Injury Pattern and Outcomes Following All-Terrain Vehicle Accidents in Kentucky Children: A Retrospective Study

PURPOSE

All-terrain vehicles (ATVs) pose a significant risk for morbidity and mortality amongst children. We hypothesize that current vague legislation regarding helmet use impacts injury patterns and outcomes in pediatric ATV accidents.

METHODS

The institutional trauma registry was queried for pediatric patients involved in ATV accidents from 2006 to 2019. Patient demographics and helmet wearing status were identified in addition to patient outcomes, such as injury pattern, injury severity score, mortality, length of stay, and discharge disposition. These elements were analyzed for statistical significance.

RESULTS

720 patients presented during the study period, which were predominantly male (71%, n = 511) and less than 16 years old (76%, n = 543). Most patients were not wearing a helmet (82%, n = 589) at time of injury. Notably, there were 7 fatalities. A lack of helmet use is positively associated with head injury (42% vs 23%, P < .01), intracranial hemorrhage (15% vs 7%, P = .03), and associated with lower Glasgow Coma Scale (13.9 vs 14.4, P < .01). Children 16 years and older were least likely to wear a helmet and most likely to incur injuries. Patients over 16 years had longer lengths of stay, higher mortality, and higher need for rehabilitation.

CONCLUSION

Not wearing a helmet is directly correlated with injury severity and concerning rates of head injury. Children 16 years and older are at greatest risk for injury, but younger children are still at risk. Stricter state laws regarding helmet use are necessary to reduce pediatric ATV-related injury burden.

LEVEL OF EVIDENCE

level III retrospective comparative study.

Identification of Control-Related Signal Path for Semi-Active Vehicle Suspension with Magnetorheological Dampers

This paper presents a method for the identification of control-related signal paths dedicated to a semi-active suspension with MR (magnetorheological) dampers, which are installed in place of standard shock absorbers. The main challenge comes from the fact that the semi-active suspension needs to be simultaneously subjected to road-induced excitation and electric currents supplied to the suspension MR dampers, while a response signal needs to be decomposed into road-related and control-related components. During experiments, the front wheels of an all-terrain vehicle were subjected to sinusoidal vibration excitation at a frequency equal to 12 Hz using a dedicated diagnostic station and specialised mechanical exciters. The harmonic type of road-related excitation allowed for its straightforward filtering from identification signals. Additionally, front suspension MR dampers were controlled using a wideband random signal with a 25 Hz bandwidth, different realisations, and several configurations, which differed in the average values and deviations of control currents. The simultaneous control of the right and left suspension MR dampers made it necessary to decompose the vehicle vibration response, i.e., the front vehicle body acceleration signal, into components related to the forces generated by different MR dampers. Measurement signals used for identification were taken from numerous sensors available in the vehicle, e.g., accelerometers, suspension force and deflection sensors, and sensors of electric currents, which control the instantaneous damping parameters of MR dampers. The final identification was carried out for control-related models evaluated in the frequency domain and revealed several resonances of the vehicle response and their dependence on the configurations of control currents. In addition, the parameters of the vehicle model with MR dampers and the diagnostic station were estimated based on the identification results. The analysis of the simulation results of the implemented vehicle model carried out in the frequency domain showed the influence of the vehicle load on the absolute values and phase shifts of control-related signal paths. The potential future application of the identified models lies in the synthesis and implementation of adaptive suspension control algorithms such as FxLMS (filtered-x least mean square). Adaptive vehicle suspensions are especially preferred for their ability to quickly adapt to varying road conditions and vehicle parameters.

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

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.

A descriptive review of quad-related deaths in Australia (2011-20)

OBJECTIVE

To assess Australian quad-related deaths during the 2011-20 period in relation to introduction of the Consumer Goods (Quad Bikes) Safety Standard 2019.

METHODS

All Australian quad-related deaths retrieved through the National Coronial Information System.

RESULTS

There were 155 cases, with 116 occurring on a farm and 39 in a non-farm context. Deaths were evenly split between work (52%) and non-work activities, however, 66% of all farm incidents involved work. Rollovers were responsible for 59% of cases and occurred largely on farms (86%), whilst working (69%). Head injury (32%) and asphyxiation (29%) were primary causes of death. Helmet use was low (<5%) in the head injury cases, with 80% of the asphyxiation cases incurring no life-threatening injury other than being entrapped by the quad.

CONCLUSION

Quad-related deaths are prevalent, with minimal variation in the pattern of incidents from previous Australian studies. Rollover incidents continue to be a major problem especially in a farm context. Implications for public health: In tandem with existing efforts to enhance behavioural compliance (e.g. helmet use, no child access) and retrofitting Operator Protector Devices, these data support the introduction of the new Standard addressing vehicle stability and fitting Operator Protector Devices to limit potential for asphyxiation.

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.

Fatal Agricultural Accidents in Kansas: A Thirty-Nine-Year Follow-Up Study with an Emphasis on Vehicular Fatalities

The purpose of this study was to evaluate trends in agricultural mortality before and after implementation of safety initiatives. Retrospective review of Kansas mortality data from agriculture-related injuries from 1979 to 2018. The 39-year period was stratified into four periods to compare mechanisms of injury and fatality rates between study periods. There were 780 agricultural-related deaths. Mean age significantly increased between study Period I to Period IV from 46.4 to 55.3 years (P = 0.013). Tractors remain the primary cause of farm-vehicle mortality overall; however, tractor-related deaths significantly decreased during the study periods from 75.6% to 44.3% (P < 0.001). Tractor rollover mortality also decreased from 50.8% to 25.6% (P = 0.036). ATV-related deaths significantly increased from study Period II to III (5.1% to 23.9%, P < 0.001), but decreased from Period III to IV (23.9% to 17.0%). Tractor-related fatalities are decreasing, but tractors still remain the most dangerous piece of farm equipment. ATV-related fatalities are a continued concern. Continued rural education and emphasis on the use of rollover protection structures is a critical focus in the effort to prevent fatal farming injuries.

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.

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

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.

Quad bike injuries at an Australian regional hospital: a trauma registry review

BACKGROUND

Quad bikes are a prominent cause of morbidity and mortality in Australia in both agriculture and recreation. This study describes the clinical and epidemiological characteristics of quad bike injuries at the Royal Darwin Hospital (RDH).

METHODS

A retrospective review of the RDH Trauma Registry for all quad bike mechanism of injury from 1 January 2006 to 31 December 2015 was conducted. We analysed patient demographics, remoteness of injury, injury circumstances, patterns and severity of injury, surgical intervention, length of stay and outcome.

RESULTS

In total, 186 persons were injured, of whom 81% (n = 150) were male. There was an increase in quad bike incidents during the 10-year study period, and the greatest increase was seen in the 16-30 years age group. When helmet use was recorded, it was low at 36% (n = 47). Alcohol involvement was 40% (n = 74). Cases with alcohol involvement were 10 times less likely to have worn a helmet than those cases without alcohol involvement (95% confidence interval 3.8-29). The median Injury Severity Score was 8 (interquartile range 4-10). The median hospital length of hospital stay was 4 days (interquartile range 3-7). The majority, 57% (n = 106), did not require surgical intervention. The fatality rate was <5%.

CONCLUSION

Quad bike incidents presenting to RDH are increasing. This likely corresponds to the increased number of quad bikes in circulation, and has resulted in an increased demand on health care. Alcohol use and a lack of safety equipment continue to be potentially correctable factors.

Risk Factors and Outcomes From All-Terrain Vehicle Injuries Compared With Motor Vehicle Collisions in Children

We compared risk factors and outcomes of children injured from all-terrain vehicle (ATV) injuries to those injured from motor vehicle collisions (MVC). We reviewed records of patients ≤18 years of age admitted to a trauma center with ATV- or MVC-related injuries between January 1, 2000, and December 31, 2015. Demographics were compared using logistic regression. Rates of injuries were compared using χ² tests. Of 6293 patients, 1140 (18%) ATV and 5153 (82%) MVC events were identified. In multivariable analysis (adjusted odds ratio [aOR], 95% confidence interval [CI]), patients with ATV-related injuries occurred more at older age (≥12 years; aOR = 4.29, 95% CI = 3.20-5.77), in rural counties (aOR = 3.72, 95% CI = 2.62-5.28), in regions with lower median household income (aOR = 1.37, 95% CI = 1.03-1.83), and in the spring (aOR = 2.44, 95% CI = 1.87-3.18), and summer (aOR = 2.50, 95% CI = 1.93-3.25) compared with winter. ATV-related injuries occurred less frequently among females (aOR = 0.76, 95% CI = 0.65-0.89). Upper extremity injuries were associated with ATV-related injuries (P ≤ .001). Findings may facilitate identification of at-risk groups for targeted interventions.

An optimal sampling approach to modelling whole-body vibration exposure in all-terrain vehicle driving

Exposure to whole-body vibration (WBV) presents an occupational health risk and several safety standards obligate to measure WBV. The high cost of direct measurements in large epidemiological studies raises the question of the optimal sampling for estimating WBV exposures given by a large variation in exposure levels in real worksites. This paper presents a new approach to addressing this problem. A daily exposure to WBV was recorded for 9-24 days among 48 all-terrain vehicle drivers. Four data-sets based on root mean squared recordings were obtained from the measurement. The data were modelled using semi-variogram with spectrum analysis and the optimal sampling scheme was derived. The optimum sampling period was 140 min apart. The result was verified and validated in terms of its accuracy and statistical power. Recordings of two to three hours are probably needed to get a sufficiently unbiased daily WBV exposure estimate in real worksites. The developed model is general enough that is applicable to other cumulative exposures or biosignals. Practitioner Summary: Exposure to whole-body vibration (WBV) presents an occupational health risk and safety standards obligate to measure WBV. However, direct measurements can be expensive. This paper presents a new approach to addressing this problem. The developed model is general enough that is applicable to other cumulative exposures or biosignals.

Engaging Agribusinesses: Feasibility and Cost of an ATV Safety Poster Project

OBJECTIVES

All-terrain vehicle (ATV)-related deaths and injuries continue to be a significant problem. Influential change agents such as agribusinesses could be important partners for improving safety behaviors among rural ATV users. Our objective was to determine how effectively an injury prevention project could engage agribusinesses through the postal service and to assess their willingness to display a safety poster.

METHODS

One thousand two hundred forty-four agribusinesses received an ATV safety poster and a postcard survey by mail. A randomized sampling of these businesses was surveyed by telephone 4-7 weeks later. Telephone survey questions included whether they recalled receiving the poster, and if so, whether, where and how long the poster was displayed.

RESULTS

One hundred six postcards were returned. Of the 192 eligible business persons contacted by telephone, 89% agreed to participate. Approximately one-third of telephone survey participants recalled receiving the poster. Among these, 81% with walk-in customers posted it, and 74% still had it displayed 1 month later. Of participants who did not recall receiving the poster, 83% stated they would have displayed the poster. The cost of displaying each poster in a business was 16.6 cents/day during the first month. Final costs/day would be much less because of continued display.

CONCLUSION

A high percentage of agribusinesses displayed or would have displayed an ATV safety poster, and most displayed it beyond 1 month. Unfortunately, participant recruitment via postal delivery alone was challenging. Nevertheless, mass mailing of injury prevention materials to be displayed in the retail setting may be a low cost method for raising safety awareness.

Age-based risk factors for pediatric ATV-related fatalities

OBJECTIVES

To compare and contrast characteristics and determinants of fatal all-terrain vehicle (ATV) crashes among pediatric age groups.

METHODS

Retrospective descriptive and multivariable analyses of Consumer Product Safety Commission fatality data (1985-2009) were performed.

RESULTS

Relative to 1985-1989 (baseline), pediatric deaths over the subsequent 4-year periods were lower until 2001-2004, when they markedly increased. Also, the proportion of vehicles involved in fatalities with engine sizes >350 cubic centimeter increased, reaching ∼50% of crashes in 2007-2009. Ninety-five percent of all pediatric fatalities were on adult-size vehicles. Victims <6 years old had the highest proportion of girls (24%) and passengers (76%), and the lowest helmet use (17%). More than half of 6- to 11-year-old children were vehicle operators; 1 in 4 were carrying passengers in their own age range. Over the study period, 12- to 15-year-old children accounted for more than half of all pediatric ATV-related fatalities. The proportion of youth riding on the road increased with age, as did the proportion of collisions with other vehicles. Older teens had the highest proportions of roadway fatalities (72%) and collision events (63%), and 19% of their crashes involved alcohol. Head injuries occurred in 63% of victims (the major determinant being roadway riding), and helmets reduced the likelihood of head injury among fatal crash victims by 58%.

CONCLUSIONS

There were significant differences between pediatric age groups in the relative contribution of known risk factors for ATV-related fatalities. Future injury prevention efforts must recognize these differences and develop interventions based on the age range targeted.

Helmet use among Alaskan children involved in off-road motorized vehicle crashes

BACKGROUND

Off-road motorized vehicle crashes are a common source of trauma among Alaska children. Injury morbidity is worse in Alaska Native children than non-Native children, but the reasons are unclear.

OBJECTIVE

To evaluate the differences in helmet use between the Native and the non-Native children, and to assess the impact of helmet use on injury patterns and outcomes.

DESIGN

This retrospective cohort study identified patients aged 17 or younger admitted after all-terrain vehicle, snowmobile or motorbike injury between 2001 and 2011 from the Alaska Trauma Registry. Helmeted and non-helmeted patients were compared with respect to demographics, central nervous system (CNS) injury and the overall risk of death or permanent disability. Logistic regression was used to evaluate predictors of helmet use and the effects of ethnicity and helmet use on outcomes.

RESULTS

Of the 921 injured children, 51% were Alaska Native and 49% were non-Native. Helmet use was lower among Native versus non-Native patients on unadjusted comparison (24% vs. 71%) and multivariable logistic regression (OR 0.17, 95% CI 0.11-0.27, p<0.0001). Prevalence of CNS injury was higher among Native children (39.7% vs. 30.4%, p=0.016). However, on logistic regression with adjustment for helmet use, Native ethnicity was not a significant predictor of CNS injury (OR 1.07, 95% CI 0.68-1.68, p=0.78), whereas helmet use was strongly protective against CNS injury (OR 0.28, 95% CI 0.18-0.44, p<0.0001) as well as death or permanent disability (OR 0.26, 95% CI 0.10-0.67, p=0.006).

CONCLUSIONS

Helmet use is lower among Alaska Native children involved in off-road motorized vehicle crashes. These ethnic disparities in helmet use contribute to higher rates of CNS injury among Native children. Helmet use significantly improves overall outcome. Helmet promotion efforts should be expanded, especially in Native communities.

A school-based study of adolescent all-terrain vehicle exposure, safety behaviors, and crash experience

PURPOSE

More youth are killed every year in the United States in all-terrain vehicle (ATV) crashes than on bicycles, and since 2001, one-fifth of all ATV fatalities have involved victims aged 15 years or younger. Effectively preventing pediatric ATV-related deaths and injuries requires knowledge about youth riding practices. Our objective was to examine ATV use, crash prevalence, and riding behaviors among adolescent students in a rural state.

METHODS

We administered a cross-sectional survey to 4,684 youths aged 11 to 16 years at 30 schools across Iowa from November 2010 to April 2013. Descriptive and comparative analyses were performed.

RESULTS

Regardless of rurality, at least 75% of students reported having been on an ATV, with 38% of those riding daily or weekly. Among ATV riders, 57% had been in a crash. Most riders engaged in risky behaviors, including riding with passengers (92%), on public roads (81%), or without a helmet (64%). Almost 60% reported engaging in all 3 behaviors; only 2% engaged in none. Multivariable modeling revealed male youth, students riding daily/weekly, and those reporting both riding on public roads and with passengers were 1.61 (95% CI, 1.36-1.91), 3.73 (95% CI, 3.10-4.50), and 3.24 (95% CI, 2.09-5.04) times more likely to report a crash, respectively.

CONCLUSIONS

Three-fourths of youths surveyed were exposed to ATVs. The majority of riders had engaged in unsafe behaviors and experienced a crash. Given this widespread use and the potentially considerable morbidity of pediatric ATV crashes, prevention efforts, including anticipatory guidance by primary care clinicians serving families at risk, should be a higher priority.

ATV rollover, rider response, and determinants of injury: in-depth analysis of video-documented ATV rollover events

OBJECTIVE

All-terrain vehicle (ATV) rollover events can lead to serious and fatal injuries. Crush protection devices (CPDs) are intended to reduce injury by reducing the frequency of significant contact between an inverted ATV and rider. Currently, field data on real-world ATV rollovers are primarily limited to injury causing events and lack ATV and rider dynamics necessary to evaluate injury mitigation effectiveness and possible unintended consequences of CPDs. Unlike restrained automobile occupants, ATV rider posture and positioning are highly variable and scant data are available to define the dynamically changing rider position in a roll scenario. Additional data on the complex real-world dynamics and interactions of riders and vehicles are needed to further develop and evaluate the effectiveness of rollover injury prevention strategies.

METHODS

Using YouTube videos of real-world rollover events, vehicle, environment, and rider factors were categorized with a focus on vehicle dynamics and rider responses, including dismount kinematics.

RESULTS

One hundred twenty-nine ATV rollover events were coded, with side rolls representing 47%, rear 44%, and forward rolls 9%. The speed at onset of roll was relatively low, with 86% of the rolls occurring at speeds of 10 mph or less and 53% occurring at less than 3 mph. No injury was identified for 79% of the events; 16% resulted in injury due to ATV contact and 5% resulted in injury unrelated to ATV contact. Active dismount of the ATV was a commonly employed strategy, with 63% of the riders attempting active dismount, resulting in successful separation from the ATV in 72% of the attempts. The overall injury rate for riders attempting active dismount was 15% and the injury rate for riders not attempting active dismount was 32%. This investigation confirmed the importance of active rider movements, including active dismount and subsequent separation in determining the outcome of ATV roll events.

CONCLUSIONS

Rider active dynamics need to be considered when introducing new injury prevention strategies that may obstruct, impede, or otherwise contact riders during an attempted separation. To the authors' knowledge, this is the first systematic use of real-world video-documented ATV rollover events to quantify and analyze ATV rollover dynamics and rider responses. These data and techniques can guide effective design and implementation of injury mitigation strategies.

Spectrum of all-terrain vehicle injuries in adults: A case series and review of the literature

INTRODUCTION

Serious injury secondary to all terrain vehicle usage has been widely reported since the 1970s. All-terrain vehicles (ATV) or 'quad bikes' are four wheeled vehicles used for agricultural work, recreation and adventure sport. Data collected in the U.S. indicates that ATV related injury and fatality is increasing annually.

PRESENTATION OF CASES

This case series describes 3 cases of significant ATV related trauma in adults presenting to one regional hospital in the West of Ireland over a 12month period.

DISCUSSION

Epidemiology, mechanisms of injury, spectrum of injury in adults and preventative measures to reduce the number of ATV related injuries and fatalities are discussed here with a review of the literature.

CONCLUSION

A paucity of research outside of North America is highlighted by this case series. Mandatory reporting of ATV related injury, educational, training and legislative measures are suggested as injury prevention strategies.