The National Interscholastic Cycling Association Mountain Biking Injury Surveillance System: 40,000 Student-Athlete-Years of Data.

ABSTRACT: A web-based injury surveillance system was implemented through a collaboration between University of Utah researchers and the National Interscholastic Cycling Association (NICA) to better understand injury characteristics in mountain biking. Data were collected from NICA leagues during the 2018 and 2019 seasons. Injuries were tracked in 41,327 student-athlete-years, identifying 1750 unique injuries during 1155 injury events. Rider-dependent and rider-independent variables were analyzed. The most commonly reported injuries were concussion (23.6%), injuries to the wrist/hand (22.3%), and shoulder (15.6%). Half of all injury events occurred on downhills. Men and women reported similar yet significantly different injury rates (2.69% and 3.21%, respectively; P = 0.009). Women sustained more lower-limb injuries (37.8% vs 28.3%; P = 0.003). Nearly 50% of crashes resulted in an emergency room visit. Youth mountain bike racing is a rapidly growing sport. Acute traumatic injuries are common. Injury surveillance system data are now being used to inform injury prevention strategies and direct future research.

Shared electric scooter injuries admitted to Auckland City Hospital: a comparative review one year after their introduction.

AIM: E-scooters were introduced to New Zealand in 2018 as a means of city transport. Since their introduction, their use has resulted in high injury rates. No studies have directly compared e-scooters to other forms of transport. METHOD: The Auckland City Hospital trauma registry was retrospectively searched for patients admitted with an e-scooter injury. A comparison group of patients admitted with an injury secondary to cycling during the same period was collected. RESULTS: 178 patients were identified: 69 with e-scooter injuries and 109 with injuries sustained while cycling. The hospitalisation rate for e-scooter injuries was 326 hospitalisations per million hours. There was a significant difference found in blood ethanol levels (18.6 vs 6.4% positive, p-value=0.01), mechanism of injury (isolated falls: 87 vs 60.6%), time of injury (55.1 vs 40.4% between 5pm-8am) and protective gear use (worn in 10.1 vs 78.9%). No differences were found in injury severity, ICU admissions, length of stay or mortality. CONCLUSION: This study demonstrates a concerningly high e-scooter-related hospitalisation rate and suggests e-scooters are currently not as safe as cycling. Strategies to improve e-scooter safety are needed and could include zero tolerance for alcohol, mandatory protective gear, restricted operating times and changes in road laws.

Material deprivation and rates of all-terrain vehicle- and snowmobile-related injuries in Ontario from 2003 to 2018: a population-based study.

OBJECTIVES: Socio-economic status (SES) is a well-established predictor of health outcomes; however, there is a dearth of evidence on the relationship between SES and off-road vehicle (ORV) injuries. In Ontario, all-terrain vehicles (ATVs) and snowmobiles present a serious risk for preventable injury. This study assessed the association between area-level material deprivation and the risk of ATV- and snowmobile-related injuries in Ontario, as well as the impact of sex and age. METHODS: A population-based, repeat cross-sectional study was conducted using administrative data of ATV- and snowmobile-related emergency room visits from 2003 to 2018. Material deprivation was measured using the Ontario Marginalization Index, which assigned a score and quintile of deprivation to each dissemination area in Ontario. Age-standardized incidence rates and relative index of inequality values were calculated, stratified by quintile of deprivation, sex, age group, vehicle type, and health region. RESULTS: We found a significant, positive relationship between ORV-related injuries and quintile of material deprivation (RII = 1.28, 95% CI: 1.01-1.63). Rates of ATV- and snowmobile-related injuries remained stable over time. Across all age groups, sex, and rural categories, we found an inverse u-shaped relationship between rates of injuries and quintile material deprivation. Males, individuals living in rural areas, and adolescents and young adults experienced the highest rates of injuries. CONCLUSION: Despite the positive relationship between ORV-related injuries and quintiles of deprivation, the inverse u-shaped relationship suggests that this increased risk of injury is likely related to exposure to ORVs. These results contribute to an understanding of the prevalence of the injury problem at a local level in Ontario. Stable rates of injury over time suggest that current public health programs are not sufficient in reducing these injuries, and further research should determine which factors amenable to intervention are contributing to increased risk of injury.

RéSUMé: OBJECTIFS: Le statut socioéconomique (SSE) est un prédicteur bien établi des résultats pour la santé, mais il existe une pénurie de preuves sur la relation entre le SSE et les blessures des véhicules hors route. En Ontario, les véhicules tout-terrain (VTT) et les motoneiges présentent un risque sérieux de blessures évitables. Cette étude a évalué l'association entre la privation matérielle au niveau de la zone et le risque de blessures liées aux VTT et aux motoneiges en Ontario, ainsi que l'impact du sexe et de l'âge. MéTHODES: Une étude transversale répétée basée sur la population a été menée à l'aide des données administratives des visites aux urgences liées aux VTT et aux motoneiges de 2003 à 2018. La privation matérielle a été mesurée à l'aide de l'Ontario Marginalization Index, qui a attribué un score et un quintile de privation à chaque aire de diffusion en Ontario. Les taux d'incidence normalisés selon l'âge et l'indice relatif des valeurs d'inégalité ont été calculés, stratifiés par quintile de privation, sexe, groupe d'âge, type de véhicule et région sanitaire. RéSULTATS: Nous avons trouvé une relation positive significative entre les blessures liées aux VTT et le quintile de privation matérielle (RII = 1,28, IC à 95% : 1,01 ­ 1,63). Les taux de blessures liées aux VTT et aux motoneiges sont demeurés élevés au fil du temps. Dans tous les groupes d'âge, sexe et catégories rurales, nous avons trouvé une relation en forme de U inverse entre les taux de blessures et les quintiles de privation matérielle. Les hommes, les personnes vivant dans les zones rurales, les adolescents et les jeunes adultes ont connu les taux de blessures les plus élevés. CONCLUSION: Malgré la relation positive entre les blessures liées aux VTT et les quintiles de privation, la relation en forme de U suggère que ce risque accru de blessures est probablement lié à l'exposition aux VTT. Ces résultats contribuent à une compréhension de la prévalence du problème de blessures au niveau local en Ontario. Des taux stables de blessures au fil du temps suggèrent que les programmes de santé publique actuels ne sont pas suffisants pour réduire ces blessures, et des recherches plus poussées devraient déterminer quels facteurs susceptibles d'intervenir contribuent à augmenter le risque de blessures.

Nonfatal All-Terrain Vehicle-Related Head and Neck Injuries to Children Treated in US Emergency Departments.

This study investigates children <18 years old with nonfatal all-terrain vehicle (ATV)-related head and neck injuries treated in United States emergency departments by analyzing data from the National Electronic Injury Surveillance System from 1990 to 2014. An estimated 279 391 children received emergency treatment during the 25-year study period. The number of injuries remained relatively constant from 1990 to 1997, increased by 142.9% from 1997 to 2007, and then decreased by 37.4% from 2007 to 2014. The most common diagnoses were concussion/closed head injury (32.6%) and fracture (32.6%); 15.4% of children were admitted. The most common injury mechanisms include ejection (30.0%), crash (18.8%), and rollover (15.8%). Patients who were injured on a street/highway were 1.49 times (95% confidence interval = 1.11-1.99) more likely to be admitted than patients injured at other locations. Although the number of nonfatal ATV-related head and neck injuries decreased during the latter part of the study period, they remain common and can have serious medical outcomes.

Comparison of Urban Off-Road Vehicle and Motorcycle Injuries at a Level 1 Trauma Center.

BACKGROUND: Recently, there has been an increase in the usage of dirt bikes and all-terrain vehicles in urban environments. Previously, it has been shown that crashes involving these urban off-road vehicles (UORVs) resulted in different injury patterns from crashes that occurred in rural environments. The aim of this study was to compare injury patterns of patients involved in crashes while riding UORVs versus motorcycles (MCs). METHODS: A retrospective review (2005-2016) of patients who presented to our urban level I trauma center as a result of any MC or UORV crash was performed. Patients who presented after 48 h from the time of accident were excluded. A P < 0.05 was considered significant. RESULTS: We identified 1556 patients who were involved in an MC or UORV crash resulting in injury (MC: n = 1324 [85%]; UORVs: n = 232 [15%]). Patients in UORV crashes were younger (26.2 y versus 39.6 y), less likely to be helmeted (39.6% versus 90.2%), required fewer emergent trauma bay procedures (28.4% versus 36.7%), and needed fewer operative interventions (45.9% versus 54.2%) (all P < 0.05). Both groups had a similar Injury Severity Score (12.2 versus 12.6; P = 0.54) and Glasgow Coma Score (13.8 versus 13.5; P = 0.46). UORV patients had a lower mortality (0.9% versus 4.7%; P < 0.05) compared to MC crash patients despite similar injury patterns. CONCLUSIONS: Our data demonstrate that patients sustaining UORV injuries were younger and less likely to be helmeted but have a lower mortality rate after a crash, despite sustaining similar injuries as motorcyclists. This study provides an overview of how crashes involving UORV usage is a unique phenomenon and not entirely comparable to MC crashes.

Potential predictors of hospital length of stay and hospital charges among patients with all-terrain vehicle injuries in rural Northeast Texas.

BACKGROUND: All-Terrain Vehicles (ATVs) have become popular for recreation use in recent years. Texas has had more ATV related fatalities than any other state in the nation, with rural Northeast Texas having even higher rates of injuries. There is limited data examining the relationship between ATV injuries and the length of hospital stay, as well as hospital costs. This paper examines both issues in children as well as adults. METHODS: The regional trauma registry was analyzed for all ATV related injuries between January 2011- October 2016. Injury Severity Score, Glasgow Coma Scale and if they are seen at a Level I Trauma center are predictive for both hospital length of stay and charges. RESULTS: Length of Stay was predicted positively by Injury Severity Score, Emergency Department Respiration Rate and facility at which patients were treated and negatively by Glasgow Coma Scale. Hospital charges were predicted positively by age, Injury Severity Score, facility of treatment, means of transportation, and Emergency Department pulse and negatively by Glasgow Coma Scale. CONCLUSIONS: The study found that vital signs can be useful in predicting length of stay and hospital charges. This study not only confirms the findings of other studies regarding what predictors can be used, but expands the research into rural traumatic injuries. It is hoped that this data can help contribute to the development of algorithms to predict which patients will be most likely to require resource intensive treatment.

The cost of electric-scooter related orthopaedic surgery.

AIM: To highlight the growing cost of electric-scooter (e-scooter) related injuries necessitating surgical intervention by the Auckland City Hospital Orthopaedic Department. METHODS: Retrospective audit of operations by the Auckland City Hospital Orthopaedic Department from 15 October 2018 up to and inclusive of 22 February 2019. Inclusion criteria was that the direct cause of injury necessitating surgery was secondary to an e-scooter accident. Further demographic data was collected including injury sustained and operation details. The surgical costs were calculated, including anaesthetic time, surgical time, staffing, implants used and inpatient stay as well as clinic follow-up. RESULTS: Over the 19-week period of this study there were 21 patients requiring 23 operations as a direct result of e-scooters. The summative anaesthetic, theatre suite and staffing costs of these operations was $162,901. Implants required to fix the fractures totalled $39,898. Ninety-three inpatient nights and 61 follow-up clinic appointments were required incurring an additional expense of $141,639 and $16,119 respectively. Overall, these 23 cases cost a total of $360,557. The extrapolated loss of income was $44,368 secondary to these injuries. This represents a total economic cost of $404,925, or $19,282 per person. CONCLUSION: This study highlights that there can be serious consequences of e-scooter travel. High energy trauma not previously associated with scooter injuries is becoming increasingly prevalent as a result of readily available e-scooters. Many of the injuries identified represent significant morbidity to patients in terms of pain, lengthy rehabilitation and loss of income. Furthermore, the socioeconomic costs for DHBs continues to climb and adds to the acute surgical burden in an already busy healthcare system. The hazards of e-scooters should not be underestimated by both the general public and policy-makers.

Orthopaedic injuries from snowmobile accidents: a multi-centre analysis of demographics, injury patterns, and outcomes.

PURPOSE: More than 2 million people in North America use snowmobiles, resulting in an estimated 200 fatalities and 14,000 injuries annually. The purpose of this study is to document the demographics, orthopaedic injury patterns, and short-term outcomes of patients with snowmobile-related injuries. MATERIALS AND METHODS: A retrospective review was performed at two regional trauma centres in a region where snowmobile use is prevalent. Patients who sustained snowmobile-related injuries over a 12-year period were identified from the hospitals' trauma registries using E-codes (E820-E820.9). Patient demographics were recorded, as were injury characteristics including rates of substance use, open fractures, Injury Severity Score (ISS), Abbreviated Injury Score (AIS) for the extremities, and mortality. Rates of inpatient surgery, as well as hospital and ICU length of stay (LOS), were also recorded. RESULTS: We identified 528 patients with snowmobile-related injuries. Average age was 37 years, and 418 patients (79%) were male. Eighty-eight per cent of all patients with snowmobile injuries were admitted to the hospital with an average LOS of 5.7 days. Among those admitted to the hospital, average ISS was 12.3, and 28% of these patients had ISS > 15. A total of 261 patients (56%) suffered extremity injuries (including 163 upper and 173 lower extremity fractures) with an average extremity AIS of 2.4. There were 700 total fractures (1.5 per patient), and 9% of all fractures were open. A total of 208 patients (45%) suffered head injuries, and 132 patients (28%) sustained vertebral column fractures. A total of 201 patients (43%) required inpatient surgery, and eight patients (1.7%) sustained fatal injuries. CONCLUSIONS: We present a detailed multi-centre analysis of orthopaedic injury patterns and outcomes resulting from snowmobile-related injuries. Patients injured while snowmobiling share similar injury patterns with patients injured in motorcycle and other high-energy motor vehicle accidents.

Risk Factors and Outcomes From All-Terrain Vehicle Injuries Compared With Motor Vehicle Collisions in Children.

We compared risk factors and outcomes of children injured from all-terrain vehicle (ATV) injuries to those injured from motor vehicle collisions (MVC). We reviewed records of patients ≤18 years of age admitted to a trauma center with ATV- or MVC-related injuries between January 1, 2000, and December 31, 2015. Demographics were compared using logistic regression. Rates of injuries were compared using χ2 tests. Of 6293 patients, 1140 (18%) ATV and 5153 (82%) MVC events were identified. In multivariable analysis (adjusted odds ratio [aOR], 95% confidence interval [CI]), patients with ATV-related injuries occurred more at older age (≥12 years; aOR = 4.29, 95% CI = 3.20-5.77), in rural counties (aOR = 3.72, 95% CI = 2.62-5.28), in regions with lower median household income (aOR = 1.37, 95% CI = 1.03-1.83), and in the spring (aOR = 2.44, 95% CI = 1.87-3.18), and summer (aOR = 2.50, 95% CI = 1.93-3.25) compared with winter. ATV-related injuries occurred less frequently among females (aOR = 0.76, 95% CI = 0.65-0.89). Upper extremity injuries were associated with ATV-related injuries (P ≤ .001). Findings may facilitate identification of at-risk groups for targeted interventions.

Agricultural Youth Injuries: A Review of 2015-2017 Cases from U.S. News Media Reports.

Background: The hazardous nature of the agricultural environment, reflected in the numerous injuries and deaths to children who live, work and play on farms, coupled with the lack of a comprehensive national surveillance system in the United States, highlights the need for making the best use of publicly available youth agricultural injury data. Objective: The purpose of this study was to describe a 3-year collection of youth agricultural injuries using the publicly available injury and fatality data from AgInjuryNews.org and present recommendations for future injury prevention strategies. Methods: Data were obtained from AgInjuryNews.org, a web-based collection of U.S. news reports of agricultural injuries. We analyzed cases from 2015 to 2017 for youth aged 0-17. We classified injuries as occupational and non-occupational related, based on the Farm and Agricultural Injury Classification (FAIC) code. Each case was also coded for source and event using the Occupational Injury and Illness Classification System (OIICS). Results: Of the 348 injury reports reviewed, 51% were fatal, and about one-third of the victims were 6 years old or younger. Most injuries were non-occupational, and the most frequent injury sources were vehicles (includes tractors and all-terrain vehicles) and machinery. Youth operators, extra riders, roadway operations, and unsupervised youth playing near or in a worksite were four key contributing factors associated with vehicle and machinery related injuries. Conclusions: This study reaffirms that youth agricultural-related injuries and fatalities are still a persistent problem in the United States. The hypothesis generating AgInjuryNews system can provide more current data than traditional surveillance datasets as a tool for understanding the sources of youth agricultural injuries, monitoring injury trends, and informing policy efforts and prevention strategies. Future studies should continue to explore and evaluate the comprehensiveness of this system's data and the impact of its dissemination, as well as similar rural health informatics solutions for integration into sustainable interventions that can be customized and delivered domestically and abroad.

Motocross versus motorcycle injury patterns: A retrospective National Trauma Databank analysis.

BACKGROUND: Motocross-related injury patterns and outcomes are poorly understood. The purpose of this analysis was to characterize the epidemiology, injury patterns, and outcomes of motocross collisions. These parameters were compared with motorcycle collisions for context. METHODS: The National Trauma Databank (NTDB) (2007-14) was used to identify and compare injured motorcycle and motocross riders. Variables extracted were demographics, Abbreviated Injury Scale for each body area, Injury Severity Score, and emergency department vital signs. Outcomes included mortality, ventilation days, intensive care unit length of stay, and hospital length of stay. RESULTS: Of the 5,774,836 NTDB patients, 141,529 were involved in motocross or motorcycle collisions (31,252 motocross and 110,277 motorcycle). Overall, 94.4% were drivers and 87.4% were male. Motocross riders were younger (23 vs. 42, p < 0.001), more likely to use helmets (68.9% vs. 54.1%, p < 0.001), and less likely to have used alcohol (8.4% vs. 23.0%, p < 0.001). Head and chest injuries were less common in motocross patients (28.6% vs. 37.2%, p < 0.001; 25.5% vs. 37.7%, p < 0.001, respectively), as were Injury Severity Score of greater than 15 and Glasgow Coma Scale of less than or equal to 8 (18.2% vs. 28.1%, p < 0.001; 3.7% vs. 7.7%, p < 0.001, respectively). Overall mortality was significantly lower in the motocross group (0.3% vs. 1.4%, p < 0.001). Stepwise logistic regression analysis identified age of older than 60 years, Glasgow Coma Scale of less than or equal to 8, hypotension on admission, head Abbreviated Injury Scale of greater than or equal to 3, and riding a motorcycle, either as a driver or passenger, to be independent predictors of mortality. Subgroup analysis revealed being a motocross driver or passenger to be an independent predictor of improved survival (odds ratio [OR], 0.458; 95% confidence interval [CI], 0.359-0.585; p < 0.001 and OR, 0.127; CI 95%, 0.017-0.944; p = 0.044, respectively). Helmets were protective against mortality for all patients (OR, 0.866; 95% CI, 0.755-0.992; p = 0.039). CONCLUSION: Motocross and motorcycle collisions are distinct mechanisms of injury. Motocross riders are younger, more likely to wear protective devices, and less likely to use alcohol. Motocross collisions are associated with better outcomes compared with motorcycle collisions. Wearing a helmet is associated with improved survival for all riders. LEVEL OF EVIDENCE: Retrospective epidemiological study, level IV.

Motorized scooter injuries in the era of scooter-shares: A review of the national electronic surveillance system.

INTRODUCTION: There has been a spike in recent news regarding motorized scooter injuries due to the expansion of scooter sharing companies. Given the paucity of literature on this topic, the purpose of our study was to describe and quantify emergency department encounters associated with motorized scooter related injuries. METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for motorized scooter related injuries from 2013 to 2017. Patient demographics, diagnosis, injury location, narrative description of incident, and disposition data were collected from emergency department encounters. RESULTS: There were an estimated 32,400 motorized scooter injuries from 2013 to 2017. The estimated incidence did not change significantly over time with 1.9 cases per 100,000 in 2013 and 2.6 cases per 100,000 in 2017. A 77.0% increase in scooter injuries was noted for millennials from 2016 to 2017. Head injuries were the most common body area injured (27.6%). Fractures or dislocations (25.9%) were the most common diagnosis. The most common site of fracture was the wrist and lower arm (35.4%). There were no deaths. Major orthopaedic injury and concussion were the strongest independent predictors of hospital admission. CONCLUSIONS: Head injuries were the most commonly injured body part, while fractures or dislocations were the most common diagnosis. These results highlight the importance of using protective equipment while riding motorized scooters, and lay a foundation for future policies requiring helmet use.

Cause of Death in Utah Avalanche Fatalities, 2006-2007 through 2017-2018 Winter Seasons.

INTRODUCTION: Understanding patterns of avalanche fatalities can aid prevention and rescue strategies. In 2007, we published a report reviewing avalanche deaths in Utah between the 1989-1990 and 2005-2006 winter seasons. In the current report, we discuss Utah avalanche fatalities from the 2006-2007 to 2017-2018 seasons. METHODS: Avalanche fatality data were obtained from the Utah Avalanche Center and Utah State Office of the Medical Examiner. Autopsy reports were reviewed to determine demographic information, type of autopsy (external vs internal), injuries, and cause of death. RESULTS: Thirty-two avalanche deaths occurred in Utah during the study period. The mean (±SD) age of victims was 32±13 (8-54) y. Thirty victims (94%) were male and 2 (6%) were female. Seventy-two percent of deaths were from asphyxiation, 19% from trauma alone, and 9% from a combination of asphyxiation and trauma. Snowmobilers accounted for the largest percentage of avalanche fatalities (15 victims; 47%) during the 2007-2018 period. CONCLUSIONS: Asphyxia continues to be the most prevalent killer in avalanche burial. Patterns of ongoing avalanche deaths continue to suggest that rapid recovery and techniques that prolong survival while buried may decrease fatality rates. Trauma is a significant factor in many avalanche fatalities. Education and technologies focused on reducing traumatic injuries such as improved education in techniques for avalanche risk avoidance and/or use of avalanche airbags may further decrease fatality rates. Snowmobilers represent an increasing percentage of Utah avalanche deaths and now make up the majority of victims; increased education targeting this demographic in the basics of avalanche rescue gear and avalanche rescue may also reduce fatalities.

Prominent Injury Types in Vehicle Underbody Blast.

BACKGROUND: To fully understand the injury mechanisms during an underbody blast (UBB) event with military vehicles and develop new testing standards specific to military vehicles, one must understand the injuries sustained by the occupants. METHODS: Injury data from Service Members (SM) involved in UBB theater events that occurred from 2010 to 2014 were analyzed. Analysis included the investigation of prominent skeletal and visceral torso injuries. Results were categorized by killed-in-action (n = 132 SM) and wounded-in-action (n = 1,887 SM). RESULTS: Over 90% (553/606 SM) of casualties in UBB events with Abbreviated Injury Scale (AIS) 2+ injury sustained at least one skeletal fracture, when excluding concussion. The most frequent skeletal injuries from UBB were foot fractures (13% of injuries) for wounded-in-action and tibia/fibula fractures (10% of injuries) for killed-in-action. Only 1% (11/1037 SM) of all casualties with AIS 2+ injuries had visceral torso injuries without also sustaining skeletal fractures. In these few casualties, the coded injuries were likely due to trauma from a loading path other than direct UBB loading. CONCLUSION: Skeletal fractures are the most frequent AIS 2+ injury resulting from UBB events. Visceral torso injuries are infrequent in individuals that survive and they generally occur in conjunction with skeletal injuries.

Characterization of all-terrain vehicle-related chest injury patterns in children.

PURPOSE: To evaluate chest injury patterns in pediatric patients involved in all-terrain vehicle (ATV) accidents. METHODS: Retrospective review of patients 0-18 years old admitted to a level I trauma institute following an ATV-related incident from 2004 to 2013 was performed. Chest injury type, accident mechanism, driver/passenger status, and demographic and clinical data were compared between patients with and without chest injury. RESULTS: Chest injury was present in 102 (22%) of total 455 patients. The most common chest injuries were pulmonary contusion (61%), pneumothorax (45%), and rib fracture (34%). There were no cardiac, esophageal, or tracheobronchial injuries. Pulmonary lacerations, hemothoraces, and scapular fractures were predominantly not detected on radiography and recognized on CT only (86-92%). Patients with chest injury had longer median hospital stays (3 days vs 2 days, p = 0.0054). There was no significant difference in admission to intensive care after controlling for injury severity scores in patients with chest injury compared to those without (17 vs 9). Eight patients with chest injury died (8%) compared to 2 patients without chest injury (0.6%) (p = 0.0002). CONCLUSIONS: Chest injuries are common in children following ATV accidents and may be a marker of more severe trauma. Increased public awareness of these potentially devastating injuries and continuing safety efforts are needed.

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.

Twelve-Year Review of Urban Versus Rural Off-road Vehicle Injuries at a Level 1 Trauma Center.

OBJECTIVE: Traditionally, all-terrain vehicles (ATVs) and dirt bikes (DBs) have been used in rural locations for recreation and work. Recently, there has been an increase in the use of these vehicles in an urban environment. The aim of this study is to compare the injury patterns of patients involved in crashes while riding off-road vehicles in both urban (UORV) and rural (RORV) environment. METHODS: A retrospective review (2005-2016) of patients who presented to an urban level 1 trauma center as a result of any ATV or DB crash was performed. UORV was defined as any ATV or DB accident that occurred on paved inner city, suburban, or major roadways. RORV was defined as those accidents that occurred on secondary roadways or off-road. Patients who presented more than 48 h from time of accident were excluded. A P < 0.05 was considered significant. RESULTS: Five hundred and twenty-eight patients were identified to have an ATV or DB injury (RORV n = 296 [56%]; UORV n = 232 [44%]). UORV accidents had a higher Injury Severity Score (12.2 versus 9.7; P < 0.05), lower presenting Glasgow Coma Scale (13.8 versus 14.3; P < 0.05), more likely to need emergent trauma bay procedures (28.5% versus 17.9%; P < 0.05), were less likely to have been helmeted (39.6% versus 71.2%; P < 0.05) with a higher unhelmeted Abbreviated Injury Scale head of ≥3 (13.5% versus 5%; <0.05), and more likely to have extremity injuries (53.5% versus 41.2%; P < 0.05). There were no significant differences in additional injury patterns or hospital outcomes including mortality for the two groups. CONCLUSIONS: Our data suggest that UORV use was associated with decreased helmet use, higher mean Injury Severity Score, lower presenting Glasgow Coma Scale, an increased need for emergent trauma bay procedures, higher unhelmeted Abbreviated Injury Scale head scores, and higher rates of extremity injuries.

Risk behaviors contributing to recent serious unintentional injuries among school-going adolescent boys in Kolkata: Application of zero-inflated count model.

BACKGROUND: Unintentional injuries have become a major noncommunicable disease burden, especially among the adolescents. OBJECTIVE: The current study was conducted to estimate the effect of different aspects of daily activities of adolescence for sustaining serious unintentional injuries in the past 1 year. METHODS: A cross-sectional survey with multistage sampling with validated pretested questionnaire was done among the school-going adolescent boys in Kolkata. Poisson regression was used to model the counts of serious injuries. To account for the excess of zero in the outcome, zero-inflated Poisson regression was performed. RESULTS: Among the participants, 73.5% did not report any serious unintentional injury sustained in the past 1 year, 11.9% reported to have sustained serious unintentional injury once in the past 1 year, and rest had more than one count. Statistically significant higher chance of sustaining an episode of injury was found among frequent users of motorbike (incidence rate ratio [IRR]: 1.183), frequently walking on roads (IRR: 1.910), and frequently crossing major roads on bicycle (IRR: 2.181) were observed. A statistically significant protective rate ratio was also obtained for those frequently obeying traffic signals while crossing roads (IRR: 0.493) and frequent users of bicycles (IRR: 0.384). Significantly lower rate ratio for sustaining a serious injury was observed with frequently getting into fight at home (IRR: 0.343) and getting beaten up at school (IRR: 0.595). CONCLUSIONS: The study revealed traveling in a car and obeying traffic rules were protective from sustaining serious injury. However, walking and participation in sports appeared to be risky, especially for sustaining another episode of serious injury.

The characteristics of all-terrain vehicle (ATV)-related deaths: A forensic autopsy data-based study.

Using forensic autopsy-based data from a regional medical examiner office in the midwestern U.S. with a mixed small urban-rural population, we describe the characteristics of all-terrain vehicle (ATV)-related deaths occurring between 2000 and 2018. During this period, there were 25 ATV-related deaths. There was a strong male predominance with 22 male and 3 female decedents. The average age at death was 35 years, with a range from 10 to 82 years, and a bimodal age distribution with one peak at 10-19 years old, and a second peak at 60-69 years old. The most common cause of death was blunt trauma (n = 22), with the remainder being torso compression (n = 1), drowning (n = 1) and hypothermia (n = 1). Of the 22 blunt trauma deaths, 15 were due to head trauma. The most common mechanism of accident was roll-over (n = 11), followed by striking a stationary object (n = 6). Of the stationary objects struck, the most common was cable wire fencing accounting for 3 of the 6. A survival period following discovery of the body was present in 11 of the 25 deaths. Postmortem toxicology was positive for ethanol in 7 deaths and tramadol in 1 death.