In their 2000 policy statement, the American Academy of Pediatrics (AAP) recommended restricting the use of ATVs to those >16 years, to off-road environments only, and to restrict passengers.
Despite this, in the time period 1982-2015, a significant proportion (22%) of those killed by ATV crashes were children <16 years of age. Studies since then have found an increase in injuries among children from ATV use in the early 2000s, with a possible decrease in incidence in the later 2000s.
A newly released study sought to report the incidence, mortality trend, and anatomic distribution of fractures due to ATV use in children and teens using a sample of patients admitted to over 30 trauma centers within Pennsylvania between 2004-2014.
- Over 1,900 patients aged 0-17 years sustained an injury while using an ATV, with a median of 170 patients per year
- Estimated mean annual incidence was 6.2 cases per 100,000 children
- Incidence fell by 13% (6.7 per 100,000 children to 5.8 per 100,000 children) when comparing the first 5 years to the last 5 years of the study, though this was not considered statistically significant
- Mean mortality was 0.09 deaths per 100,000 children
- 74% of the injured patients were boys
- Helmet use was reported by less than half of the patients (48%)
- Mean hospital length of stay was 3 days
- 28% of patients were admitted to the intensive care unit
- Older children had higher injury severity scores compared to younger children (0-5 years)
- 1.5% of patients died during the initial admission after an ATV crash
- Of these, 28% reportedly wore a helmet
- 57% were aged 12-15 years (similar to a previous study)
- Riding on a street was associated with more deaths
- Over half (55%) of patients sustained at least one bone fracture below the cervical spine (head and facial fractures were excluded from analysis)
- Older children were more likely than younger children (0-5 years) to sustain a fracture
- Femur and tibia (leg) were the most common
Although this study says that previous studies show inconclusive evidence about the effectiveness of regulations, states with stricter regulations have had some reduction in rates of injury.
As one example of a restrictions on ATV use: Current Pennsylvania laws mandate use of helmets for all ages, and restrict ATV use by those <8 years on state lands. However, those 8-16 years can operate an ATV if they have attended safety training and possess a training certificate to operate the ATV on state lands.
In addition to the laws of your state, consider the following recommendations for ATV use by the AAP:
- Families should be asked about recreational activities as part of anticipatory guidance
- If your patients are interested in ATV use, they should be counseled on the hazards of all ATVs
- Children who are not licensed to drive a car should not be allowed to drive an ATV
- Injuries occur to passengers too, and should not be permitted among children
- All riders should wear protective gear, to include helmets, eye protection, and reflective clothing
- Never permit use of off-road vehicles on streets or during nighttime
- Never drive an ATV after drinking alcohol
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