All-terrain vehicle riding among youth: how do they fair?

PURPOSE: Pediatric all-terrain vehicle (ATV) injuries have been increasing annually for more than a decade. The objective of this study was to describe the riding behaviors, helmet use, and crash history of young ATV riders. METHODS: A 38 question self-administered survey was distributed to a convenience sample of children at 4 agricultural fairs during 2007. A total of 228 surveys were reviewed. Collected data included demographic information, ATV characteristics, helmet use, driving habits, and crash history. RESULTS: Survey respondents were predominantly male (71%) with an average age of 13.6 +/- 2.0 years. Riding began at a young age (9.2 +/- 3.2 years). Few children reported using age-appropriate sized engines (3% < 90 cm(3)), and 22% of children rode ATVs with engines more than 300 cm(3). Respondents rode primarily for recreation (94%), and more than a third reported riding without a helmet (40%). More than 70% of children reported riding with passengers, 60% without adult supervision, and nearly half (46%) rode after dark. Less than 5% of riders received any formal ATV riding/safety instruction. Of the respondents, 45% reported being involved in an ATV crash. Those children who reported a crash also rode more powerful ATVs, were more often self-taught, and overall reported higher rates of riding with passengers and without supervision, and riding after dark (P < .05). CONCLUSION: Dangerous driving behavior among children who ride ATVs is widespread, and current safety recommendations are largely ignored. Renewed efforts are needed to improve safety programs and create policy measures that prevent pediatric ATV crash-related injuries.

Pediatrician attitudes, knowledge, and practice behavior regarding teen driving safety.

PROBLEM: Each year about 4,000 teens ages 16-19 die on U.S. roads. Injury prevention counseling is recommended as a valuable and cost-effective part of routine health supervision. This study describes pediatrician knowledge and practice regarding teen driving safety. METHODS: A 31-item self-administered survey was mailed to pediatricians. RESULTS: 160 of 392 pediatricians (41%) completed the survey. During a health supervision visit 93% of pediatricians reported discussing seat belt use, 89% impaired driving, 54% teen licensing laws, and 16% parent teen contract. Half reported having a teen in their practice killed in a crash. CONCLUSIONS: A majority surveyed report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduated driver licensing laws or related issues. IMPACT ON INDUSTRY: Broadly adopted, this inexpensive counseling approach, could lead to reductions in teen motorvehicle crash injuries.

Laparoscopic excision of a familial paraganglioma.

Pheochromocytomas are rare neuroendocrine tumors that secrete catecholamines and usually arise from the adrenal medulla. Catecholamine-producing tumors that arise from extra-adrenal chromaffin tissue are referred to as paragangliomas, or extra-adrenal pheochromocytomas. Contrary to the traditional "Rule of Tens," as many as 25% of pheochromocytomas occur in hereditary tumor syndromes, such as multiple endocrine neoplasia-2, von Hippel-Lindau disease, neurofibromatosis-1, or hereditary or familial paraganglioma syndrome. Surgical resection remains the only curative therapy for pheochromocytomas, and advances in minimally invasive techniques have shown laparoscopic adrenalectomy to be safe and effective. Paragangliomas are extremely rare tumors, especially in children, and the role of laparoscopy in their treatment is evolving. This case report and the accompanying video demonstrate that the laparoscopic approach to retroperitoneal paraganglioma resection provides excellent exposure of the tumor and surrounding structures. Given proper patient preparation and perioperative monitoring, laparoscopic exploration and resection of paragangliomas can be safely and successfully accomplished in children. In addition, genetic analysis should be considered for all patients presenting with these tumors.