title: Recreational all-terrain vehicle injuries among children: an 11-year review of a Central Kentucky level I pediatric trauma center database.
abstract: BACKGROUND
  A database review of 238 admissions for recreational all-terrain vehicle (ATV) accident-related injuries treated over an 11-year period at a level I pediatric trauma center in Central Kentucky was performed.
  
  
  METHODS
  Descriptive statistical analysis of patient demographics (age and sex), helmet use, county of residence, county of ATV accident, injury mechanism, injuries sustained, days of hospitalization, days in the intensive care unit, Glasgow Coma Scale (GCS) score, Injury Severity Score, Functional Independence Measure (FIM) score, and discharge disposition was performed.
  
  
  RESULTS
  All-terrain vehicle accident-related admissions increased approximately 4.7 times, and overall fracture number increased 4 times over the study period. Most injuries were sustained in the county of residence (81.1% [193 of 238]). The single largest group of patients resided and sustained injuries (48.3% [115 of 238]) in a level I county (metropolitan area population, > or =1 million). Mean Injury Severity Score was 7.3 +/- 5.6, and average hospitalization was 4.3 +/- 4.0 days. Most patients (84% [201 of 238]) were not wearing a helmet, and 18.1% (43 of 238) were admitted to the intensive care unit. Patients were aged 11.4 +/- 3.6 years, predominantly boys (70% [166 of 238]), between the age of 11 and 15 years (59.7% [142 of 238]), and 63% (150 of 238) sustained at least 1 fracture. The lower extremity (32.4% [66 of 204]), upper extremity (25% [51 of 204]), and face-skull (25% [51 of 204]) were the most common fracture sites. The femur (45.5% [30 of 66]) and tibia-fibula (42.4% [28 of 66]) were the most common lower extremity fracture sites. The radius-ulna (39.2% [20 of 51]) and humerus (25% [13 of 51]) were the most common upper extremity fracture sites. Nine patients (4.4% of total fractures) sustained spinal fractures. Most patients (93.7% [223 of 238]) were discharged home, 6.3% (15 of 238) were discharged to a rehabilitation facility or to another hospital. Helmet use was related to higher component GCS and FIM communication scores, and patients with higher component GCS and FIM scores were more likely discharged to home.
  
  
  CONCLUSIONS
  Hospital admissions and fractures concurrently increased over the study period, with the greatest increase occurring between 1998 and 1999, shortly after expiration of the 1988 Consent Decrees between the Consumer Product Safety Commission and the ATV industry.
authors.affiliation: Department of Orthopaedic Surgery, University of Louisville, KY 40202, USA.
authors.forename: Blakely
authors.initials: B
authors.lastname: Kute
authors.forename: John A
authors.initials: JA
authors.lastname: Nyland
authors.forename: Craig S
authors.initials: CS
authors.lastname: Roberts
authors.forename: Vicki
authors.initials: V
authors.lastname: Hartwick-Barnes
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D050723:Fractures, Bone / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007629:Kentucky / Q000453:epidemiology; D018986:Motor Vehicles; D011998:Recreation; D014193:Trauma Centers / Q000706:statistics & numerical data*