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

Do All-terrain or Recreational Off-highway Vehicle Crashes Have a Higher Odds of Amputation?

BACKGROUND

Riding off-road vehicles is associated with the risk of injury to the extremities. There are two main types of four-wheel recreational off-road vehicles: quads or all-terrain vehicles (ATVs), which are essentially four-wheel off-road motorcycles, and recreational off-highway vehicles (ROVs), also colloquially referred to as utility terrain vehicles, which have side-by-side seating, higher maximum speeds, and a roll cage. There are multiple orthopaedic society position statements on ATVs, but none on ROVs. Perhaps this is because the injury patterns and differences between the two vehicles have not been elucidated.

QUESTIONS/PURPOSES

(1) What patient, vehicle (ROVs versus ATVs), and injury factors are associated with amputation? (2) What are the anatomic location distributions of fractures and amputations by vehicle type?

METHODS

Records of all patients in our hospital's billing system who had both a diagnostic code indicating an accident related to an off-road vehicle and one indicating an extremity or pelvic fracture between February 2014 and January 2020 were screened; this resulted in the identification of 328 patients with fractures resulting from off-road vehicle collisions. A total of 16% (51 of 328) of patients were excluded from the analysis because their injury did not involve either an ATV or an ROV; 277 patients were included in the final analysis. The following variables were collected: age at time of the injury, gender, BMI, vehicle type, Gustilo-Anderson type if applicable, amputation level if applicable, anatomic locations of injuries, ethanol level, and drug screen. ATV crashes accounted for 52% (145 of 277) of patients, and ROV crashes accounted for 48% (132 of 277). Patients from ATV crashes did not differ from those in ROV crashes in terms of mean age (24 ± 16 years versus 24 ± 13 years; p = 0.82), BMI (25 ± 7 kg/m 2 versus 26 ± 6 kg/m 2 ; p = 0.18), or gender (79% [114 of 145] men/boys versus 77% [102 of 132]; p = 0.79). Among patients who had a drug or ethanol screen, there was a higher percent of ATV riders who used marijuana (39% [19 of 49] versus 17% [7 of 42]; p = 0.04), but there were no differences in abnormal blood alcohol screen or abnormal nonmarijuana drug screen; however, these results were available in only about one-third of patients (99 of 277 for ethanol and 91 of 277 for drug screen). Statistical analysis was performed using logistic regression analysis for factors associated with amputation, with p values < 0.05 considered significant.

RESULTS

After controlling for differences in demographic factors, the stepwise increase in Gustilo-Anderson grade of open fracture (OR 9.8 [95% CI 3.6 to 27.0]; p < 0.001) and ROV vehicle type (OR 15.7 [95% CI 3.6 to 68.5]; p < 0.001) were both associated with amputation. There was no increase in the odds of amputation associated with age (OR 1.0 [95% CI 0.9 to 1.1]; p = 0.81), gender (OR 1.4 [95% CI 0.3 to 5.8]; p = 0.68), or BMI (OR 1.1 [95% CI 0.9 to 1.2]; p = 0.37). The most frequent ATV fractures occurred in the forearm and wrist (22% [45 of 203]), whereas most ROV injuries occurred through the metacarpals (41% [107 of 262] of fractures and 58% [18 of 31] of amputations).

CONCLUSION

ROV crashes are associated with a higher odds of amputation when compared with ATV crashes. Because most ROV injuries were in the forearm and below, this likely occurs when upper extremities are crushed and mangled under the roll cage in rollover ROV crashes. Because of this danger, we urge our orthopaedic societies to either update current ATV position statements to include ROVs or release separate statements on ROVs.

LEVEL OF EVIDENCE

Level III, prognostic study.

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.

[Forensic medical characteristics of fatal injuries in a traffic accident in the car cabin]

The study objective is to identify the most common fatal injuries in car accidents and observe the trends of the proportion of deaths at the scene, in an ambulance, and a hospital. We analyzed all forensic examination reports (protocols) of those who died in the car due to a traffic accident in Moscow from 2018 to 2020. Male drivers died 15 times more often than female drivers, and male passengers died twice as often as females. Most of the victims were young and middle-aged. Both drivers and passengers most commonly had traumatic brain injury with fractures of the bones of the vault and base of the skull, intracranial hemorrhages, crushing, and dislocation of the damaged brain. At the scene of traffic accidents, the cause of death was fatal bodily injuries. An increased risk of fatal traffic accidents was identified in autumn and winter.

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.