Motocross morbidity: economic cost and injury distribution in children.

BACKGROUND: Motocross is a nationally organized sport that is growing in popularity. The distribution and severity of motocross injuries in the pediatric population is not known. We hypothesize a high rate of musculoskeletal injuries requiring hospitalization and/or surgical intervention. METHODS: All patients 17 years of age or younger with injuries sustained while using off-road 2-wheeled motorcycles were identified through surgical, diagnostic, and trauma registries at a level 1 regional trauma center. Type, severity, and mechanism of injury were assessed, as well as charges billed for medical care. Both recreational and competitive motocross activities were included. RESULTS: From 2000 to 2007, 299 cases were noted in 249 unique patients. In 141 instances, hospital admission was required, for a total of 412 inpatient days. Twenty patients required ICU admission. Surgery was performed in 91 cases (81 orthopaedic, 6 general, 1 urology, and 4 facial reconstructions). Orthopaedic surgical procedures included treatment of 29 femur fractures, 8 forearm, 6 ankle, 5 tibial shaft, 6 proximal tibia, 5 spine, 6 proximal humerus, 4 hand, 4 foot, 3 elbow fractures, and 5 other. Orthopaedic interventions also included 8 reductions under general anesthesia and 31 conscious sedations. Mean age at injury was 14.1 years (range: 5.4 to 17.9). Ninety-four percent of patients were male and 85% were White. The majority of patients were wearing helmets/safety equipment. One hundred and eighty-four injuries occurred on a track, with 150 during competition. The mean charge billed per injury was $14,947 (range: $105 to $217,780), with a total cost of $4.5 million. CONCLUSIONS: Nearly half of motocross patients treated at a regional level 1 trauma center required hospitalization, and nearly one-third required surgery. The vast majority of surgical procedures (89%) were orthopaedic. Despite a high usage rate of helmets and protective gear, severe injuries were still sustained, including femur fracture (29), hemiparesis/spinal cord injury (2), and head injury (43). The majority of injuries occurred during organized race or practice. Families should be counseled with regard to the use of safety equipment and the severity of injuries sustained during competitive motocross activity. LEVEL OF EVIDENCE: Level IV, case series.

Engaging Agribusinesses: Feasibility and Cost of an ATV Safety Poster Project.

OBJECTIVES: All-terrain vehicle (ATV)-related deaths and injuries continue to be a significant problem. Influential change agents such as agribusinesses could be important partners for improving safety behaviors among rural ATV users. Our objective was to determine how effectively an injury prevention project could engage agribusinesses through the postal service and to assess their willingness to display a safety poster. METHODS: One thousand two hundred forty-four agribusinesses received an ATV safety poster and a postcard survey by mail. A randomized sampling of these businesses was surveyed by telephone 4-7 weeks later. Telephone survey questions included whether they recalled receiving the poster, and if so, whether, where and how long the poster was displayed. RESULTS: One hundred six postcards were returned. Of the 192 eligible business persons contacted by telephone, 89% agreed to participate. Approximately one-third of telephone survey participants recalled receiving the poster. Among these, 81% with walk-in customers posted it, and 74% still had it displayed 1 month later. Of participants who did not recall receiving the poster, 83% stated they would have displayed the poster. The cost of displaying each poster in a business was 16.6 cents/day during the first month. Final costs/day would be much less because of continued display. CONCLUSION: A high percentage of agribusinesses displayed or would have displayed an ATV safety poster, and most displayed it beyond 1 month. Unfortunately, participant recruitment via postal delivery alone was challenging. Nevertheless, mass mailing of injury prevention materials to be displayed in the retail setting may be a low cost method for raising safety awareness.

Effectiveness of roll-over protective structures in reducing farm tractor fatalities.

OBJECTIVE: The purpose of this systematic review was to evaluate the effectiveness of roll-over protection structures (ROPS) as an engineering control for prevention of fatalities from farm tractor roll-overs. METHODS: Using a systematic approach to literature searching, relevant studies from peer-reviewed journals, technical and government reports, and unpublished reports were retrieved. Studies meeting initial criteria for possible inclusion were screened to determine whether they addressed the review topic (ROPS), included comparison data and included outcomes data such as injury or fatality. Articles that evaluated the use and impact of ROPS on operators of agricultural tractors were reviewed. Outcomes included two primary categories: implementation of ROPS and fatalities. MAIN RESULTS: Of a total 207 citations reviewed, 53 met initial screening criteria and 21 studies were included in this review. Farm tractor roll-overs result in approximately 200 fatalities per year in the United States. ROPS or crush-proof cabs, which are designed to protect the farmer during a roll-over incident, are currently used on only about 50% of the estimated 4.8 million tractors in the United States. A significant proportion of tractors built after 1985 (when manufacturers began implementing a voluntary ROPS standard) have had ROPS removed. Evidence from Sweden and other Northern European countries clearly demonstrates that ROPS can essentially eliminate roll-over fatalities. In the United States, the only fatalities associated with roll-overs of ROPS-equipped tractors occurred when farmers did not use a seatbelt to hold them within the protective envelope of the ROPS. Estimates of costs of programs to retrofit older tractors with ROPS range from approximately $500,000 to $900,000 per life saved, which is comparable to other accepted life-saving interventions. CONCLUSIONS: Future research efforts should include the development of collapsible and telescoping ROPS that can be used in low clearance areas such as dairy barns and fruit orchards. ROPS retrofits also need to be developed for many older tractor models. Effective educational and incentive programs need to be developed to increase the acceptance and use of ROPS among U.S. farmers. A national policy should be implemented to ensure that all tractors operated in the United States are equipped with ROPS or crush-proof cabs.

The care and cost of snowmobile-related injuries.

From January 1, 1991, through May 1, 1993, we identified 42 patients from our prospective computer-based trauma registry (38 males, four females; mean age, 25 years) who were hospitalized after snowmobile accidents. The primary reason for hospitalization varied: bone fracture (n = 18), blunt abdominal trauma (n = nine), closed head injury (n = five), and miscellaneous injuries (n = 10). The mean injury Severity Score was 9.3 (range, one to 43; median, nine). Twenty-six patients (62%) required emergent operation. Mean hospital stay was six days (range, one to 16 days). Thirteen patients had complications: seven had wound infection; three, ileus; and three, miscellaneous. One severely injured hypothermic patient died. Medical charges totaled $569,566 (mean, $16,227; range, $1,003 to $51,642). Snowmobiling causes significant accidental injury in young persons. The physical and financial costs of such injuries are high.

A stochastic analysis of tractor overturn costs on catfish farms.

An area of health and safety risk in agriculture that can be especially dangerous is catfish farming. One of the potential sources of injuries on catfish farms is tractor overturns that often result in crushing injuries. There is likely a higher probability of tractor overturns on a catfish farm than on a traditional crop farm due to the conditions that prevail on catfish farms. A catfish farm requires tractor movement near pond levees and water, and these levees have steep banks. Many of the activities on a catfish farm, such as mowing, feeding, and pond maintenance, require operating a tractor near a pond levee. Rollover protection structures (ROPS) on tractors can help to minimize the injuries caused by tractor overturns. ROPS do not lessen the probability of overturns, but ROPS mitigate the expected injury severity and lower the associated costs of an overturn. Despite the benefits of ROPS, not every tractor is so equipped. Some earlier work indicated that the cost to retrofit older tractors might outweigh the expected benefits. This article uses stochastic (i.e., randomly determined) analysis to determine if risk-averse farmers are more likely than risk-neutral farmers to retrofit tractors with ROPS. For this analysis, a distribution function of injury costs should an overturn occur was developed for both ROPS and non-ROPS tractors, and a Monte Carlo simulation was conducted. Results indicate that many risk-averse producers would be willing to retrofit older tractors with ROPS. However producers who are risk-neutral probably will not retrofit. These results might explain why not all tractors have been retrofitted despite the long-term availability of retrofit kits.

Risk analysis of tractor overturns on catfish farms.

Fatal and nonfatal injuries occur on catfish farms as a result of tractor overturns, but these injuries can be greatly mitigated when a tractor is equipped with a rollover protective structure (ROPS) and seatbelt. This study analyzed the proportion of tractors on catfish farms in Mississippi not equipped with ROPS and the cost of retrofitting those tractors with a ROPS and seatbelt as compared to the expected benefits gained from adding the protection. To determine if farmers have the financial incentive to retrofit older tractors, a net present value framework was used because the expected benefits occur over a number of years. The ROPS retrofit is a one-time cost that occurs immediately, and thus the present value does not need to be calculated, i.e., time period 0. According to this study adding ROPS will provide a net benefit of $22,877 in the event of an overturn. When dealing with small farms (<125 acres) where an average tractor is used for approximately twice as many hours compared to an average tractor on large farms, the extra hours worked by a single tractor resulted in total benefits of retrofitting ROPS of $9.45 per year, whereas for large farms the net benefit is $4.70 (=125 acres). Given that the least expensive retrofit is $147, it would take 15.5 years of tractor use on the small farms for the expected benefits to outweigh the cost. Given the large range of costs that could occur due to an overturn, there could be a significant premium for not having ROPS protection. In other words, there likely is a smaller range of costs from an overturn with ROPS than without ROPS because ROPS reduces the more serious incidents.

Cost effectiveness of wearing head protection on all-terrain vehicles.

The use of all-terrain vehicles (ATVs) has increased in the United States and elsewhere over the last three decades, along with an increased frequency of incidents resulting in serious injuries, among which have been head injuries. ATVs are designed for motorized off-highway work and recreation, can weigh up to 600 lbs (272 kg), and may reach speeds as high as 75 mph (120 km/h). ATV crashes, including collisions and overturns, were responsible for 8104 fatalities from 1982 to 2006. One third of those killed were youth under 16 years of age. Helmets may reduce risk of death by 42% and nonfatal injury by 64%. In this study, a decision analysis was applied to determine the potential reduction in the rate of fatal and nonfatal head injuries associated with crashes, based upon the universal wearing of head protection while riding on ATVs. In addition, based upon this reduction in injury rate, a cost-effectiveness analysis was conducted to determine the savings per injury averted among ATV riders with head protection. The authors found that 238 head injuries, including 2 fatalities per 100,000 ATV drivers with an average of 145 hours of annual operation, could be averted by the universal wearing of head protection while riding on ATVs. Taking into account the social direct and indirect costs of fatal and nonfatal head injuries at a 5% discount rate, US$364,306 could be saved per injury averted over a 50-year period if there were universal wearing of head protection by ATV drivers. If the exposure is adjusted to 2000 hours per year for an equivalent work year, 3276 head injuries could be averted including 23 fatalities per 100,000 at a social cost savings of US$509,172.

Net monetary benefit of cost-effective rollover protective structures (CROPS): an estimate of the potential benefits of the CROPS research project.

This study builds on an earlier study to examine the net monetary benefit of installing cost-effective rollover protective structures (CROPS) instead of utilizing existing ROPS retrofits for all estimated non-ROPS tractors in the year 2004. With the conservative estimates used in the analyses, results indicate that compared to the baseline option (no protective structure), the Install-ROPS option results in a loss of $310 million to society, while the Install-CROPS option results in a net monetary benefit of $276 million over a 20-year period. A comprehensive sensitivity analysis indicated that, for the extreme values (estimates) used, the estimated net monetary benefit is most sensitive to the probability of tractor overturn. Break-even analysis indicated that the unit cost of intervention for the Install-CROPS option can increase by about 58% and still be able to pay for itself. Even when the minimal unit cost of intervention for ROPS is used, the payback period is reduced substantially for the Install-CROPS option, by almost half the payback period. Finally, compared to existing ROPS retrofits, the net monetary benefit is $586 million, representing an estimate of the potential benefits of the CROPS research.

Installing a cost-effective rollover protective structure (CROPS): a cost-effectiveness analysis.

Cost-effective rollover protective structures (CROPS) are tractor model-specific rollover protective structures (ROPS) that are as effective as existing ROPS retrofits (passed standardized structural static testing such as SAE J2194), but less costly (less than one-half the cost of existing ROPS retrofits). This study estimated the expected effects and costs at a per-tractor level for two options: No-CROPS and Install-CROPS. Expected injuries per tractor were 0.00169 with no CROPS and 0.00016 with CROPS installed, resulting in 0.00153 injuries prevented per tractor over a 20-year period. Expected costs were $457 and $248 with and without CROPS, respectively, over the same time period, giving the cost per injury prevented as $136,601. Comprehensive sensitivity analyses indicated that the probability of an overturn is one of the most important variables. When the cost of intervention ($1,000 for purchasing, shipping, and installation of ROPS retrofit) is used in the analysis, the cost-effectiveness ratio is $497,000 per injury prevented over the 20-year period. Thus, installing CROPS instead of existing ROPS retrofits improved the cost-effectiveness ratio substantially, with a 73% reduction in the net cost per injury prevented.

A stable dynamic cohort analysis of installing cost-effective rollover protective structures (CROPS).

Cost-effective rollover protective structures (CROPS) are less costly model-specific rollover protective structure (ROPS) retrofits that are being developed and evaluated with the hope of increasing adoption and eventually preventing or mitigating injuries due to tractor overturns. A dynamic cohort of the estimated retrofittable non-ROPS tractors (accounting for attrition due to aging) was tracked over a 20-year period to determine the expected costs, as well as the expected number of fatal and non-fatal injuries resulting from tractor overturns. Two alternatives were tracked: No-ROPS and Install-CROPS. For a starting cohort size of 1,065,164 (an estimate for the year 2004), the Install-CROPS option prevented an estimated total of 878 (192 fatal and 686 non-fatal) injuries over the 20-year period. Expected costs were $513 million (cost of installing CROPS on all the non-ROPS tractors plus cost of the associated injuries) and $284 million (cost of injuries resulting from the No-ROPS option) over the same time period. Thus, the net cost per injury prevented was $260,820. When the cost of intervention ($1000 for purchasing, shipping, and installation of existing ROPS retrofit) was used in the analysis, the cost-effectiveness ratio was $927,000 per injury prevented over the 20-year period. Thus, installing CROPS instead of existing ROPS retrofits improved the cost-effectiveness ratio substantially, with a 72% reduction in the net cost per injury prevented.

All-terrain vehicles: injuries and prevention.

All-terrain vehicles, including three- and four-wheeled recreation and utility off-road motorized devices, are a serious risk to the public especially to children younger than 16 years. Statistics show the injuries, which often are musculoskeletal in nature, and fatalities are increasing: in 2002, approximately 111,000 people sustained injuries related to all-terrain vehicles. Although agencies such as the Consumer Product Safety Commission initially recognized and restricted three-wheeler sales, they largely have failed to address the problem caused by other all-terrain vehicles during the past 10 years. To reduce the frequency and severity of injuries from all-terrain vehicles, numerous methods have been recognized and discussed. State and federal laws are needed to implement these methods to protect the public; these legislative solutions also are included in the discussion.