1
|
Murphy L, Roberts A. Just the facts: all-terrain vehicle-related trauma. CAN J EMERG MED 2024; 26:530-532. [PMID: 38958911 DOI: 10.1007/s43678-024-00727-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/27/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Laurel Murphy
- Departments of Emergency Medicine and Critical Care, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Alysha Roberts
- Department of Emergency Medicine, Halifax Infirmary, Dalhousie University, QEII Health Sciences Centre, Halifax, NS, Canada.
| |
Collapse
|
2
|
Freeman JM, Keatley MN, Wong SHX, Brown AM, Webster EL. A Qualitative Enquiry of On-Farm Rules About Quad Bikes (ATVs): How Rules Are Determined and Implemented at a Farm Level in Rural Australia. J Agromedicine 2024:1-11. [PMID: 38898777 DOI: 10.1080/1059924x.2024.2368181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
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.
Collapse
Affiliation(s)
- Joseph Michael Freeman
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Rural Health, The University of Sydney, Dubbo, New South Wales, Australia
| | - Megan Nicole Keatley
- School of Rural Health, The University of Sydney, Dubbo, New South Wales, Australia
| | - Sarah Hui Xin Wong
- School of Rural Health, The University of Sydney, Dubbo, New South Wales, Australia
| | - Anthony M Brown
- School of Rural Health, The University of Sydney, Dubbo, New South Wales, Australia
| | - Emma Louise Webster
- School of Rural Health, The University of Sydney, Dubbo, New South Wales, Australia
| |
Collapse
|
3
|
Kureshi N, Walling S, Erdogan M, Opra I, Green RS, Clarke DB. Alcohol is a risk factor for helmet non-use and fatalities in off-road vehicle and motorcycle crashes. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02572-1. [PMID: 38888789 DOI: 10.1007/s00068-024-02572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/01/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Off-road vehicle (ORV) and motorcycle use is common in Canada; however, risk of serious injury is heightened when these vehicles are operated without helmets and under the influence of alcohol. This study evaluated the impact of alcohol intoxication on helmet non-use and mortality among ORV and motorcycle crashes. METHODS Using data collected from the Nova Scotia Trauma Registry, a retrospective analysis (2002-2017) of ORV and motorcycle crashes resulting in major traumatic brain injury was performed. Patients were grouped by blood alcohol concentration (BAC) as negative (< 2 mmol/L), legally intoxicated (2-17.3 mmol/L) or criminally intoxicated (> 17.3 mmol/L). Logistic regression models were constructed to test for helmet non-use and mortality. RESULTS A total of 424 trauma patients were included in the analysis (220 ORV, 204 motorcycle). Less than half (45%) of patients involved in ORV crashes were wearing helmets and 65% were criminally intoxicated. Most patients involved in motorcycle crashes were helmeted at time of injury (88.7%) and 18% were criminally intoxicated. Those with criminal levels of intoxication had 3.7 times the odds of being unhelmeted and were 3 times more likely to die prehospital compared to BAC negative patients. There were significantly increased odds of in-hospital mortality among those with both legal (OR = 5.63), and criminal intoxication levels (OR = 4.97) compared to patients who were BAC negative. CONCLUSION Alcohol intoxication is more frequently observed in ORV versus motorcycle crashes. Criminal intoxication is associated with helmet non-use. Any level of intoxication is a predictor of increased in-hospital mortality.
Collapse
Affiliation(s)
- Nelofar Kureshi
- Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
| | - Simon Walling
- Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Mete Erdogan
- Nova Scotia Health Trauma Program, Nova Scotia Health, Rm 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Izabella Opra
- Nova Scotia Health Trauma Program, Nova Scotia Health, Rm 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Robert S Green
- Nova Scotia Health Trauma Program, Nova Scotia Health, Rm 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
- Department of Critical Care, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - David B Clarke
- Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| |
Collapse
|
4
|
Green RS. Alcohol and drug impairment in off-road vehicle crashes. CAN J EMERG MED 2024; 26:295-296. [PMID: 38713357 DOI: 10.1007/s43678-024-00702-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Affiliation(s)
- Robert S Green
- Departments of Critical Care, Emergency Medicine, Anesthesia and Surgery, Dalhousie University, Halifax, NS, Canada.
- Trauma Nova Scotia, Nova Scotia Health, Halifax, NS, Canada.
| |
Collapse
|
5
|
Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
Collapse
Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| |
Collapse
|
6
|
Ganga A, Kim EJ, Araia ES, Hagan M, Shao B, Svokos K, Klinge PM, Cielo DJ, Fridley JS, Gokaslan ZL, Toms SA, Sullivan PZ. Pediatric all-terrain vehicle (ATV) related head injury rates and patterns: A 10-year nationwide analysis. Am J Emerg Med 2023; 67:56-62. [PMID: 36804750 DOI: 10.1016/j.ajem.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/23/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Arjun Ganga
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Eric J Kim
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Ermias S Araia
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Matthew Hagan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Belinda Shao
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Konstantina Svokos
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Petra M Klinge
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Deus J Cielo
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Jared S Fridley
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Ziya L Gokaslan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Steven A Toms
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Patricia Zadnik Sullivan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America.
| |
Collapse
|
7
|
Andreu M, Sanchez LMQ, Spurlock MS, Hu Z, Mahavadi A, Powell HR, Lujan MM, Nodal S, Cera M, Ciocca I, Bullock R, Gajavelli S. Injury-Transplantation Interval-Dependent Amelioration of Axonal Degeneration and Motor Deficit in Rats with Penetrating Traumatic Brain Injury. Neurotrauma Rep 2023; 4:225-235. [PMID: 37095855 PMCID: PMC10122235 DOI: 10.1089/neur.2022.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Penetrating traumatic brain injury (pTBI) is increasingly survivable, but permanently disabling as adult mammalian nervous system does not regenerate. Recently, our group demonstrated transplant location-dependent neuroprotection and safety of clinical trial-grade human neural stem cell (hNSC) transplantation in a rodent model of acute pTBI. To evaluate whether longer injury-transplantation intervals marked by chronic inflammation impede engraftment, 60 male Sprague-Dawley rats were randomized to three sets. Each set was divided equally into two groups: 1) with no injury (sham) or 2) pTBI. After either 1 week (groups 1 and 2), 2 weeks (groups 3 and 4), or 4 weeks after injury (groups 5 and 6), each animal received 0.5 million hNSCs perilesionally. A seventh group of pTBI animals treated with vehicle served as the negative control. All animals were allowed to survive 12 weeks with standard chemical immunosuppression. Motor capacity was assessed pre-transplant to establish injury-induced deficit and followed by testing at 8 and 12 weeks after transplantation. Animals were euthanized, perfused, and examined for lesion size, axonal degeneration, and engraftment. Compared to vehicle, transplanted groups showed a trend for reduced lesion size and axonal injury across intervals. Remote secondary axonal injury was significantly reduced in groups 2 and 4, but not in group 6. The majority of animals showed robust engraftment independent of the injury-transplant time interval. Modest amelioration of motor deficit paralleled the axonal injury trend. In aggregate, pTBI-induced remote secondary axonal injury was resolved by early, but not delayed, hNSC transplantation.
Collapse
Affiliation(s)
- MaryLourdes Andreu
- Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | | | - Markus S. Spurlock
- Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Zhen Hu
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Anil Mahavadi
- University of Alabama Birmingham, Birmingham, Alabama, USA
| | - Henry R. Powell
- Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Maria M. Lujan
- Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Samuel Nodal
- Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Melissa Cera
- Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Isabella Ciocca
- Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Ross Bullock
- Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
| | - Shyam Gajavelli
- Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
- Address correspondence to: Shyam Gajavelli, PhD, Miami Project to Cure Paralysis, University of Miami, 1095 Northwest 14th Terrace, Miami, FL 33136, USA.
| |
Collapse
|
8
|
Torrez TW, Hicks J, Bonner V, Seidenstein AH, McGwin G, Kothari E, Gilbert SR. Increased open fracture complications following pediatric all-terrain vehicle accidents. Injury 2022; 53:3322-3325. [PMID: 36031440 DOI: 10.1016/j.injury.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/11/2022] [Accepted: 08/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND ATV (All-Terrain Vehicle) related open fractures are often high energy and may be highly contaminated. We asked whether they were more complicated than other open fractures in pediatric patients. METHODS A retrospective chart review was performed comparing ATV associated open fractures to open fractures sustained in non-ATV related accidents. 97 pediatric open fractures from 2015 to 2021 were identified based on ICD-10 codes. Of these fractures, 62 were non-ATV related and 35 were ATV related. Charts were reviewed to collect basic demographics, fracture pattern, Gustilo-Anderson classification, procedures performed, operative findings, and complications. RESULTS Our cohort was predominantly male (71% in the ATV group and 76% in the non-ATV group). White race was more common in both the ATV (28 (80%)) and non-ATV (50(78%)) groups. The distribution of AO/OTA fractures was significantly different (p = 0.046), with humerus fractures being more common in the ATV group (8 (22%)) vs. non-ATV group (6 (9.3%)). The ATV group had a higher proportion of more severe type II and III open fractures with 77.1% (n = 27), versus 56% (n = 35) in the non-ATV group (p = 0.020).. Revision and reoperation were more likely in the ATV group (16 (23%)) vs. the non-ATV group (12 (15%)), as was malunion (ATV group 3 (4.3%) Vs. non-ATV 0 (0%)). CONCLUSION Open fractures resulting from ATV injuries tend to be more complex and have higher rates of revision and malunion. This information supports the large body of evidence on the dangers of ATVs to children and can help guide expectations of both clinicians and family members of patients presenting with these injuries.
Collapse
Affiliation(s)
- Timothy W Torrez
- University of California Los Angeles, David Geffen School of Medicine, CA, USA; University of Alabama at Birmingham, Department of Orthopedic Surgery, AL, USA
| | - Jimmy Hicks
- University of Alabama at Birmingham, Department of Orthopedic Surgery, AL, USA
| | - Vincent Bonner
- University of Alabama at Birmingham, Department of Orthopedic Surgery, AL, USA
| | | | - Gerald McGwin
- University of Alabama at Birmingham, Department of Orthopedic Surgery, AL, USA
| | - Ezan Kothari
- University of Alabama at Birmingham, Department of Orthopedic Surgery, AL, USA
| | - Shawn R Gilbert
- University of Alabama at Birmingham, Department of Orthopedic Surgery, AL, USA.
| |
Collapse
|
9
|
Jennissen CA, Denning GM, Aitken ME. A Comprehensive Report on All-Terrain Vehicles and Youth: Continuing Challenges for Injury Prevention. Pediatrics 2022; 150:189564. [PMID: 36180617 DOI: 10.1542/peds.2022-059280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 12/26/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Charles A Jennissen
- Departments of Pediatrics.,Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Gerene M Denning
- Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Mary E Aitken
- Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, Texas
| | | |
Collapse
|
10
|
Menon P, El-Deyarbi M, Khan MA, Al-Rifai RH, Grivna M, Östlundh L, Ei-Sadig M. Risk factors associated with quadbike crashes: a systematic review. World J Emerg Surg 2022; 17:27. [PMID: 35619139 PMCID: PMC9137103 DOI: 10.1186/s13017-022-00430-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022] Open
Abstract
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
Collapse
Affiliation(s)
- Preetha Menon
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marwan El-Deyarbi
- Department of Pharmacology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Moien Ab Khan
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rami H Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Linda Östlundh
- National Medical Library, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohamed Ei-Sadig
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
| |
Collapse
|
11
|
Wiener RC, Waters C, Harper M, Shockey AKT, Bhandari R. All-Terrain Vehicle-Related Emergency Department Visits: Interaction of Sex and Age, NEISS, 2019. J Emerg Med 2022; 62:810-819. [PMID: 35562243 DOI: 10.1016/j.jemermed.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/12/2022] [Accepted: 02/25/2022] [Indexed: 11/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- R Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, West Virginia.
| | - Christopher Waters
- Department of Dental Research, School of Dentistry, West Virginia University, Morgantown, West Virginia
| | - Matthew Harper
- Department of Restorative Dentistry, School of Dentistry, West Virginia University, Morgantown, West Virginia
| | | | - Ruchi Bhandari
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia
| |
Collapse
|
12
|
Vittetoe KL, Allen JH, Unni P, McKay KG, Yengo-Kahn AM, Ghani O, Mummidi P, Greeno AL, Bonfield CM, Lovvorn HNB. Socioeconomic factors associated with helmet use in pediatric ATV and dirt bike trauma. Trauma Surg Acute Care Open 2022; 7:e000876. [PMID: 35372699 PMCID: PMC8928387 DOI: 10.1136/tsaco-2021-000876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/22/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives Recreational off-road vehicle crashes can produce severe injury and death among children, often from head trauma sustained while riding unhelmeted. Although required for competition, recreational riders commonly forego helmets. This study aimed to identify socioeconomic factors associated with unhelmeted injuries among children riding all-terrain vehicles (ATVs) and dirt bikes recreationally, thus informing injury prevention efforts. Methods A retrospective review was completed of patients younger than 18 years who presented after recreational ATV or dirt bike crash to a single American College of Surgeons-verified level 1 pediatric trauma center (2010-2019). Demographic, injury, and outcome data were collected. US Census data regarding median and per capita income, poverty prevalence, and scholastic graduation rates were recorded for each patient's home county. Relationships between helmet use at the time of injury, demographics, and socioeconomic variables were examined. Results The cohort comprised 680 injured recreational ATV (n=510; 75%) and dirt bike (170; 25%) riders. Unhelmeted riders (n=450) were significantly older (median age 13 vs 11 years; p=0.008) and more often rode ATVs (n=399). Significantly greater percentages of females (77.9%; p<0.001) and passengers (89.5%; p<0.001) were unhelmeted at the time of injury. Residents of counties with lower median and per capita income, higher poverty prevalence, and lower high school and college graduation rates were significantly more likely to be unhelmeted at the time of their crash (p=0.003). In multivariable analysis, unhelmeted injuries were independently associated with ATV use (OR=6.757; p<0.0001), passenger status (OR=6.457; p<0.0001), and older age (OR=1.219; p<0.0001). Conclusion In children, ATV use, passenger status, and older age associated independently with unhelmeted riding in recreational vehicle crash. Residence in a county with both lower median income and scholastic graduation rates associated with unhelmeted crashes, and lower median income significantly predicted unhelmeted crashes. This study revealed socioeconomic factors that identify communities with greatest need for injury prevention initiatives. Level of evidence III-retrospective comparative epidemiological study.
Collapse
Affiliation(s)
- Kelly L Vittetoe
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Jackson H Allen
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Purnima Unni
- Pediatric Trauma/Injury Prevention Program, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Katlyn G McKay
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Owais Ghani
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pradeep Mummidi
- Director of Business Analytics, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Amber L Greeno
- Pediatric Trauma/Injury Prevention Program, Monroe Carell Junior Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Christopher M Bonfield
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Harold N Bo Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
13
|
Holt MF, Fortmann J, Testerman GM. Trauma Surgeon-Led and Funded Injury Prevention Program Decreases Number of All-Terrain Vehicle-Related Admissions. Am Surg 2022; 88:638-642. [DOI: 10.1177/00031348211050815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background All-terrain vehicle (ATV) laws regarding helmet use, alcohol involvement, and roadway riding are poorly enforced or largely ignored. We hypothesized that direct surgeon funding and leadership in injury prevention would decrease ATV crashes. To focus prevention efforts, we reviewed a rural level 1 trauma center 11-year experience with ATV crashes comparing helmeted and unhelmeted rider outcomes. Methods For the latter 6 years of the study period, a trauma surgeon sponsored an injury prevention fund promoting ATV safety using simulators and discussions for area high school students. Helmet use, alcohol avoidance, and safe ATV operating were emphasized. A trauma registry review of ATV admissions from 2009 through 2020 examined demographics, helmet use, and clinical outcomes using chi-square, t-test, and regression analysis. Results Unhelmeted ATV riders suffered more severe head and neck injuries (OR 19, CI 1.5-1.8, P < .001), worse overall Injury Severity Score (ISS), (OR 25, CI 12.1-14.2, P < .001), and higher mortality rates (OR 4.0, CI .02-.05, P < .001). Helmet use corresponded with an average decrease in AIS and increase in GCS status. Although only 15% of riders were helmeted, ATV crash admissions have decreased in the last 5 years ( P < .001). Discussion All-terrain vehicle trauma and mortality is still frequent, especially in unhelmeted riders. The recent decrease in area ATV crashes is encouraging. Trauma surgeons have an opportunity to make a difference in public awareness and education through comprehensive physician-funded and directed injury prevention and research efforts.
Collapse
Affiliation(s)
- Matthew F. Holt
- Department of Surgery, Steward Health Care St. Elizabeth’s Medical Center – A Boston University Teaching Hospital, Brighton, MA, USA
| | - Joshua Fortmann
- Center for Rural Health Research, East Tennessee State University College of Public Health, Johnson City, TN, USA
| | - George M. Testerman
- Department of Surgery, Ballad Health Holston Valley Medical Center, East Tennessee State University Quillen College of Medicine, Kingsport, TN, USA
| |
Collapse
|
14
|
Allen JH, Yengo-Kahn AM, Vittetoe KL, Greeno A, Owais Abdul Ghani M, Unni P, Lovvorn HN, Bonfield CM. The impact of helmet use on neurosurgical care and outcomes after pediatric all-terrain vehicle and dirt bike crashes: a 10-year single-center experience. J Neurosurg Pediatr 2022; 29:106-114. [PMID: 34638104 DOI: 10.3171/2021.6.peds21225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE All-terrain vehicle (ATV) and dirt bike crashes frequently result in traumatic brain injury. The authors performed a retrospective study to evaluate the role of helmets in the neurosurgical outcomes of pediatric patients involved in ATV and dirt bike crashes who were treated at their institution during the last decade. METHODS The authors analyzed data on all pediatric patients involved in ATV or dirt bike crashes who were evaluated at a single regional level I pediatric trauma center between 2010 and 2019. Patients were excluded if the crash occurred in a competition (n = 70) or if helmet status could not be determined (n = 18). Multivariable logistic regression was used to analyze the association of helmet status with the primary outcomes of 1) neurosurgical consultation, 2) intracranial injury (including skull fracture), and 3) moderate or severe traumatic brain injury (MSTBI) and to control for literature-based, potentially confounding variables. RESULTS In total, 680 patients were included (230 [34%] helmeted patients and 450 [66%] unhelmeted patients). Helmeted patients were more frequently male (81% vs 66%). Drivers were more frequently helmeted (44.3%) than passengers (10.5%, p < 0.001). Head imaging was performed to evaluate 70.9% of unhelmeted patients and 48.3% of helmeted patients (p < 0.001). MSTBI (8.0% vs 1.7%, p = 0.001) and neurosurgical consultation (26.2% vs 9.1%, p < 0.001) were more frequent among unhelmeted patients. Neurosurgical injuries, including intracranial hemorrhage (16% vs 4%, p < 0.001) and skull fracture (18% vs 4%, p < 0.001), were more common in unhelmeted patients. Neurosurgical procedures were required by 2.7% of unhelmeted patients. One helmeted patient (0.4%) required placement of an intracranial pressure monitor, and no other helmeted patients required neurosurgical procedures. After adjustment for age, sex, driver status, vehicle type, and injury mechanism, helmet use significantly reduced the odds of neurosurgical consultation (OR 0.250, 95% CI 0.140-0.447, p < 0.001), intracranial injury (OR 0.172, 95% CI 0.087-0.337, p < 0.001), and MSTBI (OR 0.244, 95% CI 0.079-0.758, p = 0.015). The unadjusted absolute risk reduction provided by helmet use equated to a number-needed-to-helmet of 6 riders to prevent 1 neurosurgical consultation, 4 riders to prevent 1 intracranial injury, and 16 riders to prevent 1 MSTBI. CONCLUSIONS Helmet use remains problematically low among young ATV and dirt bike riders, especially passengers. Expanding helmet use among these children could significantly reduce the rates of intracranial injury and MSTBI, as well as the subsequent need for neurosurgical procedures. Promoting helmet use among recreational ATV and dirt bike riders must remain a priority for neurosurgeons, public health officials, and injury prevention professionals.
Collapse
Affiliation(s)
| | | | | | - Amber Greeno
- 3Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Purnima Unni
- 3Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harold N Lovvorn
- 3Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | |
Collapse
|
15
|
Goldwag JL, Porter ED, Wilcox AR, Li Z, ScD TDT, Crockett AO, Wolffing AB, Mancini DJ, Martin ED, Scott JW, Briggs A. Geriatric All-Terrain Vehicle Trauma: An Unhelmeted and Severely Injured Population. J Surg Res 2021; 270:555-563. [PMID: 34826691 DOI: 10.1016/j.jss.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/17/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND All-terrain vehicle (ATV) use is widespread, however, little is known about injury patterns and outcomes in geriatric patients. We hypothesized that geriatric patients would have distinct and more severe injuries than non-geriatric adults after ATV trauma. METHODS A retrospective cohort study was performed using the National Trauma Databank comparing non-geriatric (18-64) and geriatric adults (≥65) presenting after ATV trauma at Level 1 and 2 trauma centers from 2011 to 2015. Demographic, admission, and outcomes data were collected, including injury severity score (ISS), abbreviated injury scale (AIS) score, discharge disposition, and mortality. We performed univariate statistical tests between cohorts and multiple logistic regression models to assess for risk factors associated with severe injury (ISS>15) and mortality. RESULTS 23,568 ATV trauma patients were identified, of whom 1,954 (8.3%) were geriatric. Geriatric patients had higher rates of severe injury(29.2 v 22.5%,p<0.0001), and thoracic (55.2 v 37.8%,p<0.0001) and spine (31.5 v 26.0%,p<0.0001) injuries, but lower rates of abdominal injuries (14.6 v 17.9%,p<0.001) as compared to non-geriatric adults. Geriatric patients had overall lower head injury rates (39.2 v 42.1%,p=0.01), but more severe head injuries (AIS>3) (36.2 vs 30.2%,p<0.001). Helmet use was significantly lower in geriatric patients (12.0 v 22.8%,p<0.0001). On multivariate analysis age increased the odds for both severe injury (OR 1.50, 95% CI 1.31-1.72, p<0.0001) and mortality (OR 5.07, 95% CI 3.42-7.50, p<0.0001). CONCLUSIONS While severe injury and mortality after ATV trauma occurred in all adults, geriatric adults suffered distinct injury patterns and were at greater risk for severe injury and mortality.
Collapse
Affiliation(s)
- Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756
| | - Eleah D Porter
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756
| | - Allison R Wilcox
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756
| | - Zhongze Li
- Biomedical Data Science Department, Geisel School of Medicine at Dartmouth College
| | - Tor D Tosteson ScD
- Biomedical Data Science Department, Geisel School of Medicine at Dartmouth College
| | - Andrew O Crockett
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756; Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH, 03755
| | - Andrea B Wolffing
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756; Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH, 03755
| | - D Joshua Mancini
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756; Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH, 03755
| | - Eric D Martin
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756; Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH, 03755
| | - John W Scott
- Department of Surgery, University of Michigan, Ann Arbor, MI, 48109
| | - Alexandra Briggs
- Department of Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03756; Geisel School of Medicine, 1 Rope Ferry Rd, Hanover, NH, 03755.
| |
Collapse
|
16
|
Menon P, El-Sadig M, AB Khan M, Östlundh L, El-Deyarbi M, Al-Rifai RH, Grivna M. Risk factors associated with quad bike crashes: a protocol for systematic review of observational studies. BMJ Open 2021; 11:e044456. [PMID: 33820787 PMCID: PMC8030468 DOI: 10.1136/bmjopen-2020-044456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Quad bikes are four-wheeled vehicles, driven off-road on uneven terrains by farmers for work or young adults for leisure. Quad bike accidental crashes result mostly due to the unique ecosystem of uneven terrain, where these unstable vehicles are commonly driven, in addition to numerous distinctive sociodemographic characteristics related to drivers. This is a protocol for a systematic review of observational studies from all geographical regions and demographic groups in the world to summarise the common risk factors relating to quad bike crashes. METHODS AND ANALYSIS A comprehensive search for the literature on quad bike crashes and related injuries will be conducted in six electronic databases: PubMed, Embase, Scopus, Web of Science, IEEE and PsycINFO. Proquest Dissertation and Thesis, OpenGrey and BASE will be searched for grey literature. Five researchers will be involved in the screening, and the review of full text articles, using the inclusion and exclusion criteria. Disagreements between reviewers will be resolved by discourse. Three researchers will help resolving conflicts that may arise during the screening process and will resolve eventual conflicts identified in the process with the help of the systematic review software 'Covidence' for automatic deduplication and blinded screening. Information on crashes leading to injuries and death, target population characteristics and risk factors involved will be extracted from eligible articles in addition to the assessment of the quality of the researched articles. ETHICS AND DISSEMINATION Since this is a systematic review of published literature, a formal ethical approval is not needed. Results of the review will be disseminated through peer-reviewed publications, conference presentations and reports to the concerned authorities. PROSPERO REGISTRATION NUMBER CRD42020170245.
Collapse
Affiliation(s)
- Preetha Menon
- Institute of Public Health, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, UAE
| | - Mohamed El-Sadig
- Institute of Public Health, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, UAE
| | - Moien AB Khan
- Department of Family Medicine, UAE University College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
| | - Linda Östlundh
- National Medical Library, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
| | - Marwan El-Deyarbi
- Department of Pharmacology, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, UAE
| | - Rami H Al-Rifai
- Institute of Public Health, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, UAE
| | - Michal Grivna
- Institute of Public Health, United Arab Emirates University, College of Medicine and Health Sciences, Al Ain, UAE
| |
Collapse
|
17
|
Khorsandi F, Ayers P, Denning G, Jennissen C, Jepsen D, Myers M, Oesch S, Pate M, White DJ. Agricultural All-Terrain Vehicle Safety: Hazard Control Methods Using the Haddon Matrix. J Agromedicine 2020; 26:420-435. [PMID: 33169657 DOI: 10.1080/1059924x.2020.1837705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
Collapse
Affiliation(s)
- Farzaneh Khorsandi
- Agricultural Safety and Health Engineering Assistant Specialist in Cooperative Extension, Defpartment of Biological and Agricultural Engineering, University of California, Davis
| | - Paul Ayers
- Professor, Department of Biosystems Engineering and Soil Science, University of Tennessee, Knoxville
| | - Gerene Denning
- Emeritus Research Scientist in Emergency Medicine, Department of Emergency Medicine, University of Iowa Carver College of Medicine
| | - Charles Jennissen
- MD,Clinical Professor of Pediatrics and Emergency Medicine, Department of emergency medicine, University of Iowa Carver College of Medicine
| | - Dee Jepsen
- Associate Professor / State Agricultural Safety Leader, Department of Food, Agricultural and Biological Engineering, agricultural safety and health program, The Ohio State University
| | - Melvin Myers
- Associate Professor (Adjunct), Environmental Health, Emory University, Emory Rollins School of Public Health, Atlanta, Georgia
| | | | - Michael Pate
- Associate Professor, Applied Sciences, Technology & Education, Agricultural Systems Technology and Education program, Utah State University
| | - David J White
- PhD, Professor of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, School of Social and Behavioral Health Sciences and Extension 4-H Youth Development, Oregon State University
| |
Collapse
|
18
|
Weichelt B, Gorucu S, Jennissen C, Denning G, Oesch S. Assessing the Emergent Public Health Concern of All-Terrain Vehicle Injuries in Rural and Agricultural Environments: Initial Review of Available National Datasets in the United States. JMIR Public Health Surveill 2020; 6:e15477. [PMID: 32469319 PMCID: PMC7293057 DOI: 10.2196/15477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/17/2020] [Accepted: 02/15/2020] [Indexed: 02/03/2023] Open
Abstract
Background Injuries related to the operation of off-road vehicles (ORVs), including all-terrain vehicles (ATVs), continue to be a significant public health concern, especially in rural and agricultural environments. In the United States alone, ATVs have played a role in thousands of fatalities and millions of injuries in the recent decades. However, no known centralized federal surveillance system consistently captures these data. Traditional injury data sources include surveys, police reports, trauma registries, emergency department data, newspaper and online media reports, and state and federal agency databases. Objective The objectives of this study paper were to (1) identify published articles on ORV-related injuries and deaths that used large databases and determine the types of datasets that were used, (2) examine and describe several national US-based surveillance systems that capture ORV-related injuries and fatalities, and (3) promote and provide support for the establishment of a federally-funded agricultural injury surveillance system. Methods In this study, we examined several national United States–based injury datasets, including the web-based AgInjuryNews, the Fatality Analysis Reporting System, databases compiled by the US Consumer Product Safety Commission, and the National Fatality Review Case Reporting System. Results Our review found that these data sources cannot provide a complete picture of the incidents or the circumstantial details needed to effectively inform ORV injury prevention efforts. This is particularly true with regard to ORV-related injuries in agricultural production. Conclusions We encourage the establishment of a federally funded national agricultural injury surveillance system. However, in lieu of this, use of multiple data sources will be necessary to provide a more complete picture of ORV- and other agriculture-related injuries and fatalities.
Collapse
Affiliation(s)
- Bryan Weichelt
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, United States
| | - Serap Gorucu
- Department of Agricultural and Biological Engineering, Penn State University, University Park, PA, United States
| | - Charles Jennissen
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Gerene Denning
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | | |
Collapse
|
19
|
Siman-Tov M, Marom-Trabelsi I, Radomislensky I, Bodas M, Peleg K. Injuries among all-terrain vehicle users: a population-based study. Inj Prev 2020; 26:540-545. [DOI: 10.1136/injuryprev-2019-043425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 11/04/2022]
Abstract
BackgroundThe use of off-road vehicles such as all-terrain vehicles (ATVs) and recreational off-highway vehicles has increased in recent years. A higher percentage of patients hospitalised following ATV crashes suffered severe injuries, compared with those hospitalised following other MVCs.ObjectiveTo identify incidence of ATV-related injury and characterise groups with higher prevalence.MethodsA retrospective study of the Israel National Trauma Registry data between years 2008 and 2016. ATV crash victims were compared with other types of MVC casualties according to demographics, injuries and hospital resource utilisation. Identifying groups with greater prevalence for severe injuries caused by ATV crashes was conducted using logistic regressions.ResultsAn increase of 49% in the number of casualties hospitalised following an ATV crash was observed between 2013 and 2016. Non-Jews, males and users 15–29 years old were hospitalised at a higher rate compared with their proportion in the population. ATV crash casualties were more severely injured compared with other MVC casualties (22% vs 14%), had longer hospital length of stay (8+ days) (25% vs 18%), more admissions to intensive care units (16% vs 10%) and underwent more surgery (39% vs 26%, respectively). Males, non-Jews and casualties who did not wear a helmet were about two times more likely to suffer from severe head injury (95% CI 1.20 to 3.60, 1.41 to 2.75 and 1.27 to 4.73, respectively).ConclusionsAn increase in ATV-related casualties was observed. A customised safety intervention programme is needed that targets demographic groups identified with higher injury incidence. Awareness of legislated and common sense ATV safety practices, specifically helmet use, should be raised.
Collapse
|
20
|
Testerman GM, Rollins SE, Tucker WD, Murfee JR. Trauma Surgeon–Funded Injury Prevention and Research Decrease ATV Crash Injuries. Am Surg 2019. [DOI: 10.1177/000313481908501106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- George M. Testerman
- Department of Surgery ETSU College of Medicine Ballad Holston Valley Hospital Level 1 Trauma Center Kingsport, Tennessee
| | - Sarah E. Rollins
- Department of Surgery ETSU College of Medicine Ballad Holston Valley Hospital Level 1 Trauma Center Kingsport, Tennessee
| | - William D. Tucker
- Department of Surgery ETSU College of Medicine Ballad Holston Valley Hospital Level 1 Trauma Center Kingsport, Tennessee
| | - John R. Murfee
- Department of Surgery ETSU College of Medicine Ballad Holston Valley Hospital Level 1 Trauma Center Kingsport, Tennessee
| |
Collapse
|
21
|
Butts CA, Gonzalez R, Nguyen L, Gaughan JP, Ross S, Porter J, Hazelton JP. Twelve-Year Review of Urban Versus Rural Off-road Vehicle Injuries at a Level 1 Trauma Center. J Surg Res 2018; 233:331-334. [PMID: 30502267 DOI: 10.1016/j.jss.2018.07.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/05/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Traditionally, all-terrain vehicles (ATVs) and dirt bikes (DBs) have been used in rural locations for recreation and work. Recently, there has been an increase in the use of these vehicles in an urban environment. The aim of this study is to compare the injury patterns of patients involved in crashes while riding off-road vehicles in both urban (UORV) and rural (RORV) environment. METHODS A retrospective review (2005-2016) of patients who presented to an urban level 1 trauma center as a result of any ATV or DB crash was performed. UORV was defined as any ATV or DB accident that occurred on paved inner city, suburban, or major roadways. RORV was defined as those accidents that occurred on secondary roadways or off-road. Patients who presented more than 48 h from time of accident were excluded. A P < 0.05 was considered significant. RESULTS Five hundred and twenty-eight patients were identified to have an ATV or DB injury (RORV n = 296 [56%]; UORV n = 232 [44%]). UORV accidents had a higher Injury Severity Score (12.2 versus 9.7; P < 0.05), lower presenting Glasgow Coma Scale (13.8 versus 14.3; P < 0.05), more likely to need emergent trauma bay procedures (28.5% versus 17.9%; P < 0.05), were less likely to have been helmeted (39.6% versus 71.2%; P < 0.05) with a higher unhelmeted Abbreviated Injury Scale head of ≥3 (13.5% versus 5%; <0.05), and more likely to have extremity injuries (53.5% versus 41.2%; P < 0.05). There were no significant differences in additional injury patterns or hospital outcomes including mortality for the two groups. CONCLUSIONS Our data suggest that UORV use was associated with decreased helmet use, higher mean Injury Severity Score, lower presenting Glasgow Coma Scale, an increased need for emergent trauma bay procedures, higher unhelmeted Abbreviated Injury Scale head scores, and higher rates of extremity injuries.
Collapse
Affiliation(s)
- Christopher A Butts
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - Roberto Gonzalez
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - Linh Nguyen
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - John P Gaughan
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - Steven Ross
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - John Porter
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - Joshua P Hazelton
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey.
| |
Collapse
|
22
|
Mylonas KS, Hemmati P, Tsilimigras DI, Texakalidis P, Economopoulos KP. Preventing pediatric cardiothoracic trauma: Role of policy and legislation. World J Cardiol 2018; 10:49-51. [PMID: 30079150 PMCID: PMC6068736 DOI: 10.4330/wjc.v10.i7.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/11/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
Data from the last 50 years suggest that pediatric patients typically suffer cardiothoracic injuries following blunt traumatic force (70%) in the setting of either motor vehicle crashes (53.5%) or vehicle-pedestrian accidents (18.2%). Penetrating trauma accounts for 30% of pediatric cardiothoracic injuries, half of which are gunshot wounds. Graduated driver licensing programs, gun-control legislation, off-road vehicle regulation, initiatives such as “Prevent the Bleed”, as well as professional society recommendations are key in preventing pediatric cardiothoracic injuries.
Collapse
Affiliation(s)
| | - Pouya Hemmati
- Department of Surgery, Mayo Clinic, Rochester, MN 55902, United States
| | - Diamantis I Tsilimigras
- School of Medicine, National and Kapodistrian University of Athens, Athens 11527, Greece
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
| | - Pavlos Texakalidis
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54621, Greece
| | - Konstantinos P Economopoulos
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
| |
Collapse
|