Orthopedic Trauma From Recreational All-Terrain Vehicle Use in Central Kentucky: A 6-Year Review

Abstract

All-terrain vehicle (ATV) crashes and injuries have become an increasing concern for the medical community. After the expiration of federal guidelines in 1998, the United States Consumer Product Safety Commission has tracked an increasing incidence of usage and injury. This retrospective review of data from a Level I trauma center presents ATV crash-related injury prevalence, type, and location sustained in central Kentucky and compares the data with previous reports. Patient demographics, helmet and alcohol use, insurance type, injury type and location, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, Functional Independence Measure (FIM), duration of hospital stay, days in an intensive care unit (ICU), internal disposition, and discharge destination were analyzed among individuals who had sustained ATV crash-related injuries between January 1998 and December 2003. Patients were primarily male (85.4%), white (98%), resided in a rural county (85.1%), and relied on commercial insurance (36.2%) or self-pay (31.4%) for medical expenses. Alcohol use before injury was documented for 25% and 85.5% were not wearing a helmet. Rollover was the primary ATV crash mechanism (63.3%) and 52.1% of patients lost consciousness. Of 707 total injuries, 319 (45.1%) were fractures or dislocations with the spine (26%), ribs (24.1%), clavicle (6%), radius-ulna (5.3%), and tibia-fibula (4.7%) being the most common locations. Admitted patients were hospitalized for 8.1+/-12.7 days (range=0-127 days), 42% were transferred to the standard care ward, 28.2% spent 8.4+/-7.7 days (range=1-34 days) in the ICU, and 18.6% were taken directly to the operating room. At discharge 78.2% of patients went home, 12.8% were transferred to a rehabilitation facility, 4.8% died, and 3.2% were transferred to another hospital. Patients who never lost consciousness or who were discharged to home had lower ISSs and greater composite and component GCS and FIM scores. Almost half of all patients sustained one fracture or joint dislocation with the spine being the most prevalent location. Injury severity, the low number referred to rehabilitation facilities, and predominantly rural residence locations suggests that many may not be accessing needed healthcare services. Prospective longitudinal outcome studies are needed to assess patient functional independence, quality of life, and health care system effectiveness.