All-terrain vehicle and bicycle crashes in children: Epidemiology and comparison of injury severity

• Published in: Journal of pediatric surgery 2002-03, Vol.37 (3), p.375-380
• Main Authors: Brown, Rebeccah L., Koepplinger, Matthew E., Mehlman, Charles T., Gittelman, Michael, Garcia, Victor F.
• Format: Article
• Language: English
• Subjects: Accidents, Traffic - mortality; Adolescent; Bicycling - injuries; Biological and medical sciences; Child; Child, Preschool; Female; Humans; Injury Severity Score; Male; Medical sciences; Miscellaneous; Off-Road Motor Vehicles; Retrospective Studies; Risk-Taking; Traumas. Diseases due to physical agents; United States - epidemiology
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1053/jpsu.2002.30826

Background/Purpose: Despite statements by the American Academy of Pediatrics (AAP) and the US Consumer Product Safety Commission (CPSC) against the use of all-terrain vehicles (ATVs) by children under the age of 16 years, nearly half of ATV-related injuries and over 35% of all ATV-related deaths continue to occur in this age group. Because ATV and bicycle crashes have been associated with serious injury in children, the authors compared the demographics, mechanism of injury, injury severity, and outcome of children with ATV- and bicycle-related injuries. Further, the authors sought to identify whether ATV-related injuries elicited changes in risk-taking behavior. Methods: A retrospective, comparative analysis of 109 children admitted for ATV-related injuries and 994 children admitted for bicycle-related injuries to a level 1 pediatric trauma center between January 1991 and June 2000 was performed. A phone survey was conducted to determine self-reported changes in safety behaviors or use patterns after ATV injury. Results: Mean age was 11.1 [plusmn] 3.5 years (range, 2 to 18 years) for ATV crashes versus 9.4 [plusmn] 3.3 years (range, 1 to 17 years) for bicycle crashes ( P [lt ] .05). Ninety-three percent of ATV crashes occurred in children less than 16 years of age; 31% in children [le ]10 years of age; and 7% in children [le ]5 years of age. Male-to-female ratio was about 3:1 for both groups. White race accounted for 97% of ATV injuries compared with 79% of bicycle injuries ( P [lt ] .05). Falls from ATVs or bicycles were the most common mechanism of injury (41% v 59%, respectively). Collisions with motor vehicles were more common for bicyclists (32% v 10%), whereas collisions with stationary objects were more common among ATV riders (27% v 9%). Sixteen percent of ATV crashes were caused by a roll-over mechanism. Mean injury severity score (ISS) were significantly higher for victims of ATV crashes (8.3 ATV v 6.7 bicycle; P [lt ] .05). ATV-related trauma was associated with multiple injuries, more operative interventions, and longer hospital stays. Location and distribution of injuries were similar for both groups. Helmet use was low in both groups but higher for ATV riders (23% v 8%; P [lt ] .5). Mortality rate was similar for both groups (0.9% for ATV riders v 0.7% for bicyclists). There was a 39% response for the phone survey post-ATV injury. Twenty-three of 43 (53%) respondents owned the ATV, and 70% of these received safety information at the time of