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Discussion |
The spectrum of head injuries resulting from these accidents ranges
from relatively minor to very severe and life threatening. There are
no other series in the literature dealing with recreational ute
surfing as a cause of head injury. One series which looked at
"car-surfing" (riding on a vehicle's bonnet, roof or boot) in Iowa
revealed a similar spectrum of injuries to those in our patients, with
a preponderance of severe head injuries.1 Other series have looked at
mortality from the use of these vehicles in a transport role, but have
not detailed the incidence of head injury.2,3
Some comparisons might be drawn from overseas studies looking at the
outcome of accidents in all-terrain vehicles (ATVs) -- open
vehicles, some without the protection of even a roll cage, in which
occupants are similarly exposed to direct contact with the ground
should they be ejected. Accidents in these vehicles show a permanent
disability rate of up to 10%,4 and one study found that the
mortality rate was nearly double in ATVs compared with conventional
cars.5 This illustrates the danger
of travelling in such vehicles without restraints.
Motor vehicle accidents are one of the two most common causes of severe
unintentional head injuries;6 such accidents
predominantly involve males. Australia has the 14th-highest
age-standardised mortality from motor vehicle accidents for males
in the world.7 Although the overall death
rate from MVAs has been declining since the mid 1970s, partly as a
result of better motor vehicle design, improved restraint use, and
legislation to limit the legal blood alcohol limit for drivers, there
is still concern at the high proportion of deaths and severe traumatic
brain injuries occurring among young men (the death rate per 100 000
for men aged 15-34 years in 1980 was about 60, versus 35 for all males and
12 for females).7
Many studies have shown the value of passenger restraints in
protecting occupants of vehicles involved in accidents.8-10 One showed
that the rate of severe injury was four times higher in unrestrained
passengers compared with restrained passengers, and a similar
difference in the number of facial and head injuries.8 Another study,
using a cohort of patients presenting to the emergency department
before and after the enactment of seatbelt legislation, was able to
show a reduction in major injuries of more than 50%, and a similar
reduction in total treatment costs, among restrained vehicle
occupants.9
The sequelae of head injury are well known. Three of our four patients
required ongoing rehabilitation, and it is doubtful that any will
ever fully recover from their brain injuries. This represents a
significant cost, both personally and to the community. Even
patients with a near-normal neurological outcome will often have
ongoing psychosocial problems.11 Studies have found
diminished ability with cognitive tasks and a disturbingly high
incidence of psychiatric diagnoses after even mild head injuries
sustained in motor vehicle accidents.12-14 One such study found a
trend to poor frontal lobe function in unrestrained compared with
restrained motor vehicle accident victims, after controlling for
Glasgow Coma Score.14
Alcohol consumption is frequently implicated in motor vehicle
accidents,15 and is also often
associated with a variety of other risk-taking behaviours,
including travelling unrestrained.16 At least two of our
patients had consumed some alcohol and all had ridden as unrestrained
passengers on the back of a utility-type vehicle.
Our four cases illustrate the risks of serious neurological sequelae
associated with riding unrestrained in an open load space on a utility
vehicle. As ute surfing is not likely to be a recreation confined to our
referral area, a public education campaign might be warranted to try
to reduce the incidence of these preventable injuries.
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|
John Hunter Hospital, Newcastle, NSW.
Rodney S Allan, BSc(Med), MB BS, Neurosurgery Registrar;
Peter J Spittaler, MB BS, FRACS, Neurosurgeon;
John G
Christie, MB BS, FRACS, Neurosurgeon.
Reprints will not be available from the authors.
Correspondence: Dr R
S Allan, 90/80-93 Dalmeny Avenue, Rosebery, NSW 2018.
rodneyATnetexcel.net.au
©MJA 1999
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© 1999 Medical Journal of Australia.
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|
| | Circumstances, computed tomography (CT) scans, interventions and outcomes in four young men who sustained serious head injuries in "ute surfing" accidents
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|
Patient 1
Age: 27 years.
Circumstances: Travelling at over 60km/h.
Blood alcohol level (% w:v): 0.10 initially.
Other drugs: Unknown.
Initial Glasgow Coma Score: 13.
Initial CT findings: Bifrontal and right temporal contusions.
Interventions: Outpatient rehabilitation.
Outcome: Yet to resume employment; anosmic.
|  Initial scan of patient 1, showing
extensive subfrontal contusions. |
|
| Patient 2
Age: 26 years.
Circumstances: Travelling at over 30km/h.
Blood alcohol level (% w:v): Unknown.
Other drugs: Unknown.
Initial Glasgow Coma Score: 14 (unconscious for five minutes).
Initial CT findings: Right temporoparietal extradural haematoma.
Interventions: Craniotomy and drainage.
Outcome: Good - resumed employment one month later.
|  Intial scan of patient 2, showing
large right-sided extradural haematoma. |
|
|
Patient 3
Age: 19 years.
Circumstances: Shooting rabbits from load tray.
Blood alcohol level (% w:v): 0.12 initially
Other drugs: Cannabis possibly involved.
Initial Glasgow Coma Score: 8.
Initial CT findings: Linear occipital fracture, subfrontal contusions.
Interventions: Treatment in the intensive care unit for 2 days, inpatient rehabilitation for several weeks.
Outcome: Post-traumatic amnesia for 7 days, had still not resumed studies at six months; anosmic. |  Intial scan of patient 3, showing
"contra coup" frontal contusions. |
|
| Patient 4
Age: 18 years.
Circumstances: Travelling at over 80km/h.
Blood alcohol level (% w:v): Unknown.
Other drugs: Unknown.
Initial Glasgow Coma Score: 5.
Initial CT findings: Signs of intracranial hypertension.
Interventions: Initial intracranial pressure monitoring - then decompressive craniectomy for intractable intracranial hypertension.
Outcome: 60 days' post-traumatic amnesia - returned to work in reduced capacity at 6 months.
|  Progress scan of patient 4, showing
craniectomy defect with brian herniation evident.
|
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