A prospective, multi-institutional study of pediatric all-terrain vehicle crashes

J Trauma Acute Care Surg. 2014 Jul;77(1):103-8; discussion 107-8. doi: 10.1097/TA.0000000000000266.


Background: Pediatric all-terrain vehicle (ATV) injuries have been increasing annually for more than a decade. The purpose of this study was to prospectively evaluate crash circumstances and clinical outcomes resulting from pediatric ATV crashes.

Methods: Three pediatric trauma centers prospectively collected data from patients during their hospitalization for injuries sustained in ATV crashes from July 2007 through June 2012. Patients completed a 35-item questionnaire describing the crash circumstances (ATV engine size, safety equipment use, and training/experience). Clinical data (injuries, surgical procedures, etc.) were collected for each patient.

Results: Eighty-four patients were enrolled, with a mean (SD) age of 13.0 (3.1) years, and were predominantly male (n = 55, 65%). Injuries were musculoskeletal (42%), central nervous system (39%), abdominal (20%), thoracic (16%), and genitourinary (4%). Multisystem injuries were prevalent (27%), and two patients died. Thirty-three patients (43%) required operative intervention. Most children were riding for recreation (96%) and ignored ATV manufacturers' recommendation that children younger than 16 years ride ATVs with smaller (≤90 cc) engines (71%). Dangerous riding practices were widespread: no helmet (70%), no adult supervision (56%), double riding (50%), riding on paved roads (23%), and nighttime riding (16%). Lack of helmet use was significantly associated with head injury (53% vs. 25%, p = 0.03). Rollover crashes were most common (44%), followed by collision with a stationary object (25%) or another vehicle (12%). Half (51%) of children said that they would ride an ATV again.

Conclusion: These data demonstrate a relationship between dangerous ATV riding behaviors and severe injuries in children who crash. Children younger than 16 years should not operate ATVs, and legislation that effectively restricts ATV use in children is urgently needed.

Level of evidence: Epidemiologic study, level III.

Publication types

  • Multicenter Study

MeSH terms

  • Accidents / statistics & numerical data*
  • Adolescent
  • Child
  • Female
  • Head Protective Devices
  • Humans
  • Male
  • Off-Road Motor Vehicles* / statistics & numerical data
  • Prospective Studies
  • Risk-Taking
  • United States / epidemiology
  • Wounds and Injuries / epidemiology
  • Wounds and Injuries / prevention & control