300 all-terrain vehicle crashes: an East Tennessee trauma center's experience

All-terrain vehicle (ATV) riding is a popular recreation in the mountainous areas of Southeastern Kentucky, Southwest Virginia and East Tennessee. We hypothesized that admissions for serious injuries have increased among ATV riders. A retrospective data review from a Level 1 trauma center trauma registry presents injury characteristics and outcomes, comparing patients in earlier and later time periods.

Patient demographics, drug and alcohol positivity, helmet use, injury type and location, internal disposition (admission to the Operating Room or Intensive Care Unit [ICU]), Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Functional Independence Measure (FIM), hospital length of stay, ICU length of stay, ventilator days, Abbreviate Injury Score (AIS), scores for head and neck, chest, abdomen, and extremities, procedures performed, complications, and discharge destination were analyzed among individuals who had sustained ATV crash-related injuries between March 1997 and March 2007. Further stratification of patients admitted in the last six years to earlier and later time periods was done to detect trends. Analysis was done with Chi-square test, Student t-test, and multiple logistic regression with ANOVA. A p-value of < 0.05 determined significance.

ATV crash injury patients have increased by 78 percent (p < 0.01) over the last three years. Injury severity and clinical variables were similar. Fortunately, pediatric admissions (age less 16 years) were significantly decreased. Average age of patients trended toward older age groups. Pre-injury drug and/or alcohol use was documented in 40 percent, and 96 percent were not wearing a helmet. Nine patients died in the last six years (3.6 percent), the majority from closed head injuries. At discharge, 86 percent of patients went home and seven percent were transferred to a rehab facility.

There has been a recent dramatic increase in the number of injured ATV riders requiring admission to the Level I trauma center. Injury severity and outcomes have not changed. Fortunately, pediatric ATV-related admissions have decreased. Trauma centers should continue efforts toward preventive care, teaming with citizens, parents, public officials, and other healthcare providers to combat this epidemic.