The Effect of Passengers on All-Terrain Vehicle Crash Mechanisms and Injuries

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.

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

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.

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.

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.

Pediatric moped-related injuries in the United States from 2002 to 2014: Age-related comparisons of mechanisms and outcomes

Mopeds are a popular means of transportation, especially in urban areas. However, few studies have investigated moped-related injuries in the United States. This study's goal was to compare the crash mechanisms and injuries suffered in moped-related crashes involving youth versus adults, as well as between younger and older children.

INTRODUCTION

Mopeds are a popular means of transportation, especially in urban areas. However, few studies have investigated moped-related injuries in the United States. This study's goal was to compare the crash mechanisms and injuries suffered in moped-related crashes involving youth versus adults, as well as between younger and older children.

METHODS

Descriptive and comparative analyses were performed using National Electronic Injury Surveillance System (NEISS) data and additional variables coded from injury narratives. Multivariate regression analyses were used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for categorical outcomes, controlling for significant covariates.

RESULTS

From 2003 to 2014, there were 779 youth (17 years or younger) and 2,453 adult moped-related emergency department visits in the database. The number of youth injured remained relatively constant over time, while the number of adult victims doubled. Relative to 14- to 17-year olds, victims younger than 14 years were more commonly female (p = 0.037) and non-Caucasian (p = 0.008). Victims 14 to 17 years of age had a higher proportion of brain injuries (p = 0.012) and were more commonly in motor vehicle collisions (p = 0.02), as compared to younger victims. Relative to adults, youth crashes occurred more commonly in the summer (p < 0.0001), and off the street/road (p < 0.0001). Logistic regression analysis showed crashes on streets/roads were two and a half times more likely to involve victims who were 14 to 17 years of age as compared to those younger (aOR, 2.55; CI, 1.64-3.97). Additionally, male youths were twice as likely as females to have a motor vehicle collision (aOR, 1.97; CI, 1.19-3.24), and pediatric crashes were approximately twice as likely to result in extremity injuries as compared to adult crashes (aOR, 1.95; CI, 1.19-3.20).

CONCLUSION

Differences in crash mechanism and injuries sustained between two youth age groups and between youths and adults indicate the importance of targeted injury prevention efforts. This would include improved operator training and standardized, evidence-based, well-enforced safety legislation.

LEVEL OF EVIDENCE

Epidemiologic study, level III.