All-terrain vehicle legislation for children: A comparison of a state with and a state without a helmet law

All-terrain vehicles (ATVs) continue to be a source of morbidity and mortality in the pediatric population despite recommendations from the American Academy of Pediatrics that children <16 years old not ride in or drive ATVs. ATV injuries have increased significantly in both children and adults most years since 1997. The objective of this study was to assess the effectiveness of ATV regulations for children on serious injuries by comparing ATV-related admissions to level I and II trauma hospitals in a state with and a state without ATV regulations. This was an ecologic study with subjects being children <16 years old who died and/or were treated in the trauma system of Pennsylvania or North Carolina after ATV crashes. Injury types and cause of death were examined for all children. Comparisons were made by state (Pennsylvania [regulated] and North Carolina [unregulated]) for patterns of injury, place of injury, helmet use, and death. Results showed that there were 1080 children identified in the trauma registries between January 1997 and July 2000. Forty-four percent required intensive care. Head injuries were the primary cause of death (45.7%). Fewer North Carolina children than Pennsylvania children (16.7% vs 35.8%) wore helmets, and they were more likely to be <11 years old (35.1% vs 27.8%). Living in North Carolina was an independent predictor for not wearing a helmet. In conclusion, living in Pennsylvania was associated with decreased risk factors for ATV injury such as young age and riding unhelmeted. However, despite regulations, many children suffered serious morbidity and mortality. These data support the recommendation that children <16 years old should be prohibited from riding or driving ATVs.