Medical News Today, 10/15/08 (http://www.medicalnewstoday.com/articles/125499.php)

New research unveiled at TCT 2008 by Dr. Stephen Silberstein (a leading neurologist) suggests that 66 percent of chronic migraine sufferers have abnormal blood flow caused by a hole in their heart or a right-to-left shunt that bypasses the filtration process of the lungs. Most of these defects are known as a PFO, a heart condition prior research shows is found in 25 percent of the population.

New research presented this morning suggests that two-thirds of all chronic migraine sufferers have a hole in their heart or a right-to-left shunt. This leads to abnormal blood flow that bypasses the filtration process within the lungs and may be a significant contributor to chronic headache pain.

Dr. Stephen Silberstein, director of the Jefferson Headache Center at Thomas Jefferson University Hospital and former president of the American Headache Society, presented these research findings this morning at the Transcatheter Cardiovascular Therapeutics scientific symposium in Washington, D.C. TCT is the largest annual gathering in the United States of interventional cardiologists, and Dr. Silberstein’s research was sponsored (in part) via a grant from Coherex Medical.

Dr. Silberstein’s presentation was titled “First Report of Clinical Trial Results: The Prevalence of PFO in Patients with Chronic Migraine.” In the study, 66 percent (86 of 131) of adult chronic migraine sufferers in the statistically valid research effort were found to have an abnormal right-to-left shunt of blood that travels to the left side of the heart without being properly filtered by the lungs. According to Dr. Silberstein, the most common form of RLS heart defects are patent foramen ovales (PFOs), a condition that previous research shows is typically found in 25 percent of all people.

According to Dr. Silberstein, not all PFOs cause clinical problems in patients; however, this new data may indicate that patients who suffer from chronic migraine have a higher prevalence on PFO versus the general population.

“Although the possible connection between PFO heart defects and migraines has been known for awhile, we believe this is the first time such a clear connection can be drawn between those suffering chronic migraines and RLS defects,” Dr. Silberstein said. “Since the vast majority of all RLS defects are PFOs and PFOs are found in roughly 25 percent of the population, we would expect roughly 25 percent of the participants in our study to have an RLS or a PFO – in other words, approximately 33 patients.

“Instead, we found a correlation more than 2.6 times the expected results (86 patients). This is a very significant difference. In other words, it’s highly likely there’s a strong connection between PFO/RLS heart defects and chronic migraines. If our results are borne out in future research, such studies will suggest a fairly simple way to eliminate or reduce chronic migraine pain – close PFO defects.”

Research Study Highlights

In the study directed by Dr. Silberstein and led by Dr. Stephanie Nahas, a team of Thomas Jefferson University Hospital researchers selected 277 consecutive chronic migraine patients at the hospital’s headache center as possible study participants. Of these

• 182 patients agreed to participate in the study,
• 140 entered the study, and
• 131 completed the study.

For the purpose of the study, chronic migraineurs were defined as those patients who experienced a migraine headache at least once every other day for three months or more (with or without “aura”), with each migraine lasting four hours or longer.

Finally, each participant was screened for the possibility of an RLS heart defect via a bubble Transcranial Doppler (TCD) sonographic procedure. In this test, a saline solution was pre-agitated so both the solution and microscopic air bubbles could be injected into each patient. Medical professionals then used the TCD to monitor the flow of blood to the head to see how many (if any) air bubbles streamed into the brain.

According to Silberstein, the study results were quite remarkable. Sixty-six percent of the study participants (86 out of 131) were found to have an abnormal right-to-left blow flow shunt, most likely a PFO heart defect. Additionally, 55 patients were classified as having a moderate to large amount of bubbles streaming into the brain (11-300 bubbles or more than 300 bubbles, respectively).

“We applaud Drs. Silberstein and Nahas and their team for the quality and significance of their research,” said Richard J. Linder, president and CEO of Coherex Medical. “To show such a correlation between chronic migraine headaches and a right-to-left shunt, likely through a PFO heart defect, is of high scientific value and significant news for the more than 100 million chronic migraine sufferers around the world.

“Interestingly enough, Dr. Silberstein’s research also found that migraine with aura was not a predictor of having a right-to-left shunt or PFO in chronic migraine populations. This finding may indeed impact future randomized controlled trials in treating chronic migraine in patients with PFO.”

MEDSCAPE CASE REPORT:  A 42-year-old man (http://cme.medscape.com/viewarticle/581997_2) presents to the otolaryngology clinic with a right ear mass situated in the conchal bowl. The mass has been present for a few months, without any notable changes in size. The patient’s primary concern is his cosmetic appearance. He denies experiencing any pain, warmth, or tenderness associated with the mass.

The patient’s past medical history is significant for a 4-month history of a left-sided cervical neck mass and ipsilateral Horner syndrome, for which he received treatment about 2 years ago. Fine-needle aspiration at that time revealed numerous sinus histiocytes, but further tissue was needed for a definitive diagnosis. Magnetic resonance imaging (MRI) scans taken at that time demonstrated that the mass was encasing the carotid artery and showed prominence of nasopharyngeal tissue, which was also seen on the clinical examination. The patient was taken to the operating room and underwent biopsies of the nasopharynx and tonsils, which were negative for malignancy. The patient was then treated by the oncology service with dexamethasone 4 mg twice daily for 14 days. He had noted resolution of his ptosis and a decrease in the size of his neck mass. The patient returned 2 months later with improved, but still notable, miosis, as well as the presence of a neck mass. He was once again given dexamethasone 4 mg twice daily for 1 month, but he was subsequently lost to follow-up until his current presentation in the otolaryngology clinic. The patient now notes that he experienced complete resolution of his Horner syndrome from the previous presentation 2 years ago. There are no other positive pertinent symptoms.

He is not currently on any medications and has no active medical conditions. He does not chew tobacco, smoke, or use any illicit substances. The family history is unremarkable.

The patient appears comfortable and is in no obvious distress. His clinic vital signs are a temperature of 98.2°F (36.8°C), a blood pressure of 134/88 mm Hg, a pulse of 89 bpm, a respiratory rate of 12 breaths/min, and an oxygen saturation of 100% while breathing room air. A focused HEENT (head, eyes, ears, nose, and throat) examination reveals a mass situated in the right conchal bowl of approximately 4-5 cm in size, with no overlying edema or erythema. The mass is firm to palpation and nontender. The remainder of the physical examination is unremarkable, despite a detailed examination for occult adenopathy.

A fiberoptic endoscopy reveals no other abnormalities. Surgical excision for pathology is proposed to the patient, and he agrees to surgical excision of the right auricular mass. A histologic examination shows macrophages with engulfed lymphocytes.The pathologic analysis reveals positive staining for S100  and CD68, as well as many large histiocytic cells with abundant amphophilic cytoplasm and vesicular nuclei.

DISCUSSION: 

The pathology from the surgical excision enabled a conclusive diagnosis of an auricular presentation of recurrent Rosai-Dorfman disease. The history of a response to steroid treatment also suggested a systemic process, which correlated with the history of cervical lymphadenopathy and an auricular mass. The pathologic findings for Rosai-Dorfman disease most commonly show positive staining for S100 (Fig 3) and CD68 (Fig 4), as well as many large histiocytic cells with abundant, amphophilic cytoplasm and vesicular nuclei.

Named after the physicians who discovered it, Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is a systemic disease that is a rare, self-limiting benign process that was first described in 1969.^[1] The incidence is very rare, with less than 1000 cases reported in the literature. This case presents a patient successfully treated for cervical lymphadenopathy caused by Rosai-Dorfman, who then presents 2 years subsequent to the initial presentation with a recent development of an auricular mass.

The etiology of Rosai-Dorfman disease is unknown, but it has been proposed to be linked to viral infection via human herpesvirus 6 and an undefined immunologic defect.^[2] It most commonly involves the cervical lymph nodes; however, approximately 30% of patients have extranodal involvement.^[3] Rosai-Dorfman disease typically presents as a painless, massive, bilateral cervical lymphadenopathy associated with fever, leukocytosis with neutrophilia, an elevated erythrocyte sedimentation rate, and polyclonal hypergammaglobulinemia (specifically, of immunoglobulin G [IgG]). Patients are commonly in their first and second decade of life and have no other underlying medical conditions. It is equally prevalent among the sexes but does show a predominance among black patients.

The appearance of extranodal manifestations of Rosai-Dorfman disease has been limited to case reports, and there have been only 3 other cases involving the ear. These involved bilateral cauliflower ears,^[4] middle ear or external auditory canal lesions,^[5] and a preauricular mass.^[6] In 1990, Foucar, Rosai, and Dorfman published an update on the disease, with 423 cases; this registry showed a 43% rate of extranodal lesions.^[7] These lesions were most frequently found in the nasal cavity and paranasal sinuses.

Other sites of extranodal involvement include the soft tissues, central nervous system, orbits, skin, oral cavity, and bones. Presentation resulting from bone marrow involvement has not been seen since the disease was first identified. Patients may also present with amyloidosis, anemia, autoimmune lymphoproliferative syndrome, human immunodeficiency virus (HIV) infection, or lymphoma. The disease can initially be identified in many different locations of the human body. Central nervous system disease may present as meningitis, seizures, headache, and cranial nerve palsies. Rosai-Dorfman disease of the skin may present as papulonodular or plaque-like lesions. Other common locations and presentations include the kidneys (eg, presence of a renal mass), the oral cavity (eg, hypertrophy of the maxillary alveolus), the breasts (eg, breast mass), the cervix (cervical mass), and the vascular system (ie, development of vasculitis). It can also present in the gastrointestinal system as involvement of the liver, pancreas, or gastrointestinal (GI) tract. The presentation in the head and neck region can also be quite varied; the condition can be seen in the salivary glands (as a salivary mass in the setting of lupus erythematosus), the larynx (as dysphonia), and the eyes (as uveitis, papilledema, or compressive orbital neuropathy). The most common presentation of this disease, however, is one of a painless, massive cervical lymphadenopathy.

The main mechanism of lymphadenopathy is secondary to sinus histiocytosis and the stimulation of monocytes and macrophages via macrophage colony-stimulating factor (M-CSF). Monocytes are found in small amounts within the pulp of reactive lymph nodes, which secrete M-CSF. M-CSF acts as a chemotactic factor to recruit more blood monocytes. These monocytes are stimulated to differentiate into mature macrophages by M-CSF, as opposed to differentiating into dendritic cells when exposed to granulocyte/macrophage colony-stimulating factor (GM-CSF).^[8] Molecular studies have found no evidence of clonal rearrangement, implying that this disease is a reactive condition rather than a neoplastic one.

Ultimately, the diagnosis must be confirmed by pathologic analysis. The characteristic histology is that of a greatly enlarged lymph node, with dilatation of the sinuses. The pathologic features of Rosai-Dorfman disease are represented by large histiocytes, with prominent emperipolesis and fine vacuoles in the cytoplasm, scattered in a background of benign lymphocytes, plasma cells, and polymorphonuclear leukocytes.^[9] Emperipolesis is a hallmark of Rosai-Dorfman disease and represents engulfment of the lymphocytes by the large histiocytes, as evidenced by a halo around the cell. Immunohistochemical analysis of the large histiocytes often shows strong positive cytoplasmic staining for S-100 protein. It is important to note that these cells will not stain positive for CD 1, which is a commonly used marker of Langerhans cells. Crystal deposition has been reported in an isolated occurrence in which a skin biopsy showed classic features of cutaneous Rosai-Dorfman disease, along with conspicuous rhomboidal and needle-shaped crystals within the cytoplasm of many lesional plasma cells, histiocytes, and extracellular involvement. The plasma cells were polyclonal, which was determined by light chain immunostaining. These crystals were likely a result of the reactive plasma cell proliferation. Staining with other markers has also been reported, including CD 31, CD 11c, CD 14, CD 33, CD 68, and LN 5. These cells will be negative on staining for CD 1a.

The differential diagnosis of Rosai-Dorfman disease can be quite complex. The symptoms and physical findings associated with Rosai-Dorfman disease vary depending upon the specific areas of the body that are affected. The differential diagnosis of a chronic inflammatory infiltrate containing many large histiocytes includes granulomatous diseases, such as Wegener granulomatosis, and sarcoid, Hodgkin disease, and Langerhans histiocytosis. Other diseases that should be considered when confronted with a patient whose symptoms may correlate with Rosai-Dorfman disease include lymphoma, rhinoscleroma, meningioma, and other types of cancers.

The treatment of Rosai-Dorfman disease most commonly involves radiotherapy, corticosteroids, or acyclovir; chemotherapy is generally ineffective in treating the disease.^[10] Observation of these lesions can be offered if the patient is not suffering any adverse consequences; however, treatment for Rosai-Dorfman disease should be based on the clinical manifestations. Many lesions are asymptomatic, heal spontaneously, and do not require treatment. When destructive or disseminated disease is present, radiotherapy, surgical excision, systemic glucocorticoids, and alkylating agents may be used. Rosai-Dorfman disease has a generally favorable prognosis, but involvement of a greater number of nodal groups and associated extranodal systems worsens the prognosis. Patients with associated immunologic abnormalities also usually have a less favorable prognosis than those without them.

The patient in our case underwent a course of intravenous steroids in addition to the aforementioned surgical excision. His auricle on follow-up was noted have healed well, with no local recurrence of the disease. On long-term follow-up several months later, he was noted to be systemically disease-free. In addition to follow-up with otolaryngology, the patient was followed by the oncology service, although no radiotherapy was administered.

References

1. Rosai J, Dorfman RF. Sinus histiocytosis with massive lymphadenopathy: a newly recognized benign clinicopathologic entity. Arch Pathol. 1969;89:63-70.
2. Adhikari RC, Sayami G, Lee MC, et al. Fine-needle aspiration cytology of Rosai-Dorfman disease. Diagnostic Cytopathology. 2004;31:198-9. Abstract
3. Sanchez R, Rosai J, Dorfman RF. Sinus histiocytosis with massive lymphadenopathy: an analysis of 113 cases with special emphasis on its extranodal manifestations. Lab Invest. 1977;36: 21-22.
4. Oo KK, Pang YT, and Thamboo TP. Bilateral cauliflower ear deformity: An unusual presentation of cutaneous Rosai-Dorfman disease. Plastic and Reconstructive Surgery. 2004;113:967-969. Abstract
5. Ahsan SF, Madgy DN, Poulik J. Otolaryngologic manifestations of Rosai-Dorfman disease. Int J Pediatr Otorhinolaryngol. 2001;59:221.
6. Tsang WYW, Chan JK, Ho WK, et al. Extranodal Rosai-Dorfman disease: An uncommon cause of persistent nodule in the ear. J Laryngol Otol. 1992;106:249.
7. Foucar E, Rosai J, and Dorfman RF. Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease). Review of the entity. Semin Diagn Pathol. 1990;7:19-73. Abstract
8. Middel P, Hemmerlein B, Fayyazi A, et al. Sinus histiocytosis with massive lymphadenopathy: evidence for its relationship to macrophages and for a cytokine-related disorder. Histopathology. 1999;35:525-533. Abstract
9. Deshpande V, Verma K. Fine needle aspiration cytology of Rosai-Dorfman disease. Cytopathology. 1998;9:329-335. Abstract
10. Pulsoni A, Anghel G, Falcucci P, et al. Treatment of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): report of a case and literature review. Am J Hematol. 2002;69:67.

FDA Creates Web Page with Drug Safety Information for Patients, Health Care Professionals
Consolidates information in one access point Consumers and health care professionals can now go to a single page on the U.S. Food and Drug Administration’s Web site to find a wide variety of safety information about prescription drugs. The Web page, http://www.fda.gov/cder/drugSafety.htm, provides links to information in these categories:

• Drug labeling, including patient labeling, professional labeling, and patient package inserts;
• Drugs that have a Risk Evaluation and Mitigation Strategy (REMS) to ensure that their benefits outweigh their risks;
• A searchable database of postmarket studies that are required from, or agreed to by, drug companies to provide the FDA with additional information about a drug’s safety, efficacy, or optimal use;
• Clinicaltrials.gov, a searchable database of clinical trials, including information about each trial’s purpose, who may participate, locations, and useful phone numbers;
• Drug-specific safety information, including safety sheets with the latest information about the drug as well as related FDA press announcements, fact sheets, and drug safety podcasts;
• Quarterly reports that list certain drugs that are being evaluated for potential safety issues, based on a review of information in the FDA’s Adverse Event Reporting System (AERS);
• Warning Letters, Import Alerts, Recalls, Market Withdrawals, and Safety Alerts;
• Regulations and guidance documents;
• Consumer information about using medications safely and disposing of unused medicines;
• Instructions how to report problems to the FDA through its MedWatch program;
• Consumer articles on drug safety; and
• The FDA’s response to the Institute of Medicine’s 2006 report on the future of drug safety.

“By placing Web links to these up-to-date resources on a single page, we’re helping consumers and health care professionals find drug safety information faster and easier,” said Paul Seligman, M.D., M.P.H., associate director of Safety Policy and Communication in the FDA’s Center for Drug Evaluation and Research. “This type of communication is aimed at helping consumers and health care professionals make well-informed decisions about medication use.”

Establishing such a Web page is one of the requirements of the Food and Drug Administration Amendments Act of 2007, and is among FDA’s many efforts to address the safe use of drugs throughout their lifecycle.

Oct. 15 (Bloomberg) — A dose of “Saturday Night Fever” might help mend a broken heart.

The Bee Gees’ disco anthem “Stayin’ Alive” from 1977 has 103 beats a minute, close to the number of chest compressions needed for cardiopulmonary resuscitation to work, according to a study at the University of Illinois College of Medicine at Peoria. Students who listened to the tune while practicing CPR on a dummy learned to give the right number of pumps, an abstract of the research in the Annals of Emergency Medicine said.

The rhythm stayed in their heads. Five weeks later, the participants delivered compressions at 113 beats a minute, still an acceptable range. Ten doctors and five medical students took part in the experiment.

“This was a small study, but the results are encouraging enough that a further study, using a larger and more diverse population, is warranted,” said David Matlock, one of the researchers, in a statement distributed by the American College of Emergency Physicians. The results will be presented at a meeting of the Dallas-based group later this month, in Chicago.

UPI, 10/15/08 (http://www.upi.com/Science_News/2008/10/15/Most_angioplasty_patients_not_stressed/UPI-42281224097634/): 

U.S. researchers say they’ve found patients receiving elective angioplasty and stenting aren’t first stress tested, as called for in medical guidelines.

Percutaneous coronary intervention, or PCI — the clinical name for angioplasty and cardiac stenting — is used to open narrowed coronary arteries. Guidelines published by the American College of Cardiology, the American Heart Association and the Society for Cardiovascular Angiography and Intervention state that, for most patients, vessels to be dilated by PCI must be shown by non-invasive stress tests to be “associated with a moderate to severe degree of ischemia.”

The researchers said prior studies showed patients undergoing PCI according to the guidelines had better outcomes.

To determine if the guidelines were being followed, researchers from the University of California-San Francisco, the Maine Medical Center and the Dartmouth-Hitchcock Medical Center analyzed data from a random sample of nearly 24,000 Medicare patients 65 years of age or older, who had elective PCI at U.S. hospitals during 2004.

The researchers said they found 44.5 percent of the patients underwent stress testing during the 90 days before the elective PCI procedure.

The study appears in the Journal of the American Medical Association.

MedPage Today, 10/15/08 reported that “bivalirudin (Angiomax) significantly reduced cardiac and all-cause mortality after stenting for myocardial infarction (MI), compared with standard anticoagulants,” according to a study presented at the Transcatheter Cardiovascular Therapeutics meeting.  Roxana Mehran, M.D., of Columbia University, and colleagues, recruited “3,602 patients with symptomatic STEMI within 12 hours from symptom onset” for the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS AMI) trial. 

“In addition to dual antiplatelet therapy with aspirin and clopidogrel (Plavix), patients were randomized to unfractionated heparin plus abciximab (ReoPro), or eptifibatide (Integrilin) plus unfractionated heparin, or bivalirudin (0.75 mg/kg bolus then 1.75 mg/kg/hr).”  The researchers found that patients on “bivalirudin had a 43 percent relative reduction (P=0.029) in all-cause mortality, and a 31 percent (P=0.005) relative reduction in cardiac-related mortality, versus controls.”

UPI, 10/15/08 (http://www.upi.com/Science_News/2008/10/15/Most_angioplasty_patients_not_stressed/UPI-42281224097634/):

  U.S. researchers say they’ve found patients receiving elective angioplasty and stenting aren’t first stress tested, as called for in medical guidelines.

Percutaneous coronary intervention, or PCI — the clinical name for angioplasty and cardiac stenting — is used to open narrowed coronary arteries. Guidelines published by the American College of Cardiology, the American Heart Association and the Society for Cardiovascular Angiography and Intervention state that, for most patients, vessels to be dilated by PCI must be shown by non-invasive stress tests to be “associated with a moderate to severe degree of ischemia.”

The researchers said prior studies showed patients undergoing PCI according to the guidelines had better outcomes.

To determine if the guidelines were being followed, researchers from the University of California-San Francisco, the Maine Medical Center and the Dartmouth-Hitchcock Medical Center analyzed data from a random sample of nearly 24,000 Medicare patients 65 years of age or older, who had elective PCI at U.S. hospitals during 2004.

The researchers said they found 44.5 percent of the patients underwent stress testing during the 90 days before the elective PCI procedure.

The study appears in the Journal of the American Medical Association.

Prevalent Cocaine Use and Myocardial Infarction
Stella Aslibekyan, Emily B. Levitan, Murray A. Mittleman
American Journal of Cardiology – 15 October 2008 (Vol. 102, Issue 8, Pages 966-969, DOI: 10.1016/j.amjcard.2008.06.016)

ABSTRACT

BACKGROUND:  Studies have reported a possible link between cocaine use and risk for cardiovascular events.

OBJECTIVE:  The aim of this study was to examine the association between self-reported cocaine use and physician-diagnosed myocardial infarction (MI) in the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994.

METHODS:  Odds ratios (ORs) were estimated using logistic regression models adjusted for age and additionally for gender, race, and other MI risk factors, which accounted for the complex sampling design.

RESULTS:  In the group aged 18 to 59 years, there was no statistically significant association between any exposure to cocaine and MI (age-adjusted OR 1.56, 95% confidence interval [CI] 0.44 to 5.50, p = 0.48; multivariate-adjusted OR 1.06, 95% CI 0.30 to 3.73, p = 0.92). Participants who reported using cocaine >10 times had a nonsignificant higher prevalence of MI (age-adjusted OR 3.13, 95% CI 0.80 to 12.25, p = 0.10; multivariate-adjusted OR 1.84, 95% CI 0.46 to 7.29, p = 0.40). However, participants aged 18 to 45 years who reported >10 occasions of cocaine use had a significantly elevated prevalence of MI in age-adjusted models (OR 4.60, 95% CI 1.12 to 18.88, p = 0.035). The association was attenuated in multivariate-adjusted models (OR 3.84, 95% CI 0.98 to 15.07, p = 0.054). The lifetime prevalence of cocaine use increased from 14% in NHANES III to 19% in NHANES 2005–2006.

CONCLUSION:  In conclusion, these data support a substantial association between cocaine use and MI; the temporal trend in cocaine use may increase the occurrence of MI, particularly in younger populations.

MMWR Press Release, 10/16/08: 

Illnesses and Injuries Related to Total Release Foggers

PRESS CONTACT: Fred Blosser
National Institute for Occupational Safety and Health, Public Affairs Officer
(202) 245-0645

Total-Release Foggers (TRFs) pose a risk for acute, usually temporary health effects among users and bystanders. The most effective way to reduce the risk of occupational or residential health effects from TRFs and other pesticides is to minimize the need for use of these and other pesticide products by using integrated pest management control strategies that prevent insects from entering homes and workplaces. Concepts of integrated pest management control that should be promoted and adopted include eliminating the pests’ access to food, water and shelter. Because TRFs are often used by consumers as a low cost alternative to professional pest control services, the hazards and proper use of TRFs need to be better communicated on the TRF label and in public media campaigns. During 2001-2006, 466 cases of acute pesticide-related illness/injury associated with exposure to insecticides from total-release foggers or “bug bombs” occurred in eight states, resulting in cough, shortness of breath and upper airway irritation as the most common symptoms. The preventable TRF exposures sometimes occurred in workplaces but predominantly in homes and were often due to inability or failure to vacate before the TRF discharged, reentry into the treated space too soon after the TRF was discharged, excessive use of TRFs for the space being treated, accidental discharge of a TRF and failure to notify others nearby.

MMWR News Synopsis, 11/16/08

Injuries Resulting From “Car Surfing” – United States, 1990-2008

PRESS CONTACT: National Center for Injury Prevention and Control Media Line
(770) 488-4902

Parents, educators, and health-care providers should be aware of the dangers of car surfing, whichcan lead to injury or death at nearly any speed.  A review of newspapers stories indicates that since 1990, at least 99 people have died or been seriously injured as a result of car surfing – an activity practiced mainly by teens which involves riding on the exterior of a moving vehicle while it is being driven by another person. Car surfing fatalities have been reported to have occurred at a range of vehicle speeds, from five to 80 mph. with sudden maneuvers, such as braking or swerving, sometimes making even slow speeds very dangerous. CDC researchers analyzed newspaper stories in LexisNexis® obtained from 1990 through 2008. Although car surfing injuries are not as frequent as many other motor vehicle injuries, they can be extremely serious and even deadly. This severity raises the importance of preventing car surfing injuries and convincing teens that they should never engage in this risky behavior.