S. Khan3, T. W. Costantini1, L. N. Godat1, J. J. Doucet1, A. E. Berndtson1 1University Of California – San Diego,Trauma, Surgical Critical Care, Burns And Acute Care Surgery,San Diego, CA, USA 3University Of California – San Diego,School Of Medicine,La Jolla, CA, USA
Introduction: Off-road vehicles, including all-terrain vehicles (ATVs) and dirt bikes, are a major source of trauma morbidity and mortality. The Southern California Off Road Enthusiasts (SCORE) International Off-Road Racing group has been holding multi-sport off-road races since 1967, including the well-known Baja race series. Race participation effects on injury patterns of both racers and crew have not been studied. We hypothesized that race participants and crew (Race) would be both more likely to wear protective gear and more likely to sustain severe injury than Non-Race riders.
Methods: We performed an IRB approved, retrospective cohort study of patients presenting to an ACS-verified Level 1 trauma center from January 2010 to August 2018 who were injured while riding an off-road vehicle. Data collected included demographics, race status, injuries, procedures and outcomes. Univariate regression models were used to compare Race vs Non-Race groups, and multivariate analysis to determine risk factors contributing to head injury severity.
Results:
Thirty-one of 600 total off-road vehicle accidents (5.2%) were associated with SCORE Baja races. Race patients were more likely to be male (96.8% vs. 79.3%, p=0.04) and Caucasian (90.5% vs. 65.0%, p=0.02) than Non-Race patients, with no significant difference in age. Co-morbidities were similar except for a higher rate of pre-existing musculoskeletal conditions in Race patients (54.8% vs 19.5%, p<0.001). Race patients more often rode dirt bikes versus ATVs (64.5% vs. 29.0%, p<0.001), but had higher mortality when on ATVs (9.1% vs. 0.7%, p=0.03). There were no significant differences in injury severity score, hospital length of stay, ICU admission or operative interventions.
Helmet use was no different between the groups, however, Race patients were more likely to have an abnormal Glasgow Coma Scale (GCS) at both admission and discharge, and a trend towards higher head Abbreviated Injury Severity (AIS) scores (see table). On multivariate analysis severe head injury (AIS ≥ 3) was associated with helmet use, which was protective (OR 0.3, 95% CI 0.1-0.5, p<0.001); it was not associated with age, gender, Race status, type of vehicle, or toxicology results.
Conclusion: Baja race participants had a trend towards more severe head injuries and were more likely to die in ATV crashes than Non-Race patients, despite similar rates of helmet use and overall injury severity. Helmet use decreased the severity of head injuries for all patients. Safety equipment, particularly helmet use, must be encouraged for all off-road riders, and use enforced at racing events.
