May 20th, 2017

Really, how dangerous can it be? Motocross injuries in the emergency department

By Daniel Cabrera, M.D.

Author: Lucas Silva (@lucasojesilva12)

Rider in photo: Elisa M. Smith, MD (EM Resident at Mayo Clinic, Rochester, MN)

 

An 18 year-old freshman of the University of Minnesota went back to Wabasha, his hometown, to ride motocross with his high-school friends over the weekend. He was jumping over an obstacle when he suddenly lost control in mid-air and was ejected from his bike, hitting his head and losing his consciousness for 30 seconds. EMS transported him to the emergency department (ED) for evaluation.

In the ED, he reported headache, nausea, and back pain. His GCS was 15 and he had no neurologic deficits on exam.  The emergency providers ordered CTs of the head, neck, chest, abdomen/pelvis with spine reconstructions which revealed a stable lumbar spine fracture. The patient was discharged from the hospital one day later with concussion instructions and outpatient follow-up with the Spine Clinic.

Motocross is a popular that has seen an increasing number of injuries related to the rising on participation (1, 2). Its burden on ED visits, however, has not been well described for adult patients. Motocross has one of the highest incidence rates of injuries compared with other high-impact sports (3) and emergency providers should be aware of the risks associated with this activity, in order to facilitate early recognition and management of injuries in these patients.

In a study of consecutive adult patients presenting to our academic ED with motocross-related injuries over a 6-year period we aimed to describe the rates of head and spine injuries.

We found that adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries and marked levels of morbidity and mortality (Table 1). Among 145 ED visits, 95% of the patients were male and the median age was 25 years.  Almost half of the patients had head and/or spine injuries (67/145, 46.2%).  Almost 93% of patients with head or spine injuries were wearing a helmet at the time of injury.  Among the 43 patients with head injuries, almost 85% were concussions (and over 75% of these were associated with loss of consciousness), 7 were associated with at least 1 head CT abnormality, including skull fracture (n = 2), subdural hematoma (n = 1), subarachnoid hemorrhage (n = 4), intraparenchymal hemorrhage (n = 3), and diffuse axonal injury (n = 3). Approximately 70% of the 46 spinal injuries were acute fractures.  Six patients (4%) had significant persistent neurologic injuries, including:  3 patients with severe TBIs (including 2 with persistent cognitive impairment and 1 in a persistent vegetative state); 2 patients with paraplegia; 1 patient with right upper extremity weakness.  One patient had a minor sensory deficit.  One patient died.

Our findings demonstrate that almost one half of adult ED patients evaluated following motocross accidents had head and/or spine injuries with 4% resulting in significant impairment, and 0.7% died. The long-term functional and economic burden caused by these injuries in these young patients is unknown. Emergency providers and motocross participants should be aware of the high rates of head and spine injuries associated with this sport.  The development of improved safety procedures or equipment may help to mitigate these injuries.

 

Table 1. Emergency Department Visits—Baseline Characteristics and Outcomesa  (used with permission)

  ED Visits
 

Variable

All
(N=145)
Head Injuries (n=43) Spine Injuries (n=46)
Age, y 25 (21-38) 27 (21-40) 25.5 (21-38.5)
Male sex 138 (95.2) 41 (95.3) 43 (93.5)
ED Glasgow coma scaleb      
3 3 (2.1) 3 (7) 2 (4.35)
4-8 2 (1.4) 2 (4.7) 0 (0)
9-14 3 (2.1) 3 (7) 2 (4.35)
15 135 (94.4) 35 (81.3) 42 (91.3)
Head injury (n=43)      
Loss of consciousness 33 (76.8)
Concussion 36 (83.7)
Skull fracture 2 (4.7)
Epidural hematoma 0 (0)
Subdural hematoma 1 (2.3)
Subarachnoid hemorrhage 4 (9.3)
Intraparenchymal hemorrhage 3 (7)
Diffuse axonal injury 3 (7)
Spine injury (n=46)      
Acute spinal fracture 32 (69.6)
Epidural hematoma 4 (8.7)
Acute disc herniation 1 (2.2)
Ligamentous injury 5 (10.9)
Cervical strain 3 (6.5)
Thoracolumbar strain 10 (21.7)
CT imaging      
Head 83 (57.2) 41 (95.3) 36 (78.3)
Any spine 106 (73.1) 41 (95.3) 46 (100)
Cervical spine 105 (72.4) 40 (93) 46 (100)
Lumbar spine 85 (58.6) 33 (76.7) 41 (89.1)
Thoracic spine 61 (42.1) 32 (74.4) 42 (91.3)
ED disposition      
Home 40 (27.6) 7 (16.2) 4 (8.7)
General surgical floor 53 (36.5) 18 (41.9) 19 (41.3)
Intensive care unitc 21 (14.5) 12 (27.9) 12 (26)
Operating room 31 (21.4) 6 (14) 11 (24)
Head or spine intervention or surgery 10 (6.9) 5 (11.6) 8 (17.4)
Persistent neurologic deficit at hospital discharge 7 (4.8) 5 (11.6) 4 (8.7)
Hospital length of stay, d 2 (0-4) 2 (1-5) 3 (1-5)
In-hospital death 1 (0.7) 1 (2.3) 1 (2.2)

Abbreviations: CT, computed tomography; ED, emergency department.

a Data are summarized as number (%) or median (interquartile range).

b Data not available for 2 patients.

c Includes all types of intensive care units at our institution.

 

FULL-ARTICLE:

  • Silva LOJe, Fernanda Bellolio M, Smith EM, et al. Motocross-associated head and spine injuries in adult patients evaluated in an emergency department. The American Journal of Emergency Medicine doi: https://doi.org/10.1016/j.ajem.2017.04.058

 

REFERENCES

  1. Sharma VK, Rango J, Connaughton AJ, et al. The Current State of Head and Neck Injuries in Extreme Sports. Orthopaedic journal of sports medicine 2015;3(1):2325967114564358. doi: 10.1177/2325967114564358 [published Online First: 2015/11/05]
  2. Singh R, Theobald P, Hamad AK, et al. Motocross biking for competition and for recreation: a prospective analysis of 423 injured riders. BMJ Open Sport & Exercise Medicine 2015;1(1)
  3. Gobbi A, Tuy B, Panuncialman I. The incidence of motocross injuries: a 12-year investigation. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2004;12(6):574-80. doi: 10.1007/s00167-004-0510-z [published Online First: 2004/05/11]

 

 

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