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

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.

Golf-related injuries treated in United States emergency departments

OBJECTIVE

This study investigates unintentional non-fatal golf-related injuries in the US using a nationally representative database.

METHODS

This study analyzed golf-related injuries treated in US hospital emergency departments from 1990 through 2011 using the National Electronic Injury Surveillance System database. Injury rates were calculated using golf participation data.

RESULTS

During 1990 through 2011, an estimated 663,471 (95% CI: 496,370-830,573) individuals ≥7years old were treated in US emergency departments for golf-related injuries, averaging 30,158 annually or 12.3 individuals per 10,000 golf participants. Patients 18-54years old accounted for 42.2% of injuries, but injury rates per 10,000 golf participants were highest among individuals 7-17years old (22.1) and ≥55years old (21.8) compared with 18-54years old (7.6). Patients ≥55years old had a hospital admission rate that was 5.01 (95% CI: 4.12-6.09) times higher than that of younger patients. Injured by a golf club (23.4%) or struck by a golf ball (16.0%) were the most common specified mechanisms of injury. The head/neck was the most frequently injured body region (36.2%), and sprain/strain (30.6%) was the most common type of injury. Most patients were treated and released (93.7%) and 5.9% required hospitalization.

CONCLUSIONS

Although golf is a source of injury among all age groups, the frequency and rate of injury were higher at the two ends of the age spectrum. Given the higher injury and hospital admission rates of patients ≥55years, this age group merits the special attention of additional research and injury prevention efforts.

The relationships between golf and health: a scoping review

OBJECTIVE

To assess the relationships between golf and health.

DESIGN

Scoping review.

DATA SOURCES

Published and unpublished reports of any age or language, identified by searching electronic databases, platforms, reference lists, websites and from consulting experts.

REVIEW METHODS

A 3-step search strategy identified relevant published primary and secondary studies as well as grey literature. Identified studies were screened for final inclusion. Data were extracted using a standardised tool, to form (1) a descriptive analysis and (2) a thematic summary.

RESULTS AND DISCUSSION

4944 records were identified with an initial search. 301 studies met criteria for the scoping review. Golf can provide moderate intensity physical activity and is associated with physical health benefits that include improved cardiovascular, respiratory and metabolic profiles, and improved wellness. There is limited evidence related to golf and mental health. The incidence of golfing injury is moderate, with back injuries the most frequent. Accidental head injuries are rare, but can have serious consequences.

CONCLUSIONS

Practitioners and policymakers can be encouraged to support more people to play golf, due to associated improved physical health and mental well-being, and a potential contribution to increased life expectancy. Injuries and illnesses associated with golf have been identified, and risk reduction strategies are warranted. Further research priorities include systematic reviews to further explore the cause and effect nature of the relationships described. Research characterising golf's contribution to muscular strengthening, balance and falls prevention as well as further assessing the associations and effects between golf and mental health are also indicated.

A cracking shot! depressed skull fracture sustained from a golf ball in a 16-year old

Depressed skull fractures sustained from golf balls are quite rare. We report such a case in a 16-year old, and demonstrate its appearance in a 3D CT reconstruction.

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.

Golf club related basal skull fracture: a case study

Basal skull fractures, although rare, do occur and a high index of suspicion for high velocity injuries, should be at the forefront of the clinicians mind, particularly those from a golf club. Head injury in children is a common presentation to any Paediatric Emergency Department. With effective examination skills, recognition of signs of basal skull fracture such as haemotympanum, even in the absence of altered neurological findings, ensures safe and effective practice enabling correct and justifiable clinical decisions to be made. This is vital to ensure not only the correct investigative procedure is requested and performed, but also on discussion with the appropriate specialists, the correct treatment is also prescribed. This case study examines the use of computed tomography in the diagnosis of basal skull fractures and highlights further discussion into the appropriate treatment of children diagnosed with basal skull fractures.

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.

The "swing-ding": a golf-related head injury in children

OBJECT

In recent years there has been an increased incidence of golf-associated head injuries in children and adolescents. At the authors' institution, they have identified a unique pattern of head injury associated with a swinging golf club. In this study, the authors highlight the mechanism of this injury and report their experience treating it.

METHODS

The authors reviewed the database of Rainbow Babies and Children's Hospital Trauma Center and performed a retrospective analysis of golf injuries recorded over a 10-year period (January 2000-April 2010). They identified 13 children (9 boys and 4 girls) who sustained head injuries in golfing accidents. All patients were 10 years of age or younger. The medical charts were reviewed and follow-up interviews were conducted to better delineate the details of the injuries.

RESULTS

Injuries included 13 depressed skull fractures, 7 epidural hematomas, and 1 cerebral contusion. All 13 patients sustained their injuries after being struck in the head by a golf club. Seven sustained injuries on the follow-through of the initial swing and 3 sustained injuries on the backswing. All but one patient required neurosurgical intervention. Five patients developed neurological sequelae. None of the children had prior experience with golf equipment. All but one injury occurred in the child's own backyard. There was no direct supervision by an adult in any of the cases.

CONCLUSIONS

Golfing can lead to serious head injuries in children. The authors noticed a unique pattern of golf-related head injuries, previously not described, that they have termed the "swing-ding." This golf club-inflicted injury occurs when a child stands too close to a swinging golfer and is struck in the head, subsequently sustaining a comminuted depressed skull fracture in the frontal or temporal region, with or without further intracranial injury. The study suggests that a lack of adult supervision, minimal previous golf experience, and proximity of the child to the swinging golfer are all implicated in this head injury pattern.

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.

Pediatric golf-related head injuries

OBJECTIVES

Golf-related head injuries constitute an increasingly common mechanism of head trauma in children. We present our experience with 33 pediatric cases of golf-associated head injury, with special emphasis in the type of injury, management strategy, and outcome.

MATERIALS AND METHODS

A thorough review of all children admitted to our hospital with golf-related head injury during a period of 10 years (1 January 1994 to 31 December 2003) was undertaken. The patients' charts, operative reports, imaging studies, and follow-up data were analyzed. A comparison of our findings with those described in the pertinent literature was subsequently performed.

CONCLUSIONS

Pediatric golf-related head trauma is a significant cause of sport-associated head injury, sometimes harboring a very dismal prognosis. The significance of establishing a task force for the prevention of these injuries cannot be overemphasized.