Neurological injuries from car surfing

Clinical article

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Trauma secondary to car surfing is a unique mechanism of head and spinal injury in children and adolescents. In this study, the authors present their experience with neurological injuries resulting from car surfing and describe the growing national trend of car-surfing injuries and the increasing portrayal of this activity in the media.


A retrospective study of the Rainbow Babies and Children's Hospital trauma database was conducted to identify all cases of neurological injuries secondary to car surfing. Between January 1995 and December 2008, 7 patients ≤ 16 years of age, including 6 boys and 1 girl, were identified. The charts of these patients were reviewed. National data on car-surfing fatalities over the same time period in children and adolescents 10–20 years of age were obtained from the National Highway Traffic Safety Administration, and these data were analyzed for national trends in car-surfing fatalities.


All 7 children with injuries due to car surfing suffered traumatic head injuries. Three patients fell from the back of the moving vehicle, 2 fell from the hood, 1 fell from the side of the vehicle, and 1 patient sustained head injuries after intentionally jumping off the moving vehicle. All 7 children suffered intracranial bleeding, and 4 had associated skull fractures. One patient underwent craniotomy to evacuate an acute subdural hematoma. The other 6 patients required nonoperative treatment. Four patients had permanent neurological problems. National statistics have shown a steady rise in car-surfing fatality rates since 2000, especially in California, Florida, and Texas.


Car surfing is an unusual but serious mechanism of neurological injury in children and adolescents. Despite its dangers, car surfing is becoming a more common pastime in the pediatric population. National statistics have shown a steady rise in car-surfing fatalities since 2000. This national rise in fatalities chronologically overlaps with the introduction of media depictions of the activity since 1995. Increased awareness of the dangers of car surfing may help prevent future head injuries.

Abbreviations used in this paper: ATV = all-terrain vehicle; FARS = Fatality Analysis Reporting System; GCS = Glasgow Coma Scale; MVC = motor vehicle collision; SDH = subdural hematoma.

Article Information

Address correspondence to: Shenandoah Robinson, M.D., Pediatric Neurological Surgery, Room B501, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, Ohio 44106.

© AANS, except where prohibited by US copyright law.



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    Computed tomography scan obtained in a car surfer who fell off the exterior of a moving car, struck his head, and suffered a loss of consciousness and amnesia. He had a left occipital scalp laceration with an underlying subgaleal hematoma (long arrow), and a right frontal contrecoup contusion (arrowhead) and acute SDH (short arrows). The acute SDH required emergency evacuation via craniotomy due to the patient's neurological decline within 2 hours of injury.

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    Bar graph showing the distribution by state of car-surfing fatalities per 100,000 children and adolescents aged 10–20 years between 1998 and 2006. States are listed in order of declining state population.

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    Bar graph demonstrating the yearly trend of cumulative carsurfing fatalities in California, Florida, and Texas between 1998 and 2006 in children and adolescents ≤ 21 years of age.

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    Bar graph showing the yearly trend of cumulative car-surfing fatalities in California, Florida, and Texas correlating with the year of introduction of various media depictions of car surfing. Shown are Grand Theft Auto (A), Grand Theft Auto 2 (B), Grand Theft Auto III (C), Jackass: The Movie and Grand Theft Auto: Vice City (D), and YouTube and Grand Theft Auto: San Andreas (E). Jackass the TV series spanned the period between 2000 and 2002. Stars above particular years represent individual patients injured that year in the present series.


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