PEDIATRICS J Neurosurg Pediatr Volume 15 • March 2015 cliNical article J Neurosurg Pediatr 15:261–265, 2015 S portS are a major cause of traumatic brain injuries (TBIs) in the pediatric population. Conservatively, it is estimated that over 300,000 sport-related TBIs occur annually in the United States, although this fgure only includes patients who suffer a loss of consciousness (LOC). 19,20,22,32,33 More likely, 1.6–3.8 million sport-relat- ed TBIs occur worldwide, 4,19,30 with an estimated 90% of sport-related concussions going unidentifed. 34 Emergency department visits for sport-related TBIs in the pediatric population have increased 60% in the past decade. 9 The highest rate of emergency room visits for sport-related concussion occur in the 10- to 14-year age group, 10 and concussion accounts for more than 10% of athletic injuries in high school athletes. 14,25 The long-term consequences of traumatic brain injury in the pediatric population is cur- rently unknown, and recently all 50 states have passed laws surrounding “return to sports” following sport-related concussions. Although it is well recognized that high-impact sports such as football and hockey are associated with a high inci- dence of head and spinal injuries, not much is known about the pediatric injury patterns associated with 2-wheel mo- torbike use. Since the 1960s, miniature motorcycles have been marketed to children for recreational and competitive use. 1 Motocross racing is a popular sport organized by the American Motorcyclist Association that includes specifc aBBreVatiONS ASIA = American Spinal Injury Association; ATV = all-terrain vehicle; CN = cranial nerve; GCS = Glasgow Coma Scale; LOC = loss of consciousness; TBI = traumatic brain injury. SuBmitted March 20, 2014. accePted September 8, 2014. iNclude wheN citiNg Published online January 2, 2015; DOI: 10.3171/2014.9.PEDS14149. diSclOSure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. High occurrence of head and spine injuries in the pediatric population following motocross accidents david J. daniels, md, Phd, 1 michelle J. clarke, md, 1 ross Puffer, md, 1 t. david luo, md, 2 amy l. mcintosh, md, 2 and Nicolas m. wetjen, md 1 Departments of 1 Neurosurgery and 2 Orthopaedic Surgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota OBJect 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 confrm, 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 identifed 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 fndings, neurological defcits, 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 identifed in 60 (20.1%) of 298 cases (involving 58 of 248 patients). Fifty-seven cases were associated with LOC, and abnormalities were identifed 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 confrmed in 43 (71.6%) of the cases involving TBI. Spine fractures were identifed in 13 patients (4.3%) and 5 required surgical fxation 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. http://thejns.org/doi/abs/10.3171/2014.9.PEDS14149 KeY wOrdS motocross; motorcycle; pediatric; sports injury; trauma 261 ©AANS, 2015 Unauthenticated | Downloaded 10/03/22 11:42 AM UTC