1. Emergency department visits related to off-road vehicle (ORV) accidents significantly decreased in children ages 17 and younger after the passage of stricter legislation regarding ORV use in the state of Massachusetts.
2. Inpatient hospitalizations related to ORV use for patients also significantly decreased for children ages 17 and younger after passage of stricter legislation.
Evidence Rating Level: 2 (Good)
Study Rundown: ORVs, which pose a significant threat to children’s health and safety, have been a topic of legislation in recent years in response to the significant morbidity associated with their use. In 2010, Massachusetts passed the nation’s strictest statewide regulations restricting the use of ORVs in children under the age of 18, specifically banning children under age 13 from using ORVs without direct adult supervision and mandating a safety training course for children ages 14-17. Researchers compared ED visits and hospital admissions in patients for cohorts of patients under age of 18 before and after the passage of the legislation. Visits and admission rates during the same period were compared to an older cohort, ages 25 to 34, who may have operated ORVs under the previous legislations. Researchers discovered a significant decrease in ED visits related to ORVs in all age cohorts under 18, with the most significant decrease being in patients ages 10-13. Hospital admission rates also decreased for children under 18, with no significant decrease noted in the 25-34 cohort. Limitations of the study include its use of medical coding labels created prior to the initiation of the study to identify the study population, a method which may not accurately reflect the actual population of interest. The study results demonstrates the efficacy of legislation in decreasing accidents and injuries associated with ORV use.
Study Author, Dr. Michael R. Flaherty, DO, talks to 2 Minute Medicine: Division of Pediatric Critical Care Medicine, MassGeneral Hospital for Children; Instructor in Pediatrics, Harvard Medical School; Associate Program Director, PCCM Fellowship
“Our article is important for all to read because off-road vehicle injuries continue to be a major public health problem, especially for those under age 18. Over 3,000 children have lost their lives since all-terrain vehicles became popular in the 1980s, and we have a duty as pediatricians and medical professionals to help combat this preventable cause of death. Our study adds to the evidence in favor of legislation as an effective means of reducing pediatric ORV injuries and fatalities, particularly when age restrictions are meaningful and in line with professional medical societies.”
In-Depth [retrospective cohort]: This study identified ED visits and hospital admission rates associated with ORV use in children under age 18, as well as adults 25-34, in the Commonwealth of Massachusetts from 2002 to 2013. Data sources included hospital discharge summaries provided by the Massachusetts Department of Public Health. Researchers compared ED visits and admission rates before and after implementation of the new ORV law in December 2010. Patients were identified using an e-code for injuries associated with all-terrain motor vehicles. 3638 ED visits and 481 hospitalizations were identified in patients under 18 during the designated time period. After implementation of the stricter law, ED visits decreased in all age cohorts, with a 33% decrease in children ages 0-9, 50% in children ages 10-13, and 39% in children ages 14-17 (all P<.001). There was no notable decrease in ED visits in the 25-34 age cohort for that same time period. Hospitalization rates decreased by 41% (P<.001) in all children ages 17 and under after implementation of the new legislation, while there was a 26% (P=.04) decrease in the 25-34 age cohort.
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