title: All-terrain vehicle-related maxillofacial trauma in the pediatric population.
abstract: OBJECTIVE
  Nearly 40% of all-terrain vehicle (ATV) crash-related fatalities involve pediatric patients, with many of these patients dying from head and neck injuries. West Virginia is in a unique position to examine these injuries because of its high rate of ATV use. This study examines craniofacial ATV-related trauma in children.
  
  
  METHODS
  We conducted a single-center, retrospective, descriptive study of 26 children presenting with a craniofacial injury(ies) resulting from an ATV crash from January 2001 to December 2004.
  
  
  RESULTS
  Twenty-six children (65% boys) with a mean age of 13.1 years presented with craniofacial injuries during the study period. Two patients were helmeted. Mortality was 3.8% (n = 1, head injury related, postinjury day 3). Patients were most often drivers of the ATV (65%), although girls were more likely to be passengers (P = .03). Facial contusions, lacerations, and abrasions were highly prevalent (62%, 69%, 65%, respectively), as were fractures of the facial bones and skull (77%). Thirty-five percent sustained closed head injuries, which were significantly associated with mandible fractures (odds ratio 12.8%; 95% CI, 1.15-143). Mean length of hospital stay was 4.6 +/- 5 days, and 36% required an ICU stay (mean, 5.1 +/- 3 days). Twenty-four percent required ventilator support (mean, 107 +/- 43 hours; range, 48 to 168 hours). Operative intervention was required in 72% of patients (n = 18).
  
  
  CONCLUSIONS
  Maxillofacial injury patterns from ATV-related crashes in children suggest a high percentage of significant facial injuries and closed head injuries. As new ATV legislation that addresses operator use is enacted, a decrease in the number and severity of craniofacial injuries may be seen.
authors.affiliation: General Surgery Resident-PGY 3, Department of Surgery, West Virginia University School of Medicine-Charleston Division, Charleston, WV, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Prigozen
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Horswell
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Flaherty
authors.forename: James M
authors.initials: JM
authors.lastname: Henderson
authors.forename: David A
authors.initials: DA
authors.lastname: Graham
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Armistead
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Habib
authors.forename: David E
authors.initials: DE
authors.lastname: Lukowski
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003288:Contusions / Q000453:epidemiology; D003422:Critical Care / Q000706:statistics & numerical data; D005147:Facial Bones / Q000293:injuries; D005151:Facial Injuries / Q000453:epidemiology; D005260:Female; D016489:Head Injuries, Closed / Q000453:epidemiology; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006801:Humans; D022125:Lacerations / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008337:Mandibular Fractures / Q000453:epidemiology; D008446:Maxillofacial Injuries / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D015541:Off-Road Motor Vehicles; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012886:Skull / Q000293:injuries*; D012887:Skull Fractures / Q000453:epidemiology; D014903:West Virginia / Q000453:epidemiology