title: High occurrence of head and spine injuries in the pediatric population following motocross accidents.
abstract: OBJECTIVE
  Off-road motorcycling is a very popular sport practiced by countless people worldwide. Despite its popularity, not much has been published on the severity and distribution of central nervous system-related injuries associated with this activity in the pediatric population. The purpose of this study was to confirm, characterize, and document the rate of head and spine injuries associated with off-road motorcycling in this population.
  
  
  METHODS
  All patients aged 18 years or less who were treated for a motorbike injury at the authors' institution (a Level 1 regional trauma center) between 2000 and 2007 were identified through in-house surgical and trauma registries. Type, mechanism, and severity of CNS-related injuries were assessed, including: incidence of traumatic brain injury (TBI), loss of consciousness (LOC), Glasgow Coma Scale (GCS) score, head CT findings, neurological deficits, spinal fractures, cervical strain, and use of protective gear, including helmets.
  
  
  RESULTS
  During the 8-year period of study, 298 accidents were evaluated in 248 patients. The patients' mean age at the time of injury was 14.2 ± 2.7 years. Head injury or TBI was identified in 60 (20.1%) of 298 cases (involving 58 of 248 patients). Fifty-seven cases were associated with LOC, and abnormalities were identified on head CT in 10 patients; these abnormalities included skull fractures and epidural, subdural, subarachnoid, and intraparenchymal hemorrhages. The GCS score was abnormal in 11 cases and ranged from 3 to 15, with an overall mean of 14.5. No patients required cranial surgery. Helmet use was confirmed in 43 (71.6%) of the cases involving TBI. Spine fractures were identified in 13 patients (4.3%) and 5 required surgical fixation for their injury.
  
  
  CONCLUSIONS
  The authors found a high occurrence of head injuries following pediatric off-road motorcycle riding or motocross accidents despite the use of helmets. Additionally, this study severely underestimates the rate of mild TBIs in this patient population. Our data indicate that motocross is a high-risk sport despite the use of protective gear. Riders and parents should be counseled accordingly about the risks prior to participation.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: David J
authors.initials: DJ
authors.lastname: Daniels
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Clarke
authors.forename: Ross
authors.initials: R
authors.lastname: Puffer
authors.forename: T David
authors.initials: TD
authors.lastname: Luo
authors.forename: Amy L
authors.initials: AL
authors.lastname: McIntosh
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Wetjen
mesh_terms: D000059:Accidents; D000293:Adolescent; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology / Q000209:etiology; D002648:Child; D006259:Craniocerebral Trauma / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D015600:Glasgow Coma Scale; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D009049:Motorcycles; D015541:Off-Road Motor Vehicles; D012887:Skull Fractures / Q000209:etiology; D013124:Spinal Injuries / Q000453:epidemiology* / Q000209:etiology*; D014193:Trauma Centers
keywords: ASIA = American Spinal Injury Association; ATV = all-terrain vehicle; CN = cranial nerve; GCS = Glasgow Coma Scale; LOC = loss of consciousness; TBI = traumatic brain injury; motocross; motorcycle; pediatric; sports injury; trauma