title: Helmet use is associated with a decrease in intracranial hemorrhage following all-terrain vehicle crashes.
abstract: BACKGROUND
  With the recent increase in size and horsepower of all-terrain vehicles (ATVs), it is imperative that preventable injuries be identified to protect the large population using ATVs. Currently, many states have no laws regulating ATV or helmet use. By identifying preventable injuries, the legislature can design appropriate laws to protect both children and adults.
  
  
  METHODS
  A retrospective review of all patients with ATV injuries presenting between the years 2005 and 2010 was conducted. The data were grouped in several ways for analysis. This included age less than 9 years, weight less than 30 kg, crash at night, substance abuse, and presence of a helmet.
  
  
  RESULTS
  There were 481 patients included in the study. Only 28 (8%) were using a helmet at the time of the crash. Helmet use was associated with less intracranial hemorrhage (3% vs. 22%, p = 0.01) and a decreased incidence of loss of consciousness (14% vs. 35%, p = 0.01). Patients testing positive for alcohol intoxication with or without drugs were significantly more likely to have intracranial hemorrhage, to crash at night, to have facial fracture, to have rib fracture, to arrive intubated, and to have a higher Injury Severity Score (ISS) (p < 0.01 for all).
  
  
  CONCLUSIONS
  With the recent increase in size and horsepower of ATVs, it is imperative that preventable injuries be identified to help protect a growing population of ATV operators. This study reveals a high rate of intracranial hemorrhage following an ATV crash in operators who do not use a helmet. Legislative efforts to implement strict helmet laws for ATV operators may be warranted.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: From the Department of Surgery (J.W.R., K.A.D., R.P.G., S.B.B., J.D.S.), University of South Alabama, Mobile, Alabama; and Department of Surgery (N.A., E.A.R., J.S., J.M.P., W.H.R.), University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Rostas
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Donnellan
authors.forename: Richard P
authors.initials: RP
authors.lastname: Gonzalez
authors.forename: Sidney B
authors.initials: SB
authors.lastname: Brevard
authors.forename: Naveed
authors.initials: N
authors.lastname: Ahmed
authors.forename: Emily A
authors.initials: EA
authors.lastname: Rogers
authors.forename: Joey
authors.initials: J
authors.lastname: Stinson
authors.forename: John M
authors.initials: JM
authors.lastname: Porter
authors.forename: William H
authors.initials: WH
authors.lastname: Replogle
authors.forename: Jon D
authors.initials: JD
authors.lastname: Simmons
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D020198:Intracranial Hemorrhage, Traumatic / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D015541:Off-Road Motor Vehicles / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult