ATVs: Unsafe at every speed

All terrain vehicles are a clear and constant danger to children. That's the grim conclusion by researchers at St. Louis Children's Hospital. A retrospective review of children admitted to that institution with ATV-related injury revealed a significant increase in the number and severity of injuries over the study period. An abstract of that study was reported at a gathering this week of the Section on Surgery at the AAP 2004 National Conference and Exhibition.

Washington University surgeon Patrick Dillon, MD, compared data for admissions between January 1993 and June 1998 with a similar five-year period from July 1998 through December 2003. Sales of ATVs increased 89% during the second five-year period.

Dr. Dillon found that the number of children treated increased between the two periods from a mean of 9/year to 25/year. The percentage of children who required immediate surgical intervention nearly doubled, climbing from 9% in the first period to 17% the second. Patients with injury severe enough to result in immediate ICU admission, immediate surgery, or death rose from 27% to 36%. Among the severely injured in the second period, 19% were admitted directly to the ICU, 15% went directly into the operating room, and 1.6% died soon after admission.

Half of all injured children ultimately required surgery, Dr. Dillon found, and half of surgical patients required multiple procedures. The typical ATV-injured child spent just over five days in the hospital.

Only 35% of children injured in an ATV accident were wearing a helmet at the time of the injury, researchers found. Patients who were wearing a helmet had an injury severity score of 7.8, compared to 12.9 for those without a helmet. Injuries included orthopedic (51%), soft tissue (50%), craniofacial (40%), neurologic (34%), and thoracic or abdominal (23%) damage. Just over two thirds of patients sustained multiple injuries.

Injured children were driving the ATV in 62% of accidents. The median age of ATV drivers was just under 13 years, compared to 8.34 years for passengers.The biggest surprise, researchers said, was the lack of helmet use and the young age of both drivers and passengers - especially since ATVs are widely recognized as accident-prone vehicles. They concluded that the data make a strong case for increased education for child drivers as well as their parents, who can influence driving and riding behavior. The increasing number and severity of pediatric injuries also point to the need for preventive measures such as helmet use, driver education, and speed limits.