Golf cart related injuries in a North Carolina island community, 1992-4

Traumatic Injuries From Low Speed Vehicles and Golf Carts: A Scoping Review

ABSTRACT

With increasing use of golf carts and low speed vehicles for recreational, work-related, and commuting purposes, the number of related injuries is also on the rise. The body of literature describing these injuries is informative but limited. From this scoping review, we found that low speed vehicle-related injuries preferentially affect children, older adults, and males. Common mechanisms of injury include ejection and collision. Associated alcohol consumption is common and typically related to increasing severity of injury. Various injuries may result from low speed vehicles as described in the review, including soft tissue injuries, orthopedic injuries, and traumatic brain injury. Description of trends and classifications of injury will hopefully improve reporting and ability to make recommendations on safe use and regulation.

Golf cart-related neurosurgical injuries

Background

Head and spine injuries sustained following golf cart accidents have been rarely analyzed. This study aimed to describe a series of patients sustaining golf cart injuries requiring neurosurgical management for head or spine injuries.

Methods

The University of Puerto Rico Neurosurgery database was used to retrospectively identify and investigate patients who sustained a golf cart-related injury requiring a neurosurgical evaluation during 15 years.

Results

The analysis identified 25 patients with golf cart-related injuries requiring neurosurgical management with a median age of 16 (interquartile range 13-34). Seventeen patients (68%) were female. The primary mechanism of injury was ejection from the cart in 84% of the patients (n = 21). The most frequent head injury was a skull fracture in 80% of patients (n = 20). Intracranial hemorrhage was present in 76% of patients (n = 19), with brain contusions (n = 16, 64%) being the most common. Eighteen patients (72%) were admitted for surgery or neurological monitoring. The median hospital length of stay among hospitalized patients was 5.5 days. Ten patients (40%) were admitted to the intensive care unit (ICU) with a median stay of 8.5 days. Four patients (16%) required surgery for their injuries. At discharge, 80% of patients (n = 20) had a good outcome.

Conclusion

This study showed that children and adolescents are at high risk for golf cart-related neurosurgical injuries. This form of transportation can produce considerable neurological injuries, the primary mechanism of injury being ejection from the cart. Approximately three-quarters of the patients need hospital admission, with half requiring an ICU stay.

Golf cart injuries in children: the experience of trauma centers in a single state in the USA

Golf carts remain a source of morbidity in children. We aimed to establish the incidence and injury characteristics of pediatric patients injured due to golf cart usage over an 11-year period. This is a retrospective study using a single state trauma database of patients ages 0-17 years admitted to a trauma center and who sustained injures while a golf cart was in use. Thirteen Pediatric and Adult Trauma Centers within the state of Pennsylvania were evaluated from 1 January 2004 to 31 December 2014. The inclusion criteria were met by 108 patients. The mean annual incidence of injuries was 0.35/100 000. The median age of patients was 11 years. The median hospital length of stay and injury severity score were 2 days and 9.5, respectively. The majority of the patients (75.9%) sustained at least one bone fracture. Skull fractures were more prevalent (43.5%), whereas extremity fractures were sustained by 26.9% of patients. Intracranial hemorrhages were sustained by 29.6% of patients. Ejections and rollovers accounted for 58.3% and 31.4% of patient injuries, respectively. The concussion rate was 26.9%. Neither age group nor sex was associated with a difference in fractures, intracranial hemorrhage or concussions. Golf cart injuries in pediatric patients commonly stem from ejections and rollover mechanisms resulting in skull fractures, extremity fractures, intracranial hemorrhages and concussions. The overall incidence of injury was 0.35 cases per 100 000. Further efforts are needed to increase awareness of these injuries and modify regulations regarding the use of golf carts in the pediatric population.

Fun ride or risky transport: Golf cart-related injuries treated in U.S. emergency departments from 2007 through 2017

INTRODUCTION

Golf cart-related injuries constitute a substantial source of morbidity, most notably in pediatric populations. Despite the high rate of injuries, there have been no meaningful changes in golf cart design or legislation to reduce the overall burden of these injuries. This study sought to characterize the epidemiology of golf cart-related injuries treated in United States hospital emergency departments.

METHOD

A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System for patients of all ages who were treated in emergency departments (EDs) (2007-2017) for a golf cart-related injury.

RESULTS

From 2007 through 2017, an estimated 156,040 (95% CI = 102,402-209,679) patients were treated in U.S. EDs for golf cart-related injuries. The average rate of traumatic brain injuries (TBIs) in children (1.62 per 100,000 children) was more than three times that of TBIs in adults (0.52 per 100,000 adults; rate ratio = 2.38; 95% CI = 2.36-2.41) and nearly twice that of TBIs in seniors (1.11 per 100,000 seniors; rate ratio = 1.21; 95% CI = 1.19-1.22). The rate of injuries in seniors increased significantly by 67.6% from 4.81 per 100,000 seniors in 2007 to 8.06 per 100,000 seniors in 2017 (slope = 0.096; p = 0.041).

CONCLUSIONS

Golf cart use remains an important source of injury for people of all ages, especially in children. As use continues to increase, it is unlikely that golf cart-related injuries will decrease without substantial changes to product design, regulation, and/or legislation. Practical Applications: Use of golf carts pose a considerable risk of injury and morbidity; safety recommendations should be followed.

Motorized mobility scooters: the use of training/intervention and technology for improving driving skills in aging adults - a mini-review

BACKGROUND

Motorized mobility scooters (MMS) have become the most acceptable powered assistive device for those with impaired mobility, who have sufficient upper body strength and dexterity, and postural stability. Although several benefits have been attributed to MMS usage, there are likewise risks of use, including injuries and even deaths.

OBJECTIVE

The aim of the current review was to summarize results from clinical studies regarding the enhancement of MMS driver safety with a primary focus on improving driving skills/performance using clinical approaches. We addressed three main objectives: (1) to identify and summarize any available evidence (strong, moderate, or weak evidence based on the quality of studies) regarding improved driving skills/performance following training/intervention; (2) to identify types of driving skills/performance that might be improved by training/intervention, and (3) to identify the use of technology in improving MMS performance or training procedure.

METHODS

Articles were searched for in the following medical and engineering electronic databases: PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, PsycINFO, CINAHL, ERIC, EI Compendix, IEEE Explore, and REHABDATA. Inclusion criteria included: aging adults or those with ambulatory problems, intervention or targeted training, and clinical trial. Outcomes included: MMS skills/performance.

RESULTS

Six articles met the inclusion criteria and are analyzed in this review. Four of the six articles contained training approaches for MMS drivers including skill trainings using real MMS inside and outside (i.e. in the community) and in a 3D virtual environment. The other two studies contain infrastructural assessments (i.e. the minimum space required for safe maneuverability of MMS users) and additional mobility assistance tools to improve maneuverability and to enhance driving performance.

CONCLUSIONS

RESULTS from the current review showed improved driving skills/performance by training, infrastructural assessments, and incorporating mobility assistance tools. MMS driving skills that can be improved through driver training include: weaving, negotiating with and avoiding pedestrian interference, simultaneous reading of signs and obstacle avoidance in path, level driving, forward and reverse driving, figure 8s, turning in place, crossing left slope, maneuvering down a 2-inch curb, and driving up and down inclines. However, several limitations exist in the available literature regarding evidence of improved driving skills/performance following training/intervention, such as small sample sizes, lack of control groups and statistical analysis.

Ejection of a rear facing, golf cart passenger

The following report details the findings of a series of experiments and simulations performed on a commercially available, shuttle style golf cart during several maneuvers involving rapid accelerations of the vehicle. It is determined that the current set of passive restraints on these types of golf carts are not adequate in preventing ejection of a rear facing passenger during rapid accelerations in the forward and lateral directions. Experimental data and simulations show that a hip restraint must be a minimum of 13 in. above the seat in order to secure a rear facing passenger during sharp turns, compared to the current restraint height of 5 in. Furthermore, it is determined that a restraint directly in front of the rear facing passenger is necessary to prevent ejection. In addressing these issues, golf cart manufacturers could greatly reduce the likelihood of injury due to ejection of a rear facing, golf cart passenger.

Etiologies of pediatric craniofacial injuries: a comparison of injuries involving all-terrain vehicles and golf carts

OBJECTIVE

To determine incidence and etiologies of craniofacial injuries in the pediatric population through comparison of injuries caused by all-terrain vehicles and golf cart trauma.

STUDY DESIGN

Case series with chart review.

SETTING

Level 1 trauma center.

SUBJECTS AND METHODS

Retrospective review of pediatric traumas at a tertiary academic medical center from 2003 to 2012 identified 196 patients whose injuries resulted from accidents involving either all-terrain vehicles or golf carts. Data was collected and variables such as age, gender, driver vs. passenger, location of accident, Glasgow coma scale, Injury severity scale, Abbreviated injury scale, and presence or absence of helmet use were examined.

RESULTS

196 pediatric patients were identified: 68 patients had injuries resulting from golf cart accidents, and 128 patients from ATV accidents. 66.4% of ATV-related traumas were male, compared to 52.9% of golf cart-related traumas. Ages of injured patients were similar between the two modalities with average age of ATV traumas 10.8 (±4.0) years and golf cart traumas 10.0 (±4.6) years. Caucasians were most commonly involved in both ATV (79.7%) and golf cart traumas (85.3%). 58.6% of all ATV related trauma and 69.1% of all golf cart trauma resulted in craniofacial injuries. The most common craniofacial injury was a closed head injury with brief loss of consciousness, occurring in 46.1% of the ATV traumas and 54.4% of the golf cart traumas. Temporal bone fractures were the second most common type of craniofacial injury, occurring in 5.5% of ATV accidents and 7.4% of the golf cart traumas. Length of hospital stay and, cases requiring surgery and severity scores were similar between both populations. Intensive care admissions and injury severity scores approached but not reach statistical significance (0.096 and 0.083, respectively). The only statistically significant differences between the two modalities were helmet use (P=0.00018%) and days requiring ventilator assistance (P=0.025).

CONCLUSIONS

ATVs and golf carts are often exempt from the safety features and regulations required of motor vehicles, and ATV and golf cart accidents represent a significant portion of pediatric traumas. This study found that ATV and golf cart accidents contribute significantly to craniofacial trauma requiring hospitalization, with resultant morbidity and mortality. Further investigation of these injuries and their prevention in the pediatric population is needed before efforts to promote effective safety regulations for such vehicles in the future can be addressed.

Craniofacial Injuries Due to Golf Cart Trauma

Objective. To characterize craniofacial injuries due to golf cart trauma.

Study Design. Case series with chart review.

Setting. Level 1 trauma center.

Subjects and Methods. A tertiary academic medical center’s trauma database was queried for golf cart–related trauma from 2000 to 2009 and returned 68 patients. Data were obtained from the trauma database and by individually reviewing patient charts.

Results. Of the 68 patients identified, 55% were male, with a median age of 13.4 years. Sixty-nine percent had head injuries, with 32% sustaining skull or facial fracture and 20.6% intracranial hemorrhage. The highest Abbreviated Injury Scale (AIS) by region was the head and neck. The average Glasgow Coma Scale score was 14.2, Injury Severity Score (ISS) 9.0, hospital stay 4.5 days, and intensive care unit (ICU) stay 2.8 days; 36.8% were admitted to the ICU. Ejection and rollover were the most common mechanisms of injury, with ejection having a significantly higher head and neck AIS compared with rollover and hitting a stationary object ( P = .0055). Alcohol was detected in 59.2% of patients older than 16 years; the average blood alcohol concentration was 182.6 mg/dL. Children were involved 60.3% of the time, with an average age of 9.2 years, and children were passengers in the golf cart 69.2% of the time.

Conclusions. Golf cart trauma can cause significant craniofacial injuries, particularly in the pediatric population and in adults who consume alcohol.

Morbidity associated with golf-related injuries among children: findings from a pediatric trauma center

OBJECTIVE

To describe injuries due to golf-related activities among pediatric patients requiring hospital admission.

METHODS

We conducted a retrospective analysis of all sports-related injuries from 2000 to 2006 using a level 1 trauma center database.

RESULTS

Of 1005 children admitted with sports-related injuries, 60 (6%) had golf-related injuries. The mean injury severity score was significantly higher for golf-related injuries (11.0) than that for all other sports-related injuries (6.8). Most golf-related injuries occurred in children younger than 12 years (80%), at home (48%), and by a strike from a club (57%) and resulted in trauma to the head or neck (68%).

CONCLUSIONS

Golf-related injuries, although an infrequent cause of sports-related injuries, have the potential to result in severe injuries, especially in younger children. Preventive efforts should target use of golf clubs by younger children in the home setting.

A parametric study of golf car and personal transport vehicle braking stability and their deficiencies

This paper describes research and parametric analyses of braking effectiveness and directional stability for golf cars, personal transport vehicles (PTVs) and low speed vehicles (LSVs). It is shown that current designs, which employ brakes on only the rear wheels, can lead to rollovers if the brakes are applied while traveling downhill. After summarizing the current state of existing safety standards and brake system designs, both of which appear deficient from a safety perspective, a previously developed dynamic simulation model is used to identify which parameters have the greatest influence on the vehicles' yaw stability. The simulation results are then used to parametrically quantify which combination of these factors can lead to yaw induced rollover during hard braking. Vehicle velocity, steering input, path slope and tire friction are all identified as important parameters in determining braking stability, the effects of which on rollover propensity are presented graphically. The results further show that when vehicles are equipped with front brakes or four-wheel brakes, the probability of a yaw induced rollover is almost entirely eliminated. Furthermore, the parametric charts provided may be used as an aid in developing guidelines for golf car and PTV path design if rear brake vehicles are used.

Golf ball-related head injuries in children

Golf has become one of the most popular sports in the world. Golf-related head injuries are well-documented and include golf club, golf cart, and more recently golf ball trauma. We report on 2 cases of golf ball-associated traumatic brain injuries. The unique biomechanics of golf ball head trauma are reviewed. Initially golf injuries may cause minor clinical signs, with absence of skull fractures. However, the association of significant underlying intracranial hemorrhage should prompt a thorough neurologic evaluation.

Incidence of golf cart-related injury in the United States

BACKGROUND

Golf carts have become a popular mode of transportation off of the links because of their small size, low maintenance, and ease of use. Case reports suggest severe, debilitating injuries as a consequence of golf cart incidents. To date, there has been no national population-based study of golf cart- related injuries.

METHODS

The National Electronic Injury Surveillance System identified individuals who visited participating emergency departments from January 1, 2002 to December 31, 2005 for injuries sustained as a result of golf carts.

RESULTS

An estimated 48,255 (95% confidence interval, 35,342-61,108) golf cart-related injuries occurred in the U.S. between 2002 and 2005; the injury rate was 4.14 of 100,000 population. The highest injury rates were observed in 10 to 19 year olds and those aged 80 and older. Male patients had a higher injury rate than female patients, and whites had a higher rate than blacks or Asians. Contusions/abrasions were the most common diagnosis for the hip and lower extremity region; fractures were the most common diagnosis for shoulder and upper extremity region; and intracranial injuries, including concussions, subdural hematomas, and hemorrhage, were the most common diagnosis for head and neck region. The two most common geographic settings of injuries were sports fields such as golf courses (45.0%) and places of residence (16.0%).

CONCLUSION

The popularity of golf carts as a means of transportation calls for mandatory safety standards to be met along with implementation of available safety courses for children who will potentially be operating these vehicles.

Golf cart-related injuries in the U.S

BACKGROUND

Golf carts today are used in a variety of public and private settings. Injuries related to golf carts are an important and increasing problem for people of all ages. This study analyzes trends and potential causes of nonfatal golf cart-related injury on a national level.

METHODS

The National Electronic Injury Surveillance System database was used to examine all cases of nonfatal golf cart-related injury treated in U.S. emergency departments (EDs) from 1990 to 2006. Analysis was conducted in 2007.

RESULTS

An estimated 147,696 (95% CI=144,404; 150,987) injuries, involving individuals aged 2 months to 96 years, were treated in EDs in the U.S. for golf cart-related injuries during the study period. Injuries to children (aged<16) constituted 31.2% of the cases. The most common type of injury was soft tissue damage (47.7%). Patients required hospitalization in 7.8% of the cases. Falling from a golf cart was the most common cause of injury (38.3%). Of golf cart-related injuries with a reported location, 70.3% occurred at sports facilities, 15.2% occurred on streets or public property, and 14.5% occurred around a home or farm. The number of golf cart-related injuries increased steadily each year, with an increase of 132.3% over the 17-year study period.

CONCLUSIONS

Given the growing capabilities and popularity of golf carts, coupled with the marked increase in golf cart-related injuries observed over the study period (>130%), intensified efforts are needed to prevent these injuries, especially among children.

Braking hazards of golf cars and low speed vehicles

Research and analysis of braking issues for golf cars and other low speed vehicles (LSVs) are reported in this study. It is shown that many such vehicles only provide braking for their rear wheels, which can lead to a driver losing control during travel on typical steep downgrades. The braking performance of a golf car equipped with brakes on two or four wheels was analyzed to determine the effects of two and four wheel brake designs on braking efficiency and vehicle yaw stability. Besides reducing braking efficiency, it is demonstrated that installing brakes on only the rear wheels can lead to directional instability (fishtailing) and rollover when the rear wheels are braked until skidding occurs. The nonexistence of golf course standards and the inadequacy of golf car and LSV standards are noted and a connection between this and the comparatively high level of accidents with such vehicles is inferred. Based on these results, it is advisable to install brakes on all four wheels of golf cars and LSVs. In addition, new safety standards should be considered to reduce the occurrence of golf car accidents on steep downhill slopes.

Low speed vehicle passenger ejection restraint effectiveness

Current golf carts and LSV's (Low Speed Vehicles) produce a significant number of passenger ejections during sharp turns. These LSV's do not typically possess seatbelts, but do provide outboard bench seat hip restraints that also serve as handholds. However, many current restraint designs appear incapable of preventing passenger ejections due to their low height and inefficient handhold position. Alternative handhold and hip restraint designs may improve passenger safety. Accordingly, this paper examines minimum size requirements for hip restraints to prevent passenger ejection during sharp turns and evaluates the effectiveness of a handhold mounted at the center of the bench seat. In this study, a simulation of a turning cart supplies the dynamic input to a biomechanical model of an adult male seated in a golf cart. Various restraint combinations are considered, both with and without the central handhold, to determine the likelihood of passenger ejection. It is shown that only the largest restraint geometries prevent passenger ejection. Adequate hip restraints should be much larger than current designs and a central handhold should be provided. In this way, golf cart and LSV manufacturers could reduce passenger ejections and improve fleet safety by incorporating recommendations provided herein.

Golf-associated head injury in the pediatric population: a common sports injury

OBJECT

Golf-related injuries constitute a common type of sports injury in the pediatric population. The increase in the frequency of these injuries is largely attributed to the increase in the popularity of golf and greater use of golf carts by children.

METHODS

The purpose of this study was to investigate the mechanisms and complications associated with golf-related injuries in the pediatric population and, by doing so, assist in the prevention of such injuries. We reviewed the charts of 2546 pediatric patients evaluated by the neurosurgery service at the authors' institution over a 6-year period. There were 64 cases of sports-related injuries. Of these, 15 (23%) were golf-related, making these injuries the second-largest group of sports-related injuries. Depressed skull fracture was the most common injury observed. Neurosurgical intervention was required in 33% of the cases. With rare exceptions, patients made good recoveries during a mean follow-up period of 22.2 months. One death occurred due to uncontrollable cerebral edema following a golf cart accident. One child required shunt placement and several revisions following an injury sustained from a golf ball.

CONCLUSIONS

Children should be advised on the proper use of golf equipment as a preventive measure to avoid these injuries. Precautionary guidelines and safety training guidelines should be established. The institution of a legal minimum age required to operate a golf cart should be considered.