As incidence of pediatric ATV-related injuries decreases, mortality remains stable

1. While the mean incidence of all-terrain vehicle (ATV)-related injuries in children <18 years decreased from 2009-2014 as compared to 2004-2008, the mean mortality remained relatively stable.

2. Most patients injured secondary to ATV-related trauma sustained at least 1 bone fracture, with the femur and tibia being the most common.

Evidence Rating Level: 2 (Good)

Study Rundown: Despite safety guidelines established by industry and medical organizations, all-terrain vehicle (ATV)-related crashes have resulted in pediatric morbidity and mortality since ATV development 4 decades ago. While previous work has determined the incidence of pediatric morbidity and mortality in ATV crashes, there is a lack of recent research examining injury secondary to ATVs. Researchers in this study used data from the Pennsylvania Trauma Systems Foundation (PTSF) to determine the incidence of ATV-related injuries and the anatomic location of fractures. Results showed that the overall incidence of injuries decreased over most the study period while mortality rates remained relatively stable. The majority of injuries were in male patients and helmets were used in less than half of those injured. The majority of injured patients sustained at least 1 fracture of a bone below the level of the cervical spine, with the femur and the tibia being the two most frequently injured bones. By including data from trauma center databases, this study is limited by selection bias as patients admitted to these facilities were likely to be more severely injured than patients not treated at trauma centers. The actual mortality rate is likely higher than reported here, as this study does not include patients who died prior to reaching the trauma center. These results suggest the need to strengthen preventative measures to reduce ATV-related morbidity and mortality in the pediatric population.

Click to read the study, published today in Pediatrics

Relevant reading: On-road all-terrain vehicle (ATV) fatalities in the United States

In-depth [retrospective cohort]: Researchers collected data from 32 trauma centers, analyzing data from1912 patients (74.5% male, 23.6% were passengers) injured in ATV crashes between January 1, 2004 and December 31, 2014. Crash and patient characteristics including location of the crash, helmet use, injury severity, admission to the intensive care unit, and anatomical fracture location, were compiled using the PTSF database. Results showed an average of 6.2 ATV-related injuries per year, with a 13.4% decrease in mean incidence of injuries during the last 6 years of the study period as compared to during the first 5 years (5.8 vs. 6.7 per 100 000 children respectively, p = .08). Mortality rates were relatively stable throughout the period at 0.09 deaths per 100 000 children.  A total of 48.7% of patients reported using a helmet and 55.4% of patients had at least 1 bone fracture below the cervical spine. The femur and tibia were the most frequently fractured bones (21.6% and 17.7%, respectively). Helmet use was associated with fewer deaths (p = .031). Of those children killed in crashes, 28.6% were reported to be wearing a helmet. Crashes that occurred on the street or roadway were associated with an increase in deaths (p=.026). In terms of demographics, no association was noted between sex or age group and mortality.

Image: PD

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