1. Pediatric Motocross Chest and Abdominal Injuries
Amy L. McIntosh MD
Version 1, released July 2013

5. Over 400 bed hospital
One of the busiest Level 1 pediatric trauma center in the country

6. N = 299
30% required surgery of which 90% of procedures were orthopedic
Multiple injury episodes
> 20% Loss of Consciousness

7. Accepted Journal of Neurosurgery:Pediatrics.
David J. Daniels, M.D., Michelle J. Clarke, M.D., Ross Puffer, M.D., T. David Luo, Amy McIntosh, M.D., Nicolas M. Wetjen, M.D.
High occurrence of head and spine injuries in the pediatric population following motocross accidents.
Accepted Journal of Neurosurgery:Pediatrics.
N = 248 patients
Mean patient age : /- 2.7
Head injury or TBI was identified in 60 cases (58 patients) for an overall occurrence rate of 20.1% in this population.
CT in 10 patients including skull fractures, epidural, subdural, subarachnoid, and intraparenchymal hemorrhages.
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 five required surgical fixation for their injury.

8. Accepted Journal of Neurosurgery: Pediatrics
T. David Luo, BS, Michelle J. Clarke, MD, Amy K. Zimmerman, MD Michael Quinn, CRNA, David J. Daniels, MD, PhD, Amy L. McIntosh, MD
Concussion symptoms in youth motocross riders: a prospective, observational study.
Accepted Journal of Neurosurgery: Pediatrics
N = 139
67 (48%) youth riders who reported at least one concussion symptom during the season.
riders (98%) reported “always” wearing a helmet
72% received professional help with fitting of their helmets
Sixty-six (47%) riders reported having received sponsor support for motocross participation.
Proper helmet fitting was associated with a 41% decreased risk of concussion symptoms (RR = 0.59, 95% CI 0.44 – 0.81, p < 0.01).
Sponsor support conferred a relative risk of 1.48 (95% CI 1.05 – 2.08) of concussion symptoms (p = 0.02).

9. Accepted Journal of Neurosurgery: Pediatrics.
David J Daniels, MD, PhD, T. David Luo, BS, Ross Puffer, MD, Amy McIntosh, MD, A Noelle Larson, MD, Nicholas M. Wetjen, MD, Michelle J. Clarke, MD. Degenerative changes in adolescent spines: a comparison of motocross racers and age-matched controls.
Accepted Journal of Neurosurgery: Pediatrics.
Increased degenerative changes in the cervical and thoracic spine were identified in adolescent motocross racers compared to age-matched controls.

10. Childhood motocross truncal injuries:
high-velocity, focal force to the chest and abdomen
Raelene D Kennedy,1 D Dean Potter,1 John B Osborn,2 Scott Zietlow,2 Abdalla E Zarroug,1 Christopher R Moir,1 Michael B Ishitani,1 Amy McIntosh3
N= 167
18.5% thoracic or abdominal injuries
27% required surgical intervention
50% required ICU admission
Average hospital stay = 4 days
13% multiple injury episodes

13. The splenectomized patient should be vaccinated to decrease the risk of overwhelming postsplenectomy sepsis (OPSS)
organisms such as Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis.
Risk of infection 4.4%
Risk of death 2.2%

16. CONCLUSION Amateur motocross evaluated at Level 1 trauma center
Orthopedic injuries are the most common 30%
TBI w/ LOC  20%
Spine fracture  4%
Thoracic and/or abdominal trauma  18.5%
50% self report concussion symptoms during the outdoor season
↓ risk of concussion with professional help with helmet fit
Increased degenerative changes in the cervical and thoracic spine compared to aged matched controls (football, soccer, hockey).

17. Thank you slide featuring logo at right.