ATV-related Trauma Research Articles

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.

Characterization of all-terrain vehicle-related thoracolumbar spine injury patterns in children using the AOSpine classification system.

To evaluate thoracolumbar spine injury patterns, demographics, and clinical characteristics in pediatric patients following all-terrain vehicle-related trauma. A retrospective review of patients 0-17years old admitted to a level I trauma center following an ATV-related incident from 2004 to 2013 was performed. Thoracolumbar spine injury patterns, accident mechanism, driver/passenger status, and demographic and clinical data were compared between patients with and without a spine injury. Of 456 pediatric patients involved in ATV-related trauma, 36 sustained one or more thoracolumbar spine injuries (7.9%). These patients tended to be older, taller, heavier, and had a higher BMI. ATV rollover was the major statistically significant mechanism of injury to cause spine fractures (61%). Patients with spine injuries had twice the hospital length of stay compared with those without (4days vs. 2days, P = 0.003). Nonstructural spine injuries (A0) were the most common type of injury (49.1%), followed by wedge-compression fractures (A1) (41.1%). In patients with a thoracolumbar spine injury, there was a mean of 3.11 spine injuries per child. Four (10%) patients with thoracolumbar spine fractures also sustained a cervical spine fracture. Once a thoracolumbar spine injury has been detected in a patient, the entire spinal column should be scrutinized because there is a high likelihood for additional injuries throughout the spine. Younger pediatric patients (≤ 8years old) exhibit a spine fracture pattern distinct from that of older children who have a mature osseous-ligamentous complex.

All-terrain vehicle use related fracture rates, patterns, and associations from 2002 to 2015 in the USA

BackgroundSince their introduction to USA markets in the late 20th century, all-terrain vehicles (ATVs) have been a significant source of trauma. Many paediatric studies have demonstrated the disproportionate rate in which minors are affected by ATV-related trauma, but no studies have been performed on a large sample size spanning all age and geographic ranges. This study is the first to analyze ATV-related fracture rates, patterns, and associated risks across all ages nationwide. Methods & statistical analysisThe National Electronic Injury Surveillance System (NEISS) was queried for ATV-related trauma for the years 2002–2015. The data were analyzed by age, sex, race, alcohol usage, helmet usage, type of injury, fracture location, and disposition from the emergency department (ED). Continuous data were analyzed using the t-test (2 groups) or ANOVA (≥3 groups). Discrete data were analyzed using χ2 tests. SUDAAN 10™ software was used to account for the stratified and weighted nature of the data. Significance was set at p < 0.05. ResultsThere were an estimated 1,862,342 ED visits for ATV-related injuries from 2002 to 2015; 482,501 (25.9%) sustained fractures with a mean age of 27.5 years. Among those with fractures, 75.7% were male, 28.5% resulted in hospital admission, 43.9% occurred at home, and 57.5% were unhelmeted. Anatomically, 51.8% involved the upper extremity, 23.6% involved the lower extremity, 6.4% involved the spine, 8.5% involved the skull/face, and 9.7% involved the ribs/sternum. Alcohol use was most frequently associated with skull (13.2%) and cervical spine (13.0%) fractures. Patients with skull or facial fractures were unhelmeted 88% of the time, and 87% of skull fractures were associated with brain injury. ATV-related fractures peaked in 2007 at 44,283 and trended downward through 2014. ConclusionThis study is the first of its kind to analyze ATV-related trauma over all age groups throughout the entire USA. It can serve as a reference for clinical decision-making and future studies. It also reinforces the need for ATV regulation advocacy, specifically helmet use.

Increasing incidence of All-Terrain Vehicle trauma admissions in the pediatric and adult populations: An evaluation of injury types and severity

ObjectivesAll Terrain Vehicles (ATVs) are increasing in popularity and becoming larger and faster at a production level. As a Level I Trauma Center, we perceived a disproportionately high volume of ATV-related admissions. Our goal was to study injury patterns and severity in adult and pediatric populations. MethodsAll ATV-related trauma admissions at a single Level I trauma center were retrospectively analyzed over a seven-year period. ResultsOn-road incidents were more likely to result in a higher average Injury Severity Score (ISS) (p < 0.05). Higher ISS also occurred in children, un-helmeted, and impaired rider groups (p < 0.05). The pediatric population was more likely to have a major head injury (62.5% of children versus 31.8% of adults, p < 0.05) while thoracic injury was more common in adults (43.4% of adults versus 16.7% of children, p < 0.05). Death rates were similar in both adult and pediatric populations. ConclusionATV-related injuries vary depending on incident characteristics and patient populations. On-road use incurs a significant increase in injury severity. The pediatric population is significantly more likely to incur a severe injury and the presenting injury pattern differs from the adult population. Knowledge of population and presentation trends can help direct trauma care providers in the care and management of injured ATV riders.

Preventing injuries from all-terrain vehicles

All-terrain vehicles (ATVs) are widely used in Canada for recreation, transportation and occupations such as farming. As motorized vehicles, they can be especially dangerous when used by children and young adolescents who lack the knowledge, physical size, strength, and cognitive and motor skills to operate them safely. The magnitude of injury risk to young riders is reflected in explicit vehicle manual warnings and the warning labels on current models, and evidenced by the significant number of paediatric hospitalizations and deaths due to ATV-related trauma. However, helmet use is far from universal among youth operators, and unsafe riding behaviours, such as driving unsupervised and/or driving with passengers, remain common. Despite industry warnings and public education that emphasize the importance of safety behaviours and the risks of significant injury to children and youth, ATV-related injuries and fatalities continue to occur. Until measures are taken that clearly effect substantial reductions in these injuries, restricting ridership by young operators, especially those younger than 16 years of age, is critical to reducing the burden of ATV-related trauma in children and youth. This document replaces a previous Canadian Paediatric Society position statement published in 2004.

Imaging findings in 512 children following all-terrain vehicle injuries

Injuries related to all-terrain vehicle (ATV) use by children have increased in recent years, and the pattern of these injuries is not well known among radiologists. Our purpose was to identify different radiologically diagnosed injuries in children suffering ATV-related trauma and determine associations among various injuries as well as between injuries and outcome. The study included 512 consecutive children suffering from ATV injuries treated at a tertiary care pediatric hospital. All imaging studies were reviewed and correlated with injury frequency and outcome using multivariate analysis. Head injuries occurred in 244 children (48%) and in five of six deaths. Calvarial skull fractures occurred in 104 children and were associated with brain, subdural and epidural injuries. Brain and orbit injuries were associated with long-term disability. A total of 227 extremity fractures were present in 172 children (34%). The femur was the most commonly fractured bone. Nine children had partial foot amputations. Multiorgan injuries occurred in nearly half of the 97 children with torso injuries. Determinants for long-term disability or death were head injuries (odds ratio 3.4) and extremity fractures (odds ratio 3.3). Head and extremity injuries are the two most common injuries in children suffering ATV injuries and are associated with long-term disability. ATV use by children is dangerous and is a significant threat to child safety.

All-Terrain Vehicle–Related Maxillofacial Trauma in the Pediatric Population

Nearly 40% of all-terrain vehicle (ATV) crash-related fatalities involve pediatric patients, with many of these patients dying from head and neck injuries. West Virginia is in a unique position to examine these injuries because of its high rate of ATV use. This study examines craniofacial ATV-related trauma in children. We conducted a single-center, retrospective, descriptive study of 26 children presenting with a craniofacial injury(ies) resulting from an ATV crash from January 2001 to December 2004. Twenty-six children (65% boys) with a mean age of 13.1 years presented with craniofacial injuries during the study period. Two patients were helmeted. Mortality was 3.8% (n = 1, head injury related, postinjury day 3). Patients were most often drivers of the ATV (65%), although girls were more likely to be passengers (P = .03). Facial contusions, lacerations, and abrasions were highly prevalent (62%, 69%, 65%, respectively), as were fractures of the facial bones and skull (77%). Thirty-five percent sustained closed head injuries, which were significantly associated with mandible fractures (odds ratio 12.8%; 95% CI, 1.15-143). Mean length of hospital stay was 4.6 +/- 5 days, and 36% required an ICU stay (mean, 5.1 +/- 3 days). Twenty-four percent required ventilator support (mean, 107 +/- 43 hours; range, 48 to 168 hours). Operative intervention was required in 72% of patients (n = 18). Maxillofacial injury patterns from ATV-related crashes in children suggest a high percentage of significant facial injuries and closed head injuries. As new ATV legislation that addresses operator use is enacted, a decrease in the number and severity of craniofacial injuries may be seen.

P031: ATV-Related Trauma at a Tertiary Referral center

P031: ATV-Related Trauma at a Tertiary Referral center

All-terrain vehicle major injury patterns in children: a five-year review in Southwestern Ontario

The aim of the study was to characterize the nature of the injuries sustained by children involved in all-terrain vehicle (ATV) crashes in Southwestern Ontario over a 5-year period. A retrospective chart review was conducted of children who sustained ATV-related trauma and who presented to the emergency department at the Children's Hospital of Western Ontario between Sept. 1, 1998, and Aug. 31, 2003, with an Injury Severity Score (ISS) = 12. Patients were identified by the London Health Sciences Centre Trauma Program Registry. Patient charts were then retrieved and reviewed to record patient demographics, injuries, interventions and length of stay in hospital. Seventeen patients, 14 male and 3 female, met inclusion criteria. Ages ranged from 8-17 years, with an average age of 13.7 years. Thirteen were <16 years of age. Overall there were 7 different systems injured in these 17 patients. Fourteen patients sustained an injury to more than 1 system. The average ISS was 22.8. The average length of hospital stay was 9.7 days. Six patients sustained significant head injuries; 4 of these 6 patients were not wearing helmets. Eight patients suffered splenic injuries, and 3 required a splenectomy. Thirteen patients sustained fractures. ATV trauma is a significant threat to the children in Southwestern Ontario. These results clearly support the Canadian Paediatric Society's recommendation that children <16 years of age should be prohibited from operating or riding on ATVs.

Geriatric All-Terrain Vehicle Trauma

More than 300 all-terrain vehicle (ATV) trauma deaths occur annually. Most experience to date focuses on the pediatric trauma. However, senior citizens constitute the fastest growing segment of ATV enthusiasts. We queried our trauma registry from January 1988 to December 2002 and found 200 total ATV accidents. There were 8 patients over age 60. We compared geriatric and nongeriatric riders for presentation and outcome data. The anatomic distribution of injury was similar. Younger patients were more likely to have used ethanol or drugs. Tachypnea and hypotension were generally absent at presentation. The geriatric patients had worse predictive physiologic scores. Clinical outcomes for the geriatric group trended toward longer hospital stays, and they had significantly worse functional outcomes. The geriatric group nonsignificantly trended toward a higher mortality (12.5% vs 3.45%). Our study reflects the recent national trend toward a dramatic rise in geriatric ATV-related trauma. We recommend that geriatric ATV safety programs be instituted.

1. Awareness and prevention of all-terrain vehicle injuries

Purpose: While the number of all-terrain vehicles (ATVs) used for recreation and farming increases, little research and education is targeted toward associated injury awareness. The purpose of the study was to examine ATV-related trauma admissions, assess common injuries, and compare injury severity for those wearing a helmet versus the unhelmeted.

All-terrain vehicles—unstable, unsafe and unregulated: A prospective study of ATV-related trauma in rural Ireland

All-terrain vehicles (ATVs) are fast, powerful machines that pose a significant threat to public safety. In the USA, ATVs are responsible for 273 deaths and over 68,000 injuries each year. As the incidence of ATV-related accidents in Britain and Ireland is unknown we carried out a prospective audit of all patients presenting to our Accident and Emergency Departments with ATV-related trauma over a 1-year period. Of 32 patients with ATV-associated injuries, 10 were under 16 years of age and 23 had no previous experience of operating an ATV. We documented 24 fractures (2 open) and 1 tension pneumothorax. Helmet usage was high and head injuries were few and not of a serious nature. Two-thirds of injuries occurred on commercial adventure sports courses. Since ATVs are off-road vehicles, they are exempt from safety regulations that apply to other forms of transport. As care-providers to trauma victims, we must make prevention of these injuries a priority and campaign for both voluntary and legislative controls to make ATV use a safer leisure pursuit.

Major injury associated with all-terrain vehicle use in Nova Scotia: a 5-year review

Riding all-terrain vehicles (ATVs) is a popular recreational activity, with approximately 1.5 million users in Canada. Despite legislation aimed at reducing injury rates, ATV-related incidents remain a major cause of trauma and death. This paper reviews the epidemiology of major injury associated with ATV use in Nova Scotia. The Nova Scotia Trauma Registry was used to identify all adults over age 15 who sustained major ATV-related trauma (Injury Severity Score [ISS] >/=12) within a 5-year period. Demographic variables, temporal statistics, alcohol use, helmet use, injury characteristics and injury outcome variables, including ISS, length of stay (LOS), Glasgow Coma Scale score and discharge status were evaluated. Twenty-five patients met the inclusion criteria. Most (92%) were males, and 64% were between 16 and 34 years of age. Most injuries occurred between 1300 hrs and 1900 hrs, 52% occurred on the weekend, and 40% occurred in the spring. The average ISS was 22.1, and injuries to the central nervous system comprised 39% of all major injuries. Alcohol was involved in up to 56% of all incidents, and only 4 patients (16%) were known to be wearing a helmet at the time of injury. Average hospital LOS was 21.6 days. ATV-related incidents are a continuing source of major injury. This paper describes the epidemiology of ATV-related major trauma presenting to the sole tertiary care referral centre in one province. Information gained from this study should be used to influence ATV public education programs.

All-terrain vehicle and bicycle crashes in children: Epidemiology and comparison of injury severity

Background/Purpose: Despite statements by the American Academy of Pediatrics (AAP) and the US Consumer Product Safety Commission (CPSC) against the use of all-terrain vehicles (ATVs) by children under the age of 16 years, nearly half of ATV-related injuries and over 35% of all ATV-related deaths continue to occur in this age group. Because ATV and bicycle crashes have been associated with serious injury in children, the authors compared the demographics, mechanism of injury, injury severity, and outcome of children with ATV- and bicycle-related injuries. Further, the authors sought to identify whether ATV-related injuries elicited changes in risk-taking behavior. Methods: A retrospective, comparative analysis of 109 children admitted for ATV-related injuries and 994 children admitted for bicycle-related injuries to a level 1 pediatric trauma center between January 1991 and June 2000 was performed. A phone survey was conducted to determine self-reported changes in safety behaviors or use patterns after ATV injury. Results: Mean age was 11.1 [plusmn] 3.5 years (range, 2 to 18 years) for ATV crashes versus 9.4 [plusmn] 3.3 years (range, 1 to 17 years) for bicycle crashes ( P [lt ] .05). Ninety-three percent of ATV crashes occurred in children less than 16 years of age; 31% in children [le ]10 years of age; and 7% in children [le ]5 years of age. Male-to-female ratio was about 3:1 for both groups. White race accounted for 97% of ATV injuries compared with 79% of bicycle injuries ( P [lt ] .05). Falls from ATVs or bicycles were the most common mechanism of injury (41% v 59%, respectively). Collisions with motor vehicles were more common for bicyclists (32% v 10%), whereas collisions with stationary objects were more common among ATV riders (27% v 9%). Sixteen percent of ATV crashes were caused by a roll-over mechanism. Mean injury severity score (ISS) were significantly higher for victims of ATV crashes (8.3 ATV v 6.7 bicycle; P [lt ] .05). ATV-related trauma was associated with multiple injuries, more operative interventions, and longer hospital stays. Location and distribution of injuries were similar for both groups. Helmet use was low in both groups but higher for ATV riders (23% v 8%; P [lt ] .5). Mortality rate was similar for both groups (0.9% for ATV riders v 0.7% for bicyclists). There was a 39% response for the phone survey post-ATV injury. Twenty-three of 43 (53%) respondents owned the ATV, and 70% of these received safety information at the time of purchase. However, only 14% of injured riders received any formal training before riding ATVs. Postinjury, 60% of children continued to ride, although 42% reported decreased riding time. Fifty-four percent of children reportedly wore helmets preinjury, and there were no changes in helmet usage postinjury. There were no differences in pre- and postinjury parental supervision (61% v 65%). Conclusions: Both ATV and bicycle-related injuries occur predominantly in boys, but ATV victims are older and almost all are white. Almost all ATV injuries occurred in children under the age of 16 years. Although both ATV and bicycle crashes cause severe injuries in children, injury severity is higher for ATV crashes in terms of multiple injuries, need for operative intervention, and longer length of stay. Despite severe injuries, the majority of children injured by ATVs continue to ride, albeit fewer hours per day, and safety behaviors are unaltered. These data reinforce the current AAP stance that legislation prohibiting the use of ATVs in children under the age of 16 years without a valid driver's license should be pursued and enforced aggressively.