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INTRODUCTION: Patients presenting to emergency departments (ED) for injuries resulting from recreational activities represent a unique source of information on important directions for injury prevention efforts. We describe the epidemiology of non-motorized wheeled activity-related injury in pediatric patients presenting to Canadian EDs as well as patients' helmet use. METHODS: Data for the years 2004 to 2009 were abstracted from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), a national ED injury surveillance program in fifteen hospitals. RESULTS: Most of the 28 618 children aged 1 to 16 years injured during non-motorized wheeled activities were injured while cycling, followed by skateboarding. Most injuries occurred among boys. Children injured on scooters tended to be younger whereas skateboarders were the oldest. On average, the number of all injuries decreased by 6% over the time period. Falls were the most common mechanism of injury; 8.3% of patients had head injuries, which were seen more often among cyclists than other wheeled-activity users. Helmet use was greatest among cyclists (62.2%) and lowest among skateboarders (32.9%). Injured patients presenting to EDs in jurisdictions with legislation mandating helmet use had 2.12 greater odds of helmet use and 0.86 lesser odds of head injury compared with those presenting in jurisdictions without helmet laws. CONCLUSION: These results provide further evidence that legislation mandating helmet use may be an effective way of reducing injury among all wheeled-activity users. The small number of patients who presented with helmet use and protective gear (59.4% overall) suggests that this remains an area for intervention.

TITRE: Blessures et port du casque au cours d'activités non motorisées sur roues chez des patients pédiatriques. INTRODUCTION: Les patients qui se présentent aux urgences en raison de traumatismes subis au cours d'activités récréatives constituent une source d'information unique qui peut orienter de manière déterminante les interventions visant à prévenir les blessures. Nous décrivons ici l'épidémiologie des blessures associées aux activités non motorisées sur roues chez les patients pédiatriques se présentant aux urgences au Canada et faisons état du port du casque chez ces patients. MÉTHODOLOGIE: Nous avons extrait les données relatives aux années 2004 à 2009 du Système canadien hospitalier d'information et de recherche en prévention des traumatismes (SCHIRPT), un programme national de surveillance des blessures dans les urgences de 15 hôpitaux. RÉSULTATS: La majorité des 28 618 enfants âgés de 1 à 16 ans qui ont été blessés au cours d'activités non motorisées sur roues l'ont été durant la pratique de la bicyclette, la deuxième cause étant la pratique de la planche à roulettes. Les enfants blessés étaient majoritairement des garçons. Les enfants blessés en trottinette étaient généralement plus jeunes, ceux blessés en planche à roulettes plus âgés. En moyenne, le nombre total de blessures a diminué de 6 % au cours de la période étudiée. Les chutes étaient le mécanisme lésionnel le plus courant, et 8,3 % des patients présentaient un traumatisme crânien, blessure plus fréquente chez les cyclistes que chez les utilisateurs d'autres dispositifs sur roues. Le port du casque était plus répandu chez les cyclistes (62,2 %), les utilisateurs de planche à roulettes affichant le plus faible taux d'utilisation (32,9 %). Les patients blessés qui s'étaient présentés aux urgences dans une région où le port du casque était obligatoire étaient 2,12 fois plus susceptibles de porter un casque et 0,86 fois moins susceptibles de souffrir d'un traumatisme crânien, comparativement aux patients des régions où il n'y avait pas de réglementation sur le port du casque. CONCLUSION: Ces résultats corroborent les études selon lesquelles la réglementation rendant obligatoire le port du casque pourrait être un moyen efficace de réduire les blessures chez tous les utilisateurs de dispositifs à roues non motorisés. Le petit nombre de patients qui portaient un casque et un équipement de protection (59,4 % en tout) laisse penser que cela demeure un champ d'intervention.

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BACKGROUND: Legislation in the province of Ontario, Canada, mandates users under the age of 18 to wear a helmet when they ride a bicycle, and legislation has been shown to significantly increase rates of bicycle helmet use. Legislation does not exist in Ontario for older bicyclists or for users of other non-motorised modes of transportation, and there are no current data available regarding rates of helmet use in these categories. This study was designed to determine the prevalence of helmet use among users of bicycles, skateboards, push scooters and inline skates in Toronto, Ontario, and the surrounding area. Further analysis was performed to examine factors associated with helmet use. METHODS: We performed a cross-sectional, observational study. Three trained, stationary observers captured 6038 users of bicycles (5783), skateboards (77), inline skates (165) and push scooters (13) in the summer of 2009. Observations were separated into three time periods capturing commuters, midday users and recreational users. A general linear model was used to assess the factors associated with helmet use among bicyclists. RESULTS: Helmets were worn by 48.9% of all users observed and 50.0% of all bicyclists. Among bicyclists, females were more likely to wear helmets than males (prevalence ratio 1.27, 95% CI 1.17 to 1.36), while children were significantly more likely to wear helmets than adults (prevalence ratio 1.17, 95% CI 1.37 to 2.15). Significant behavioural variation was observed among users during the three observation periods (p<0.001), with commuters being the most likely to wear a helmet. CONCLUSION: In the absence of comprehensive legislation encompassing all ages of users, only half of users of non-motorised, wheeled transportation devices are choosing to wear a helmet to protect against traumatic brain injury. Implementation of evidence-based strategies to increase helmet use, such as the introduction of legislation encompassing all ages and all equipment, is required.

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Current Canadian helmet bylaws focus mainly on bicycle helmet use. In this way, law makers are ignoring head injuries associated with other wheeled sports. Cycling, in-line skating, skateboarding, and scootering can all cause serious injury to participants if proper protective gear is not worn. Legislation has been shown to work in promoting helmet use and decreasing injuries. Nurses, using theory and research to guide practice, can be key players in advocating for healthy public policies and amendments to provincial legislation. Nurses have the opportunity to play an active leadership role that can be guided by PEACE, a philosophy that encompasses praxis, empowerment, awareness, cooperation, and evolvement.

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The sales of foot-propelled scooters in the United States has skyrocketed with a concomitant increase in emergency department visits related to injuries. It is estimated that more than 60% of injuries could be prevented or reduced in severity if protective gear had been worn. Pediatric nurses should support efforts to decrease scooter-related injuries in children by advocating for the usage of protective gear. Further research is indicated to assess knowledge of potential dangers in those with reported scooter-related injuries, the extent of injuries, and protective gear worn prior to injury occurrence.

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During recent years, an increasing number of skateboard accidents have been registered in Odense Hospital. Typically, boys aged 10-14 years are involved and these had fallen on outstretched arms. No injuries endangering life were registered but 36% had fractures and half of these were localized to the wrist. Approximately 8% of the injuries resulted in hospitalization. Despite prohibition in the traffic legislation, 65% of the injuries occurred in trafficated regions and only 15% occurred in specially made skateboard rinks. The real risk involved in board skating are unknown but, in this selected group of board skaters, no significant connection could be demonstrated between routine experience in board skating, employment of protective equipment and frequency of fractures. Employment of protective equipment was commonest among persons who were members of a club and among those injured on skateboard ramps. The frequency of fractures was significantly higher among persons injured on ramps than among the remainder. Possible prophylactic measures are discussed and simple rules are recommended.

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