title: Larger ATV engine size correlates with an increased rate of traumatic brain injury.
abstract: BACKGROUND
  Since the introduction of all-terrain vehicles (ATV) to the United States in 1971, injuries and mortalities related to their use have increased significantly. Furthermore, these vehicles have become larger and more powerful. As there are no helmet requirements or limitations on engine-size in the State of Alabama, we hypothesised that larger engine size would correlate with an increased incidence of traumatic brain injury (TBI) in patients following an ATV crash.
  
  
  METHODS
  Patient and ATV data were prospectively collected on all ATV crashes presenting to a level one trauma centre from September 2010 to May 2013. Collected data included: demographics, age of driver, ATV engine size, presence of helmet, injuries, and outcomes. The data were grouped according to the ATV engine size in cubic centimetres (cc). For the purposes of this study, TBI was defined as any type of intracranial haemorrhage on the initial computed tomography scan.
  
  
  RESULTS
  There were 61 patients identified during the study period. Two patients (3%) were wearing a helmet at the time of injury. Patients on an ATV with an engine size of 350 cc or greater had higher Injury Severity Scores (13.9 vs. 7.5, p ≤ 0.05) and an increased incidence of TBI (26% vs. 0%, p ≤ 0.05) when compared to patients on ATV's with an engine size less than 350 cc.
  
  
  CONCLUSIONS
  Patients on an ATV with an engine size of 350 cc or greater were more likely to have a TBI. The use of a helmet was rarely present in this cohort. Legislative efforts to implement rider protection laws for ATVs are warranted.
authors.affiliation: Department of Surgery, University of South Alabama, United States. Electronic address: cbutts@health.southalabama.edu.
authors.forename: C Caleb
authors.initials: CC
authors.lastname: Butts
authors.affiliation: Department of Surgery, University of South Alabama, United States. Electronic address: jrostas@health.southalabama.edu.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Rostas
authors.affiliation: Department of Surgery, University of South Alabama, United States. Electronic address: yllee@southalabama.edu.
authors.forename: Y L
authors.initials: YL
authors.lastname: Lee
authors.affiliation: Department of Surgery, University of South Alabama, United States. Electronic address: rgonzalez@health.southalabama.edu.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Gonzalez
authors.affiliation: Department of Surgery, University of South Alabama, United States. Electronic address: sbrevard@health.southalabama.edu.
authors.forename: Sidney B
authors.initials: SB
authors.lastname: Brevard
authors.affiliation: Department of Surgery, University of South Alabama, United States. Electronic address: afrotan@health.southalabama.edu.
authors.forename: M Amin
authors.initials: MA
authors.lastname: Frotan
authors.affiliation: Department of Surgery, University of Mississippi Medical Center, United States. Electronic address: nahmed@umc.edu.
authors.forename: Naveed
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: Department of Surgery, University of South Alabama, United States. Electronic address: jdsimmons@health.southalabama.edu.
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; D001930:Brain Injuries / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015541:Off-Road Motor Vehicles / Q000331:legislation & jurisprudence*; D011446:Prospective Studies; D011634:Public Health; D014481:United States / Q000453:epidemiology
keywords: ATV; Helmet; Intracranial haemorrhage; Prevention; Traumatic brain injury