All-terrain Vehicle Injuries Research Articles

Impact of Surgical Team Involvement at the Time of Trauma Activation for Pediatric Patients With Motorized Cycle or All-Terrain Vehicle Injury Mechanism.

At our institution, level 2 trauma (L2T) activations are primarily managed by pediatric emergency medicine (PEM) physicians, whereas level 1 activations are co-managed by pediatric surgery and PEM. Starting in September 2019, the response to L2T activations due to all-terrain vehicles or motorized cycles (ATVs/MCs) changed to include surgical assessment upon patient arrival due to increased likelihood of significant injuries and need for higher level of care. The impact of PEM/surgery co-management of ATV/MC L2T patients on time to an admission decision is unknown. We retrospectively reviewed patients <18 years of age presenting to our American College of Surgeons-verified level 1 pediatric trauma center as L2T activations with ATV/MC mechanism between 1/2016 and 10/2022. Patient demographics, injury characteristics, details of imaging, interventions, and emergency department (ED) course were recorded. The χ 2 and Fisher exact tests were performed. One hundred fifty-five patients met the inclusion criteria prior to augmenting our response to include surgical presence at L2T-ATV/MC activations, and 216 patients were treated after our protocol change. There were no statistically significant differences in age, sex, race, transfer status, vehicle subtype, or Injury Severity Scores between groups. Trauma surgery was involved in the care of 74.8% of L2T-ATV/MC patients before protocol augmentation and 87% after ( P = 0.003). Time to an admission decision significantly decreased by 22.5 minutes (117 minutes [interquartile range, 72-178] vs 94.5 minutes [interquartile range, 60-139]; P = 0.023) after protocol augmentation. There was a trend toward increased completion of mandated postsecondary survey communication huddles after protocol change (84.6% to 91.2%, P = 0.089). The median total ED length of stay did not differ between admitted and discharged patients. Early surgical assessment for pediatric patients with ATV/MC injuries improved time to an admission decision and trauma communication huddle compliance. Next steps include identifying process improvement opportunities to decrease ED total length of stay for patients with ATV/MC injuries.

Golf cart injuries have similar severity to all-terrain vehicle injuries in children: a multicenter comparison over a 5-year period

BackgroundGolf carts (GCs) and all-terrain vehicles (ATVs) are popular forms of personal transport. Although ATVs are considered adventurous and dangerous, GCs are perceived to be safer. Anecdotal experience suggests increasing...

ATV-Related Trauma in the Pediatric Population.

All-terrain vehicles (ATVs) are prevalent in Appalachia and cause significant morbidity and mortality in the pediatric population. This study investigated the injury types and severity in pediatric patients over a 15-year period. A retrospective chart review was performed on pediatric ATV-related traumas presenting to our institution from 2005 to 2020. Patients were divided into 3 age groups (0-7, 8-12, and 13-17y) to evaluate differences in accident demographics, hospitalization, Glasgow Coma Scale, Injury Severity Score, substance use, characterization of orthopaedic and nonorthopaedic injuries, and procedures performed. Inclusion criteria were met by 802 patients. Males represented 71.7% (n=575) and females 28.3% (n=227); the mean age was 12.4 years. The majority (88.5%, n=710) of patients admitted following their accident had a mean stay length of 3.3 days. Of admissions, intensive care unit admission was required by 23.8%, n=191 (mean stay 4.0d). There were 7 fatalities. The vast majority of accidents occurred between May and September (79.2%, n=635). In patients with documented helmet status, 45% (n=271) were helmeted. Roughly half of all patients (n=393) sustained a fracture (excluding fractures to the head), 370 sustained an injury to the head/face, 129 sustained intra-abdominal/intra-thoracic injuries, and 29 sustained injuries to all 3 systems. The most common fractures involved the forearm (n=98), femur (n=65), and spine (n=59). The most common open fractures were the tibia (n=12), humerus (n=8), and forearm (n=8). The oldest group was more likely than the middle or younger groups to sustain spine ( P <0.0001), pelvis ( P =0.0001), hand ( P =0.0089), and foot ( P =0.0487) fractures. Ethanol testing was positive in 5.0% (n=25) of the oldest group and cannabinoids were present in 6.8% (n=34). The youngest group was significantly more likely to sustain a fracture of the humerus than the middle or older groups ( P <0.0001). Orthopaedic surgical management was required in 24.4% (n=196) of patients. Pediatric ATV accidents present a significant source of morbidity and mortality. Further intervention is necessary to minimize pediatric ATV injuries. Level IV-Retrospective Case Series.

Severity of All-Terrain Vehicle–Related Injuries by Age in Canada, 2002-2019

Rates of pediatric hospitalizations following an injury while riding an all-terrain vehicle (ATV) are increasing. Few studies have compared the rates of severe injuries among children, adolescents, and adults. To investigate whether younger ATV riders are at risk for more severe ATV-related injuries. This cross-sectional study was conducted using administrative data from hospitals in 9 provinces in Canada. Participants included patients admitted to hospitals with ATV-related injuries between 2002 and 2019. Statistical analysis was performed from June 2020 to September 2021. The primary exposure was age younger than 16 years. Comparison groups were youths aged 16 to 20 years and adults aged 21 years and older. The main outcomes of interest were death, spinal cord injury, and an Injury Severity Score (ISS) greater than 25. Secondary outcomes were less severe injuries, including head injuries, crush type injuries, and fractures. Among 52 745 patients with complete data, 15% were youths younger than 16 years, 13% were youths aged 16 to 20 years, 82% were male, and 47% lived in rural areas. After adjusting for covariates, the odds of dying were higher among youths aged 16 to 20 years (adjusted odds ratio [aOR], 1.64; 95% CI, 1.04-2.60) compared with those younger than 16 years. Youths aged 16 to 20 years also had higher odds of spinal cord injury (aOR, 2.72; 95% CI, 1.80-4.20) and an injury severity score greater than 25 (aOR, 1.63; 95% CI, 1.36-1.96) compared with youths 16 years of age or less. Sex-specific analyses revealed these associations were greater for male youths aged 16 to 20 years (spinal cord injury: aOR, 3.81; 95% CI, 1.38-11.10, and dying in a hospital: aOR, 4.37; 95% CI, 1.19-21.02) than female youths aged 16 to 20 years. In this cross-sectional study of patients hospitalized for ATV injuries in Canada, youths aged 16 to 20 years and adults aged 21 years and older were at an increased risk of death and severe injuries compared with youths younger than 16 years. The increased risk of death and severe injuries was most evident among male patients.

Regional surveillance of medically-attended farm-related injuries in children and adolescents.

Due to numerous environmental hazards such as heavy machinery and large livestock, youth who live and work on farms are at high risk of injury, disability, and death. This study described a regional surveillance system for monitoring farm-related injuries in children and adolescents. As the risk of farm-related injuries are not exclusive to farm residents, trends in farm-related injuries over the previous 5 years were reported and compared between children/adolescents who did and did not live on farms in north-central Wisconsin. A retrospective cohort of child and adolescent patients of the Marshfield Clinic Health System was assembled. Incident farm-related injuries, including from agricultural work or other activities in a farm environment, were extracted from medical records from 2017 through 2021. Generalized linear models were created to compare age- and sex-adjusted farm-related injury rates by year. There were 4,730 (5%) in-farm and 93,420 (95%) out-farm children and adolescents in the cohort. There were 65 incident farm-related injury cases in the in-farm group and 412 in the out-farm group. The annual incidence rate of farm-related injuries was higher in the in-farm group, but changes during the 5-year timeframe were not significant in either group. In the in-farm group, rates ranged from a high of 61.8 [95% confidence interval (CI): 38.3, 94.5] incident farm-related injuries per 10,000 children/adolescents in 2017 to a low of 28.2 (13.5, 51.9) injuries per 10,000 children/adolescents in 2018. In the out-farm group, rates ranged from 10.7 (8.3, 13.6) to 16.8 (13.7, 20.5) incident farm-related injuries per 10,000 children/adolescents per year between 2017 and 2021. The in-farm group had a higher proportion of injured males and heavy machinery injuries, while the out-farm group had more all-terrain vehicle injuries and pesticide poisonings. Farm residency remains hazardous for children and adolescents, as injury rates were three times higher in the in-farm group and remained stable over 5 years. All-terrain vehicle injuries were high in both groups, and should be a priority in rural safety interventions. With additional adaptations to other states, this surveillance model could be scaled across other healthcare systems.

Comparative analysis of all-terrain vehicles, motorcycle and automobile-related trauma in a rural border community of the USA

IntroductionThere is widespread use of all-terrain vehicles (ATVs) in the USA for both work-related and recreational activities. In this study, we aimed to determine the difference in injury severity, Glasgow...

Effect of Quarantine and Reopening Measures on Pediatric Trauma Admissions During the 2019 SARS-CoV2 Virus Pandemic.

Several studies have reported decreased trauma admissions and increased physical abuse in children resulting from stay-at-home measures. However, these studies have focused on a limited period after the implementation of lockdown policies. The purpose of this study was to examine the effect of quarantine and reopening initiatives on admissions for varying types of injuries in pediatric patients. Registry data for an urban Level I pediatric trauma center were evaluated from April 1, 2018, to March 30, 2021. A timeline of local shutdown and reopening measures was established and used to partition the data into 6-month intervals. Data about demographics and injury characteristics were compared with similar intervals in 2018 and 2019 using appropriate statistical methodology for categorical, parametric, and nonparametric data. A total of 3,110 patients met criteria for inclusion. A total of 1,106 patients were admitted the year after the closure of schools and nonessential businesses. Decreases in overall admissions and evaluations for suspected child abuse noted early in the pandemic were not sustained during shutdown or reopening periods. However, we observed a 77% increase in all-terrain vehicle injuries, along with a 59% reduction in sports injuries (chi-square [8, N = 3,110] = 49.7; p < 0.001). Significant shifts in demographic and payor status were also noted. This is the first study to comprehensively examine the effects of quarantine and reopening policies on admission patterns for a pediatric trauma center in a metropolitan area. Total admissions and child abuse evaluations were not impacted. If shutdown measures are re-instituted, preventative efforts should be directed towards ATV use and recreational activities.

Epidemiology and factors associated with all-terrain vehicle accidents in children: A retrospective cross-sectional study of a trauma registry in Saudi Arabia.

Background:All-terrain vehicle (ATV) accidents have a substantial impact on the pediatric population in Saudi Arabia; however, few local studies are available. An in-depth study of this issue and adequate implementation of regulations are required to prevent additional casualties. The aim of this study was to describe the epidemiology of ATV injuries in the pediatric population and the outcomes associated with the injuries.Methods:We conducted a retrospective chart review at a Level 1 trauma center in Riyadh. All patients, aged ≤14 years and admitted due to an ATV accident, from 2004 to 2018 were included in this study. Demographic information, hospital course, and injury outcomes were extracted from the King Abdulaziz Medical City trauma registry. Each medical record was reviewed for short-term complications and the mechanism of injury. The primary outcome measure was the type of injury associated with ATV accidents; the secondary outcomes were injury site and mechanism of injury, and the association between the impact of injury and the clinical and demographic variable.Results:In total, 165 patients were involved in ATV accidents and met our inclusion criteria. The mean age was 8 ± 4 years, and 79% (131/165) were boys. Over 50% (84/165) of the sample had lower limb injuries. The majority of patients had fracture injuries (37%, 61/165), followed by amputations (30%, 50/165). Of the amputation group, the majority (86%, 43/50) was from 1 to 5 years compared to the no amputation group (P < 0.001). For the amputation group, 67% (33/50) had a limb trapped in the chain of the vehicle as to the mechanism of injury.Conclusion:The majority of patients had lower-extremity injuries, specifically fractured (37%) or amputated (30%) with children from age 1–5 years having a significantly higher proportion of hospital admission compared to the rest of the study population. Despite the existing legislation for ATV use in children, they are not enforced. The finding of this study recommends urgent implementation of these regulations for both ATV retailers and users and promotes public awareness about the severity of such injuries.

The dark side of nighttime all-terrain vehicle use

BackgroundDriving at night is considered a risk factor for all-terrain vehicle (ATV) crashes and injuries but few studies have addressed this issue. Our objective was to compare daytime and nighttime ATV crashes to better understand the potential risk factors associated with riding at night.MethodsA retrospective study was conducted on Iowa ATV-related crashes and injuries from January 1, 2002 through December 31, 2019 using four statewide datasets: the Iowa Department of Transportation (2002–2019), the Iowa Department of Natural Resources (2002–2019), the Iowa State Trauma Registry (2002–2018) and Iowa newspaper clippings (2009–2019). A standardized coding system was developed, and matching records were identified using Link Plus®. Descriptive (frequencies) and bivariate (chi-square, Fisher's exact test) analyses were performed using VassarStats (Statistical Computation Website).ResultsAmong crash victims where light conditions were documented (2125/3752, 57%), about one-quarter (485/2125, 23%) were injured at night. Nighttime crash victims were less likely youth (14% vs. 30%, p < 0.0001), less likely to be wearing helmets (11% vs. 18%, p = 0.003), and less frequently involved in motor vehicle crashes (7% vs. 14%, p < 0.0001) as compared to daytime victims. Nighttime victims were also more likely to be passengers (22% vs. 15%, p = 0.002), to test positive for alcohol (44% vs. 13% in adults, p < 0.0001), and to be injured on a roadway (53% vs. 45%, p = 0.007) and on weekends (76% vs. 63%, p < 0.0001). Numerous differences between daytime and nighttime characteristics were observed for males, females, and adults, whereas most characteristics were similar for youth. The severity of injuries and proportion of fatalities were similar among daytime and nighttime crash victims.ConclusionsNighttime crash victims, particularly adults, were characterized by more frequent risky behaviors like carrying passengers, roadway riding, alcohol use, and lack of helmets. Whereas the frequency of risky behaviors among youth was similar for daytime and nighttime crashes, these behaviors put children at potential risk for injury. Multi-factorial, targeted injury prevention strategies are needed, including improved vehicle design, education about the dangers of nighttime operation, and passage and enforcement of ATV safety laws. Particularly relevant to our study are laws that prohibit nighttime riding.

Using a Resident-Led School Outreach Program to Improve Knowledge of All-Terrain Vehicle Safety

During the past decade, all-terrain vehicle (ATV)-related injuries treated in US emergency departments decreased by 33%, down to approximately 100,000 injuries in 2016. In comparison, the number of children evaluated for ATV injuries in the Children's of Alabama emergency department more than doubled between 2006 and 2016, counter to the national trend. The American Academy of Pediatrics guidelines state that ATV operators should be at least 16 years old; however, children younger than 16 continue to represent almost one-third of all ATV-related injuries nationwide, and nearly all of the injuries to children in Alabama. Using surveillance data from the Children's of Alabama hospital electronic medical record database, several Alabama counties near Birmingham were identified as having an increased number of children with ATV-related injuries in 2016. The Safety Tips for ATV Riders (STARs) program, developed in Iowa, was provided to middle school students in these counties by pediatric residents. Surveys were anonymously administered to children before and after the program and included information about demographics, knowledge of safe ATV practices, and the likelihood of using the education afterward. In total, 525 students participated in January 2019; their ages ranged from 11 to 15 years and the proportion of males and females was equivalent. More than 50% of the children reported riding ATVs in the last 12 months, and of these riders, 47% reported never wearing a helmet when riding. Initially, only 20% of the overall participants knew ATVs were not intended for passengers, 20% knew the recommended engine size for their age, and 57% knew that Alabama law prohibits riding on public roads. After education, this increased to 91%, 90%, and 89%, respectively. Before the STARs program, only 6% knew all three correct answers, whereas 80% answered all of the questions correctly on the postprogram survey. After the program, 34% reported they were very likely/likely to use this information in the future. The STARs program dramatically improved short-term ATV safety knowledge, and many participants reported they were likely to subsequently use the safe practices presented. School-based programs, such as STARs, may help increase ATV safety awareness and change behaviors in high-risk age groups. This training may be successfully provided by various motivated individuals, including medical residents.

JA:2021-10. The Epidemiology of All-Terrain-Vehicle Injuries: 2015-2017

ABSTRACT Purpose: Injuries related to the operation of off-road vehicles (ORVs), including all-terrain vehicles (ATVs), continue to be a significant public health concern, especially in rural areas and agricultural production. In fact, a previous study of ATV-related occupational deaths utilizing the Bureau of Labor Statistics’ annual Census of Fatal Occupational Injuries found 61% were in the agriculture production industry, and the ATV-related fatality rate per million workers in agriculture was 143 times greater than all other industries. This study was designed to describe the characteristics of ATV injuries and fatalities by using three different national databases. Methods (if applicable): Data on ATV-related injuries and fatalities during the years 2015–2017 was obtained from the Fatality Analysis Reporting System (FARS), AgInjuryNews.org (AIN), and Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS). Results/Findings: We are currently analyzing the data for this ongoing study. A preliminary analysis was performed on FARS, AIN, and NEISS for 2015–2017. By using FARS, we identified 1004 ATV roadway fatalities in 974 crashes. These crashes were mostly single-vehicle (76%) and not a collision with a motor vehicle (77%; overturn/rollover, fall from the vehicle, hit fixed object) crashes. There were 156 fatal and 114 non-fatal agriculture-related ATV injuries by using AIN dataset. Of these injuries, 46% were to youth aged 16 years or younger, and 25% of the victims were using ATV for farm work at the time of the incident. Using NEISS data, an estimated 325,096 ATV-related injuries were treated in U.S. emergency departments from 2015–2017. Almost 30% of these injuries were to youth aged 16 years or younger. Practical Application: By presenting the results from these three datasets, we are hoping to provide a more complete picture of the burden of ATV-related fatalities and injuries. This is much needed to effectively inform injury prevention efforts in rural areas and in agriculture.

Assessing the Emergent Public Health Concern of All-Terrain Vehicle Injuries in Rural and Agricultural Environments: Initial Review of Available National Datasets in the United States.

BackgroundInjuries related to the operation of off-road vehicles (ORVs), including all-terrain vehicles (ATVs), continue to be a significant public health concern, especially in rural and agricultural environments. In the United States alone, ATVs have played a role in thousands of fatalities and millions of injuries in the recent decades. However, no known centralized federal surveillance system consistently captures these data. Traditional injury data sources include surveys, police reports, trauma registries, emergency department data, newspaper and online media reports, and state and federal agency databases.ObjectiveThe objectives of this study paper were to (1) identify published articles on ORV-related injuries and deaths that used large databases and determine the types of datasets that were used, (2) examine and describe several national US-based surveillance systems that capture ORV-related injuries and fatalities, and (3) promote and provide support for the establishment of a federally-funded agricultural injury surveillance system.MethodsIn this study, we examined several national United States–based injury datasets, including the web-based AgInjuryNews, the Fatality Analysis Reporting System, databases compiled by the US Consumer Product Safety Commission, and the National Fatality Review Case Reporting System.ResultsOur review found that these data sources cannot provide a complete picture of the incidents or the circumstantial details needed to effectively inform ORV injury prevention efforts. This is particularly true with regard to ORV-related injuries in agricultural production.ConclusionsWe encourage the establishment of a federally funded national agricultural injury surveillance system. However, in lieu of this, use of multiple data sources will be necessary to provide a more complete picture of ORV- and other agriculture-related injuries and fatalities.

Potential predictors of hospital length of stay and hospital charges among patients with all-terrain vehicle injuries in rural Northeast Texas.

:Background:All-Terrain Vehicles (ATVs) have become popular for recreation use in recent years. Texas has had more ATV related fatalities than any other state in the nation, with rural Northeast Texas having even higher rates of injuries. There is limited data examining the relationship between ATV injuries and the length of hospital stay, as well as hospital costs. This paper examines both issues in children as well as adults. Methods:The regional trauma registry was analyzed for all ATV related injuries between January 2011- October 2016. Injury Severity Score, Glasgow Coma Scale and if they are seen at a Level I Trauma center are predictive for both hospital length of stay and charges. Results:Length of Stay was predicted positively by Injury Severity Score, Emergency Department Respi-ration Rate and facility at which patients were treated and negatively by Glasgow Coma Scale. Hospital charges were predicted positively by age, Injury Severity Score, facility of treatment, means of transportation, and Emergency Department pulse and negatively by Glasgow Coma Scale. Conclusions:The study found that vital signs can be useful in predicting length of stay and hospital charges. This study not only confirms the findings of other studies regarding what predictors can be used, but expands the research into rural traumatic injuries. It is hoped that this data can help contribute to the development of algorithms to predict which patients will be most likely to require resource intensive treatment.

Trends in All-terrain Vehicle Injuries From 2000 to 2015 and the Effect of Targeted Public Safety Campaigns.

All-terrain vehicles (ATVs) represent a notable portion of orthopaedic injuries presenting to emergency departments (EDs) in the United States. Public awareness campaigns have targeted these injuries, and this study sought to examine the effect of the 2007 American Academy of Orthopaedic Surgeons public safety campaign on ATV use. The United States Consumer Product Safety Commission National Electronic Injury Surveillance System (NEISS) was used to obtain national estimates of ATV and dirt bike injuries for the years 2000 to 2015. ED visits resulting from ATV injuries and dirt bike injuries were identified using NEISS product codes (ie, 3285-3287, 3296, and 5036). Patient demographics, injury-related data, and total annual case numbers were estimated. Chi-square tests and logistic regression were used for comparative analyses as appropriate. All statistical analyses were performed using SAS statistical software v.9.4 (SAS Institute). Statistical significance was set at P < 0.05 a priori. Beginning in 2000, the incidence of ATV injuries consistently increased over time and peaked in 2007 (54.1/100,000 people). Since 2007, the incidence of ATV injuries has consistently decreased (33.7/100,000 people in 2015). The frequency of ATV injuries differed significantly (P < 0.001) by age group, with children aged 14 to 17 years experiencing the highest incidence of ATV injury (2.8× national average). ATV injuries were also more common in males (2.7× national average; P < 0.001). The most common injuries were contusions and abrasions (25.3%), fractures (24.5%), and lacerations (11.4%). The decreased rate of ATV injury beginning in 2007 did not differ significantly (P = 0.81) from a comparative decrease in dirt bike-related injuries. This study provides the most current data on ATV injuries presenting to EDs in the United States. The rate of ATV-related injuries has steadily decreased since 2007, which corresponds to the American Academy of Orthopaedic Surgeons public awareness campaign. However, the reasons for this decrease are likely multifactorial. Children aged 14 to 17 years are at high risk of ATV-related injuries, with orthopaedic injuries accounting for a notable proportion.

Twelve-Year Review of Urban Versus Rural Off-road Vehicle Injuries at a Level 1 Trauma Center

ObjectiveTraditionally, all-terrain vehicles (ATVs) and dirt bikes (DBs) have been used in rural locations for recreation and work. Recently, there has been an increase in the use of these vehicles in an urban environment. The aim of this study is to compare the injury patterns of patients involved in crashes while riding off-road vehicles in both urban (UORV) and rural (RORV) environment. MethodsA retrospective review (2005-2016) of patients who presented to an urban level 1 trauma center as a result of any ATV or DB crash was performed. UORV was defined as any ATV or DB accident that occurred on paved inner city, suburban, or major roadways. RORV was defined as those accidents that occurred on secondary roadways or off-road. Patients who presented more than 48 h from time of accident were excluded. A P < 0.05 was considered significant. ResultsFive hundred and twenty-eight patients were identified to have an ATV or DB injury (RORV n = 296 [56%]; UORV n = 232 [44%]). UORV accidents had a higher Injury Severity Score (12.2 versus 9.7; P < 0.05), lower presenting Glasgow Coma Scale (13.8 versus 14.3; P < 0.05), more likely to need emergent trauma bay procedures (28.5% versus 17.9%; P < 0.05), were less likely to have been helmeted (39.6% versus 71.2%; P < 0.05) with a higher unhelmeted Abbreviated Injury Scale head of ≥3 (13.5% versus 5%; <0.05), and more likely to have extremity injuries (53.5% versus 41.2%; P < 0.05). There were no significant differences in additional injury patterns or hospital outcomes including mortality for the two groups. ConclusionsOur data suggest that UORV use was associated with decreased helmet use, higher mean Injury Severity Score, lower presenting Glasgow Coma Scale, an increased need for emergent trauma bay procedures, higher unhelmeted Abbreviated Injury Scale head scores, and higher rates of extremity injuries.

A Cross-Sectional Study of Emergency Department Visits by Children After All-Terrain Vehicle Crashes, Motor Vehicle Crashes, and Sports Activities.

All-terrain vehicle (ATV) crashes have been responsible for significant injuries among children, despite public education efforts. Our study examined pediatric ATV injury patterns in US emergency departments (EDs) compared with injuries after motor vehicle crash (MVC) and sports activities. We studied 2006 to 2011 data from the Nationwide Emergency Department Sample. Children younger than 18 years and involved in ATV crashes, MVC, or sports activities were included. The primary outcome analyzed was a constructed binary measure identifying severe trauma, defined as injury severity score greater than 15. Logistic regression models were fit to determine the association between mechanism of injury and severe trauma. A total of 6,004,953 ED visits were identified. Of these, ATV crashes accounted for 3.4%, MVC accounted for 44.7%, and sports activities accounted for 51.9%. Emergency department visits after ATV crashes were more likely to result in admission (8%) and incur higher median charges ($1263) compared with visits after sports activities (1%, $1013). Visits after sports activities were 90% less likely to result in severe trauma when compared with ATV crash visits. Emergency department visits after ATV crashes result in severe injuries similar to those sustained in MVC (odds ratio, 1.03; P = 0.626). Pediatric ED visits after ATV crashes result in significant injuries and charges. Public health interventions such as education, legislation, and engineering are needed to reduce injuries among children and the subsequent ED visits for care. The impact of proven interventions may be greatest for children living in rural areas and among older children, 10 to 17 years old.

Prevention of all-terrain vehicle injuries: A systematic review from The Eastern Association for the Surgery of Trauma.

Despite increasing usage since their introduction, there exist no evidence-based guidelines on all-terrain vehicles (ATVs) and injury prevention. While the power and speed of these vehicles has increased over time, advancements in ATV safety have been rare. A priori questions about ATV injury pattern and the effect of helmet and safety equipment use and legislation mandating use were developed. A query of MEDLINE, PubMed, Cochrane Library, and Embase for all-terrain vehicle injury was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. Grading of Recommendations Assessment, Development, and Evaluation methodology was used to perform a systematic review and create recommendations. Twenty-eight studies were included. Helmet use reduced traumatic brain injury (TBI). However, studies examining whether legislation mandating helmet use reduced TBI had mixed results. When ATV safety legislation was enforced, overall injury rates and mortality decreased. However, enforcement varied widely and lack of enforcement led to decreased compliance with legislation and mixed results. There was not enough evidence to determine the effectiveness of non-helmet-protective equipment. Helmet use when riding an ATV reduced the rate of TBI. ATV safety legislation, when enforced, also reduced morbidity and mortality. Compliance with laws is often low, however, possibly due to poor enforcement. We recommend helmet use when riding on an ATV to reduce TBI. We conditionally recommend implementing ATV safety legislation as a means to reduce ATV injuries, noting that enforcement must go hand in hand with enactment to ensure compliance.

Pediatric ATV Injuries in a Statewide Sample: 2004 to 2014.

To establish the incidence, mortality rate, and fracture location of pediatric patients injured while using an all-terrain vehicle (ATV) over an 11-year period. A retrospective study using a state trauma database for patients ages 0 to 17 years who sustained injuries while using an ATV. Thirty-two pediatric and adult trauma centers within the state were evaluated from January 1, 2004, to December 31, 2014. The inclusion criteria were met by 1912 patients. The estimated mean annual incidence during the period of the study was 6.2 patients per 100 000 children in the pediatric population <18 years of age. There was a decrease of 13.4% in the mean incidence when comparing the first 5 years of the study with the last 6 years. The median age of patients was 14 years. The median hospital length of stay and injury severity score were 3 days and 9, respectively. There were 28 fatalities (1.5%). The mean mortality incidence was 0.09 deaths per 100 000 children and remained relatively constant. The majority of patients (55.4%) sustained at least 1 bone fracture at or below the cervical spine. The femur and tibia were more commonly fractured (21.6% and 17.7% of the patients, respectively). Despite current guidelines by the American Academy of Pediatrics, patients younger than 16 years of age remain victims of ATV injuries. Although there was a 13.4% reduction in the incidence of ATV-related injuries in recent years, continued preventive guidelines are still necessary to avert these injuries in children and adolescents.

Pediatric all-terrain vehicle (ATV) injuries: An epidemic of cost and grief

ObjectiveEvaluate cost of care of all-terrain vehicle (ATV) related injuries sustained by riders 16 years and younger in Pennsylvania. MethodsPopulation-based retrospective cohort design reviewing costs of care of 78 patients (≤16 years), admitted (01/01/2007–12/31/2009) to our institution for injuries sustained during an ATV accident. ResultsCost of care varied from $322 to $310,435. Mean and median costs for all patients were $25,760 and $8,066, respectively. Average costs increased with increasing age. Patients wearing helmets or driving the ATV had lower mean costs, but these trends were not statistically significant. Crashes with stationary objects not involving rollover or ejection had significantly lower mean costs than other crash types (p = 0.01). Patients involved in rollover accidents were significantly more likely to require an overnight hospital stay (OR = 3.45, p = 0.02). Patients wearing helmets were marginally less likely to require an overnight admission (OR = 0.34, p = 0.07). ConclusionATV crashes involving unhelmeted riders and rollover accidents result in significant medical costs. Interventions to increase helmet use and measures to improve stability are likely to reduce these costs and shorten hospital stays. Level of evidenceLevel IV, Economic study.

All-Terrain Vehicle Injury in Children and Youth: Examining Current Knowledge and Future Needs

BackgroundAll-terrain vehicle (ATV)-related injuries remain a large public health problem in the United States and disproportionately affect American youth. Although children account for only 14–18% of ATV riders, they comprise 37–57% of those injured in ATV-related accidents. Since the U.S. Consumer Product Safety Commission began collecting data in 1982, 23% of ATV-related deaths have occurred in children. ObjectiveWith this review, we outline the major risk factors for injuries among young ATV riders in the United States and suggest research-based interventions to successfully modify such risk factors. DiscussionWe reviewed data from 16 published reviews regarding epidemiology and risk factors among ATV-related injuries in American children. All data pointed to young driver age and lack of appropriate safety equipment as major risk factors for such injuries. Although these risk factors are modifiable, legislation and programs designed to mitigate such risks have been unsuccessful. Among adults, the brief intervention model has become widely used among trauma patients exhibiting risky behaviors. Additionally, peer-to-peer interventions have demonstrated success with respect to drug and alcohol use in school-aged children. Both the brief and peer-to-peer interventions are promising avenues for decreasing risky ATV-related behavior in youths but have not been studied in this field. ConclusionsATV-related injuries disproportionately affect American youths. Although risk factors for such injuries are modifiable, current methods for intervention (mainly legislation) have not been successfully implemented. The brief intervention and peer-to-peer interventions have shown promise in other fields and should be studied with respect to pediatric ATV use.