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

doi:10.1016/j.ijotn.2017.10.001

International Journal of Orthopaedic and Trauma Nursing

Volume 28, February 2018, Pages 33-36

https://doi.org/10.1016/j.ijotn.2017.10.001 Get rights and content

Abstract

Objectives

All 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.

Methods

All ATV-related trauma admissions at a single Level I trauma center were retrospectively analyzed over a seven-year period.

Results

On-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.

Conclusion

ATV-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.

Introduction

First introduced to the US consumer in 1971, All Terrain Vehicles (ATVs) have gained widespread popularity with a currently estimated 10.6 million ATVs in use in the United States (United States Consumer Product Safety Commission, 2014). ATV models are made in a variety of sizes and types which can weigh in excess of 850 pounds and travel at speeds of 85mph or greater especially with off-market modifications (Consumer Federation of America, 2007). Used as both a recreational vehicle and a work utility vehicle, ATVs can provide sport entertainment, and increase work productivity. Yet, despite efforts to promote safe riding practices and industry innovations in protective equipment, ATV related accidents continue to demonstrate an increasing trend in occurrence.

Section snippets

Background

Between 1997 and 2004 the number of hospitalizations for ATV-related injuries quadrupled in the United States (Breslau et al., 2012). Within this admission data, hospitalizations for children with ATV-related injuries was found to increase from roughly 1600 to over 4000 admissions (Breslau et al., 2012) The pediatric population is inherently at more risk due to their smaller size and the considerable strength, psychomotor skills, and cognitive judgment required to operate such a vehicle. Even

Methods

With Institutional Review Board approval all ATV-related admissions from June 1999 to August 2005 at a Level I trauma center were identified. Patient clinical information, as well as data obtained from patient questionnaires, were retrospeectively. Questionnaires were obtained by the trauma staff and information gathered from the patients or their family members either at admission, during their hospital stay, or during post-discharge follow up. The questionnaires specifically evaluated for:

Results

From 1999 to 2005, 225 ATV-related trauma admissions were identified. Both pediatric and adult admissions were highest in 2004, which was more than double the admission rates seen in 2001 (Fig. 1). All age ranges were predominantly male with a total of 179 males and a total of 46 females. Adults accounted for 57.3% of the admissions (n = 129) and children, defined as age 17 or younger, accounted for 42.7% (n = 96). The age of pediatric admissions ranged from 4 to 17 with a mean age of 12.5 (

Discussion

ATV-related accidents are of growing concern for healthcare providers as the morbidity and mortality resulting from the associated injuries are significant. From 2000 to 2010 the annual death toll from ATV-related incidents was as high as 833 per year with deaths in children as high as 182 per year; accounting for nearly 24% of total reported deaths in all age groups(United States Consumer Product Safety Commission, 2014). Survey data from Jennissen et al., revealed at least 75% of adolescents,

Conclusion

With an estimated 10.2 million ATV's in the United States, the products' increasing trend in popularity, and manufacture upgrades in horsepower and speed, the incidence of ATV-related accidents are projected to increase (Breslau et al., 2012). The machines are large, fast, difficult to control, often used in a manner for which they were not designed or intended, and are commonly operated by children, thus contributing to accidents resulting in significant injury. Attempts to enact legal

Ethical statement

The study design and procedures were approved by the Medical Center Institutional Review Board.

References (15)

N. Blecker et al.
Pediatric all-terrain vehicle trauma: the epidemic continues unabated
Pediatr. Emerg. Care
(2012)
J. Breslau et al.
Emergency Department Visits and Inpatient Hospital Stays for All-terrain-vehicle-related Injuries, 2009
(2012)
Consumer Federation of America
All-terrain vehicle (ATV) safety crisis: America's children at risk
G. Denning et al.
All-terrain vehicles (ATVs) on the road: a serious traffic safety and public health concern
Traffic Inj. Prev.
(2013)
L. Ganti et al.
Impact of helmet use in traumatic brain injuries associated with recreational vehicles
Adv. Prev. Med.
(2013)
C. Jennissen et al.
A school-based study of adolescent all-terrain vehicle exposure, safety behaviors, and crash experience
Ann. Fam. Med.
(2014)
I. Mazotas et al.
A prospective, multi-institutional study of pediatric all-terrain vehicle crashes
J. Trauma Acute Care Surg.
(2014)

There are more references available in the full text version of this article.

Cited by (7)

Pediatric all-terrain vehicle (ATV) related head injury rates and patterns: A 10-year nationwide analysis
2023, American Journal of Emergency Medicine
The use of all-terrain vehicles (ATVs) carries significant risk of permanent injury and death, disproportionately affecting children. These injuries commonly affect the head and are especially severe among children as they are often unhelmeted and more likely than adults to experience rollover injuries. Many studies examining patients with ATV-related injuries are single-center cohort studies, with few focusing specifically on head injuries. In the present study, we aimed to characterize the annual incidence of ATV-related head injuries between 2012 and 2021, classify and compare head injury types, and identify descriptive characteristics of ATV-related head injury victims.
Using the US Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) database, we queried all head injuries associated with operating or riding an ATV in children under 18 years-old from over 100 emergency departments (EDs). Patient information regarding age, race, sex, location of incident, diagnoses, and sequelae were analyzed. We also collected the estimated number of ATV-related head injuries from all US EDs using the NEISS algorithm provided by the database.
Using the NEISS algorithm we identified 67,957 (95% CI: 43,608 - 92,305) total pediatric ATV-related head injuries between 2012 and 2021. The annual incidence of ATV-related head injury was similar throughout this study period except for a 20% increase during the COVID-19 pandemic period of 2019–2021 (2019: 6382 injuries, 2020: 6757 injuries, 2021: 7600 injuries). A subset of 1890 cases from approximately 100 EDs were then analyzed. Unspecified closed head injuries were the prevailing type of injury (38%, 900/1890), followed by concussions (27%, 510/1890). More severe injuries included intracranial hemorrhages in 91 children (3.8%, 91/1890). Injuries of all types were predominantly seen in 14–17 year-old's (780/1890, 41%) and in males (64.1%, 1211/1890). In addition, ATV-associated injuries were significantly more common in those coded as white (58.0%, 1096/1890) than any other racial group. ATV-associated accidents among children younger than 9 more commonly occurred at the home compared to accidents involving children older than 9 (57% vs. 32%, p < 0.0001).
ATV-related head injuries cause a significant annual burden among children, with growing incidence in recent years. Further research may wish to explore potential benefits of helmet use and supervision of younger children in possible prevention of these accidents and their associated economic and non-economic costs.
All-Terrain Vehicle-Related Emergency Department Visits: Interaction of Sex and Age, NEISS, 2019
2022, Journal of Emergency Medicine
Citation Excerpt :
This lack of helmet use is even more alarming for the pediatric population. In another level I trauma center study, researchers found that 62.5% of children had a major head injury, compared with 31.8% of adults (31). One measure is the use of state laws regulating ATVs.
Epidemiologic patterns of all-terrain vehicle (ATV)-related emergency department (ED) visits by male and female individuals may vary at different ages. To our knowledge, this has not been researched previously.
The purpose of this study was to determine the interaction of sex and age differences in their association with ATV-related ED visits.
Data from the 2019 National Electronic Injury Surveillance System were extracted for ATV-related ED visits, including sex, age, race, location of crash, injured body part, and whether alcohol was involved. Descriptive statistics and logistic regression analyses were conducted. We modeled sex in separate multivariable models, adjusting for the same independent variables.
There were an estimated 95,995 (unweighted n = 1999) ATV-related ED visits. There was a significant age-by-sex interaction in the association between ATV-related ED visits vs. other ED injuries, indicating that the effect of age on ATV-related ED visits differed by sex and vice versa. Overall, male individuals were 1.7 times as likely to have an ATV-related ED visit as female individuals. In the stratified analysis for female individuals, odds were substantially greater for girls younger than 18 years (adjusted odds ratio [AOR] 2.33; 95% confidence interval [CI] 1.61–3.69) and women aged 18–35 years (AOR 4.76; 95% CI 3.48–6.51) compared with woman older than 35 years. For men, odds were significant for ages 18–35 years (AOR 2.21; 95% CI 1.72–2.85) compared with men older than 35 years. Conclusions: As newer ATVs become more powerful and faster, there is a need to know who is at greatest risk for ATV-related ED visits to develop policies and safety measures.
Whose line is it anyway? The impact of injury transport across state lines
2024, Trauma Surgery and Acute Care Open
All-terrain vehicle (ATV)-related injuries among different age groups: insights from a 9-year observational study
2022, European Journal of Trauma and Emergency Surgery
Epidemiology and factors associated with all-terrain vehicle accidents in children: A retrospective cross-sectional study of a trauma registry in Saudi Arabia
2021, International Journal of Critical Illness and Injury Science
Completeness of medical records of trauma patients admitted to the emergency unit of a university hospital, upper egypt
2021, International Journal of Environmental Research and Public Health

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

Abstract

Objectives

Methods

Results

Conclusion

Introduction

Section snippets

Background

Methods

Results

Discussion

Conclusion

Ethical statement

Pediatric all-terrain vehicle trauma: the epidemic continues unabated

Pediatr. Emerg. Care

Emergency Department Visits and Inpatient Hospital Stays for All-terrain-vehicle-related Injuries, 2009

All-terrain vehicle (ATV) safety crisis: America's children at risk

All-terrain vehicles (ATVs) on the road: a serious traffic safety and public health concern

Traffic Inj. Prev.

Impact of helmet use in traumatic brain injuries associated with recreational vehicles

Adv. Prev. Med.

A school-based study of adolescent all-terrain vehicle exposure, safety behaviors, and crash experience

Ann. Fam. Med.

A prospective, multi-institutional study of pediatric all-terrain vehicle crashes

J. Trauma Acute Care Surg.