Saturday, April 13, 2019

Roller coaster morbidity


Nam CBY, Pablo AS, Elena SV (2018) Non-Fatal Injuries Associated with Riding Roller Coaster. J Emerg Trauma Care Vol.3 No.3:1.

Abstract
The deaths related to riding roller coaster are insignificant, but there are multiple reports about nonfatal injuries like neurological, cardiovascular, urological, ophthalmological and connective tissue injuries. The most common lesions reported in the literature associated with riding roller coaster are cardiac and brain damage. We conducted a literature review from 1995 to 2017 using the keywords roller coaster and neurological/vascular injuries. We found 21 articles related to neurological injuries and 13 for vascular injuries it was important for the selection that articles clearly describe neurological o vascular clinical cases and the association with riding a roller coaster. Finally, we work only with 9 articles for neurological and 6 for vascular injuries. Some of the cases presented in this review were correlated to pre-existing trauma or aneurysms. With this review is clear that the risk of injury by riding a roller coaster is low, but emergency physicians should know that amusement park rides could be related to inexplicable symptoms associated with extreme conditions in the roller coaster rides.

Tseng P, Kearl YL, Ansari A. Roller Coaster-Induced Subdural Hematoma in a Previously Healthy Teenager. Pediatr Emerg Care. 2019 Apr;35(4):e76-e78.

Abstract
Of the multitude of neurologic injuries related to roller-coaster rides, a majority of them are reported about adults. In this case, we present a patient who presented to the pediatric emergency department with new-onset seizure and hemiplegia 2 days after a roller-coaster ride. She was ultimately diagnosed with a subdural hematoma. The acceleration and G forces of roller coasters are hypothesized to cause enough stress and shearing forces that are thought to directly cause subdural hemorrhage.Advances in roller-coaster technology may surpass the passenger's physical capacity for acceleration and rotary forces, and we may see an increased number of medical complications after these rides. We recommend that emergency and pediatric health care providers consider amusement park thrill rides as a possible cause of subdural hematomas in previously healthy patients with new neurologic complaints.
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In a case study published in April 2019 in Pediatric Emergency Care, physicians at the University of Southern California in Los Angeles described a teenage patient who was diagnosed with subdural hematoma when she presented to the pediatric ED with new-onset seizures and hemiplegia 2 days after riding a roller coaster. “The acceleration and G forces of roller coasters are hypothesized to cause enough stress and shearing forces that are thought to directly cause subdural hemorrhage,” the researchers wrote. “Advances in roller coaster technology may surpass the passenger’s physical capacity for acceleration and rotary forces, and we may see an increased number of medical complications after these rides.” Thus, they recommend that clinicians “consider amusement park thrill rides as a possible cause of subdural hematomas in previously healthy patients with new neurologic complaints.”

Findings from a 2009 study suggest that head motions during roller coaster rides typically confer a very low risk for traumatic brain injury (TBI), and a 2017 study found that brain strain rates during roller coaster rides were similar to those observed during running and lower than those that occur during soccer headers. The researchers in the 2017 study mentioned recently published case reports of brain injuries related to roller coasters:  subdural hematomas, 2 subarachnoid hemorrhages, and multiple concussions. These types of injuries are “thought to be mostly caused by excessive mechanical deformations of the bridging veins causing subdural hematoma, of aneurysms causing subarachnoid hemorrhage, and of the parenchymal brain tissue itself causing concussion,” they explained…

Some cases involved individuals with a pre-existing medical condition that may have made them more susceptible to injury. For example, patients with Chiari I malformation or connective tissue disorders such as Ehlers-Danlos or Marfan syndrome could experience an “exacerbation of symptoms due to whiplash — especially with the head turned since we know that on the football field, rotational acceleration presents a higher risk, even in the absence of a head injury,” Gerald Grant, MD, endowed professor and chief of pediatric neurosurgery at Stanford University Medical Center in California, told Neurology Advisor. “If there is a history of neck strain, roller coaster rides can be problematic since the strain on the neck during the ride is quite extreme, especially with the older roller coasters that have less padding and a less secure harness.”

It should also be noted that, in some case reports, patients had repeated the ride multiple times during the park visit, for instance, 13 times for a patient with macular hemorrhage and 11 times for a patient with subdural hematoma). “Going back on the roller coaster with no break in between can be troubling, since symptoms can be delayed after getting off the ride, and the forces are cumulative over time,” said Dr Grant.

https://www.neurologyadvisor.com/topics/traumatic-brain-injury/a-closer-look-at-long-term-neurologic-injury-risk-due-to-roller-coaster-rides/

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