METHODS

This prospective study was based at the accident and emergency department of North Tees University Teaching Hospital in the North East of England. This department serves mostly an urban population with a small rural percentage. The study was from January until June 2001. All MS related accidents were documented, but only accidents involving children (less than 16 years) were analysed in the study. At the beginning of the study, all personnel in the department were informed of the study and the nature of data to collect. Data were collated by a combination of methods. Information gathered included age, sex, place of incident, the model of the MS (if known), and use of protective clothing. This was performed by a brief interview by Department of Trade and Industry (DTI) accident clerks. Further information was gathered from the accident and emergency notes for mechanism and nature of injuries, outcome and the use of imaging. Radiology reports were examined to confirm the presence of fractures. Place of accident were classed either as home (driveways), or public place such as roads, pavements, or public recreational areas (parks). Injury severity score was calculated for each child.

RESULTS

For the study period (January to June 2001) 92 children were seen with MS related injuries with a total of 104 injuries. There were 52 boys and 40 girls. These constitute about 1.53% of our paediatric attendance for the study period. The mean (SD) age being 9.36 (2.73) years with a range of 3 to 15 years. There were eight adults (over 17 years) with MS related injuries, these were not included in the analysis. The male:female ratio was1.3:1 and 51% of our patients were over age 10 years.

Of the 104 injuries, 21 were fractures, and the other 83 were soft tissue injuries. The mean injury severity score (ISS) and SD for soft tissue injuries was 1.54 (1.50) with a range of 1 to 4 and for fractures, mean ISS (SD) was 4.1 (3.58) these figures were skewed by a single displaced forearm fracture of both radius and ulna. The median ISS for fractures was 4. The combined ISS (SD) for all injuries was 2.08 (2.31) with a range of 1 to 18. The anatomical distribution of injuries are shown in tables 1 and 2.

Soft tissue injuries predominate. The commonest injuries were of the upper limb especially around the wrist. Sprains and fractures around the wrist constitutes almost 27% (28 of 104) of all injuries. These were followed by facial lacerations. All head injuries seen were minor in nature.

DISCUSSION

Presently, very little has been published on injuries related to MS. This is because the MS is a recent introduction to the list of recreational toys/devices (although the manufacturers deem the MS as a means of travel and not a toy). The MS shares a few features that are similar to the roller blades and in-line skates particularly that they are self propelled, narrow based with low friction wheels, and possibly similar in speed generated on the flat. The MS has a rudimentary braking system and differs in possessing a steering mechanism.

Much has been published regarding injuries sustained by in-line skaters and roller bladers.^5–9 The pattern of injuries sustained from MS accidents in this study are quite similar to those sustained by children from in-line skating and roller blading despite the scooter possessing a steering mechanism.^5–9

There is a predominance of sprain injuries particularly of the wrist. The commonest fractures also involved the wrist. The most frequent mechanism of injury was attributable to loss of control of the MS and a fall onto outstretched arms.

Almost all accidents occurred in public places, especially on pavements with few accidents occurring in patients' own driveways. All injuries occurred in children using the scooter and none involved a non-rider despite most accidents being in public places. This differs somewhat from roller blading accidents where the public have been injured.⁸ The difference may be attributable to the ability to steer the MS.

Reported injuries so far have been mostly of low severity. No deaths occurred over the study period. One of our patients required inpatient care for fracture manipulation under anaesthesia, while two patients with fractured teeth required maxillofacial follow up. Most other injuries required simple intervention for wound care and fracture immobilisation. In the USA, legislation to compel riders of MS to wear protective clothing—helmets, pads, and wrist guards—has been suggested.³ None of our patients wore any protective clothing. This is in total breach of the manufacturers' advice. Unlike in roller blading, there are no specific clothing designed for users of MS. Retailers do not particularly promote the use of protective clothing with MS. It is also possible that parents lack the appreciation of the potential speed that can be achieved by MS, particularly on slopes and the possibilities for injuries. Wrist guards have been shown to increase the threshold for fractures of the forearm and wrists in falls onto outstretched arms.¹⁰ All people involved in the sale of the MS should encourage parents and their children on the use of protective clothing to reduce injuries associated with MS accidents.

In conclusion, this study shows MS related injuries are on the increase. Currently, the need for protective gear as advised by the manufacturers is being ignored. So far injuries have been mostly of low severity. This may change, as children become more adventurous with the activities performed with the MS. Parents and riders should be educated on the potential injuries associated with the MS and take similar precautions to those used by the cyclists.