Newswise — Nicolas Hillman's (Los Angeles, Calif.) mother describes her 18-year-old son as someone with "amazing agility" who skateboarded and played roller hockey for more than 10 years without experiencing anything more than a scraped knee. That's why she wasn't prepared for what she saw in Cedars-Sinai Medical Center's intensive care unit in late August, 2004.
"My heart stopped," Mrs. Mei Ling Hoo recalls of that early Sunday morning. Half of Nicolas' long hair had been shaved off and "something was coming out of his head that looked like an antenna." He was conscious but was lethargic and not acting like himself.
Nick remembers only some of that Sunday morning. "I was riding down a steep hill on a skateboard that I had borrowed from someone at the park. All of a sudden, I began losing control of the board and I started swerving and wobbling. I'm not sure what happened but the next thing I remember I woke up in the emergency room."
Ali H. Mesiwala, M.D., a neurosurgeon at Cedars-Sinai's Maxine Dunitz Neurosurgical Institute, was called to examine Nick, who was not wearing a helmet when he was injured. A CT scan showed Nick had a left-sided skull fracture and a very thin epidural hematoma. "Nothing emergently surgical to worry about at the time," Dr. Mesiwala said, but his conditioned worsened over the next 12 hours.
Nick was transferred from the emergency room to the intensive care unit and during the next 12 hours he became more and more lethargic. A second CT scan showed that the hematoma had expanded significantly and was causing massive pressure on his brain. Nick was immediately scheduled for surgery where Dr. Mesiwala removed the blood clot, sealed off the blood vessel that was bleeding, and repaired Nick's skull fracture.
"Injuries like Nick's are becoming significantly more common as kids become more aggressive in what they can do on a skateboard," says Dr. Mesiwala. "The technology has advanced and that's allowing them to do things they couldn't do before."
According to the American Academy of Orthopaedic Surgeons, each year in the U.S. skateboarding injuries cause about 50, 000 visits to emergency departments. More than 1,500 children and adolescents need to be hospitalized. Most of the hospitalizations involve head injuries. Some heal quickly and others lead to disabilities including loss of vision, hearing and speech and changes in thinking and behavior. Some injuries lead to death: in most of those cases the rider was not wearing a helmet
Properly-fitting helmets are the best defense against serious head injuries. The National Safety Council warns that not all helmets are created equal and picking the right helmet for a sport is important. The Bicycle Helmet Safety Institute suggests buying a brand and size that fits well prior to adjustments, and then using the adjustable straps and/or sizing pads to ensure a snug fit. It also recommends that parents select a helmet that fits their child now, not a helmet to "grow into."
Realizing that it can be difficult to impress on teens the importance of wearing a helmet, Dr. Mesiwala contacted someone he knew whom Nicolas and his friends admired ?internationally-renowned champion skateboarder Tony Hawk. Hawk said, "I wear helmets for protection after being knocked unconscious more than six times in my career. You never know what can happen, especially when you're starting out. I could have easily died without one."
Nick only rides his skateboard short distances now and wears a helmet. He's doing physical and speech therapy while he recuperates.
The American Academy of Pediatrics' guidelines for skateboarding recommend that kids under 10 shouldn't use skateboards without supervision and children under five should not use boards at all. .
Skateboarding is a special risk for young children because they have a higher center of gravity and poor balance. These factors make children more likely to fall and injure their heads.
Protective gear, such as closed, slip-resistant shoes, helmets, and specially designed padding, may not fully protect skateboarder from fractures, but the National Safety Council recommends its use to reduce the number and severity of injuries. The Council gives these tips for safe skateboarding:
1. Never ride in the street. 2. Don't take chances. Complicated tricks require careful practice and a specially designed area. Only one person per skateboard. Never hitch a ride from a car, bus, truck, bicycle, etc.3. Learning how to fall in case of an accident may help reduce your chances of being seriously injured. If you are losing your balance, crouch down on the skateboard so that you will not have so far to fall. In a fall, try to land on the fleshy parts of your body. If you fall, try to roll rather than absorb the force with your arms. Even though it may be difficult, during a fall try to relax your body rather than stiffen.
"The bottom line," says Dr. Mesiwala, "is that it's great that people are going out and enjoying activities such as skateboarding. They can have fun doing them but everyone needs to stop and take a moment to realize that professionals do these sports every day and even they wear helmets. Anytime you're going to participate in sports activities you need to do things that maximize your ability to have fun again and again. With today's affordable and fashionable helmets, there's no excuse for not taking 30 seconds to put one on."
One of only four hospitals in California whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the western United States. For 17 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and was recently fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP). Additional information is available at http://www.cedars-sinai.edu.
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