Snyder Christopher W, Muensterer Oliver J, Sacco Frank, Safford Shawn D
Department of Surgery, 6th Medical Group, MacDill Air Force Base, Tampa, FL, USA ; Department of Surgery, The Children's Hospital at Providence Alaska Medical Center, Anchorage, AK, USA ; Division of Acute Care Surgery, University of South Florida, Tampa, FL, USA.
Division of Pediatric Surgery, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
Int J Circumpolar Health. 2014 Sep 16;73:25191. doi: 10.3402/ijch.v73.25191. eCollection 2014.
Off-road motorized vehicle crashes are a common source of trauma among Alaska children. Injury morbidity is worse in Alaska Native children than non-Native children, but the reasons are unclear.
To evaluate the differences in helmet use between the Native and the non-Native children, and to assess the impact of helmet use on injury patterns and outcomes.
This retrospective cohort study identified patients aged 17 or younger admitted after all-terrain vehicle, snowmobile or motorbike injury between 2001 and 2011 from the Alaska Trauma Registry. Helmeted and non-helmeted patients were compared with respect to demographics, central nervous system (CNS) injury and the overall risk of death or permanent disability. Logistic regression was used to evaluate predictors of helmet use and the effects of ethnicity and helmet use on outcomes.
Of the 921 injured children, 51% were Alaska Native and 49% were non-Native. Helmet use was lower among Native versus non-Native patients on unadjusted comparison (24% vs. 71%) and multivariable logistic regression (OR 0.17, 95% CI 0.11-0.27, p<0.0001). Prevalence of CNS injury was higher among Native children (39.7% vs. 30.4%, p=0.016). However, on logistic regression with adjustment for helmet use, Native ethnicity was not a significant predictor of CNS injury (OR 1.07, 95% CI 0.68-1.68, p=0.78), whereas helmet use was strongly protective against CNS injury (OR 0.28, 95% CI 0.18-0.44, p<0.0001) as well as death or permanent disability (OR 0.26, 95% CI 0.10-0.67, p=0.006).
Helmet use is lower among Alaska Native children involved in off-road motorized vehicle crashes. These ethnic disparities in helmet use contribute to higher rates of CNS injury among Native children. Helmet use significantly improves overall outcome. Helmet promotion efforts should be expanded, especially in Native communities.
越野机动车辆碰撞是阿拉斯加儿童创伤的常见原因。阿拉斯加原住民儿童的损伤发病率高于非原住民儿童，但原因尚不清楚。
评估原住民儿童和非原住民儿童在头盔使用方面的差异，并评估头盔使用对损伤模式和结局的影响。
这项回顾性队列研究从阿拉斯加创伤登记处确定了2001年至2011年间因全地形车、雪地摩托或摩托车受伤后入院的17岁及以下患者。比较了戴头盔和未戴头盔患者的人口统计学特征、中枢神经系统（CNS）损伤以及死亡或永久性残疾的总体风险。采用逻辑回归评估头盔使用的预测因素以及种族和头盔使用对结局的影响。
在921名受伤儿童中，51%是阿拉斯加原住民，49%是非原住民。在未经调整的比较中，原住民患者的头盔使用率低于非原住民患者（24%对71%），多变量逻辑回归分析显示（比值比[OR]0.17，95%置信区间[CI]0.11 - 0.27，p<0.0001）。原住民儿童中枢神经系统损伤的患病率较高（39.7%对30.4%，p = 0.016）。然而，在对头盔使用进行调整的逻辑回归分析中，原住民种族并不是中枢神经系统损伤的显著预测因素（OR 1.07，95% CI 0.68 - 1.68，p = 0.78），而头盔使用对中枢神经系统损伤有很强的保护作用（OR 0.28，95% CI 0.18 - 0.44，p<小于0.0001）以及对死亡或永久性残疾也有保护作用（OR 0.26，95% CI 0.10 - 0.67，p = 0.006）。
参与越野机动车辆碰撞的阿拉斯加原住民儿童的头盔使用率较低。头盔使用方面的这些种族差异导致原住民儿童中枢神经系统损伤率较高。头盔使用显著改善总体结局。应加大头盔推广力度，尤其是在原住民社区。
