Skateboard Accidents

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PEDIATRICS

Vol. 59 No. 6 June 1977 939

EXPERIENCE

AND

REASON-Briefly

Recorded

“In Medicine one must pay attention not to plausible theorizing but to experience and reason together. ...I agree that theorizing is to be approved, provided that it is based on facts,

and systematically makes its deductions from what is observed. ... But conclusions drawn

from unaided reason can hardly be serviceable; only those drawn from observed fact.” Hippocrates: Precepts. (Short communications offactual material are published here. Comments and criticisms appear as Letters to the Editor.)

Skateboard

Accidents

Accidents have been the leading cause of

death’ and a major cause of injury among children

5 to 14 years of age in the United States since

1930. Since 1973 there has been a significant

increase in the number of patients treated for

skateboard accidents (Fig. 1). An alarming

number of deaths resulting from skateboard

acci-dents is similarly being noted.2’3 This report

describes the experience with skateboard injuries

at the Childrens Hospital of Los Angeles (CHLA)

and comparative national data.

METHODOLOGY

All hospital admissions at CHLA for injuries

known

to be related to skateboard accidents for

the three-year period from January 1, 1973, to

December 31, 1975, were reviewed. Emergency

room visits at CHLA for skateboard injuries for

the same period were also reviewed and

compared to national data provided by the

National Electronic Injury Surveillance System

(NEISS) (Fig. 2 to 4).

CASE REPORTS

Seventeen patients with skateboard injuries were hospital-ized at GHLA during the study period. Three representative case histories are detailed below.

Case 1

Patient 1 (R.M.), a 16-year-old boy, was in good health until several hours after a fall from his skateboard when he noted grossly bloody urine. On admission to CHLA, results of

physical examination were normal except for minimal right flank tenderness and a blood pressure of 160/80 mm Hg. Laboratory data included a hemoglobin level of 15.4 gm/100 ml; hematocrit value, 47%; and platelet count, 202,000/cu mm. Blood urea nitrogen level was 12 mg/ 100 ml, and the serum sodium and potassium levels were 140 mEqiliter and 3.9 mEq/liter, respectively. Urinalysis showed a pH of 7, proteinuria (2 +

),

and numerous red blood cells in an unspun specimen. An excretory urogram showed enlargement of the right kidney. Radioisotope study of the kidneys two days after admission showed delayed and diminished perfusion of the right kidney. Gross hematuna cleared by the second hospital day, but his blood pressure remained elevated at 150/105 mm Hg. At follow-up examination 12 days after the injury, the patient’s blood pressure was 160/90 mm Hg, but results of the urine examination were normal. Repeated radioisotope study of the kidneys two months after the injury

showed a mild disparity of function with greater uptake by the left kidney. Blood pressure at that time wa 158/86 mm

Hg. At follow-up examination six months after admission, the urinalysis showed no abnormalities and his blood pressure

was 128/60 mm Hg.

Case 2

J.B., a 4-year-old boy, fell from a skateboard while riding with an older cousin. He was taken to another hospital where he was found to be unconscious. He was given mannitol and dexamethasone (Decadron) intravenously and transferred to CHLA. Examination on admission revealed an intermittently lethargic and combative boy. His blood pressure was 118/78 mm Hg. There was a 2.5-cm indurated, ecchymotic area in the mid-forehead and an abrasion 3 cm long on the nose. The left pupil was slightly larger than the right but the pupils were equally reactive. The fundi and tympanic membranes were normal. Radiographic examination demonstrated a bipanetal skull fracture. Results of brain scan were normal. Left hemiplegia and global aphasia were present at the time of admission but these gradually improved. Outpatient follow-up examination showed a complete return to normal

function.

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NATIONAL CHLA

nfl

1973 974 1975 1973 1974 1975

Fu;. 1. Outpatient visits for skateboard accidents.

Case 3

EM., a 15-year-old boy, fell off his skateboard onto his right forearm. On admission to GHLA, examination revealed abrasions over the right lateral elbow and right shoulder, and an open laceration over the distal third of the right ulna and radius. Peripheral pulses were normal and sensation was intact. Radiographic examination demonstrated fractures of the right nIna and radius. Debridement and closed reduction

ofthe fractures was performed. The patient was followed tip as an outpatient until four months after admission when he lacked only 5#{176}flexion at the right elbow and x-ray examina-tion showed good healing.

RESULTS

The CHLA emergency room has seen an

18-fold increase in accidents from skateboards during

the period January 1, 1973, to December 31,

1975.

Over the same period a tenfold increase is

being reported nationally by NEISS (Fig.1).

It appears that boys are most often injured. The

peak age range is 10 to 14 years both at CHLA

and nationally. Statistics from CHLA show a

second peak incidence in the 5- to 9-year-old age

group as opposed to the 15- to 19-year-old age

group demonstrated in the NEISS Survey (Fig. 2).

This disparity may be secondary to the patient

population of a children’s hospital. Injuries are

predominantly fractures, contusions and

abra-sions, strains and sprains, and lacerations (Fig. 3).

The lower arm, lower leg, head, and face seem to

be the parts of the body most affected (Fig. 4).

Seventeen patients with skateboard injuries

were hospitalized at CHLA during the study

period January 1, 1973, to December 31, 1975.

The number of admissions increased markedly

during the three-year study period. There were

no admissions in 1973, two in 1974 requiring nine

hospital days, and 15 in 1975 requiring 88 hospital

days. The patients ranged in age from 3#{189}to 16

years, with 12 being between 10 and 14 years,

three above 15 years, and two less than 5 years

old. There were 15 boys and two girls.

Seven patients had significant head trauma

resulting in cerebral concussion (six), cerebral

contusion (one), linear skull fracture (two),

possible basilar skull fracture (one), hypertension

(one), and global aphasia (one). Seven patients had

significant orthopedic injuries, including fracture

of the ulna and/or radius (three), humenis (two),

tibia and fibula (one), and contusion of the knee

(one). Three of the patients with orthopedic

J2L

H

Mole Female 2-4 5-9 lOI4 15-I9 20-24 2534 35+

FIG. 2. Sex and age distribution of skateboard injuries (1975 national data).

I

IS

940 SKATEBOARD ACCIDENTS

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a. 60 50 40 30

z

20 I0 0 1000 900 800

700

Ui 6OO 0 500 400 300 200

z

I 00 0 300 200 1100 l0O( 900 800 700 600 500 400 300 200 I 00 0

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I

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data).

EXPERIENCE AND REASON 941

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FIG. 3. Types of injuries caused by skateboard accidents (1975 national data).

injuries had residual limitation of motion. Renal

injuries in three patients consisted of renal

contu-sion with gross (one) and microscopic (one)

hema-tuna, and transient hypertension (one). The third

patient had a fracture of the kidney with

extra-vasation leading to formation of a urinoma; a

urinary fistula and hydronephrosis of the left

upper pole developed, necessitating left

nephrec-tomy.

DISCUSSION

The limited information available in the

litera-ture as well as a review of national statistics4

shows a rapid rise in injuries from skateboard

riding, not surprising since, as a sport, it is going

through a popularity explosion. Over the past

several years, skateboards have become a

signifi-cant cause of childhood trauma and morbidity.

The increase in injuries seems more pronounced

in the CHLA data and may reflect the favorable

climate of southern California, which allows a

longer riding season.

The most common injuries caused by

skate-board accidents are nondisabling. Yet the cases

reported in this article and reports from other

sources illustrate that injuries from skateboards

may produce significant mortality and morbidity

and the incidence is increasing at an alarming

rate.24 Some of the injuries described can lead to

long-term limitation of function and concomitant

restriction in future competitive sports. The wide

increase in popularity of the skateboard seems to

stem from modifications in design, which have

made it more flexible and faster. Speeds of up to

80 kph have been reported.5 Its wide availability

at a relatively low cost makes owning a

skate-board possible for most youngsters from the age of

5 years upward. Equipment for other sports, such

as bicycling or skiing, is considerably more

expen-FIG. 4. Body location of skateboard injuries (1975 national

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942 PEDIATRICS Vol. 59 No. 6 June 1977

sive, which may limit their use by children of this

age. The great speed possible without any braking

mechanism, the hard surface necessary for a

“good ride,” and the absence of safety equipment

such as helmets all contribute to the increasing

frequency and severity of injury. These factors

make the skateboard extremely hazardous,

although it looks so easy to ride. This false

appearance leads many youngsters to take

unnec-essary risks and many adults to foolishly attempt

riding their child’s skateboard.

More serious, it has been brought to our

atten-tion that seven skateboarding accidents resulting

in death have served as sources for cadaver

kidneys for renal transplantation.2 It can safely be

assumed that this does not represent the entire

incidence of fatal skateboard injuries, since many

fatal injuries occur under conditions that preclude

organ donation.

It appears that an educational campaign must

be fostered and sponsored by organizations such

as the Pro Am Skate Board Racing Association,

schools, and other community organizations to

distribute materials and provide classes in the

appropriate use and safety of skateboards. The

wearing of shoes, long pants and long-sleeve

shirts, and helmets would provide some

protec-tion from the rough, hard surfaces skateboards are

used on. The teaching of proper rolling and

somersault techniques could serve to minimize

injuries to the head and extremities. Skateboards

should be banned from high-density or high-speed

traffic areas, although restricting skateboards

from the public streets and highways is unrealistic

and would result in laws that are unenforceable.

This approach has failed in San Diego,3 where it

was attempted some time ago. Competitive

events on graded tracks with earthen shoulders to

minimize injuries from falling, and providing

supervised “safe” competition as is done in many

other childhood sports would seem indicated.

The pediatrician and family practitioner can

play an active and significant role in providing

accident prevention information for children and

parents. This may be provided in office practice

and through active participation in community

organizations. His role in “anticipatory guidance”

is as important as that of direct patient care once

injuries have occurred.

CONCLUSION

Skateboard-related trauma is causing

signifi-cant morbidity and mortality that are rapidly

increasing in frequency. The spectrum of injuries

is predominantly fractures, contusions and

abra-sions, strains and sprains, and lacerations of the

lower arm, lower leg, head, and face. Significant

renal injuries are also a common cause of

hospi-talization.

ROBERT A. JACOBS, M.D.

EUGENE L. KELLER, M.D.

Department of Pediatrics,

University of Southern California

School of Medicine,

and Childrens Hospital of

Los Angeles Los Angeles, California

ADDRESS FOR REPRINTS: (R.A.J.) Ghildrens Hospital of Los Angeles, 4650 Sunset Boulevard, Los Angeles, Gali-fornia 90054.

REFERENCES

1. Vaughan V. McKay R: Nelson’s Textbook of Pediatrics, ed 10. 1975, p 4. (Based on data from the National Center for Health Statistics, Dept of Health, Educa-tion and Welfare)

2. Fine 5: Personal communication.

3. Atienza F, Sia C: The hazards of skateboard riding.

Pediatrics 57:793, 1976.

4. National Electronic Injury Surveillance System, United States Consumer Product Safety Commission. 5. Maddox D: Skateboards zip and zap riders once again.

The Physician and Sportsmedicine 24-25, 1976.

ACKNOWLEDGMENT

Review of the manuscript by Barbara Korsch, M.D., and James Apthorp, M.D., is gratefully appreciated. Our thanks to Mrs. Marjorie Proctor and Mrs. Phyllis Kochavi for their patience during the preparation of the manuscript.

Bullous

Pemphigoid

in Infancy:

A Case

Report

Bullous pemphigoid occurs rarely in children.

Bean and Jordan’ found only eight cases reported

as of 1974 and the youngest of these patients was

2 years of age. Presented here is the case of a

3#{189}-month-old infant who developed this disease.

CASE REPORT

A 3#{189}-month-old boy developed a progressively spreading bullous eruption (Fig. 1 and 2). Within a week the hands and feet were covered with large, tense bullae lying on a base of erythema, and scattered vesicles appeared on the back of the

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1977;59;939

Pediatrics

Robert A. Jacobs and Eugene L. Keller