Pediatric and adolescent injury in all-terrain vehicles

A Qualitative Enquiry of On-Farm Rules About Quad Bikes (ATVs): How Rules Are Determined and Implemented at a Farm Level in Rural Australia

OBJECTIVE

Quad bikes are a leading cause of death and incident-related injury on farms, yet little is understood about rules used by farmers to ensure their safe operation. This study explored rules about quad bikes set by those who live or work on farms. Through the case of quad bikes, this study sought to understand how rules are determined and implemented at the farm level.

SETTING

A mix of farm types and locations in rural Australia including Queensland, South Australia, and New South Wales.

PARTICIPANTS

Eight farmers were interviewed and recruited from information sheets at farmers' markets, through a local health organisation, and a media release.

DESIGN

Thematic analysis was used to transform data from eight semi-structured interviews with farmers in rural Australia.

RESULTS

Data were distilled into two themes - "Rule content" described the explicit rules farmers had set on their properties, while the theme "Underlying rule principles" explored the values and norms which underpinned the creation and implementation of these rules.

CONCLUSIONS

Through the case of quad bike rules, this study illustrated how rules are determined and implemented at the farm level. Perceptions of risk were tied to farmers being experts in their own environment and therefore able to mitigate risk. In contrast to injury data, reckless use of quad bikes was perceived to cause incidents, and this was the basis of rules for adults and children.

Pediatric Off-Road Vehicle Injuries: Side-by-Sides Worse for the Upper Extremity

OBJECTIVES

Side-by-side (SXS) and all-terrain vehicles (ATVs) are different off-road vehicles (ORVs) but often categorized together in the literature. We hypothesized pediatric upper extremity (UE) fracture patterns and injury severity scores (ISS) differ between ORV types.

METHODS

The authors' home-state trauma repository identified 157 pediatric patients aged 0 to 17 years with UE fractures after ORV accidents during 2011-2021. ORV injuries, fracture type, and procedures were identified using International Classification of Diseases, 9th Revision and 10th Revision coding followed by manual chart review or phone calls. We identified specific ORV type, driver/passenger status, and restraint use to compare differences between fracture characteristics, number of surgeries, and ISS. Groups were compared for differences at P < 0.05 significance.

RESULTS

Among 157 ORV injuries, 75 resulted from ATVs (48%), 50 SXSs (32%), and 32 from all other vehicles (20%). Average age was 12 years, and 49% (n = 77) required surgery. SXS injuries had significantly higher open fracture rates (42%, n = 21) compared with ATVs (7%, n = 5) and all other ORV types (16%, n = 5; P < 0.0001). Seventy percent of fractures (n = 35) sustained after SXS accidents required surgery compared with 41% (n = 31) for ATVs and 34% (n = 11) for all other ORV types (P < 0.001). SXS drivers had 71% left-sided injuries, whereas 85% passengers had right-sided injuries (P < 0.0001). Patients younger than 13 years (n = 73) had significantly higher surgery rates (59%) compared with 40% for those 13 years and older (n = 84; P = 0.02). There were no significant differences in mean ± SD ISS between ATV (8 ± 6), SXS (8 ± 6), and other vehicles (7 ± 4; P = 0.34).

CONCLUSIONS

UE fractures caused by SXS were more likely to be open and require surgery compared with ATVs and other ORVs. SXS drivers were more likely to sustain left-sided injuries, whereas passengers had significantly higher right-sided injuries. Patients younger than 13 years were more likely to require surgery compared with teenagers.

Rural adolescent attitudes and use of helmets while riding ATVs, motorcycles and dirt bikes

BACKGROUND

Head injuries are the most common cause of death in some motorized vehicles for which helmet use can significantly decrease the risk. Our objective was to determine rural adolescents' attitudes regarding helmets and their use while riding ATVs, motorcycles and dirt bikes.

METHODS

A convenience sample of 2022 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees were surveyed. After compilation, data were imported into the statistical program, R ( https://www.R-project.org/ ). Descriptive statistics, contingency table, logistic regression and non-parametric alternatives to ANOVA analyses were performed.

RESULTS

1331 adolescents (13-18 years) participated. One half lived on a farm, 21% lived in the country/not on a farm and 28% were from towns. Nearly two-thirds (65%) owned an ATV with 77% of all having ridden one in the past year. Farm residents had the highest ATV ownership (78%) and having ridden (80%) proportions, both p < 0.001. Overall, ownership and ridership for motorcycles (22% and 30%, respectively) and dirt bikes (29% and 39%, respectively) was significantly less than ATVs, all p < 0.001. Of ATV riders, those living on farms or in the country/not on a farm rode them more frequently than those from towns, p < 0.001. Higher percentages always/mostly wore helmets when riding dirt bikes (51%) and motorcycles (57%) relative to ATVs (21%), p < 0.001. Those from farms had lower proportions wearing helmets versus those living elsewhere for all vehicles. Helmet use importance ratings (1-10, 10 high) were not different for motorcycles (mean 8.6, median 10) and dirt bikes (mean 8.3, median 10), but much lower for ATVs (mean 6.1, median 6). Females, non-owners, and helmet law supporters all had higher helmet use importance ratings. Males, those from farms, and owners and riders of the vehicles all had lower proportions that supported helmet laws. Support for helmet laws was significantly lower for ATVs (30.7%) than dirt bikes (56.3%) or motorcycles (72.3%), both p < 0.001. Those whose families had strict ATV "No Helmet, No Riding" rules had much higher helmet use and helmet importance ratings.

CONCLUSIONS

Our study indicates that the safety culture surrounding helmet use is relatively poor among rural adolescents, especially on farms, and deserves targeted interventions.

A Systematic Review of Youth and All-Terrain Vehicles Safety in Agriculture

All-terrain vehicle (ATV) incidents are one of the leading causes of injuries and fatalities among youth in the agricultural industry. It has been hypothesized that many youth-related ATV incidents occur because children ride ATVs that do not fit their capabilities and are not following basic safe riding practices. In addition, various ATV safety guidelines regarding youth (e.g., CPSC, ANSI/SVIA, ASI) are inconsistent and may not align with state or local laws. To the best of our knowledge, no comprehensive studies have compared the physical and mental requirements for riding ATVs and the youth's capabilities to ride ATVs safely. Consequently, there are no scientific-based recommendations for age limitation, physical and mental capabilities, and safety requirements for youth to ride ATVs safely. Thus, there is a need to review the available sources related to youth safety and ATVs in the agricultural industry, identify the research voids, and recommend modifications to current ATV guidelines. This study conducted a systematic review of available ATV-related studies, standards, guidelines, and laws to establish better-informed minimum age, physical and mental capabilities, and safety requirements for youths to ride ATVs on the farm.

Horse-riding hazards: an observational cohort study mapping equestrian related injuries at a Scandinavian trauma centre

INTRODUCTION

Horse-riding is practiced on a regular basis by 500,000 people in Sweden. It is reputed to be one of the most dangerous sports. On average, there were 1756 acute injuries and three fatalities each year between 1997 and 2014 in Sweden related to horses. The primary aim of this study was to outline the injury spectrum related to equestrian activities cared for at a large Swedish trauma centre. The secondary aim was to identify trends in clinical outcomes and to investigate the association between age and such outcomes.

MATERIAL AND METHODS

The electronic medical records system at Karolinska University Hospital was queried for patients cared for due to equestrian related trauma between July 2010 and July 2020. Complementary data were gathered using the hospital's Trauma Registry. No exclusion criteria were applied. Descriptive statistics were used to outline the injury spectrum. Age was split into four categories which were compared using the Kruskal-Wallis H test or the Chi-squared test. Logistic regression was used to analyse correlations between age and outcomes.

RESULTS

A total of 3036 patients were included with 3325 injuries identified as equestrian related. The hospital admission rate was 24.9%. The cohort had one death. Regression analysis showed significant associations between decreasing risk of upper extremity injury (p < 0.001), increasing risk of vertebral fractures (p = 0.001) and increasing risk of thoracic injury (p < 0.001) with increasing age.

CONCLUSIONS

Equestrian activities are not without risks. The morbidity is high, and injuries are taken seriously by the medical profession, reflected by the high admission rate. There are age-related variations in the injury spectrum. Older age appears to predispose to vertebral fractures and thoracic injuries. Other factors than age appear more important in determining the need for surgery or admission to ICU.

Pediatric all-terrain vehicle (ATV) related head injury rates and patterns: A 10-year nationwide analysis

INTRODUCTION

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Recreational off-highway vehicle exposure, safety behaviors and crash experiences among adolescents

BACKGROUND

Recreational off-highway vehicles (ROVs), often called utility task vehicles (UTVs), are designed to be driven by those ≥ 16 years and manufacturers recommend passengers be at least 12 years old. This study's objective was to determine Iowa adolescents' exposure to ROVs, riders' use of restraint devices, and crash prevalence.

METHODS

Adolescents participating in the Safety Tips for ATV Riders (STARs) program at their schools were anonymously surveyed by the Iowa Off-Road Vehicle Safety Task Force from Fall 2014-Fall 2019. Frequency, bivariate (chi square and Fisher's exact test) and logistic regression analyses were performed using SAS software, V.9.4.

RESULTS

A total of 4,023 students (9-18 years) from 18 school districts participated. Overall, 68% reported having ridden in an ROV. The proportions having ridden an ROV by where participants lived were farm (85%) > country/not farm (73%) > town (60%), p < 0.0001. Of those asked additional ROV questions (n = 2152), 39% of ROV riders reported riding at least weekly in the previous 12 months. Of those riding ROVs in the past year, 29% reported having at least one crash. Males and respondents living on farms had higher percentages reporting crashes, as compared to females (31% vs. 24%, p = 0.005) and those living elsewhere (35% vs. 24%, p = 0.0003). Thirty-seven percent of ROV riders never or almost never wore their seatbelt. Seatbelt use was inversely proportional to age, p < 0.001. A higher proportion of females reported always or almost always wearing a seat belt (42% vs. 36%, p = 0.0016). Percentages never or almost never wearing seatbelts by residence were farm (47%) > country/not farm (38%) > town (32%), p = 0.0005. Almost daily riders and those reporting having been in a crash were both 1.7 times more likely to never or almost never wear a seatbelt as compared to infrequent riders and those without a crash, respectively.

CONCLUSIONS

Iowa adolescents frequently ride ROVs and often without a seatbelt, putting them at greater risk for serious injury or death in a crash. Almost 30% of riders reported an ROV-related crash in the past year. Our study identified a high-risk population that could be targeted for ROV safety education and other injury prevention efforts.

All-terrain vehicle exposure and the association of certified training on adolescent safety behaviors and crash experiences

BACKGROUND

Certified training courses in all-terrain vehicle (ATV) operation are recommended, but little has been published regarding how they affect riding behaviors. Our objectives were to determine adolescents' ATV riding exposures, crashes and injuries, and the association of completing certified ATV training on riding behaviors.

METHODS

Respondents completed an anonymous paper survey at 30 school districts approximately one year after participating in the Safety Tips for ATV Riders (STARs) program. Survey data were compiled using Qualtrics™. Frequency, chi-square, Fisher's exact test, and logistic regression analyses were performed using SAS, V.9.4.

RESULTS

4,891 students completed the survey from Fall 2012-Fall 2019. Respondents were 10-18 years old, and similar numbers of participants were male and female. Fifty-nine percent lived in town, 18% on a farm, and 22% in the country but not on farm. Forty-two percent reported their families owned an ATV. Seventy-seven percent had ridden an ATV, 40% of whom reported riding at least weekly. The vast majority (94%) used ATVs for recreation and 49% used them for work purposes. In the previous year, 22% of riders reported having been in a crash, with 7% of crash victims requiring medical attention for injuries. Greater crash likelihood was seen in males, recreational riders, more frequent riders, competitive racers and those who had ridden with passengers or on roads. Only 8% of riders had completed certified ATV safety training (note, STARs is not a certification program). Those whose families owned ATVs, more frequent riders, and public park users had greater likelihoods of course completion. Relative to their peers, respondents who completed a certification course had higher proportions that always/almost always wore helmets (39% vs. 20%, p < 0.0001) and lower proportions that never/almost never wore helmets (29% vs 58%, p < 0.0001), had ridden with passengers (63% vs. 96%, p < 0.0001), and had driven on public roads (41% vs 50%, p = 0.0065).

CONCLUSIONS

ATV safety training certification among Iowa adolescents in the study was infrequent but those that received training reported higher helmet use, less riding with passengers, and less driving on public roads. These data suggest completing safety training certification may promote safer riding behaviors among youth.

American Academy of Pediatrics Recommendations for the Prevention of Pediatric ATV-Related Deaths and Injuries

Since all-terrain vehicles (ATVs) were introduced in the mid-1970s, regulatory agencies, injury prevention researchers, and pediatricians have documented their dangers to youth. Major risk factors, crash mechanisms, and injury patterns for children and adolescents have been well characterized. Despite this knowledge, preventing pediatric ATV-related deaths and injuries has proven difficult and has had limited success. This policy statement broadly summarizes key background information and provides detailed recommendations based on best practices. These recommendations are designed to provide all stakeholders with strategies that can be used to reduce the number of pediatric deaths and injuries resulting from youth riding on ATVs.

A Comprehensive Report on All-Terrain Vehicles and Youth: Continuing Challenges for Injury Prevention

All-terrain vehicles (ATVs) represent a serious and ongoing public health and safety concern for children and adolescents. Survey studies indicate that high proportions of youth ride ATVs in both rural and nonrural populations. The significant human and economic costs of pediatric ATV-related deaths and injuries result from a number of major risk factors that are highly common in pediatric ATV crashes: operating adult-size vehicles, riding with or as passengers, lack of protective equipment, and riding on public roads. Other less well-studied but potentially significant risk factors are speed, riding at night, alcohol use among older teenagers, and lack of training and supervision. Although potentially safer than adult ATVs, youth models present a number of safety concerns that have not been addressed with rigorous study. The most common ATV crash mechanism is a noncollision event-for example, a rollover. Common injury mechanisms include ejection from the vehicle, resulting in extremity and head injuries, and being pinned or crushed by the vehicle with resulting multiorgan trauma and/or compression asphyxia. Traumatic brain injury and multisystem trauma are the 2 most common causes of death and disabling injury. Taken together, a large multidecade body of evidence is the basis for the American Academy of Pediatrics policy statement recommendation that no child younger than 16 years of age ride on an ATV. Because children continue to be allowed to ride these vehicles, however, efforts to prevent pediatric ATV-related deaths and injuries require multipronged strategies, including education of both youth and parents, safety-based engineering, and enforcement of evidence-based safety laws.

Impact of All-Terrain Vehicle Accidents on Pediatric Patient Outcomes at an Appalachian Children’s Hospital

Introduction

The use of all-terrain vehicles (ATVs) has become increasingly popular as an outdoor recreational activity among people living in the United States, particularly in areas such as the southeast. There are significant risks involved with riding ATVs, especially in the pediatric population, due to lack of training and experience. The purpose of this study was to evaluate the outcomes of pediatric patients involved in ATV-associated accidents.

Methods

This study is a retrospective review of 98 pediatric patients ages 15 years and younger involved in ATV accidents who were admitted to a pediatric hospital between January 2015 and December 2020. Outcomes, including types of injuries sustained, length of hospital stay, length of ICU stay, and injury severity score (ISS) were analyzed between age groups (0-5, 6-10, and 11-15).

Results

The mean hospital stay across all age groups was 1.7 ± 1.9 days, mean ICU stay was 3.8 ± 4.0 days, and mean injury severity score (ISS) was 5.9 ±4.8. The 11-15-year-old age group had a significantly longer hospital stay and higher ISS scores compared to both of the younger age groups (0-5 and 6-10 years old). There was no difference in ICU days between the age groups. Orthopedic injuries were the most common type of injury, occurring in 55% of all patients, followed by head injuries in 29% of patients, and spinal fractures in 2% of patients. The most common orthopedic fracture in the 11-15-year-old group was tibia/fibula, while humerus fractures were the most common type of fracture in the 0-5 and 6-10 year age groups. Orthopedic procedures were required in 35% of all included patients. There was no statistically significant difference in types of injuries and types of fractures sustained between each group. Chest injuries, including pneumothorax, lung contusions, and rib fractures, occurred most often in the older age group 11-15 years (n=65). Those who experienced chest injuries had a higher ISS, although it was not statistically significant (p=0.06) compared to those who did not have chest injuries. There was no difference in hospital or ICU length of stay in patients with chest injuries.

Conclusions

The results of this study demonstrate the outcomes of pediatric patients admitted for ATV accidents at a rural Appalachian pediatric hospital and provide an overview of the most common injuries involved in this trauma mechanism. Pediatric patients aged 11-15 years of age involved in ATV accidents are at risk for longer hospital length of stay and higher ISS compared to younger age groups. Additionally, patients ages 11-15 were more susceptible to chest injuries following ATV accidents. The results of this study will be used to develop a standardized trauma protocol for the management of this specific trauma mechanism in the pediatric population based on common injury patterns among each age group.

Comparative analysis of off-road vehicle crashes in children: motorcycles versus quad bikes

OBJECTIVE

To characterise and compare off-road motorcycle and quad bike crashes in children in New South Wales (NSW), Australia.

METHODS

A retrospective, cross-sectional study was performed of children aged 0-16 years, admitted to hospitals in NSW, from 2001 to 2018 following an injury sustained in an off-road motorcycle or quad bike crash, using linked hospital admissions, mortality and census data.Motorcycle and quad bike injuries were compared regarding: demographics; incidence; body region injured and type of injury; injury severity based on the survival risk ratio; length of stay and mortality.

RESULTS

There were 6624 crashes resulting in hospitalisation; 5156 involving motorcycles (77.8%) and 1468 involving quad bikes (22.2%). There were 10 fatalities (6 from motorcycles and 4 from quad bikes). The rates of injury declined over the study period for motorcycles, but not for quad bikes.Motorcycle riders were more likely than quad bike riders to have lower limb injuries (OR 1.49, p<0.001) but less likely to have head/neck (OR 0.616, p<0.001), abdominal (OR 0.778, p=0.007) and thoracic (OR 0.745, p=0.003) injuries. Quad bike crashes resulted in higher injury severity (mean International Classification Injury Severity Score 0.975 vs 0.977, p=0.03) and longer hospital stay (mean 2.42 days vs 2.09 days, p=0.01).

CONCLUSIONS

There are significant differences between quad bike and motorcycle crashes in injury type and affected body region. While quad bike injuries in children were more severe, there were almost four times more hospitalisations from motorcycles overall. The overall larger burden of motorcycle crashes suggests a greater focus of injury prevention countermeasures for two-wheeled riders is needed.

Risk factors associated with quadbike crashes: a systematic review

Background

Quadbikes or all-terrain vehicles are known for their propensity for crashes resulting in injury, disability, and death. The control of these needless losses resulting from quadbike crashes has become an essential contributor to sustainable development goals. Understanding the risk factors for such injuries is essential for developing preventive policies and strategies. The aim of this review was to identify the risk factors associated with quadbike crashes at multiple levels through a systematic review of a wide range of study designs.

Methods

The study incorporated a mixed-method systematic review approach and followed the PRISMA 2020 guidelines for reporting systematic reviews, including a peer reviewed  protocol. This systematic review included observational studies investigating the risk factors associated with quadbike crashes, injuries, or deaths. Seven electronic databases were searched from inception to October 2021. Studies were screened and extracted by three researchers. Quality appraisal was conducted using the Mixed Methods Appraisal Tool (MMAT). Due to extensive heterogeneity, meta-analysis was not conducted. All the risk factors have been presented in a narrative synthesis for discussion following the guidelines for Synthesis without Meta-analysis (SWiM).

Results

Thirty-nine studies combining an aggregate of 65,170 participants were included in this systematic review. The results indicate that modifiable risk factors, such as the increasing age of driving initiation, reducing substance use, and the use of organized riding parks, could reduce quadbike injuries. Riding practices such as avoiding passengers, avoiding nighttime riding, and using helmets could significantly reduce crashes and injuries among riders. Vehicle modifications such as increasing the wheelbase and limiting engine displacement could also help reduce crash incidence. Traditional interventional methods, such as legislation and training, had a weak influence on reducing quadbike injuries.

Conclusion

Multiple risk factors are associated with quadbike injuries, with most of them modifiable. Strengthening policies and awareness to minimize risk factors would help in reducing accidents associated with quadbikes.

PROSPERO registration number CRD42020170245

All-Terrain Vehicle-Related Emergency Department Visits: Interaction of Sex and Age, NEISS, 2019

BACKGROUND

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.

OBJECTIVE

The purpose of this study was to determine the interaction of sex and age differences in their association with ATV-related ED visits.

METHODS

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.

RESULTS

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.

The dark side of nighttime all-terrain vehicle use

BACKGROUND

Driving at night is considered a risk factor for all-terrain vehicle (ATV) crashes and injuries but few studies have addressed this issue. Our objective was to compare daytime and nighttime ATV crashes to better understand the potential risk factors associated with riding at night.

METHODS

A retrospective study was conducted on Iowa ATV-related crashes and injuries from January 1, 2002 through December 31, 2019 using four statewide datasets: the Iowa Department of Transportation (2002-2019), the Iowa Department of Natural Resources (2002-2019), the Iowa State Trauma Registry (2002-2018) and Iowa newspaper clippings (2009-2019). A standardized coding system was developed, and matching records were identified using Link Plus®. Descriptive (frequencies) and bivariate (chi-square, Fisher's exact test) analyses were performed using VassarStats (Statistical Computation Website).

RESULTS

Among crash victims where light conditions were documented (2125/3752, 57%), about one-quarter (485/2125, 23%) were injured at night. Nighttime crash victims were less likely youth (14% vs. 30%, p < 0.0001), less likely to be wearing helmets (11% vs. 18%, p = 0.003), and less frequently involved in motor vehicle crashes (7% vs. 14%, p < 0.0001) as compared to daytime victims. Nighttime victims were also more likely to be passengers (22% vs. 15%, p = 0.002), to test positive for alcohol (44% vs. 13% in adults, p < 0.0001), and to be injured on a roadway (53% vs. 45%, p = 0.007) and on weekends (76% vs. 63%, p < 0.0001). Numerous differences between daytime and nighttime characteristics were observed for males, females, and adults, whereas most characteristics were similar for youth. The severity of injuries and proportion of fatalities were similar among daytime and nighttime crash victims.

CONCLUSIONS

Nighttime crash victims, particularly adults, were characterized by more frequent risky behaviors like carrying passengers, roadway riding, alcohol use, and lack of helmets. Whereas the frequency of risky behaviors among youth was similar for daytime and nighttime crashes, these behaviors put children at potential risk for injury. Multi-factorial, targeted injury prevention strategies are needed, including improved vehicle design, education about the dangers of nighttime operation, and passage and enforcement of ATV safety laws. Particularly relevant to our study are laws that prohibit nighttime riding.

Comparing the Severity of Injury and Trauma Pattern between Scooter and Street Motorcycle Riders; a Prospective Cohort Study

Introduction:

The popularity of motorcycle riding in Iran is increasing. However, there is a lack of information about the safety of different motorcycle types. This study aimed to compare the severity of injury and trauma pattern between scooter (vespa) and street (standard) motorcycle riders.

Method:

In a prospective cohort study, a comparison of demographics, injury severity, trauma pattern, and clinical characteristics between 324 riders (162 Vespa and 162 standard motorcycles) admitted to emergency departments was undertaken. The risk factors associated with severe injuries in the two groups were also determined. An emergency medicine specialist determined the severity of trauma based on the abbreviated injury scale (AIS).

Results:

The Odds Ratio (OR) of severe injuries was significantly higher in the standard motorcycle riders’ group (OR: 3.09; 95% CI: 1.9-4.21; p: 0.013). The frequency of lower extremity fractures was significantly lower in the Vespa group (OR: 4.11; 95% CI: 2.01-6.25; p = 0.012). The frequency of admission to the intensive care unit was significantly higher in the standard motorbike riders’ group (OR: 1.64; 95% CI: 1.11-2.51; p = 0.033). The multivariate analysis indicated that motorcycle type, the speed at the time of the accident, use of helmet, and age of riders are the most important predictors of trauma severity in riders (p<0.05).

Conclusion:

The pattern of injury varies between standard and Vespa motorcycles. The standard motorcycle riders were prone to a higher risk of adverse outcomes such as severe injuries. Due to the particular structure of scooters, the rate of lower limb injuries was significantly lower than standard motorcycles.

Agricultural All-Terrain Vehicle Safety: Hazard Control Methods Using the Haddon Matrix

All-terrain vehicle (ATV) crashes are one of the leading causes of death and injury in agriculture across the United States. Use of ATVs is highly prevalent in rural areas and has seen an increase in their application for a variety of agricultural work tasks. Empirical research on the use of these vehicles for agricultural tasks and associated injuries is limited, especially in the United States. Moreover, little is known about the risk factors associated with ATV-related injuries while doing farm work. A comprehensive review was conducted to evaluate the current injury burden of ATV use in agriculture, the need for future research, and possible solutions related to agricultural ATV safety. Potential injury prevention approaches are evaluated based on the hierarchy of control, including elimination or substitution (using side-by-side vehicles instead of ATVs or modifying ATV design), engineering control (operator protection devices), administrative authority (regulations and standards in the United States and around the world), training, and use of personal protective equipment. In addition, vehicle nomenclature, risk factors, and crash mechanisms are reviewed. Recommendations to decrease the likelihood of ATV crashes and injuries are provided.

Nonfatal All-Terrain Vehicle-Related Head and Neck Injuries to Children Treated in US Emergency Departments

This study investigates children <18 years old with nonfatal all-terrain vehicle (ATV)-related head and neck injuries treated in United States emergency departments by analyzing data from the National Electronic Injury Surveillance System from 1990 to 2014. An estimated 279 391 children received emergency treatment during the 25-year study period. The number of injuries remained relatively constant from 1990 to 1997, increased by 142.9% from 1997 to 2007, and then decreased by 37.4% from 2007 to 2014. The most common diagnoses were concussion/closed head injury (32.6%) and fracture (32.6%); 15.4% of children were admitted. The most common injury mechanisms include ejection (30.0%), crash (18.8%), and rollover (15.8%). Patients who were injured on a street/highway were 1.49 times (95% confidence interval = 1.11-1.99) more likely to be admitted than patients injured at other locations. Although the number of nonfatal ATV-related head and neck injuries decreased during the latter part of the study period, they remain common and can have serious medical outcomes.

Parental attitudes and family helmet use for all-terrain vehicles and bicycles

Background

Helmets prevent head trauma in both all-terrain vehicle (ATV) and bicycle crashes. This pilot study’s objective was to compare family helmet use and participant attitudes regarding helmets for ATVs versus bicycles.

Methods

A convenience sampling of adults attending a 2017 university-sponsored health fair who had at least one child < 18 years living at home were surveyed. Demographics, frequency of helmet use, and information about factors influencing helmet use were collected. Descriptive (frequencies) and bivariate (Fisher’s exact test) analyses were performed. Qualitative themes of written responses were also examined.

Results

Subjects (N = 98) were 26–57 years old (mean 40 years). Three-quarters (76%) were female. The percentage always wearing a helmet riding bicycles was 63% (subjects), 58% (spouses/partners), and 51% (children), compared to 11, 14 and 37% on ATVs, respectively. Moreover, the percentage never wearing a helmet while on an ATV was 68% for subjects, 71% for spouses, and 47% for children. Despite helmet use differences between bicycles and ATVs, the importance of children wearing a helmet on these vehicles was rated highly and equally important, 9.28 and 9.58 on a 1–10 scale, respectively. Higher proportions of subjects’ oldest children wore a bike helmet 100% of the time if at least one parent always wore a helmet (81%), compared to children whose parents both wore helmets < 100% of the time or didn’t ride (21%) (p < 0.0001). The proportion of children wearing ATV and bicycle helmets less than 100% of the time was significantly higher if parents reported barriers to effectively enforcing helmet use than if they did not (p = 0.04 and p = 0.004, respectively). Many reported a “strict no helmet, no bike/ATV riding rule” as being most effective in getting their children to always wear a helmet.

Conclusions

This study is the first to explore family helmet use while riding bicycles vs ATVs. Although parent’s belief in the importance of helmet use was high for both, helmet use was greater when riding bicycles. Further research is needed to better understand the social and environmental influences that shape parental helmet attitudes and practices in order to improve safety interventions for increasing pediatric helmet use.

Recreational off-highway vehicle crashes resulting in victims being treated at a regional trauma center: mechanisms and contributing factors

BACKGROUND

Recreational off-highway vehicles (ROVs) have become increasingly popular in recent years; however, crash epidemiology is not well described. ROVs travel at least 30 mph, and unlike all-terrain vehicles, have a rollover protective structure (ROPS) and seat belts or a harness system for occupants. This study's objective was to evaluate the demographics, mechanisms, injuries, and associated risk factors of ROV crashes.

METHODS

A retrospective chart review was performed for patients of all ages with ROV-related injuries presenting to a Level 1 trauma center from 2004 to 2017. Cases were identified by ICD-9/10 codes and narrative searches. Person- and crash-related variables were examined in relation to injury outcomes including body area injured, injury severity score, and disposition (e.g. hospitalization, intensive care unit admission). Descriptive, bivariate (chi-square, Fishers exact test), and linear regression analyses were performed.

RESULTS

Seventy-two patients with ROV-related injuries were identified. The number of injured patients increased over the study period (p < 0.01). Patients were 49% youth < 16 years old, 63% males, and 99% Caucasian. Half of the injured (51%) were passengers, with a higher proportion of youth being passengers (70%) as compared to adults (35%) (p < 0.01). Nearly one-third (30%) of crash victims < 16 years old were ROV drivers. Twenty-nine percent of all crashes occurred on roadways. Almost 40% of injured adults crashed at night, while all youth were injured during the day (p < 0.01). The primary crash mechanism was a rollover (67%). Only one patient was documented as being helmeted, and approximately one-fourth (24%) sustained head injuries and/or loss of consciousness. Other documented injuries included those to the face (20%), chest (22%), abdomen (11%), extremities (58%), and skin (51%). Over 90% of narratives were consistent with victims being unrestrained. Nearly three-fourths (74%) of victims were hospitalized and 26% required ICU care, one-half (53%) of these being children.

CONCLUSIONS

Although ROVs have ROPs, lack of helmet and safety belt use are reducing their benefit. Youth are a large proportion of those injured in ROV crashes, often while driving despite vehicle operation recommended only for those ≥16 years old. Increased public education is needed regarding proper safety measures while operating and riding ROVs.

[Risk-taking Behaviour and Aspects on Adolescents' Participation in High-risk Sports]

Risk-taking Behaviour and Aspects on Adolescents' Participation in High-risk Sports The age of adolescence represents an enhanced reward sensitivity which is often linked to increased risk-taking behaviour. Peers enhance risk-taking behaviour which is shown through delinquency and substance use. Whereas most research on adolescent risk-taking has been directed towards negative risk-taking, this narrative review tries to highlight adventure and high-risk sport participation as a prosocial form of risk-taking and its potential influence on adolescents' behaviour. Adventure/high-risk sports such as mountainbiking, freeride ski and snowboarding and climbing have grown exponentially in the last years with a high popularity among adolescents. Besides the inherent risk of severe injury in case of a mismanaged accident, which should be minimized by preventive steps such as educative risk-management and protective gear, those sports bear the potential for multiple psychological benefits such as enhanced mood, autonomy, resilience and self-efficacy. Adventure/high-risk sports seem to have the possibility to satisfy the need for rewards, prestige and risk-taking in a socially accepted way. Few research projects have already successfully integrated adventure sport interventions in clinical settings in mental health treatment. The idea of testing adventure/high-risk sport interventions as an addition to the treatment in child and adolescent psychiatry and psychotherapy could be promising and an impulse for future research projects.

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

PURPOSE

To evaluate thoracolumbar spine injury patterns, demographics, and clinical characteristics in pediatric patients following all-terrain vehicle-related trauma.

METHODS

A retrospective review of patients 0-17 years 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.

RESULTS

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 (4 days vs. 2 days, 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.

CONCLUSION

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 (≤ 8 years old) exhibit a spine fracture pattern distinct from that of older children who have a mature osseous-ligamentous complex.

Enforcement of Off-Road Vehicle Laws in Iowa

Safety laws are among the most successful means of reducing injuries, but their effectiveness is strongly influenced by the level of enforcement. To characterize enforcement of off-road vehicle (ORV) laws statewide, analyses of citations were performed using Iowa Court Information System data. From 2005–2015, 5173 individuals were charged with 5643 citations issued. Citations averaged <5/county/year, decreased dramatically over time, and varied by county when normalized to registered all-terrain vehicles (ATVs). Over 90% of operators cited were male and Caucasian. One-fifth were <18 years old. The top five violations were: operation on a highway/snowmobile trail (51%), registration/identification number not documented/displayed (19%), prohibited use in a park/preserve (5.5%), and operation with more persons than the vehicle is designed to carry (4.4%). The Department of Natural Resources issued the highest percentage of citations, followed in decreasing order by Sheriff, Police, State Patrol, and Conservation officers. Significant differences were identified when citations were compared by sex, age, race, enforcement agency, disposition (guilty vs. not guilty), and when comparing counties with or without an ORV park. These characteristics suggest limited and variable enforcement of laws statewide that may reduce their potential to prevent deaths and injuries, and that improved strategies to support ORV law enforcement are needed.