Advancing emergency nursing practice in pediatric traumatic brain injury: Neuroprotection and helmet advocacy

Background: Recent institutional data reveal a rising incidence of pediatric injuries associated with recreational motorized vehicles, including all-terrain vehicles (ATVs), dirt bikes, motor bikes, snowmobiles and e-scooters. Increased household income and the widespread availability of higher-powered machines have expanded pediatric exposure and injury risk over recent decades. These trends underscore the need for targeted injury prevention strategies, public health education and policy initiatives. Concurrently, the increasing prevalence of traumatic brain injury (TBI) necessitates a strong clinical focus on the early recognition and management of TBI and elevated intracranial pressure (ICP) in children. At the conclusion of this 60 min presentation, participants will be able to: 1. Synthesize current evidence linking ATV-related trauma, shock and major injuries in pediatric patients. 2. Analyze pediatric developmental anatomy, physiology and intracranial dynamics as they relate to traumatic Brain Injury (TBI) guiding evidence-based assessment, early monitoring and management. 3. Advance emergency nursing advocacy and clinical excellence by promoting helmet use in children under 18 and applying evidence-based best practice in pediatric brain injury care. Methods: We retrospectively reviewed the trauma registry data at our hospital (Dec 2019–Jun 2023). This included 345 paediatric trauma patients (<18 years old) with severe injuries (defined as injury severity scores ISS >12). The number of recreational vehicle traumas were reviewed (defined as ATV, dirt bike /motorbike, snowmobiles and e scooters) with a multi-variant analysis looking at demographics and healthcare resources. Results: Blunt trauma accounted for 93.9% of pediatric major trauma, with recreational motorized injuries comprising 16% (17% of blunt trauma). Of these, 58% involved ATVs, 23.6% motor/dirt bikes, 14.5% snowmobiles, and 3.6% e-scooters. Most patients (72.7%) were male, with a mean age of 13.1 (SD 2.9); median 13.5 [IQR 12–15]; mode 15. ISS scores had a mean (SD) of 21.0 (8.6), median [IQR] 17 [14.5–24.8], and mode 17. Surgical intervention was common: 58.2% required one or more procedures, 18.2% underwent damage control surgery, and 22% of these were emergency neurosurgical cases. PICU admission was required in 30.9%. Helmet use was documented in only 40% of cases, while alcohol was a factor in 10%. Rural postcodes accounted for 43.6% of accidents. Locations included public roads (9.1%), off-road (32.7%), and tracks (12.7%), with 45.5% undocumented. Most children (70.9%) were vehicle operators at the time of injury. Injuries peaked between 12:00–18:00 (49.1%), followed by 18:00–00:00 (32.6%); only 7.3% occurred overnight or in the morning. Implications and lessons learned: Multisystem trauma resulting from recreational motorized vehicle use has devastating consequences for children, particularly when traumatic brain injury is involved. Current regulations, including age restrictions and safety equipment requirements, and inconsistent legislation remain insufficient to adequately protect Canadian Children. These injuries frequently result in prolonged intensive care admissions and multiple surgical interventions, placing substantial financial and resource burdens on healthcare systems. Emergency nurses are pivotal in the early identification and management of pediatric head injury and in advancing injury prevention through interprofessional collaboration and patient and family education on helmet efficacy.