Enforcement Of Helmet Laws Research Articles

Nationwide Analysis of Motorcycle-Associated Injuries and Fatalities in the United States: Insufficient Prevention Policies or Abandoned Laws?

Motorcycle road traffic collisions are a major cause of mortality in the United States. We aimed to analyze the temporal and statewide trends in motorcycle collision fatalities (MCFs) nationwide and their association with state laws regarding motorcycle helmet requirements, lane splitting, speeding, intoxicating driving, and red light cameras. A retrospective review of United States MCF/capita from 2015 to 2019 was performed using the Fatality Analysis Reporting System database. MCF/capita was defined as a motorcyclist death per 100000 motorcyclist registrations. Independent-samples t-test and ANOVA were used to determine differences, with significance defined as P < .05. Linear regression analysis and Pearson's correlation were used to further determine associations between variables. The majority of fatalities occurred in males (n = 21354, 91.0%), ages 25-54 (n = 13728, 58.5%), and Caucasians (n = 19195, 81.8%). A total of 24 states and DC exhibited positive trends in MCF/capita from 2015 to 2019. There was no significant difference in MCF/capita between states who had mandatory helmet laws for all, partial requirements, and states with no law (63.4 vs 54.3 vs 33.6, P = .360). Among fatalities involving alcohol, a significantly greater number of MCF/capita were found above the legal limit of .08 compared to the group with a blood alcohol concentration of .01-.07 (17.8 vs 4.5, P < .001). Motorcyclist fatalities continue to pose a public health risk, with 24 states showing an upward trend. Additional interventions and laws are needed to decrease the number of motorcyclist deaths. Further strategy on implementation and enforcement of helmet laws and alcohol consumption may be an essential component.

Motorized 2\u20133 wheelers death rates over a decade: a global study

BackgroundMotorized 2–3-wheelers-related death is high due to the exposed body of the driver/passenger and the high speed. The United Nation (UN) Decade of Action for road safety aimed to reduce road traffic deaths by 50% by the year 2020. We aimed to study the factors affecting the death rates of motorized 2–3 wheelers injured victims and whether the reduction in the death rates has met the UN target.MethodsData were retrieved from the WHO Global Status Reports on Road Safety published over 2009 to 2018 which covered the years of 2007 to 2016. Studied variables included motorized 2–3 wheelers death rates, percentage of helmet-wearing rate, helmet law enforcement, speed law enforcement, gross national income per capita, vehicles/person ratio, and motorized 2–3 wheelers/person ratio. A mixed linear model was used to define factors affecting the change of motorized 2–3 wheelers death rates over time.ResultsThe global mean motorized 2–3 wheelers death rates increased from 2.37/100,000 population to 3.23/100,000 population over the studied decade (a relative ratio of 1.36) which was not statistically significant. Factors that affected mortality included GNI (p = 0.025), motorized 2–3 wheelers per person ratio (p < 0.0001), percentage of helmet wearing rate (p = 0.046), and the interaction between vehicle/person ratio and motorized 2–3 wheelers/person ratio (p = 0.016). There was a significant increase in the death rates over time in the low-income countries (a relative ratio of 2.52, p = 0.019, Friedman test), and middle-income countries (a relative ratio of 1.46, p < 0.0001, Friedman test), compared with a significant decrease in the high-income countries (a relative ratio of 0.72, p < 0.0001, Friedman test).ConclusionsGlobal mortality of motorized 2–3 wheelers has increased by a relative ratio of 1.36 over a recent decade. The UN target of reducing death was not met. The increase was related to the increase in motorized 2–3 wheelers per person ratio and economic inequity which has to be addressed globally. The economic global gap significantly impacts the mortality rates of motorized 2–3 wheelers.

Change in helmet use behavior enforced by CCTV cameras with automatic helmet use detection system on an urban arterial road

Objective Many developing countries experience a high death toll among motorcycle users (both drivers and passengers), primarily due to a relatively low rate of helmet use resulting from ineffective helmet law enforcement. The objectives of this study are to explore the change in helmet use behavior due to helmet use enforcement by closed-circuit television (CCTV) camera technology with an automatic helmet use detection system and to identify the factors associated with helmet use along an urban arterial road in the city of Khon Kaen, Thailand. Methods Data collection was carried out on 49,128 samples by video cameras installed at 5 signalized intersections during 2 periods, namely, before and during the CCTV camera enforcement. The study applied logistic regression analysis to determine factors associated with helmet use and to compare the ratio of helmet use for each variable according to the odds ratio. Results The study found that CCTV camera enforcement could increase helmet usage at all study intersections by 5.3%. The results imply that 4 factors, including riding status, number of passengers, day of week, and traffic conditions, significantly affected helmet use both before and during the CCTV camera enforcement. Remarkably, 2 more variables, age and police inspection, significantly affected helmet use during the CCTV camera enforcement period. Conclusions This study confirms that CCTV camera enforcement can be an important driving force for changing helmet use behavior, particularly for child passengers. Moreover, CCTV camera enforcement can support enforcement by extending coverage to a 24-h period and to intersections without police inspection.

Epidemiology and Pattern of Traumatic Brain Injuries at Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal

Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem worldwide. It represents the greatest contribution to death and disability among all trauma-related injuries globally. TBIs are a leading cause of death and disability in Nepal, despite improvements in safety regulations and implementation of strict drunk driving laws. We describe the epidemiology of patients with TBI following admission to our hospital. We discuss the implementation of specific strategies to reduce its incidence. We conducted a retrospective cross-sectional study of patients presenting to Annapurna Neurological Institute & Allied Sciences (ANIAS), Kathmandu, with a TBI between September 2018 to September2019. One-hundred and sixty-seven patients presented with a TBI. The most common age groups were younger than 15 years old and 15-25 years old, and the majority were male (73%). The commonest cause of TBI was road traffic accidents (RTA) (59%). Drivers riding motorcycles were the predominant mechanism of RTA (38%). Helmet use was seen in 57% of patients riding 2-wheelers. Alcohol consumption was reported in 22% of all patients. Skull fractures were the most common diagnosis. Most patients were managed conservatively (84%). TBI should be recognized as an important public health problem in Nepal. TBI is responsible for a considerable number of neurosurgical admissions to ANIAS. Our study showed patients most vulnerable to TBI are males younger than 25 years old. The implementation of stricter traffic rules and regulations, helmet law enforcement, and public education programs may be helpful in decreasing the number of TBI.

Injury patterns of patients presenting to a non-governmental hospital in Western Uganda

IntroductionInjury is a leading cause of morbidity and mortality globally and disproportionately affects low-income countries. While most injury data comes from tertiary care centers in urban settings, the purpose of this study was to describe the characteristics and severity of injury in rural Uganda and the associated treatment patterns and delays in care.MethodsThis is a retrospective cohort study of a trauma registry that was implemented at Masindi-Kitara Medical Center (MKMC), a rural hospital in Western Uganda. Demographic information, injury characteristics, modified Kampala Trauma Scores (M-KTS), and treatment modalities over a 12 month period were retrospectively collected from paper-based registry forms completed for all injury patients presenting to MKMC.ResultsA total of 350 patients were entered into the trauma registry. Most patients were male (71.2%) with a median age of 26.5 years. Motorcycle crashes were the most prevalent mechanism of injury (42.3%) with the majority being unhelmeted (83.3%). Soft tissue injury was the most common diagnosis (44.9%). Patients were frequently treated in the outpatient department and then discharged (54.8%). Patients requiring admission or transfer (M-KTS = 11.57 or 11.67) tended to have a lower M-KTS than discharged patients (M-KTS = 12.75). Analgesics (74.6%) and antibiotics (52.9%) were the most common treatments administered. For those patients requiring admission (29.4%), only one in-hospital death was documented. Thirty-nine percent of patients reported a delay in seeking care, most frequently due to lack of transportation (31.5%) with a median time of delay of 11 h.ConclusionRoad traffic injuries were the leading cause of injury in Masindi, with a high proportion of injuries associated with unhelmeted motorcycle crashes. Future opportunities to prevent injury and improve care may be seen through improved prehospital care, enforcement of helmet laws, increased access to neurosurgical services, and enactment of hospital quality improvement measures.

CORRELATIONS AMONG MOTORCYCLE-RELATED DEATHS, HELMET LAW ENFORCEMENT AND HELMET USAGE FOR ASEAN COUNTRIES

The ASEAN Community is recorded to have a high rate of motorcyclist injury and death. This study aims to determine the statistical correlations among the deaths related to motorcycle accidents, helmet law enforcement and helmet use among ASEAN countries. Linear regression analysis was applied to develop models exploring the correlations at the 95% confidence level. The results indicate that those countries with higher efficiency of helmet law enforcement and higher helmet usage have achieved lower motorcycle-related death. The findings are useful for responsible organizations to determine road safety policies to reduce the deaths of motorcyclists in ASEAN countries.

Motorcycle helmet use in Calicut, India: User behaviors, attitudes, and perceptions

ABSTRACTObjectives: The objectives of this study include assessing the motorcycle helmet use pattern in Calicut, India, and analyzing the factors influencing helmet use including motorcyclists' perceptions.Methods: Field observational studies at 15 locations were conducted to determine the helmet use rate among motorcyclists and pillion passengers. A structured questionnaire interview survey was conducted with 709 motorcyclists to evaluate the users' perceptions and opinions regarding the use of motorcycle helmets.Results: There was a considerable difference in the level of motorcycle helmet use observed between the locations within and outside the city limits, where different levels of helmet law enforcement were exercised. The helmet use was observed at a maximum of 89% within the city and a minimum of 23% in some locations outside the city. The decreasing percentage of helmet use while moving toward the locations outside the city was confirmed statistically through t tests (t = 1.771, df = 13, P < .05). It was found that only 42% of users revealed that helmets are comfortable and 42% expressed that helmets affect hearing ability. It is important to note that 57% of users are of the opinion that there is no need to use a helmet if you drive slowly and carefully. The price of the helmet was not a deterrent for helmet use. In addition, it was observed that only 45% of helmets used by the motorist were standard helmets with an Indian Standards Institute (ISI) mark.Conclusion: The widely varying helmet use pattern observed in the study area may be attributed due to the users' behaviors; that is, using a helmet only when the helmet law is strictly enforced rather than using a helmet as a protective device. Further, some of the problems and beliefs associated with helmet use prevent motorcyclists from using a helmet. Hence, the road safety of motorcyclists can be improved only through addressing the identified measures comprehensively.

Recurring tragedy of road traffic accidents in India: Challenges and opportunities.

Sir, Road traffic accident (RTA) is an emerging epidemic; it is the eighth leading cause of death and most important cause of death among young people (15–29 years) globally. Every year, 1.24 million people die prematurely in RTA and moreover, 20–50 million people suffer from nonfatal injuries worldwide.[1] India recorded more number of deaths from RTA than any other countries in the world. According to National Crime Records Bureau Report, there was 17.6% increase in deaths due to RTA from 2008 to 2012.[2] Without immediate action, this tragedy will continue to increase, posing a major threat to the country. RTA poses a major burden in health care system in terms of prehospital care, emergency care, and rehabilitation. India spends 12.5 billion dollars on average, toward RTA, which excludes the economic burden of accident survivors with a permanent disability.[2] It is estimated that 3% gross domestic product lost due to RTA in India.[3] India differs from developed countries in road use patterns, with mixed traffic of slow and fast-moving vehicles, pedestrians and animals sharing the same roads.[4] India is currently experiencing a rapid increase in vehicles especially two-wheelers. As of 2009, combined two and three wheelers constitute about 71.6% of total registered vehicles in India.[3] Risk factors are broadly classified as human and environmental factors. Human risk factors are younger age (15–29 years), male sex, drunken driving, fatigue, nonobservance of traffic rules, inadequate use of helmets and safety belts, medical conditions (sudden illness, myocardial infarction, impaired vision), psychological factors (risk taking, impulsiveness), defective judgment, delayed decisions, aggressiveness, poor perceptions, family dysfunction, and distraction while driving (using mobile phones). Environmental risk factors may be related to roads (defective and narrow roads, defective layout of crossroads, poor lighting, and lack of familiarity) and vehicles (excessive speed, poorly maintained vehicles, large number of vehicles, low driving standards and overloaded buses).[4,5] Even though, there are laws and policy regulating RTA, it has been found that the enforcement of regulations is weak [Table 1].[3] According to World Health Organization report on India, enforcement of speed limit and drink law both scored 3 on a scale of 0–10. Enforcement of wearing seat belts for car occupants and helmet law enforcement both scored 2 on a scale of 0–10.[3] Factors that need to be addressed are road safety infrastructure development, appropriate vehicle designs for Indian roads, setting vehicles standard, regular inspection of vehicles, minimizing exposure by segregation of vulnerable road users such as pedestrians and cyclist, removal of encroachments on footpath, strict enforcement of legislation, adequate training of drivers, educating public about road safety, improving postcrash emergency care for the victims and better rehabilitation services, strengthening of accident research and injury surveillance system for accurate database on RTA.[4,5] Table 1 Status of road safety measures in India To reduce the alarming trend of RTA, legal reforms are necessary, it includes adoption of newer regulation regarding child restraint, apply blood alcohol concentration limits of 0.02 g/dl or less among young and novice drivers, reducing speed limit for newer and younger drivers, disqualification and cancellation of license for repeat offenders. Setting a national target to reduce the incidence of accidents proved to be successful in improving the road safety.[5] So far, India has not set a target, such national target should be set and revised at regular interval. Since there is no program, there is an urgent need for appropriate and exclusive national program to combat RTA. To conclude, RTAs are easily predictable and preventable. It requires strong political commitment and multipronged strategies to address the current demands and needs of six E's of road safety such as education, engineering (roads), engineering (vehicles), enforcement, emergency care and enactment. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Distribution and Characteristics of Severe Traumatic Brain Injury at Mulago National Referral Hospital in Uganda

Road traffic accidents are a leading cause of injury in low- and middle-income countries, where mortality rates are disproportionately higher. Patients with severe traumatic brain injury (TBI) tend to have very poor outcomes. To reduce the burden from severe TBI, we describe its distribution at Mulago National Referral Hospital (Kampala, Uganda) and identify the associations between outcomes and patient characteristics, offering insights into prevention and future research efforts to improve clinical care. This is a single-institution, retrospective chart review including patients of all ages with a Glasgow Coma Scale (GCS) score of 8 or less (measured upon admission). A database was compiled to maximize all available clinical variables. Descriptive statistics and univariable and multivariable regression models were fitted to identify significant associations with outcome (died or discharged). One hundred twenty patients were identified between July 1, 2008, and June 30, 2009. The cumulative incidence of admissions is 89 per 100,000. Thirty-one patients died in the hospital, yielding a 25.8% mortality rate. Motorcycle road traffic accident was the leading mechanism of injury, and males ages 15-29 years comprised the predominant demographic (42.5% of patients). Initial GCS, change in GCS score during hospital stay, and the presence of hematoma were strongest predictors of outcome. Severe TBI was a common condition for injury-related hospital admissions at Mulago Hospital. The capacity for neurosurgery may have explained the relatively lower mortality rate than previously reported from Sub-Saharan Africa. Further investigations are needed. Targeted prevention programs focused on motorcycle users and helmet law enforcement should decrease the incidence of severe TBI.

Does law enforcement awareness affect motorcycle helmet use? Evidence from urban cities in Thailand

Although helmet use has been compulsory for motorcycle drivers and passengers in Thailand since the enactment of the Helmet Act in 1994, recent surveys show that the prevalence of helmet usage remains low, particularly among passengers. This paper has sought to explore motorcyclists' awareness of helmet law enforcement in Thailand and examine whether it affects their helmet use behaviour. A total of 2,429 drivers and 1,328 passengers in urban cities nationwide were interviewed in 2009, and the data were analysed using a multivariate ordered logit regression technique. About 60% of the drivers and only 28% of the passengers reported that they always wore a motorcycle helmet. Apart from basic demographics (i.e. age and gender) and riding frequency, our analysis reveals that the awareness of helmet law enforcement was among the contributing factors influencing the use of motorcycle helmets in Thailand. Regardless of riding position, the prevalence of helmet use tended to be greater among those frequently observing the police's checkpoints for helmet wearing and those perceiving the high risk of being caught for non-helmet use. However, the use of helmets appeared to be lower among drivers who perceived the checkpoints to take place at the same times and locations, which were likely predicted. For motorcycle passengers, it was found that the low prevalence of helmet use was potentially attributable to the absence of knowledge on the compulsory helmet law for passengers and the perception that the law was not enforced by the police. Thus, if motorcycle helmet use in Thailand is to be increased, considerable efforts need to be given to increasing the perceived risk of apprehension for non-helmet use (e.g. more police presence and random scheduling of enforcement activities), improving the awareness of the existing helmet law for passengers, and ensuring that helmet wearing by passengers is more strictly enforced.

THE IMPACT OF SAFE COMMUNITY INITIATIVES ON HELMET WEARING RATE AND MOTORCYCLISTS' DEATH IN 14 CITES OF IRAN

BackgroundMotorcycles' riders have the highest public health burden. Since helmet reduces the risk of death by 42% to 69% it seems that the main contributing factors is improper helmet usage...

Motorcycle injuries in north-central Nigeria

The increasing use of commercial motorcycle as mode of transportation in urban cities in Nigeria has become important source of morbidity and mortality. This is coupled with poor helmet use, narrow roads, increasing traffic, and poor licensing of the motorcycle riders. The objectives of this study are to determine the pattern of injuries following accident involving motorcycles, the mortality rate, and the immediate causes of mortality. This is a combined retrospective and prospective study spanning over 2 years (1 year each). Patient's records were retrieved to collate data for the retrospective study while all the patients presenting to the casualty unit of Jos University Teaching Hospital following involvement in motorcycle accidents between April 2006 and March 2007 were selected for the study. Out of 485 motorcycle injured patients, 295 and 190 were recruited from the retrospective and prospective study respectively. The male: female (M: F) ratio was 4.8:1. The ages ranged from 2.5 to 84 years with a peak at 21-30 years. The total number of injuries was 559 with 443 patients singly injured and 42 patients multiply traumatized. Head injury (40.1%) was the most frequently occurring injury followed closely by extremity injuries (38.1%). None of the patients wore protective helmet. Thirty-six (36) mortalities (7.4%) were recorded and all dead patients had head injuries. All deaths occurred within 24 h. Head injury represents a common cause of morbidity and mortality following motorcycle injuries in our environment. Therefore, strict enforcement of helmet laws from May 10, 2010 may reduce morbidity and mortality.

ATV and bicycle deaths and associated costs in the United States, 2000-2005.

We determined the rate and costs of recent U.S. all-terrain vehicle (ATV) and bicycle deaths. Fatalities were identified from the National Center for Health Statistics Multiple Cause-of-Death public-access file. ATV and bicycle deaths were defined by International Classification of Diseases, 10th Revision codes V86.0-V86.9 and V10-V19, respectively. Lifetime costs were estimated using standard methods such as those used by the National Highway Traffic Safety Administration. From 2000 through 2005, 5,204 people died from ATV crashes and 4,924 from bicycle mishaps. A mean of 694 adults and 174 children died annually from ATV injuries, while 666 adults and 155 children died from bicycle injuries. Death rates increased among adult ATV and bike riders and child ATV riders. Males had higher fatality rates for both ATVs and bicycles. Among children, total costs increased 15% for ATV deaths and decreased 23% for bicycle deaths. In adults, ATV costs increased 45% and bike costs increased 39%. Bicycle- and ATV-related deaths and associated costs are high and, for the most part, increasing. Promotion of proven prevention strategies, including helmet use, is indicated. However, enforcement of helmet laws is problematic, which may contribute to observed trends.

Are all-terrain vehicle injuries becoming more severe?

There are several reasons to suspect that injuries from all-terrain vehicles (ATV) have become both more serious and frequent in recent years. These reasons include increasing engine power, younger age of operators and inconsistent enforcement of helmet laws. The purpose of this study was to determine if the increase in ATV injuries was out of proportion to the increase in ATV usage and whether ATV injuries have increased in severity. A retrospective analysis of the Consumer Product Safety Commission (CPSC) ATV injury data and the Pennsylvania Trauma System Foundation (PTSF) database from 1989 to 2002 was performed. ATV use, sales, deaths, trauma center admissions, Injury Severity Score (ISS), hospital length of stay (LOS) and Glascow Coma Score (GCS) were reviewed. ATV sales increased to 316%. In the decade prior to 2003, reported deaths nationally increased from 183 to 357 (95%) nationally and from 5 to 10 (100%) in Pennsylvania (PA). Admissions to trauma centers in PA increased 240%, yet the percentage of deaths to trauma center admissions remained constant at 2.6% during this period (p>.50). ISS and LOS from 1989 to 2002 did not significantly change (all p>.05) and GCS improved significantly. Despite concerns regarding the increasing dangers associated with ATVs, it appears that the severity of injuries from ATV use has not increased.

Effectiveness of cycle helmets and the ethics of legislation

Replying to criticism of their arguments for compulsory helmet-wearing by cyclists (August 2004 JRSM1), Dr Cook and colleagues cite ‘well-conducted’ work from Canada2 concerning the effects of helmet-wearing on injury rates. The Canadian study does not in fact attempt this; rather it shows (and compares) injury rates in helmet legislating provinces and non-legislating provinces. Since there is no indication of what effect, if any, the laws had on helmet usage in the jurisdictions covered it cannot be assumed that, when the authorities legislate, helmet-wearing increases. In the province of Ontario, helmet usage was already very high at 65% among children before the law’s implementation.3 Since the law has not been enforced, any increase following the law would have been modest—although that would be difficult to verify since no province-wide surveys were conducted after the law came into effect on 1 October 1995. Also there were contradictions between the Canadian authors’ data and their conclusion. Robinson4 shows that for the two largest legislating provinces, Ontario and British Columbia (BC), the greatest decreases in head injuries did not occur in the years immediately after respective helmet laws came into effect but rather immediately before. That throws further doubt on the study method. The absence of enforcement of helmet laws explains the Canadian claim that the number of children riding bicycles does not decrease because of mandatory helmet legislation.5 Children seem to know intuitively when a doubtful adult discipline is foisted on them. It did not take long for children in Ontario to figure out that if the cops do not care about helmet laws then why should they. In contrast, British Columbia observed increases in helmet use following legislation,6 but that was coincident with aggressive enforcement and ticketing campaigns by local police (Personal communications with BC cyclists). The BC government did not feel the issue important enough to organize pre-law and post-law surveys to gauge the impact of its law on cycling levels. However, a 35% reduction in all reportable cycling accidents between the two complete years immediately before and after the law’s enforcement, 1995 and 1997,7 suggests considerable declines in cycling. Interestingly, head injuries in BC declined at a slower rate than the number of cycling accidents. Helmet campaigners uncritically latch on to any claim to push helmet agendas. Campaigners in the UK8 have already used the Canadian work in support of their arguments for legislation, including a claim that mandatory helmet legislation in Canada saved lives. The authors did not respond to my requests for substantiation of the latter claim; it may have originated from non-significant differences in the fatality data of Macpherson et al.2 An analysis of 28 years of Transport Canada’s traffic fatality data9 shows that the fatality trend for cyclists is virtually identical to the one for pedestrians. Thus it seems that other factors account for declining fatality and injury trends. Dubious claims on the efficacy of helmet legislation threaten the life-extending benefits of cycling and the gains being made from exercise in reducing heart disease, cancer and obesity.

All-Terrain vehicle injuries: Bad but not worse

Study objectives: Although there are reasons to believe that injuries from all-terrain vehicles (ATVs) have become more serious and frequent in recent years, including increasing engine power, younger age of operators, and lax enforcement of helmet laws, there are few data to support this contention. The purpose of this retrospective data analysis from both state and federal databases is to determine whether ATV injuries have become more serious according to deaths, trauma center admissions, Injury Severity Score (ISS), hospital length of stay, and Glasgow Coma Scale (GCS) score. Methods: This study used the Consumer Product Safety Commission ATV injury data from 1982 to 2002 and the PA Trauma System Foundation database, which records all trauma center admissions in the Commonwealth, from 1989 to 2002. Children were defined as those younger than 16 years. α Was set at .01. Results: Of all national ATV-related deaths, 5.5% occurred in Pennsylvania during the 13-year study period. Nationwide, ATV sales have increased fourfold (316%), from 193,000 in 1993 to 803,000 in 2002. During this time, the number of deaths per year statewide increased 100%, from 5 to 10, whereas admission to a trauma center has increased 240%, from 159 to 540. Despite this, the percentage of deaths compared with trauma center admissions has remained constant ( P >.50) during the 13-year period at approximately 2.6%, with no statistically significant difference ( P >.20) between children and adults. During the same study period, ISS-defined injury severity, categorized as mild (ISS 20), was also unchanged ( P >.10). Similarly, there were no differences in the likelihood of ICU admission, number of days requiring ventilation, or length of stay (all P >.05). The GCS score for children was slightly greater at 12.9±3.9 compared with 12.6±4.0 for adults ( P =.034), but overall severity of neurologic injury as judged by GCS categories (mild ≥13, moderate 9≤GCS≤12, severe ≤8) was actually slightly milder by the end of 2002. Conclusion: Although ATV sales and trauma admissions have increased markedly in recent years, there is no evidence that ATV-related injuries are becoming more serious.