstract: BACKGROUND
  Off-road motorized vehicle crashes are a common source of trauma among Alaska children. Injury morbidity is worse in Alaska Native children than non-Native children, but the reasons are unclear.
  
  
  OBJECTIVE
  To evaluate the differences in helmet use between the Native and the non-Native children, and to assess the impact of helmet use on injury patterns and outcomes.
  
  
  METHODS
  This retrospective cohort study identified patients aged 17 or younger admitted after all-terrain vehicle, snowmobile or motorbike injury between 2001 and 2011 from the Alaska Trauma Registry. Helmeted and non-helmeted patients were compared with respect to demographics, central nervous system (CNS) injury and the overall risk of death or permanent disability. Logistic regression was used to evaluate predictors of helmet use and the effects of ethnicity and helmet use on outcomes.
  
  
  RESULTS
  Of the 921 injured children, 51% were Alaska Native and 49% were non-Native. Helmet use was lower among Native versus non-Native patients on unadjusted comparison (24% vs. 71%) and multivariable logistic regression (OR 0.17, 95% CI 0.11-0.27, p<0.0001). Prevalence of CNS injury was higher among Native children (39.7% vs. 30.4%, p=0.016). However, on logistic regression with adjustment for helmet use, Native ethnicity was not a significant predictor of CNS injury (OR 1.07, 95% CI 0.68-1.68, p=0.78), whereas helmet use was strongly protective against CNS injury (OR 0.28, 95% CI 0.18-0.44, p<0.0001) as well as death or permanent disability (OR 0.26, 95% CI 0.10-0.67, p=0.006).
  
  
  CONCLUSIONS
  Helmet use is lower among Alaska Native children involved in off-road motorized vehicle crashes. These ethnic disparities in helmet use contribute to higher rates of CNS injury among Native children. Helmet use significantly improves overall outcome. Helmet promotion efforts should be expanded, especially in Native communities.
authors.affiliation: Department of Surgery, 6th Medical Group, MacDill Air Force Base, Tampa, FL, USA ; Department of Surgery, The Children's Hospital at Providence Alaska Medical Center, Anchorage, AK, USA ; Division of Acute Care Surgery, University of South Florida, Tampa, FL, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Snyder
authors.affiliation: Division of Pediatric Surgery, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Muensterer
authors.affiliation: Department of Surgery, Alaska Native Medical Center, Anchorage, AK, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Sacco
authors.affiliation: Division of Pediatric Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Safford
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data; D000293:Adolescent; D017677:Age Distribution; D000413:Alaska / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005006:Ethnicity; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015541:Off-Road Motor Vehicles; D044382:Population Groups / Q000208:ethnology / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012424:Rural Population; D017678:Sex Distribution; D015996:Survival Rate; D014193:Trauma Centers
keywords: Alaska; all-terrain vehicle; helmet; motorbike; snowmobile; traumatic brain injury