All-terrain Vehicle Accidents Research Articles

Pediatric Orthopaedic Trauma and Associated Injuries of Snowmobile, ATV, and Dirtbike Accidents: A 19-Year Experience at a Level 1 Pediatric Trauma Center.

The purpose of this study was to evaluate the type and severity of orthopaedic and associated injuries for snowmobile, All-terrain vehicles (ATV) and motorized dirtbike accidents in a pediatric patient population. A total of 758 patients who presented following either snowmobile (n=87), ATV-related (n=308) or dirtbike (n=363)-related trauma at our institution between 1996 and 2015 were retrospectively reviewed. A total of 441 axial and appendicular fractures occurred requiring 533 procedures. Snowmobile and dirtbike accidents were associated with a higher rate of fractures (63%, 64%) than the ATV group (50%) (P=0.0008). Snowmobile injuries had the highest rate of spinal (23%) and lower extremity fractures (53%) (P=0.0004). Snowmobile and dirtbike cohorts had higher rate of femur fractures (22%, 17%, P=0.001) whereas the ATV cohort had higher rates of upper extremity (18%), hand (11%), scapula (4.6%), and open fractures (28.6%) (P<0.01). Head trauma was the most commonly associated injury in 275 patients with the highest rate in the ATV group (44%) who also had the highest rate of no helmet use (76%). Snowmobile and ATV patients had higher Injury Severity Score (11.3, 9.6) than dirtbike patients (7.8) (P=0.001). ATV patients were found to be younger (11.8 y) compared with snowmobile (13.2 y) and dirtbike (13.5 y) (P<0.01). Pediatric snowmobile, ATV and dirtbike accidents result in severe orthopaedic and associated injuries with each vehicle demonstrating significantly different injury patterns. Injury prevention should focus on improved safety mechanisms, protective gear, safe areas for off-road vehicle use and strict laws with minimum age requirements LEVEL OF EVIDENCE:: Level IV.

Pediatric isolated thoracic and/or lumbar transverse and spinous process fractures.

OBJECTIVE Isolated transverse and spinous process fractures (TPFx and SPFx) in the thoracic and/or lumbar region have been deemed clinically insignificant in the adult population. This same rule is often applied to the pediatric population; however, little evidence exists in this younger group. The goal of this study was to describe the clinical, radiographic, and long-term data on isolated TPFx and SPFx in an exclusively pediatric population. METHODS A retrospective chart review at Monroe Carell Jr. Children's Hospital at Vanderbilt University identified 82 pediatric patients with isolated TPFx and/or SPFx following a traumatic event between January 2000 and December 2013. Patient demographic information, presenting symptoms, radiographic characteristics, and follow-up data were collected. Follow-up was used to determine the outcome (presence of neurological deficits) of such injuries via complete physical examination and, when available, radiographic evidence. RESULTS In the 82 identified patients, the mean age was 15.5 ± 3.1 years (mean is expressed ± SD throughout), with 72 injuries (87.8%) resulting from a motor vehicle, motorcycle, or all-terrain vehicle accident. There was a mean of 1.7 ± 1.0 fractured vertebral levels involved and a mean of 1.8 ± 1.1 fractures was identified per patient. Seventy-one patients (86.6%) needed bedside pain control, 7 (8.5%) were prescribed a brace, and 4 patients (4.9%) received a collar. Physical therapy was recommended for 12 patients (14.6%). A total of 84.1% had follow-up, and the mean length of follow-up was 19 ± 37 months. No patients had true neurological deficits at presentation or follow-up as a result of their isolated fractures, whereas 95.1% had other associated system injuries. CONCLUSIONS These data shows that there is no appreciable long-term complication associated with isolated thoracic and/or lumbar TPFx and/or SPFx in an exclusively pediatric population. Because these fractures are, however, associated with high-energy blunt trauma, they often result in associated soft-tissue or other skeletal injury. All pediatric patients in the cohort benefited from conservative management and aggressive treatment of their comorbidities.

Craniofacial Fracture Patterns in All Terrain Vehicle Injuries

A multicenter, retrospective study was conducted to determine the frequency and distribution of craniofacial fractures sustained from all terrain vehicle (ATV) accidents. Medical records of all patients presenting to 2 trauma centers with ATV-related craniofacial trauma from 2001 to 2013 were reviewed. Patient notes and radiographic images were analyzed for detailed craniofacial injury data. The identified fractures were classified as: frontal/skullbase, naso-orbital, maxilla/zygoma, and mandible. In addition, patient demographic information, length of stay, airway status, intensive care unit stay, Glasgow coma scale, use of safety equipment, associated traumatic brain injury, and surgical intervention were compiled. One hundred fifty-six patients with craniofacial fractures secondary to ATV accidents presented from 2001 to 2013. The incidence of craniofacial fractures found in patients with ATV injuries was 12.2%. Sixty-one patients (39.1%) suffered frontal/skullbase fractures, 98 (62.8%) naso-orbital fractures, 62 (39.7%) maxillary/zygoma fractures, and 35 (22.4%) mandibular fractures. Forty-one patients (26.3%) required surgical intervention to correct their craniofacial injuries. The most common craniofacial fractures experienced in ATV injuries are naso-orbital fractures. The correlation of nonuse of safety equipment and associated traumatic brain injuries displays the importance of using helmets when operating ATVs. Future studies can be conducted examining ATV-related upper extremity injuries, among others.

All-terrain Vehicle Accident Trends at a Tennessee Trauma Center in 2014

All-terrain Vehicle Accident Trends at a Tennessee Trauma Center in 2014

All-terrain Vehicle Accidents in Children

All-terrain Vehicle Accidents in Children

Freestanding Emergency Departments and the Trauma Patient

BackgroundFreestanding emergency departments (FEDs) continue to grow in number and more research is needed on these facilities. ObjectiveWe sought to characterize the types of injuries and patients who initially presented to two FEDs and were transferred to the main tertiary care ED for trauma team consult and admission. MethodsThis retrospective cohort descriptive study examined medical records of adult trauma patients who were initially seen at an FED and then transferred to the main ED. All patients who received a trauma consultation were included. Data collection included demographics, initial mode of transport to the ED, injury, mechanism of injury, ED, hospital course and outcome. ResultsMean age was 61.8 ± 23.8, 96.7% were Caucasian and 52.5% were male. Mode of transport to the FEDs included private vehicle (46.4%) and emergency medical services (53.6%). The main injury mechanisms were fall from standing (51.9%) and fall from an object (16%). A total of 12.7% were from motor vehicle accidents and 6.6% presented from bicycle and all-terrain vehicle accidents. Blunt traumatic injuries accounted for 97.8% (n = 177) patients. Computed tomography scanning was performed on 90.1% of patients. Median ED length of stay was 189 min. Mean hospital length of stay was 3 days and 2.2% (n = 4) of patients died from their injuries. ConclusionsUnderstanding the patients and traumatic injuries that present to FEDs will guide training and identify resources needed for patients requiring additional care at a trauma center.

Ten years of trauma in the ‘top end’ of the Northern Territory, Australia: A retrospective analysis

AimTo examine characteristics of traumatic injury in adults and children at the Royal Darwin Hospital (RDH) over a 10 year period. MethodA retrospective review of the RDH Trauma Registry data from 1 January 2003 to 31 December 2012, with analysis of patient demographics, mechanism of injury, Injury Severity Score (ISS), and outcome. ParticipantsTwo thousand seven hundred twenty-five patients with an ISS greater than or equal to 9 and met all other study inclusion criteria. ResultsMotor vehicle crashes, assaults and falls consistently remained the three most common mechanisms of injury throughout the 10 year period. Indigenous admissions showed a significant downward trend (p = 0.009). Upward trends were noted in presentations from patients aged greater than 44 (p = 0.002), all-terrain vehicle accidents (p < 0.001), and hangings (p = 0.003). No other trends were noted to significant at a p < 0.05 level. Admitted Indigenous patients were significantly more likely to be present due to assault (p < 0.001) and female patients were more likely to present due to assault, falls and motor vehicle crashes (p < 0.01) than their counterparts. ConclusionPresentations for traumatic injury to Royal Darwin Hospital have remained in the most part, consistently stable for the period of 2003–2012. Though there were some increases/decreases in regard to specific demographics and mechanisms, few were found to be statistically significant at a p < 0.05 level.

Pediatric considerations in craniofacial trauma.

In many respects, craniofacial trauma in children is akin to that in adults. The appearance of fractures and associated injuries is frequently similar. However, the frequencies of different types of fractures and patterns of injury in younger children vary depending on the age of the child. In addition, there are unique aspects that must be considered when imaging the posttraumatic pediatric face. Some of these are based on normal growth and development of the skull base and craniofacial structures, and others on the varying etiologies and mechanisms of craniofacial injury in children, such as injuries related to toppled furniture, nonaccidental trauma, all-terrain vehicle accidents, and impalement injuries.

Paediatric trauma on the Last Frontier: an 11-year review of injury mechanisms, high-risk injury patterns and outcomes in Alaskan children

BackgroundPaediatric trauma system development in Alaska is complicated by a vast geographic coverage area, wide regional variations in environment and culture, and a lack of available published data.ObjectiveTo provide a detailed description of paediatric trauma mechanisms, high-risk injury patterns and outcomes in Alaska.DesignThis retrospective study included all children aged 17 years or younger in the State of Alaska Trauma Registry database admitted with traumatic injury between 2001 and 2011. Each injury record was reviewed individually and assigned a mechanism based on Centers for Disease Control E-codes. Geographic definitions were based on existing Emergency Medical Services regions. Mechanisms were compared by geographic region, patient demographics, injury characteristics and outcome. Subgroup analysis of fatal injuries was performed to identify causes of death.ResultsOf 5,547 patients meeting inclusion criteria, the most common mechanisms of injury were falls (39%), motor vehicle collisions (10%) and all-terrain vehicle (ATV) accidents (9%). The overall case fatality rate was 2%. Mechanisms with the greatest risk of death were gunshot wounds (21%), pedestrians struck by motorized vehicles (9%) and motor vehicle collisions (5%). These 3 mechanisms accounted for 15% of injuries but 60% of deaths in the overall cohort. Injury patterns involving combined central nervous system (CNS) and torso injuries were unusual but especially lethal, occurring in 3% of patients but carrying a case fatality rate of 18%. Although the distribution of mechanisms was generally similar for each geographic region, ATV and snowmobile injuries were significantly more common in remote areas (23% remote vs. 7% non-remote, p < 0.0001).ConclusionsMechanisms of paediatric trauma in Alaska have widely varying impacts on outcome and show some variation by region. Highest-risk mechanisms include gunshot wounds and motorized vehicle-related accidents. Prevention efforts should give special attention to CNS injury prevention, ATV and snowmobile safety in remote areas, and optimization of management of multisystem trauma. Further studies should investigate predictors of outcome in greater detail.

Off-road vehicle fatalities: A comparison of all-terrain vehicle and snowmobile accidents in Sweden

This study investigates accident fatalities involving two types of off-road vehicles: snowmobiles and all-terrain vehicles (ATVs). All snowmobile fatalities in Sweden from the 2006/2007 season through the 2011/2012 season, and all ATV fatalities from 2007 through 2012, were retrospectively examined. A total of 107 fatalities—57 snowmobile-related and 50 ATV-related—were found. Most deaths occurred on weekends (71% of the snowmobile-related and 72% of the ATV-related). A majority of the fatalities were males (91% and 94%), with the largest share in the age group 40–49years (19% and 24%). The most common causes of death were blunt trauma (56% and 66%), drowning (30% vs 6%), and traumatic asphyxia (9% vs 14%). Among victims who were tested (95% vs 92%), a very high share was found to be inebriated (59% vs 61%), and mean blood alcohol concentration was also high (1.9 vs 1.7g/l). Forty-seven percent of snowmobile-related fatalities and 48% of ATV-related fatalities had a blood alcohol concentration above 1.0g/l. This means that there was a very strong association between off-road vehicle fatalities and drunken riding; steps to prevent riding while intoxicated seem to be the most important preventive measure. Automatic measures such as alcolocks are probably the most effective. The obvious at-risk group to target is middle-aged men with high alcohol consumption.

Increased Severe All-terrain Vehicle Accidents at a Rural Tennessee Trauma Center despite Safety Legislation

Increased Severe All-terrain Vehicle Accidents at a Rural Tennessee Trauma Center despite Safety Legislation

Repair of Traumatic Aortoinnominate Disruption Using CorMatrix

Blunt traumatic injuries to the innominate artery are rare but potentially devastating injuries. Patients with an innominate injury who survive typically have an isolated intimal tear with an intact adventitia. There are multiple case reports and series describing off-pump repair of innominate injuries using synthetic grafts, and even reports of successful endovascular stenting. We report the first successful case of innominate artery disruption and repair using CorMatrix (CorMatrix Alpharetta, GA) extracellular matrix.

Renal Fracture

A 23-year-old man presented to the Emergency Department (ED) by ambulance with right flank pain after an all-terrain vehicle (ATV) accident. The patient's ATV collided with a tree and he was ejected from the vehicle. The patient had initially lost consciousness at the scene, but was alert and oriented upon arrival to the ED. The patient complained of severe pain to the right flank and abdomen. On examination, the patient's vital signs were: blood pressure 130/80 mm Hg, heart rate 140 beats/min, respirations 18 breaths/min, and room air oxygen saturation of 100%. The patient's abdomen was tender in the right upper quadrant and at the right costovertebral angle, without rebound tenderness, guarding, flank ecchymosis, or abrasions.

Analysis of All Terrain Vehicle (ATV) for Impact Loading and Roll over Considering the Safety of Occupants

All-terrain vehicles (ATV) are achieving wider response and significance in the present world. With their characteristic abilities of getting through any terrain along with their simple and compact structure, they rule the off-roading world. A new field of engineering research has been developed because of the increasing number of ATV accidents. For determining the reasons to how so many crashes occurs and how they can be prevented, a series of ATV tests were conducted. The tests included simulating an ATV for frontal impact, side impact and rolling over with added weight of a passenger, and due to a thrust effect. Through testing, the amount of weight needed to flip an ATV was determined. This paper highlights the ways to analyse the safety of its chassis in case of impacts or roll overs.

Mechanistic Relationship of All-terrain Vehicles and Pediatric Renal Trauma

To identify and discuss the mechanistic risk factors associated with genitourinary (GU) trauma in pediatric all-terrain vehicle (ATV) accidents. A retrospective analysis of all pediatric trauma admissions to a level 1 trauma center from 2005 to August 2011 was performed. We identified all pediatric patients who presented with GU trauma related to an ATV accident. The demographics, injury data, mechanism of injury, and treatment records of these children were investigated. A total of 304 pediatric patients were admitted with ATV-related injuries during the study period. Of these 304 patients, 10 (3.2%) had experienced GU injuries. An analysis of the mechanism revealed that 9 of the 10 had been thrown from the ATV; 1 event was described as a rollover accident. All 10 patients sustained renal trauma: 9 renal lacerations of various grades and 1 renal pedicle injury. Hematuria was observed in all cases. Spleen and liver lacerations were commonly associated injuries (40% and 30%, respectively). Pediatric ATV-related GU injuries remain an uncommon, yet serious, problem. Renal trauma is the most commonly encountered GU injury and can be suspected by the presence of hematuria. Analysis of the mechanism of injury suggests that ejection from the ATV places pediatric patients at the greatest risk of renal injury. Additional research is recommended concerning the mechanistic relationship of ATV-related GU trauma.

Retrospective review of all-terrain vehicle accidents in Alberta

All-terrain vehicles (ATVs) are frequently associated with injuries and deaths. In spite of this, very few guidelines, let alone legal restrictions, exist to guide users of these machines. We conducted a standardized review of prospectively collected data from the Alberta Trauma Registry. All patients who were involved in ATV-related traumas from 2003 to 2008 with an Injury Severity Score (ISS) greater than 12 were included. The variables studied were age, sex, type of vehicle, purpose of use, person injured (driver or passenger), ISS, distribution of injuries, length of hospital stay, helmet use and death. We evaluated 435 patients with ATV-related injuries and ISS greater than 12. The average ISS was 22.8, with an overall mortality of 4.6%; 55% of patients were not wearing helmets, and most of the deaths (85%) occurred among these individuals. Helmet use was associated with a lower risk of mechanical ventilation and of injury to the head and/or cervical spine. Children accounted for 18.9% of all patients and 15% of deaths; 57% of them were wearing helmets at the time of their accidents. All-terrain vehicle use in Alberta carries a significant risk of injury and death, and there is an association between death and lack of helmet use. A minimum age for ATV use of at least 16 years and a legal requirement for helmet use may increase public awareness of these risks and decrease morbidity and mortality.

Age-related Patterns of Spine Injury in Children Involved in All-Terrain Vehicle Accidents

With increases in use and power of all-terrain vehicles (ATVs), there have been dramatic increases in both the number and severity of ATV-related injuries. The KIDS database showed a 240% increase in the number of children admitted to a hospital for an ATV-related injury between 1997 and 2006. Over the same time period, there was a 476% increase in the number of children with ATV-related spine injuries. To better understand the nature of these injuries, a series of pediatric ATV-related spine fractures at a regional pediatric trauma center were analyzed. Records and radiographs of children and adolescents who presented to a regional pediatric trauma center with a spine injury as a result of an ATV accident were reviewed. In addition to demographic data, information was collected regarding length of stay, Glasgow Coma Score, Pediatric Trauma Score, treatment type, associated injuries, and hospital charges. Patients were divided into 2 groups based on age and American Academy of Orthopaedic Surgeons guidelines for ATV use: younger children (age, 0 to 15 y) and older children (age, 16 to 18 y). Fifty-three spine injuries were identified in 29 children (mean, 1.8 injuries/child) with an average age of 15.7 years; 16 (55%) had associated nonspine injuries and 13 had multiple spine injuries, contiguous in 9 and noncontiguous in 4. Four patients, all in the younger age group, had neurological injuries. Children older than 16 years had significantly lower Pediatric Trauma Scores and were more likely to have a thoracic spine fracture than younger children, who were more likely to have a lumbar fracture. Fourteen patients required surgery for their injuries, 7 for spine injuries and 7 for nonspine injuries; the mean hospital charge was almost $75,000 per patient. ATV-related spine injuries in children and adolescents are high-energy injuries with a high rate of associated spine and nonspine injuries. ATV-related spine injuries are different from other ATV-related injuries in children in that they are more common in older children and in females. As musculoskeletal injuries are the most common ATV-related injuries in children, orthopaedic surgeons need to be aware of these differences, and have a high index of suspicion for associated injuries, including additional and often noncontiguous spine injuries.

Pediatric all-terrain vehicle related temporal bone fractures

Objectives To determine the prevalence of helmet use in children involved in all-terrain vehicles (ATV) accidents. Study design Retrospective chart review. Setting Tertiary Academic Medical Center. Subjects and methods Retrospective review was performed using the trauma registry of an academic tertiary medical center identifying ATV injured patients under 13 years of age between 2003–2008. Data regarding age, gender, ethnicity, driver/passenger status, helmet status, length of hospital stay, Glascow Coma Scale, Injury Severity Score, Abbreviated Injury Score, and presence of temporal bone fracture were analyzed. Results Seventy-four ATV injured pediatric subjects were identified. Average age was 8.6 years, 62% male, 38 were drivers, 32 were passengers. Helmet use data were available on 47 (64%) subjects, of these 9 (19%) wore helmets, and 38 (81%) were not wearing helmets. There was no observed statistical difference between helmeted and unhelmeted riders when comparing age, gender, ethnicity, driver/passenger status, length of hospital stay, Glascow Coma Scale (GCS), Injury Severity Score, Abbreviated Injury Score, or presence of temporal bone fracture. Conclusions This review found that documented helmet use in pediatric ATV injuries to be profoundly low (19%). Within our cohort no protective benefit from helmet use was identified, suggesting the inherent and potentially unalterable dangers of pediatric ATV recreation.

Trends in All-Terrain Vehicle-related Spinal Injuries in Children and Adolescents

Despite the significant morbidity and mortality associated with all-terrain vehicle (ATV) use in children, their use continues to increase dramatically. To determine the frequency and impact of spinal fractures in children and adolescents injured in ATV accidents, we reviewed all 4 of the available Kids' Inpatient Databases. The Kids' Inpatient Databases (http://www.ahrq.gov/data/hcup/hcupkid.htm) from 1997, 2000, 2003, and 2006 were reviewed using e-codes for children (age less than 18 y) injured in ATV accidents. From the data on ATV accidents, children who sustained spinal injuries were identified by ICD-9 codes. Statistical analysis was done using SAS Windows. An estimated 4,483 children were admitted because of ATV-related accidents in 2006. Spinal injury occurred in 7.4% of patients. The most common level of fracture was thoracic (39%), followed by lumbar (29%) and cervical (16%). Pelvic fractures were the most common associated fractures, accounting for 44% of all musculoskeletal injuries, followed by forearm/wrist fractures (15%) and femoral fractures (9%). Although fewer girls were injured in ATV accidents than boys, the risk of spinal injury was higher in girls than boys (10.1% vs. 6.7%, P < 0.005), and children with spinal injuries were older than those without (14.7 y vs. 12.7 y, P < 0.001). Despite educational and legislative efforts, children account for a disproportionate percentage of morbidity and mortality from ATV-related accidents. The injury rate for children from ATV accidents has increased 240% since 1997, whereas the spinal injury rate has increased 476% over the same time frame. The risk of spinal injury in ATV-related accidents is higher for girls than for boys and for older children. Multiple injuries are frequent in children involved in ATV accidents and may be related to the high-energy nature of ATV accidents. It is important to have a high index of suspicion for multiple injuries, not only within the spine, but in other organ systems as well.

A Mathematical Model to Predict Length of Stay in Pediatric ATV Accident Victims

Children under age 12 y represent 15% of all-terrain vehicle (ATV)-related deaths, and those under 16 y old represent >36% of deaths nationwide. In recent years, this has accounted for an increasing proportion of pediatric trauma victims and longer hospitalizations secondary to worsened injuries. We believe it is possible to create a simple mathematical model that can be used to predict hospital length of stay. A retrospective review of the trauma registry was performed for all pediatric patients who were involved in ATV accidents from January 2000 to December 2009. Four hundred twenty pediatric patients were identified. A model to predict for total LOS in pediatric patients involved in ATV accidents was constructed. SPSS ver. 17 (SPSS Inc., Chicago, IL) was utilized to conduct all statistical analyses. Statistical significance of regression coefficients was assumed at a P < 0.05 level. We performed a hierarchical multiple regression analysis to build a model that would predict for total length of stay (LOS). A logarithmic transformation was employed on LOS as a dependent variable due to skewness. In Step 1, ISS accounted for a 25% increase in shared variance in LOS (P < 0.001). In Step 2, Glasgow Coma Score (GCS) accounted for 4.3% more variance in LOS (P < 0.001). Finally, in Step 3, the presence of a closed head injury further increased (3.6%) the amount of shared variance in the model (P < 0.001). The final model accounts for 32.9% of the shared variance in total LOS. When using the logarithmic transformation, the final model is: Total LOS = 1.00 + 0.05 injury severity score (ISS) - 0.06 (GCS) + 0.35 closed head injury (CHI). Based on our data and statistical analysis, we found it was possible to create a mathematical model that could predict hospital LOS in pediatric ATV accident victims.