On the backseat: Analyzing motorcycle passenger injuries in children

Introduction: Despite the high risk of fatality from traveling in a motorcycle compared to motor vehicles, only five states have an age limit for motorcycle passengers. Literature is profoundly lacking on injury patterns of motorcycle passengers, particularly children. We studied injury patterns and helmet use for motorcycle passengers in children <18 years old in the US. Methods: A 4-year retrospective cohort analysis of the ACS-TQIP for the years 2017–2020. All pediatric (age <18 years) trauma patients injured as motorcycle passengers were identified. Patients were stratified into two groups - preschool and kindergarten (Age 3–6 ​yrs [PK]), and school (Age 7–17 ​yrs [S]). Body region injuries were identified using region-specific AIS severity scores (AIS ≥1). Primary outcomes were injury patterns and TBI between the groups and how helmet utilization affected these injury patterns. We used the independent samples t-test and Mann-Whitney U test to analyze differences between continuous normally distributed variables and skewed variables, respectively. Results: We identified a total of 836 patients who were injured as passengers on a motorcycle (PK – 128, S – 708) across over 875 institutions. Overall, the mean (SD) age was 12 (4) years, and 57 ​% were male. The median ISS of both groups was 5. Helmet use was more common among school children compared to preschool and kindergarten group (S 40 ​% vs PK 18 ​%, p ​< ​0.001). Preschool and kindergarten children sustained higher rates of head injuries (PK 66 ​% vs S 52 ​%, p ​= ​0.002), whereas school children sustained higher rates of injuries to the chest (S 25 ​% vs PK 16 ​%, p ​= ​0.020), abdomen (S 23 ​% vs PK 15 ​%, p ​= ​0.033), extremities (S 77 ​% vs PK 63 ​%, p ​= ​0.001), and fractures (S 30 ​% vs PK 11 ​%, p ​< ​0.001). Helmeted children had lower rates of head injuries compared to non-helmeted children (48 ​% vs 58 ​%, p ​= ​0.009). Preschool and kindergarten children were more likely to be managed at ACS-verified level I/II pediatric trauma centers (PK 49 ​% vs S 39 ​%, p ​= ​0.035). There were no significant differences in terms of mortality between both groups (S 3.8 ​% vs PK 2.3 ​%, p ​= ​0.411). Conclusion: Younger children had higher rates of head injuries and lower helmet use compared to older children. While mortality was similar between groups, helmet use was linked to fewer head injuries across all ages.