title: Paediatric recreational vehicle-related head injuries presenting to the emergency department of a major paediatric trauma centre in Australia: Is there room for improvement?
abstract: OBJECTIVE
  This study examines clinical characteristics and helmet use of children presenting to the ED with a recreational vehicle (RV)-related head injury (HI).
  
  
  METHODS
  Observational retrospective study of children <18 years presenting with a RV-related HI to the ED of a state-wide paediatric trauma centre in Australia between April 2011 and January 2014.
  
  
  RESULTS
  In the 647 presentations identified, corresponding to 7.5% (95% CI 7.0-8.1) of all HI presentations, RVs involved were bicycles (36.3%), push scooters (18.5%), motorcycles (18.4%), horses (11.7%), skateboards (11.6%), quadbikes (2.8%) and go-karts (0.6%). Recorded helmet use was the highest in motorcycle, horse and bicycle riders (83.2%, 82.9% and 65.1%, respectively), and the lowest for push scooter (25.8%) and skateboard riders (17.3%). Overall 23% underwent a CT scan, 8.8% had intracranial injuries on CT, 30.6% were admitted, and 2.2% underwent neurosurgery. Push scooter-related HIs were the least severe. Age (in years), riding a motorised vehicle and not wearing a helmet were independently associated with intracranial injuries on CT on multiple logistic regression (OR 1.1, 95% CI 1.0-1.2; OR 2.4, 95% CI 1.3-4.6 and OR 6.0, 95% CI 3.2-11.2, respectively).
  
  
  CONCLUSIONS
  RV-related HIs accounted for a non-negligible proportion of paediatric HIs presenting to the ED and for significant morbidity and use of hospital resources. Interventions such as introduction of mandatory helmet use for off-road motorised vehicle riding and skateboard riding in children, enhanced injury prevention campaigns, and strict adult supervision during motorised vehicle riding may reduce the morbidity and health care costs associated with paediatric RV-related HIs.
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Department of Woman's and Child's Health, University of Padova, Padova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bressan
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Department of Woman's and Child's Health, University of Padova, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Daverio
authors.affiliation: Queensland Injury Surveillance Unit, Mater Medical Research Institute, Brisbane, Queensland, Australia.
authors.forename: Ruth
authors.initials: R
authors.lastname: Barker
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Molesworth
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.|Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.|Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006736:Horses; D006801:Humans; D007223:Infant; D008297:Male; D018986:Motor Vehicles; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014739:Victoria / Q000453:epidemiology
keywords: accident and emergency department; head trauma; off-road motor vehicles; paediatrics