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

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 wheteher ATV-related injuries elicited changes in risk-taking behaviour. A retrospective, comparative analysis of children admitted for ATV-related injuries and children admitted for bicycle-related injuries to a pediatric trauma centre between Jnauary 1991 and June 2000 was performed. A phone survey was conducted to determine self-reported changes in safety behavours or use patterns after ATV injury. Results showed that the mean age was 11.1 years for ATV crahes versus 9.4 years for bicycle crashes. 93% of ATV crashes ocurred in children less than 16 years of age; 31% in children less than 11 years of age; and 7% in children less than 6 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. Falls from ATVs or bicycles were the most common mechanism of injury. Collisions with motor vehicles were more common for cyclists, whereas collisions with stationary objects were more common among ATV riders. 16% of ATV crashes were caused by a roll-over mechanism. Mean injury severity scores were significantly higher for victims of ATV crashes. ATV-related trauma was associated with multiple injuries, more operative interventions, and longer hopsital stays. Location and distribution of injuries were similar for both groups. Helmet use was low in both groups but higher for ATV riders. Mortality rate was similar for both groups. There was a 39% response rate for the phone survey post ATV injury. 53% of respondents owned the ATV, and 70% of these received safety information at the time of purchase. However, only 14% of the injured riders received any formal training before riding ATVs. Postinjury, 60% of children continued to ride, although 42% reported decreased riding time. 54% of children reportedly wore helmets preinjury, and there were no changes in helmet use postinjury. There were no differences in pre- and postinjury parental supervision. In conclusion, both ATV and bicycle-related injuries occurr predominantly in boys, but ATV victims are older and almost all are white. Almost all ATV injuries occurred in childen under the age of 16 years. Although, both ATV and bicycle crashes cause severe injuries in children, injury severity is higher for ATV carshes 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 behaviours remain unaltered. These data reinforce the current American Academy Pediatrics stance that legislation prohibiting the use of ATVs in childen under the age of 16 years without a valid driver's license should be pursued and enforced aggressively.