All-terrain vehicle use related fracture rates, patterns, and associations from 2002 to 2015 in the USA.

BACKGROUND: Since their introduction to USA markets in the late 20th century, all-terrain vehicles (ATVs) have been a significant source of trauma. Many paediatric studies have demonstrated the disproportionate rate in which minors are affected by ATV-related trauma, but no studies have been performed on a large sample size spanning all age and geographic ranges. This study is the first to analyze ATV-related fracture rates, patterns, and associated risks across all ages nationwide.

METHODS & STATISTICAL ANALYSIS: The National Electronic Injury Surveillance System (NEISS) was queried for ATV-related trauma for the years 2002-2015. The data were analyzed by age, sex, race, alcohol usage, helmet usage, type of injury, fracture location, and disposition from the emergency department (ED). Continuous data were analyzed using the t-test (2 groups) or ANOVA (≥3 groups). Discrete data were analyzed using χ2 tests. SUDAAN 10™ software was used to account for the stratified and weighted nature of the data. Significance was set at p < 0.05.

RESULTS: There were an estimated 1,862,342 ED visits for ATV-related injuries from 2002 to 2015; 482,501 (25.9%) sustained fractures with a mean age of 27.5 years. Among those with fractures, 75.7% were male, 28.5% resulted in hospital admission, 43.9% occurred at home, and 57.5% were unhelmeted. Anatomically, 51.8% involved the upper extremity, 23.6% involved the lower extremity, 6.4% involved the spine, 8.5% involved the skull/face, and 9.7% involved the ribs/sternum. Alcohol use was most frequently associated with skull (13.2%) and cervical spine (13.0%) fractures. Patients with skull or facial fractures were unhelmeted 88% of the time, and 87% of skull fractures were associated with brain injury. ATV-related fractures peaked in 2007 at 44,283 and trended downward through 2014.

CONCLUSION: This study is the first of its kind to analyze ATV-related trauma over all age groups throughout the entire USA. It can serve as a reference for clinical decision-making and future studies. It also reinforces the need for ATV regulation advocacy, specifically helmet use.