title: Substance exposure and helmet use in all-terrain vehicle accidents: Nine years of experience at a level 1 trauma center.
abstract: The surging popularity of all-terrain vehicles (ATV) in the United States has caused an "epidemic of injuries and mortality." The U.S. Consumer Product Safety Commission reported 99,600 injuries and 426 fatalities from ATV accidents in 2013. The aim of this study was to examine the relationship between helmet use and positive toxicology screenings on outcomes in ATV accident victims.
  
  
  
  This is a retrospective study of patients admitted to a Level 1 Trauma Center in southwestern West Virginia following an ATV accident between 2005 and 2013. Data were obtained from the institution's Trauma Registry.
  
  
  
  A total of 1,857 patients were admitted during the study period with 39 (1.9%) reported deaths. Positive serum alcohol and/or urine drug screens were obtained in 66.4% of the patients tested (n=1,293). Those with positive screenings were 9.5% less likely to utilize a helmet (13.2% vs. 22.7%, p<0.001); and the lack of helmet use was associated with an increase in traumatic brain injury (57.1% vs. 41.7%, p<0.001). Positivity for substances or the lack of helmet use was significantly associated with higher morbidity. Lack of helmet use resulted in a 3.94-fold increase in the risk of discharge in a vegetative state or death.
  
  
  
  Drugs and alcohol use may predispose riders to be less likely to wear helmets and significantly increase the risk of a poor clinical outcome following an ATV accident. Rigorous efforts should be made to enhance safety measures through educational endeavors and amendment of current regulations to promote safe and responsible use of ATVs.
  
  
  
  Modification of regulatory requirements should be considered in order to mandate the wearing of helmets during ATV operation. In addition, expansion of safety programs should be considered in an effort to improve availability, affordability and awareness of safe ATV practices.
authors.affiliation: Center for Health Services and Outcomes Research, Charleston Area Medical Center, 501 Morris St, Charleston, WV 25301, USA. Electronic address: traumaresearchcamc@gmail.com.
authors.forename: Audis
authors.initials: A
authors.lastname: Bethea
authors.affiliation: Center for Health Services and Outcomes Research, Charleston Area Medical Center, 501 Morris St, Charleston, WV 25301, USA. Electronic address: damayanti.samanta@camc.org.
authors.forename: Damayanti
authors.initials: D
authors.lastname: Samanta
authors.affiliation: Associated Radiologists, Inc., Charleston Area Medical Center, 501 Morris St, Charleston, WV 25301, USA. Electronic address: raddocjw@gmail.com.
authors.forename: John A
authors.initials: JA
authors.lastname: Willis
authors.affiliation: WVU Physicians of Charleston, Charleston Area Medical Center, 501 Morris St, Charleston, WV 25301, USA. Electronic address: clucente@suddenlink.net.
authors.forename: Franck C
authors.initials: FC
authors.lastname: Lucente
authors.affiliation: Center for Health Services and Outcomes Research, Charleston Area Medical Center, 501 Morris St, Charleston, WV 25301, USA. Electronic address: julton.tomanguillochumbe@camc.org.
authors.forename: Julton Tomanguillo
authors.initials: JT
authors.lastname: Chumbe
mesh_terms: D000063:Accidents, Traffic / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D000070642:Brain Injuries, Traumatic / Q000191:economics / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D015331:Cohort Studies; D017281:Cost of Illness; D000066448:Driving Under the Influence / Q000706:statistics & numerical data*; D000431:Ethanol / Q000652:urine; D005652:Functional Residual Capacity; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D013287:Illicit Drugs / Q000652:urine; D009017:Morbidity; D015541:Off-Road Motor Vehicles / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014903:West Virginia / Q000453:epidemiology
chemical_list: D013287:Illicit Drugs; D000431:Ethanol
keywords: ATV; Alcohol; Drugs; Helmet; Injury diagnosis