Characteristics of Emerging Road and Trail Users and Their Safety

Other Hospital-Based Sources of Data

Literally hundreds of studies in the published literature deal with skateboard and skating injuries, and a rapidly growing body of literature addresses nonmotorized and motorized scooter injuries; a few specialized studies consider bike trailers, golf carts, and racing wheelchairs. The primary source of data for these studies has been hospital ED data-either individual case series from a single hospital, or local or regional trauma registry data. Studies have involved both retrospective examination of ED records and prospective case identification, and have most often targeted a single user category (e.g., inline skate injuries in children). In addition to studies conducted here in the United States, a significant number of studies have been conducted in Australia, Great Britain, and the Scandinavian countries.

While much can be learned from these studies, they generally do not represent viable data sources for further study. The data are typically not publicly available, and often involve some level of specialized data collection. They are also relatively small-scale studies that may not be generalizable to larger populations.

An exception would be studies based on data from a population-based trauma registry, such as a State, regional (multihospital), or national registry. Trauma registries most often capture information on hospitalized patients, but in some cases collect information on those treated in the ED, as well. An example of a large, publicly available trauma registry database is the National Trauma Data Bank (NTDB), established by the American College of Surgeons in 1997 (with data extending back to 1994). As of 2001, the NTDB contained data from four State registries and from 67 hospitals in 29 States, representing all regions of the United States. Still, overall case numbers were relatively small, at slightly more than 181,000 cases (1994-1999 data).⁽²⁴⁾  Another example of a national trauma registry is the National Pediatric Trauma Registry, a voluntary system of reporting of pediatric trauma patients ages 0 to 19 years that was operational until February 2002. Although no new data are being added to the system, researchers can still access the available data, including a total of more than 43,000 submitted cases from 1994-2001.⁽²⁵⁾

A major disadvantage of trauma registry and most other routinely collected hospital-based data is that it is not sufficiently detailed with respect to the cause of injury, and in particular the involvement of specific equipment such as inline skates, scooters, and motorized wheelchairs. Most rely on standardized E-Codes for coding the cause of injury. But while E-Codes differentiate among pedestrians and bicyclists being struck by motor vehicles on and off public roadways, they do not identify the specific equipment being used at the time, or the specific location of the user if not in the roadway. Neither is it possible to obtain this information through special follow-up studies because the identity of subjects is generally stripped from the files. Thus, existing hospital-based data sources would appear to be of limited usefulness for studying the safety characteristics of emerging road and trail users.

Such limitations could, of course, be overcome by implementing a hospital-based data collection system specifically designed to gather information on the safety of the various user groups of interest. One could also attempt to modify a data collection system or trauma registry already in place. Both are likely to be costly undertakings, especially in light of the large number of hospitals that would need to participate to generate a sufficient number of cases with respect to the "rarer" user groups, including adult tricycles, tandem bicycles, and racing wheelchairs.

^24.  American College of Surgeons. National Trauma Data Bank Report 2001. Chicago, IL: American College of Surgeons, 2001. www.facs.org/ntdbreport2001/summary.html.

^25.  National Pediatric Trauma Registry. Characteristics and Technical Highlights. Boston, MA: Tufts-New England Medical Center. www.nptr.org.