All-terrain vehicle injuries in children: industry-regulated failure.

Although the sale of all-terrain vehicles (ATVs) to children under 16 years of age was prohibited in 1988, they continue to represent half of the ATV-associated injuries. We conducted a retrospective review of ATV injuries admitted to our institution from 1988 to 1998. We identified 76 patients over the last 10 years, with 50 patients admitted in the last 4 years. Children <16 years of age account for 50 per cent of all ATV-injured patients. Only eight per cent of these children wore helmets. We conclude that despite industry regulation, nearly half of ATV injuries continue to involve children under 16 years of age. The consent decree restricting access of children <16 years of age to ATVs has been ineffective and expired in April 1998. Significant morbidity and mortality continues to occur in children <16 years of age who operate these vehicles. Reform is needed, such as legislation that would mandate the sale of safety equipment on ATV purchase, as well as provide for ATV safety education.     

All-terrain vehicle accidents in Maine

All-terrain vehicles (ATV) are designed for off-road vocational or recreational use. Their popularity has increased steadily, but only recently has information accumulated concerning morbidity and mortality associated with the use of these vehicles. The 221 ATV accidents reported in Maine during 1985 are reviewed to more fully characterize the trauma associated with ATV accidents. These data are compared with reports from other geographical areas and recommendations made regarding ATV use.     

All-terrain vehicle injuries. A review at a rural level II trauma center

All-terrain vehicles (ATVs) have become a major source of morbidity and mortality with more than 600 deaths nationwide. Nearly half of those injured are children under 16 years. Twenty three ATV accidents were seen at the Guthrie Medical Center over a 30 month period ending in August 1986. Ten patients (43.5%) were under 16 years old. Of those injured who were older, alcohol was involved in 70 per cent of the accidents. Five accidents occurred on highways (21.7%), in spite of laws banning their use on public roads. Rollover type accidents and collisions were the most frequent mechanisms of injury (39% and 35%). Of 18 patients known not to have worn a helmet, 61 per cent sustained a closed head injury. In all, there were 88 injuries in 23 patients. Common injuries included lacerations (13), long bone fractures (13), renal contusions (11) and head injury (11). There were two deaths (8.7%), two cord transections with permanent disability, and a below-knee amputation. ATVs present a serious hazard to adult and children riders alike. Age limits, state licensing, safety programs, and protective equipment are all recommended as a means to reduce injury and death from recreational riding.     

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

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 purchase. However, only 14% of injured riders received any formal training before riding ATVs. Postinjury, 60% of children continued to ride, although 42% reported decreased riding time. Fifty-four percent of children reportedly wore helmets preinjury, and there were no changes in helmet usage postinjury. There were no differences in pre- and postinjury parental supervision (61% v 65%). Conclusions: Both ATV and bicycle-related injuries occur predominantly in boys, but ATV victims are older and almost all are white. Almost all ATV injuries occurred in children under the age of 16 years. Although both ATV and bicycle crashes cause severe injuries in children, injury severity is higher for ATV crashes in terms of multiple injuries, need for operative intervention, and longer length of stay. Despite severe injuries, the majority of children injured by ATVs continue to ride, albeit fewer hours per day, and safety behaviors are unaltered. These data reinforce the current AAP stance that legislation prohibiting the use of ATVs in children under the age of 16 years without a valid driver's license should be pursued and enforced aggressively.     

All-terrain vehicles: injuries and prevention

All-terrain vehicles, including three- and four-wheeled recreation and utility off-road motorized devices, are a serious risk to the public especially to children younger than 16 years. Statistics show the injuries, which often are musculoskeletal in nature, and fatalities are increasing: in 2002, approximately 111,000 people sustained injuries related to all-terrain vehicles. Although agencies such as the Consumer Product Safety Commission initially recognized and restricted three-wheeler sales, they largely have failed to address the problem caused by other all-terrain vehicles during the past 10 years. To reduce the frequency and severity of injuries from all-terrain vehicles, numerous methods have been recognized and discussed. State and federal laws are needed to implement these methods to protect the public; these legislative solutions also are included in the discussion.     

Seat-belt injuries in children involved in motor vehicle crashes.

BACKGROUND: The efficacy of seat belts in reducing deaths from motor vehicle crashes is well documented. A unique association of injuries has emerged in adults and children with the use of seat belts. The "seat-belt syndrome" refers to the spectrum of injuries associated with lap-belt restraints, particularly flexion-distraction injuries to the spine (Chance fractures). METHODS: We describe the injuries sustained by 8 children, including 2 sets of twins, in 3 different motor vehicle crashes. RESULTS: All children were rear seat passengers wearing lap or 3-point restraints. All had abdominal lap-belt ecchymosis and multiple abdominal injuries due to the common mechanism of seat-belt compression with hyperflexion and distraction during deceleration. Five of the children had lumbar spine fractures and 4 remained permanently paraplegic. CONCLUSIONS: These incidents illustrate the need for acute awareness of the complete spectrum of intra-abdominal and spinal injuries in restrained pediatric passengers in motor vehicle crashes and for rear seat restraints that include shoulder belts with the ability to adjust them to fit smaller passengers, including older children.     

All-terrain vehicle rules and regulations: impact on pediatric mortality

Background/purpose: All-terrain vehicles (ATV) use by children leads to severe injury and death. Since the US Consumer Product Safety Commission consent decree expired in 1998, there has been little movement in regulating ATV use for children (<16 yr). The authors hypothesized that states with laws and regulations restricting pediatric ATV use may abrogate excess death compared with states without such restrictions.Methods: Pediatric mortality data reported to the consumer product safety commission from 1982 to 1998 were analyzed as well as state all-terrain vehicle requirements compiled by the Specialty Vehicle Institute of America in August 2001. The authors calculated ATV mortality rate by dividing ATV mortality frequency by 1980-2000 pediatric census results. They compared the top 26 states with the highest ATV mortality rates (TOP) with those of all other states (OTH) in terms of age, ATV type, ATV occupancy, and ATV laws. Chi-square analysis was performed.Results: There were 1,342 ATV pediatric deaths during the 16-year period. The TOP states averaged approximately a 2-fold increase in adjusted ATV mortality rate compared with the national ATV pediatric mortality rate. Ninety-two percent of TOP states have no licensing laws compared with 73% of the OTH states (P < .07). There is no difference between groups with regard to minimum age requirements and safety certification.Conclusions: Current legal and regulatory standards have low probability of decreasing ATV-related pediatric mortality. States should adopt laws that restrict the use of ATV’s for children less than 16 years of age and potentially prevent excess ATV-related pediatric mortality.     

All-terrain vehicle accidents: a survey of a community hospital's experience

A rural community hospital's record of persons injured from all-terrain vehicle use in 1985 was reviewed. A total of 46 persons sustained 67 injuries, with 11 persons (24%) requiring hospital admission. Collisions (22%), flipping backwards (18%), rollovers (18%), and falling off (18%) accounted for the majority of accidents. Helmet use (40%) and alcohol use (30%) were also recorded. This study was compared to other recently published literature. Recommendations are made to lessen the risk of injury with usage of these vehicles.     

All-terrain vehicle trauma in the elderly: an analysis of a national database

The elderly are a growing proportion of all-terrain (ATV) drivers. The purpose of this study was to determine if the outcomes of geriatric ATV trauma victims are different from those of their younger counterparts and if age is an independent predictor of mortality. ATV trauma cases in the United States reported to the National Trauma Data Bank between 1989 and 2003 comprised the study population. A logistic regression model was constructed with mortality as the outcome and age as the primary covariate of interest. A total of 6308 ATV-related traumas were reported to the National Trauma Data Bank during the study period. Geriatric victims presented with significantly higher systolic blood pressure (138.6 +/- 34.4 vs 131.4 +/- 24.8, P < 0.001) and had a significantly longer length of stay (8.3 +/- 11.4 vs 4.8 +/- 8.8, P < 0.001) and greater number of intensive care unit days (3.1 +/- 7.1 vs 1.3 +/- 4.0, P < 0.001). In a multivariate model, age older than 60 years was associated with increased risk of mortality (OR, 6.96; 95% CI, 3.75-12.92). Age older than 60 years is an independent predictor of mortality among ATV trauma cases. Improved training on the use of ATVs in this population and better safety features are warranted.     

Suboptimal restraint affects the pattern of abdominal injuries in children involved in motor vehicle crashes

Background

Both solid and hollow visceral abdominal injuries have been associated with the use of seat belts in children involved in motor vehicle crashes. The relationship between the types of restraint used and the pattern of abdominal injury is unknown.

Methods

A probability sample of restrained children involved in crashes was enrolled in an ongoing crash surveillance system (1998 through 2002) linking insurance claims data to telephone survey and crash investigation data. Significant abdominal injuries were considered when the Abbreviated Injury Scale (AIS) score was ≥2 and were defined as hollow visceral (HV; intestine, bladder), or solid visceral (liver, spleen, pancreas, kidney). Restraint type was categorized as optimal restraint (OR) or suboptimal restraint (S-OR) based on the child’s age and size.

Results

For the 33 months of review, interviews were obtained for 13,558 restrained children aged 0 to 15 years, of which, 56% were OR (n = 7,591) and 44% were S-OR (n = 5,967). A significant abdominal injury was recorded in 78 children. A hollow visceral injury was recorded in 38 (9 OR and 29 S-OR), and a solid visceral injury in 32 (18 OR and 14 S-OR). Both hollow and solid visceral injuries were present in 8 children (2 OR and 6 S-OR). Suboptimally restrained children had a higher risk for hollow visceral injury when compared with optimally restrained children (Odds Ratio, 4.14 [95% Confidence Interval 1.33 to 13.22, P < .01]).

Conclusions

Among restrained children with intraabdominal injuries, those who were suboptimally restrained were 4 times more likely to have a hollow visceral than a solid visceral injury when compared with those who were optimally restrained. This suggests that the mechanism of injury for hollow viscus may be directly related to the improper positioning of the restraint.     

Maxillofacial injuries in moose-motor vehicle collisions versus other high-speed motor vehicle collisions

BACKGROUND:

Anecdotal experience has suggested that there is a higher frequency of maxillofacial injuries among motor vehicle collisions involving moose.

OBJECTIVES:

A retrospective cohort study design was used to investigate the incidence of various injuries resulting from moose-motor vehicle collisions versus other high-speed motor vehicle collisions.

METHODS:

A chart review was conducted among patients presenting to a Canadian regional trauma centre during the five-year period from 1996 to 2000.

RESULTS:

Fifty-seven moose-motor vehicle collisions were identified; 121 high-speed collisions were randomly selected as a control group. Demographic, collision and injury data were collected from these charts and statistically analyzed. The general demographic features of the two groups were similar. Moose collisions were typically frontal impact resulting in windshield damage. The overall injury severity was similar in both groups. Likewise, the frequency of intracranial, spinal, thoracic and extremity injuries was similar for both groups. The group involved in collisions with moose, however, was 1.8 times more likely then controls to sustain a maxillofacial injury (P=0.004) and four times more likely to sustain a maxillofacial fracture (P=0.006).

CONCLUSIONS:

Occupants of motor vehicles colliding with moose are more likely to sustain maxillofacial injuries than those involved in other types of motor vehicle collisions. It is speculated that this distribution of injuries relates to the mechanism of collision with these large mammals with a high centre of gravity.     

Maxillofacial and ocular injuries in motor vehicle crashes

BACKGROUND: Injuries from motor vehicle crashes constitute a leading cause of death in the young and a high degree of morbidity and mortality in all age groups. Facial trauma has been consistently shown to be the single most common injury to the occupants of vehicles involved in crashes. This has been confirmed by more recent studies which have demonstrated a continuing high incidence of facial fractures amongst belted drivers. Airbags have been advocated as a supplemental restraint system. However, their deployment can cause injury particularly if the driver is of short stature, unrestrained or out of position within the vehicle. METHODS: The Crash Injury Research Engineering Network (CIREN) project aims to correlate the injuries received by occupants in vehicle crashes with the biomechanics of vehicle deformation. All cases of facial injury which presented to the University of Michigan Medical Center, USA in 1999 were retrospectively evaluated with reference to the methods of occupant restraint and to the correlation between the injuries sustained and vehicle deformation. RESULTS AND CONCLUSIONS: The case analysis confirmed the value of airbags to the safety of vehicle occupants but reinforced the conclusion that they must still be considered supplemental restraint systems. New generation airbags will minimise the risk of injury even to small stature or out of position occupants as they will prevent deployment in situations where they may have an adverse effect.     

Multiple injuries in children

39 patients with 42 arachnoid cysts have been reviewed in a retrospective study. All kinds of arachnoid cysts reported in the literature were also found in this study. These consist mainly of congenital primary and posttraumatic secondary cysts. Cysts which cause no major neurological deficits require conservative treatment of symptoms only. Cysts which cause major symptoms because of their space occupying nature, however, require surgical treatment. Craniotomy with removal of membranes to allow free physiological circulation of CSF is the treatment of choice in our hands. Cysto-peritoneal shunting is an alternative procedure for patients in a poor condition. More than 50% (23 out of 39 cases) were younger then 20 years of age, suggesting that these cysts are mainly congenital lesions of the brain.     

Chest injuries in children

Chest injuries of varying severity occur commonly in children, much more as a result of motor vehicle accidents and falls from a height than from penetration. The author reviews the injuries that occur with reference to mechanism, immediate and late treatment and monitoring. The differences between the injuries of children and those of adults stem from the greater resilience of most structures in children; bony injuries are not necessarily extensive even when disruptions of the lung and blood vessels are serious. Pneumothorax may occur alone or with other injuries. A chest tube should be inserted early. Persistence of the pneumothorax may indicate the presence of a tracheobronchial tear which must be repaired by thoracotomy. A flail chest may be treated without intubation if blood-gas levels are normal. In the presence of paradoxical motion and increased carbon dioxide pressure, intubation and positive-pressure ventilation are required for a few days. Penetrating wounds require the same care as in adults. Diaphragmatic tears occur from falls from excessive heights or direct passage of vehicle wheels over the chest or abdomen. Ventilation becomes progressively more inefficient. Esophageal tears occur from irregular foreign bodies. Great-vessel injuries occur by penetration. The author establishes priorities in management to assure adequate oxygen utilization, arrest of hemorrhage and restoration of circulation. Following stabilization efforts, monitoring procedures are instituted. These include insertion of central venous pressure and arterial lines to measure pH, carbon dioxide and cardiac output as well as for other biochemical and hematologic measurements.