Pediatric all-terrain vehicle injuries: does legislation make a dent?
OBJECTIVE
We sought to determine whether North Carolina legislation pertaining to all-terrain vehicles (ATVs) has affected the frequency, distribution, or severity of injury in children.


METHODS
This retrospective study reviewed the Wake Forest University Baptist Medical Center Trauma Registry from 2003 to 2008 along with North Carolina Medical Examiner's child fatality data for all children injured on an ATV. Patients were excluded if the accident did not occur in North Carolina, incomplete data, or if the vehicle was not an ATV. We evaluated the use of helmets, the extent of injury, and the mechanism of injury, comparing the patterns before the laws went into effect (2003-2005) with those after the law was enacted (2006-2008).


RESULTS
Eighty-eight patients were included for analysis, predominantly white boys with a mean age of 12.1 ± 4.1 years. Children not wearing helmets were 5-fold more likely to have a significant head/neck injury (odds ratio [OR], 5.1; confidence interval [CI], 1.61-15.88; P = 0.01) and 3.7-fold more likely to have a significant chest injury (OR, 3.73; CI, 1.01-13.86; P = 0.05). Passengers were 5-fold more likely to die or require inpatient rehabilitation (OR, 5.0; CI, 1.2-20.8; P = 0.03) and 13.7 times as likely to have a significant injury to their head/neck (OR, 13.7; CI, 3.07-60.93; P = 0.01).


CONCLUSIONS
There were no significant changes seen in the children injured without and then with legislation, which may be significant if ATV use indeed is increasing. A child's vehicular position was the most significant predictor of morbidity and mortality. Helmet use was not increased once mandated by law. Further efforts to implement such legislation and educate the public are necessary to make a significant change in injuries.
Department of Pediatrics, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA. almcbrid@wfubmc.edu
Allison S
AS
McBride
David M
DM
Cline
Rebecca H
RH
Neiberg
Katherine D
KD
Westmoreland
D000056:Accident Prevention / Q000331:legislation & jurisprudence / Q000379:methods; D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data; D000293:Adolescent; D017677:Age Distribution; D016009:Chi-Square Distribution; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D015999:Multivariate Analysis; D009657:North Carolina; D015541:Off-Road Motor Vehicles / Q000331:legislation & jurisprudence*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000517:prevention & control*