Trends in all-terrain vehicle-related spinal injuries in children and adolescents

Despite the significant morbidity and mortality associated with all-terrain vehicle (ATV) use in children, their use continues to increase dramatically. To determine the frequency and impact of spinal fractures in children and adolescents injured in ATV accidents, we reviewed all 4 of the available Kids' Inpatient Databases.

The Kids' Inpatient Databases (http://www.ahrq.gov/data/hcup/hcupkid.htm) from 1997, 2000, 2003, and 2006 were reviewed using e-codes for children (age less than 18 y) injured in ATV accidents. From the data on ATV accidents, children who sustained spinal injuries were identified by ICD-9 codes. Statistical analysis was done using SAS Windows.

An estimated 4,483 children were admitted because of ATV-related accidents in 2006. Spinal injury occurred in 7.4% of patients. The most common level of fracture was thoracic (39%), followed by lumbar (29%) and cervical (16%). Pelvic fractures were the most common associated fractures, accounting for 44% of all musculoskeletal injuries, followed by forearm/wrist fractures (15%) and femoral fractures (9%). Although fewer girls were injured in ATV accidents than boys, the risk of spinal injury was higher in girls than boys (10.1% vs. 6.7%, P < 0.005), and children with spinal injuries were older than those without (14.7 y vs. 12.7 y, P < 0.001).

Despite educational and legislative efforts, children account for a disproportionate percentage of morbidity and mortality from ATV-related accidents. The injury rate for children from ATV accidents has increased 240% since 1997, whereas the spinal injury rate has increased 476% over the same time frame. The risk of spinal injury in ATV-related accidents is higher for girls than for boys and for older children.

Multiple injuries are frequent in children involved in ATV accidents and may be related to the high-energy nature of ATV accidents. It is important to have a high index of suspicion for multiple injuries, not only within the spine, but in other organ systems as well.