Neurologic injuries associated with all-terrain vehicles and recommendations for protective measures for the pediatric population

Traumatic Spinal Injury Associated with All-Terrain Vehicle (ATV) Accidents: A 10-Year Retrospective Analysis of the Coachella Valley

Objective

The use of all-terrain vehicles (ATVs) and associated injuries have significantly increased in the last decade. This study aimed to determine the frequency of ATV-associated spinal cord injuries (SCIs) in the Coachella Valley, California, and provide recommendations for data reproducibility in other areas with a similarly substantial level of ATV usage and injuries.

Methods

This retrospective analysis included data obtained through screening the trauma database of a level II trauma center for ATV-related injuries between January 1, 2010 and January 1, 2020.

Results

Our data suggest that more than one-third of patients admitted to the trauma center over a 10-year period suffered from spinal injury. Injuries to the spine were further categorized as including the spinal cord (radiographically or clinically) or only including the bony or ligamentous elements of the spine. Injury was more common in men and predominantly located in the thoracic spine. Injuries such as epidural hematoma, vertebral artery, and cord contusion were common, with many patients requiring neurosurgical intervention.

Conclusion

Highlighting the implicit dangers of ATV accidents on the spine could help identify outcomes and variables predictive of spinal injuries and spinal cord injuries necessary for patient management. Additionally, our study sets the framework by which legislating bodies could replicate the study for proper legislation and recommendations that may help prevent such injuries.

Age- and Gender-Based Patterns in Youth All-Terrain Vehicle (ATV) Riding Behaviors

Injuries to youth on all-terrain vehicles (ATVs) have been increasing exponentially in recent years. Youth under age 16 years are 4 times more likely to require emergency room treatments. This study explored the relationships and differences in ATV risk and safety behaviors based on age, gender, and age at ATV driving/riding initiation. Data were collected from 180 farm youth between 10 and 19 years of age. The study brought to light an important factor that influences risky ATV behaviors of youth, namely, their age at ATV driving and riding initiation. The sooner that youth (boys and girls) were exposed to ATVs, including riding with their family or friends, the sooner they started driving ATVs themselves, and the more likely they were to indulge in several ATV risk behaviors when older. This effect was more pronounced for boys than girls. Overall, girls in this study were equally likely to engage in many of the risky ATV behaviors, such as taking and giving rides on single-seat ATVs, driving adult-sized ATVs, driving ATVs on public roads, and driving ATVs really fast. However, they were less likely to wear protective attire, leaving them more vulnerable to injuries and fatalities during crashes. Implications of the findings and future directions are discussed.

Pediatric all-terrain vehicle trauma: the epidemic continues unabated

OBJECTIVES

The popularity of all-terrain vehicles (ATVs) continues to increase, but this form of recreation is not as well regulated and can impact children disproportionately. This study examines the epidemiology of ATV injuries in Arizona with emphasis on pediatric injuries and compares ATV injuries to those associated with motorcycle (MCC) and motor vehicle crashes (MVC).

METHODS

The trauma registry of a level 1 trauma center was used to identify all ATV crashes during a 5-year period (2004-2008) in patients younger than 16 years. Registration data of ATV were obtained from the state DMV. All-terrain vehicle-related injuries were compared with both MVC and MCC.

RESULTS

A total of 250 pediatric ATV crashes were observed during the 5-year period, rising from 29 in 2004 to 53 in 2008. The median age of patients with ATV-related injuries was 13 years, which is higher than that of patients with MVC-related injuries (9 years). Only 34% of the patients with ATV-related injuries were helmeted, compared with 55% of patients with MCC-related injuries. All-terrain vehicle-related crashes were at least 30 times more likely than MVCs and almost 20 times more likely than MCCs. Statewide pediatric ATV deaths rose during the study period.

CONCLUSIONS

All-terrain vehicle-related crashes have increased during this study period and have become a significant source of injuries. Public education and awareness of the dangers associated with ATV use need to be targeted toward both parents and children likely to use ATVs.

A population-based study of all-terrain vehicle-related head and spinal injuries

BACKGROUND

All-terrain vehicles (ATVs) are inherently unstable and their use results in numerous injuries annually in the United States.

OBJECTIVE

We evaluated the magnitude of ATV-related head and spinal column injuries in Utah and identified risk factors that might be addressed by preventative measures.

METHODS

Four statewide trauma and hospital databases were queried to obtain data on hospital visits by patients with ATV-related neurological injuries in Utah from 2001 to 2005.

RESULTS

Seven hundred forty-one patients (median age, 24 years; range, 2-87 years) with ATV-related head and spinal injuries were identified. Five hundred one patients had injuries requiring transport to a hospital, of which 261 required intensive care. Five hundred fifty-nine patients experienced head trauma and 328 patients sustained spinal trauma. The average injury severity score was 12.6 (range, 0-75). Average hospital stay was 4 days (range, 0-34 days). Vehicle rollover was the most common mechanism of injury (28.6%), followed by loss of control and separation of rider and vehicle (20.1%) and collisions with stationary objects (6.1%) or other vehicles (4.1%). Helmet use was inconsistently documented, but patients without helmets were more likely to have a head injury. Injury frequency increased over time, from 116 in 2001 to 174 in 2005.

CONCLUSION

The number of ATV-related head and spinal injuries is increasing in Utah. Serious injuries requiring surgery or intensive care are common. Riders under 20 years of age are especially at risk, and helmet use may decrease the likelihood of admission to the intensive care unit, head injuries, and death.

Off-road vehicle trauma in children: a New South Wales perspective

OBJECTIVE

There is paucity of data on off-road vehicle injuries in children in Australia. We performed a retrospective study from 1998 to 2003 to analyze the frequency and nature of injuries in children involved in off-road vehicle crashes in the state of New South Wales.

METHODS

Medical records were identified from search of the trauma database and hospital medical records database for off-road (all-terrain) vehicles.

RESULTS

A total of 271 children were identified, 86% of whom were boys. The mean age was 10 years (range, 2-16 years); and the mean length of stay, 5.8 (9) days (range, 1-40 days). The mean injury severity score was 6 (5.9). Most were drivers (85%). Injury mechanism was falls in 161; collision with stationary object, 54; moving object, 4; rollovers, 7; and others, 8. Eighty-four percent were on 2 wheelers, whereas 11% were quad bikes, and the rest were on tricycles or other vehicles. Distribution of the body region injured was head and neck in 66 patients; face, 51; chest, 25; abdomen, 36; pelvis, 5; spines, 14; upper limbs, 96; and lower limbs, 116. Only 55% were helmeted at the time of the incident. Sixty-five percent of these children required surgical treatment. Most were fractures (98) followed by soft tissue injuries (49). Seventeen had posthead injury sequelae requiring rehabilitation support, and 21 required multiple surgeries. There were 7 deaths during the study period in New South Wales.

CONCLUSIONS

Off-road motor vehicle injuries are a significant problem in children. There are no legal safety regulations for use of these vehicles. With the increasing sales of these vehicles, the incidence of injury may rise. There seems a need for education and legislation in relation to the safety issues concerned with these vehicles.

Examining Ontario deaths due to all-terrain vehicles, and targets for prevention

BACKGROUND

All-terrain vehicle (ATV) use is increasingly popular among people of all ages. Although ATV use is known to cause significant morbidity due to head and neck trauma, there is a lack of published data detailing ATV-related fatalities. We examined all ATV-related fatalities in Ontario from 1996 - 2005 to determine the epidemiology and risk factors as a guide for improved injury prevention strategies.

METHODS

All ATV-related fatalities from 1996 - 2005 in Ontario were examined through Coroner's reports in the Office of the Chief Coroner of Ontario. Epidemiologic information and risk factors relating to the driver, environment, and vehicle were recorded.

RESULTS

There were 74 ATV-related fatalities from 1996 - 2005. There was only one fatality per year in 1996 and 1997 and a peak of 16 per year in 2004 and 2005. Head and neck injuries were the commonest causes of death. Males comprised 90.5% of the cases. The highest risk was from age 15 - 29, and 21% of fatalities occurred in children under 16. Northeastern Ontario had the highest fatality rate.

CONCLUSIONS

There was a major increase in the incidence of ATV-related fatalities in Ontario from 1996 - 2005 with the majority due to head trauma. Notable risk factors included alcohol use, riding at night, lack of helmet use, and excessive speed. We recommend the adoption of laws that focus on helmet requirements, a minimum driver age of 16, and certified training courses. Aggressive injury prevention efforts should be targeted toward males aged 15 - 29.

Injury outcomes in children following automobile, motorcycle, and all-terrain vehicle accidents: an institutional review

OBJECT

The authors performed an analysis of retrospectively obtained data to compare the outcomes of pediatric patients admitted to their institution for traumatic injuries resulting from car, motorcycle, and all-terrain vehicle (ATV) accidents.

METHODS

The authors conducted a retrospective review of Columbus Children's Hospital's Trauma Registry data collected between January 1993 and December 2003. Data obtained in patients admitted with motor vehicle-related injuries were compiled for a total of 1608 patient records. Data regarding sex, age, hospital length of stay (LOS), Glasgow Coma Scale (GCS) score, revised trauma score, injury severity score (ISS), and use of a protective device were analyzed.

CONCLUSIONS

Of 1608 patients, 1257 (78%) were injured in automobile accidents, 123 (7.6%) in motorcycle accidents, and 228 (14.2%) in ATV accidents. Injuries sustained in all vehicle types peaked during the summer months. Patients involved in automobile crashes presented with significantly lower GCS scores than those injured in motorcycle and ATV accidents; however, there was no statistically significant difference in LOS among all three injury modalities. Protective devices were underutilized in all three motor vehicle categories but, when used, were associated with significantly higher GCS scores, ISSs, and shorter LOSs among patients admitted after automobile accidents. The correlation of seat belt use with better outcomes underscores the necessity to improve motor vehicle safety education for children, who are less likely to be restrained as they age.

All-terrain vehicle injury patterns: are current regulations effective?

PURPOSE

All-terrain vehicle (ATV)-related injuries continued to increase in recent years. We aimed to analyze the ATV injury patterns at our institution to help structure public awareness campaign and encourage governmental regulation, with the ultimate goal of injury prevention.

METHODS

A retrospective review of all ATV-related admissions at a pediatric trauma center was performed.

RESULTS

From 2001 to 2004, 50 ATV-related injuries requiring hospital admission were identified. The annual incidence had increased 2.5-fold from 2001 (8 admissions) to 2004 (20 admissions). The ages ranged from 3 to 17 years (median, 13 years), with equal sex distribution. Fifty-four percent of admissions were traumatic brain injuries, 28% had orthopedic injuries, 14% with facial fractures, and 4% with abdominal injuries. Average length of stay was 6 days (range, 1-47 days); 5 of the 7 intensive care unit admissions occurred in 2004. Eighty-four percent of patients did not wear helmet (97% among those from northern communities).

CONCLUSIONS

Both the incidence and severity of ATV-related injuries are increasing in a regional pediatric trauma center. There is a lack of regulation enforcement and public awareness of the danger of ATV use in children. Efforts to ensure helmet use and limit operator age are urgently needed to reduce childhood ATV-related injuries.

Central nervous system injuries in sport and recreation: a systematic review

Many sports have been associated with a variety of neurological injuries affecting the central nervous system (CNS), with some injuries specific to that sport. A systematic review of sport-specific CNS injuries has not been attempted previously, and could assist in the understanding of morbidity and mortality associated with particular sporting activities, either professional or amateur. A systematic review of the literature was performed using PubMed (1965-2003) examining all known sports and a range of possible CNS injuries attributable to that sport. Numerous sporting activities (45) have associated CNS injuries as reported within the literature. The sports most commonly associated with CNS injuries are: football, boxing, hockey, use of a trampoline, and various winter activities. A number of sporting activities are associated with unique CNS injuries or injury-related diseases such as heat stroke in auto racing, vertebral artery dissection in the martial arts, and dementia pugilistica in boxing. Neurological injuries of the CNS due to sport comprise a wide collection of maladies that are important for the neurologist, neurosurgeon, orthopaedic surgeon, physiatrist, sports medicine doctor, athletic trainer and general physician to recognise.

Emergency department pediatric all-terrain vehicle injuries in West Central Illinois

OBJECTIVES

This study was prepared to evaluate pediatric all-terrain vehicle-related injuries treated in a tertiary care emergency department in West Central Illinois.

METHODS

A retrospective descriptive study was performed of local emergency department cases entered into the US Consumer Product Safety Commission database. All visits involving an all-terrain vehicle-related injury in children younger than 18 years from January 1994 to December 2001 were explicitly reviewed and compared with aggregate national Consumer Product Safety Commission pediatric all-terrain vehicle data.

RESULTS

One hundred eighty-seven children (age range, 2-17 years) from 14 West Central Illinois counties were treated in the emergency department during the study period. Injury patterns followed a national trend of an increasing annual incidence after 1998 (P = 0.05). The majority of patients were boys (78%) and were 12 years or younger (71%). Contusions (31.8%), fractures (25%), and lacerations (18.8%) accounted for the majority of injuries. Although observed injuries correlated well with national injury estimates for injury position, age, and sex, more head and chest injuries were noted locally. Derived injury severity scores had a mean of 3.1 (range, 1-50), and no difference was noted in the injury severity score for helmet use, sex, or age younger than 12 years.

CONCLUSIONS

Overall, the incidence of all-terrain vehicle-related injuries in West Central Illinois in the emergency department is increasing, and local injury patterns correlate well with those reported on a national level.

Neurological injury and death in all-terrain vehicle crashes in West Virginia: a 10-year retrospective review

OBJECTIVE

The purpose of this study was to profile all-terrain vehicle crash victims with neurological injuries who were treated at a Level I trauma center.

METHODS

We retrospectively reviewed trauma registry data for 238 patients who were admitted to the Jon Michael Moore Trauma Center at the West Virginia University School of Medicine after all-terrain vehicle crashes, between January 1991 and December 2000. Age, helmet status, alcohol and drug use, head injuries, length of stay, disposition, and hospital costs were studied. Death rates, head injuries, age, helmet use, and safety legislation in all 50 states were compared.

RESULTS

Eighty percent of victims were male, with an average age of 27.3 years. Only 22% of all patients were wearing helmets. Alcohol and/or drugs were involved in almost one-half of all incidents. Fifty-five of 238 patients sustained spinal axis injuries; only 5 were wearing helmets. One-third of victims (75 of 238 victims) were in the pediatric population, and only 21% were wearing helmets. Only 15% of victims less than 16 years of age were wearing helmets. There were a total of eight deaths; only one patient was wearing a helmet.

CONCLUSION

In the United States, all-terrain vehicles caused an estimated 240 deaths/yr between 1990 and 1994, which increased to 357 deaths/yr between 1995 and 2000. Brain and spine injuries occurred in 80% of fatal crashes. West Virginia has a fatality rate approximately eight times the national rate. Helmets reduce the risk of head injury by 64%, but only 21 states have helmet laws. Juvenile passengers on adult-driven vehicles are infrequently helmeted (<20%) and frequently injured (>65%). We conclude that safety legislation would save lives.

Yet More Pediatric Injuries Associated with All-Terrain Vehicles: Should Kids Be Using Them?

BACKGROUND

Use of all-terrain vehicles (ATVs) has become a popular recreational activity for all ages, yet children suffer a markedly higher proportion of ATV-related injuries and deaths compared with the adult population. Evidence needs to be developed to direct policy to eliminate unnecessary injuries in this population.

METHODS

A review of children younger than 16 years old admitted to a tertiary pediatric trauma center with ATV-related injuries over 12.5 years was conducted. Data included demographics, mechanisms of injury, use of helmets, and outcomes.

RESULTS

Of 92 patients, 79% were male, the mean age was 12.1 years, 16% were under 10 years old, and 10% had attention deficit hyperactivity disorder (general population prevalence, 1-4%). Flipping/rolling was the most common mechanism of injury (32%) and was associated with sustaining chest and abdominal injuries (odds ratio, 3.7; 95% confidence interval, 1.1-12.9) and an increased Injury Severity Score (ISS). Only 4 of 20 patients with head/facial injuries were using helmets compared with 37 of 40 (odds ratio of head injury with helmet use, 0.02; 95% confidence interval, 0.004-0.101). Forty-five patients had more than one body system injured. The mean ISS was 7.0 (range, 1-35), and high scores were associated with sustaining head and/or truncal injuries. Fourteen percent of cases had an ISS greater than or equal to 12 and two patients died. The median length of stay was 3 days; 12% were admitted over 2 weeks.

CONCLUSION

Children continue to sustain a large proportion of preventable and unnecessary injuries caused by ATVs. Although use of protective devices (i.e., helmets) diminishes the extent of injuries, children's smaller size relative to these large machines may contribute to flipping, rolling, and loss of control. Increased risk-taking by those with attention deficit hyperactivity disorder may also play a role. Efforts are needed to lobby for policies to limit the promotion and restrict the use of ATVs by children.

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.

All-terrain vehicle legislation for children: a comparison of a state with and a state without a helmet law

BACKGROUND

All-terrain vehicles (ATVs) continue to be a source of morbidity and mortality in the pediatric population despite recommendations from the American Academy of Pediatrics that children <16 years old not ride in or drive ATVs. ATV injuries have increased significantly in both children and adults most years since 1997.

OBJECTIVE

To assess the effectiveness of ATV regulations for children on serious injuries by comparing ATV-related admissions to level I and II trauma hospitals in a state with and a state without ATV regulations.

DESIGN

Ecologic study.

PATIENTS

Children <16 years old who died and/or were treated in the trauma system of Pennsylvania or North Carolina after ATV crashes.

OUTCOME MEASURES

Injury types and cause of death were examined for all children. Comparisons were made by state (Pennsylvania [regulated] and North Carolina [unregulated]) for patterns of injury, place of injury, helmet use, and death.

RESULTS

There were 1080 children identified in the trauma registries between January 1997 and July 2000. Forty-four percent required intensive care. Head injuries were the primary cause of death (45.7%). Fewer North Carolina children than Pennsylvania children (16.7% vs 35.8%) wore helmets, and they were more likely to be <11 years old (35.1% vs 27.8%). Living in North Carolina was an independent predictor for not wearing a helmet.

CONCLUSIONS

Living in Pennsylvania was associated with decreased risk factors for ATV injury such as young age and riding unhelmeted. However, despite regulations, many children suffered serious morbidity and mortality. These data support the recommendation that children <16 years old should be prohibited from riding or driving ATVs.

All-terrain vehicle rules and regulations: impact on pediatric mortality

BACKGROUND/PURPOSE

All-terrain vehicles (ATV) use by children leads to severe injury and death. Since the US Consumer Product Safety Commission consent decree expired in 1998, there has been little movement in regulating ATV use for children (<16 yr). The authors hypothesized that states with laws and regulations restricting pediatric ATV use may abrogate excess death compared with states without such restrictions.

METHODS

Pediatric mortality data reported to the consumer product safety commission from 1982 to 1998 were analyzed as well as state all-terrain vehicle requirements compiled by the Specialty Vehicle Institute of America in August 2001. The authors calculated ATV mortality rate by dividing ATV mortality frequency by 1980-2000 pediatric census results. They compared the top 26 states with the highest ATV mortality rates (TOP) with those of all other states (OTH) in terms of age, ATV type, ATV occupancy, and ATV laws. Chi-square analysis was performed.

RESULTS

There were 1,342 ATV pediatric deaths during the 16-year period. The TOP states averaged approximately a 2-fold increase in adjusted ATV mortality rate compared with the national ATV pediatric mortality rate. Ninety-two percent of TOP states have no licensing laws compared with 73% of the OTH states (P <.07). There is no difference between groups with regard to minimum age requirements and safety certification.

CONCLUSIONS

Current legal and regulatory standards have low probability of decreasing ATV-related pediatric mortality. States should adopt laws that restrict the use of ATV's for children less than 16 years of age and potentially prevent excess ATV-related pediatric mortality.

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.

Falls from rooftops after heavy snowfalls: the risks of snow clearing activities

Many patients present to emergency departments as a result of falling from a roof while shoveling snow. This study was undertaken to determine whether the frequency of such falls increases after large snowfalls, and to describe associated injuries. We reviewed the records of all patients presenting with cause of injury codes (E-codes) related to a fall: (E882, E881, and E884.9). We compared the frequency with which snow-shoveling related falls from roofs occurred on days with and without snowfalls greater than 12 inches. Fifty-nine patients met inclusion criteria. Patients were more likely to fall from a roof while shoveling snow on days with greater than 12 inches of snow accumulation than on days with less than 12 inches of snow accumulation (12/14 v 2/45, P <.001). Injuries included spinal fractures, extremity fractures, and head injury. These results suggest a need for public service campaigns emphasizing the risks of roof shoveling.