Age-related patterns of injury in children involved in all-terrain vehicle accidents.

BACKGROUND: All-terrain vehicle (ATV) accidents are considerable sources of morbidity and mortality for children and adolescents. This study was done to investigate the types and severity of injuries and the role of age and body mass index on the types of fractures sustained in children younger than 16 years.

METHODS: A retrospective chart review was done on 96 consecutive children who sustained injuries in ATV-related accidents during a 30-month period. Sixty-four patients were boys and 32 were girls. The mean age of the children was 11.0 years. To determine differences in fracture type, Glasgow Coma Scale, Pediatric Trauma Score, and length of hospitalization, the 96 patients were divided into 2 groups: group A, 54 children (56%) 12 years or younger, and group B, 42 children (44%) 13 years or older.

RESULTS: Sixty-one children (64%) required hospital admission. No statistically significant difference between the 2 groups was noted. Fifty-four (56%) children required surgical treatment. One fatality occurred. No statistically significant differences between the 2 groups were noted regarding the Glasgow Coma Scale and the Pediatric Trauma Score. Orthopaedic injuries were the most common, occurring in 58 (60%) children, followed by head injury in 34 (35%) and intraabdominal/intrathoracic injuries in 23 (24%). Nineteen (20%) children had more than 1 system involved, and 1 had 3 systems involved. Sixty-eight fractures occurred in 58 children (38 in group A and 30 in group B) including 9 open fractures. As expected, older children had a significantly increased body mass index compared with younger children (P < 0.02). Age-related patterns of fracture were observed. Younger children (<or=12 years) were more likely to sustain an isolated fracture (odds ratio 2.9, P < 0.02) and were more likely to sustain a lower extremity fracture (odds ratio 3.2, P < 0.03), specifically a femoral fracture (odds ratio 6.5, P < 0.01), than older children (>or=13 years). Older children were more likely to sustain a pelvic fracture (odds ratio 1.108, P < 0.04).

CONCLUSIONS: To our knowledge, this is the first study to evaluate age-related patterns of fractures in ATV-related accidents. It is our hope that increased awareness of the severity and types of injuries and fracture patterns will lead to more rapid diagnosis and help to bring about improved safety measures, increased public awareness, and even legislation concerning the use of ATVs by children.

LEVEL OF EVIDENCE: Level IV.