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ATV-related spine injuries in children continue to rise
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Off-road, open-air, all-terrain vehicle (ATV) injuries, including those in the spine, continue to increase at an alarming rate and ATV accidents in general are a major source of injury in children, according to a review of the Kids’ Inpatient Database from select years between 1997 and 2006.
“We searched for children who were hospitalized for any injury to the spine from an ATV-related accident,” said Jeffrey R. Sawyer, MD, an assistant professor of orthopedics at the Campbell Clinic in Memphis, who headed up the project, culling data from 1997, 2000, 2003 and 2006.
During the nearly 10-year time period, there was a 240% increase in children injured in an ATV-related accident and a 467% increase in the number of spinal injuries resultant from those accidents. In 2006, this translated into an estimated 4,483 children involved in accidents and 332 (7.4%) with spine injuries.
The median age for children who incurred a spinal injury due to an ATV-related accident in 2006 was 12.9 years, and 70% of those were under the age of 16, which is the youngest recommended age for ATV use by the American Academy of Orthopaedic Surgeons (AAOS), the American Academy of Pediatrics and the American College of Surgeons. Moreover, most patients were boys (76%), white (85%) and privately insured (63%).
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Two major risk factors for spine injuries are female gender and older age. “In most trauma studies, males are injured more than females, and when you look at ATV injuries overall, males sustain about three times the number of injuries as females,” Sawyer told Orthopedics Today. The prevalence of spine injuries in girls may be due to vehicle rider mismatch: when a vehicle rolls to prevent an accident, girls with less weight and strength simply do not have the ability to correct the vehicle. Older age children of both sexes also likely have adult-like spine characteristics — that is they are much less elastic than a 5-year old’s spine.
Year-round danger
Five years ago, when Sawyer moved to Memphis from Chicago, he was struck by the tremendous number of children injured on ATVs. “It is very common for children to ride ATVs in the South as compared to the North. Part of that is the weather. Kids can be on ATVs year-round,” he said. In addition, “when you talk to parents of kids who are injured, they almost seem surprised that someone can get injured on a four-wheeler.”
Sawyer evaluated local injuries from ATVs before assessing national data, which were presented at the annual meeting of AAOS in New Orleans. “Associated injuries are very common,” he said. “In most studies, about one-third of kids will have an associated head injury with their spine injury and about one-third will have an intrathoracic injury. So we should be looking for these second injuries. The head injury or intrathoracic injury — not the broken femur — may result in death.”
ATV guidelines
Patients with ATV-related spine injuries have longer hospitalizations (5.3 vs. 3.3 days) and higher hospital expenses ($38,738 vs. $24,952).
“Only about 30% of riders use helmets,” Sawyer said. “But a more stunning statistic is that children who sustain a head injury and then return to riding are no more likely to wear a helmet.”
Sawyer and his colleagues are working with the Pediatric Orthopaedic Society of North America in establishing guidelines for ATV riders.
“Clearly, adult supervision is needed and the most important factor in preventing injury,” Sawyer said. “The use of protective equipment, such as helmet, chest guard and wrist guards, would also reduce injury.” A smaller, appropriate-size vehicle would help as well.
Meanwhile, Sawyer is encouraged that the ATV industry “is relatively open to suggestions.” For instance, Yamaha has incorporated some safety changes on its new Rhino, which is similar to a motorized golf cart. “Devices are placed on the vehicle next to the kid’s legs, so when the vehicle rolls, legs stay inside the vehicle,” Sawyer said. – by Bob Kronemyer
Reference:
- Sawyer, JR; Schroeder, J; Bernard, MS. Trends in ATV-related spine injuries in children in the US: 1997-2006 KIDS database. Paper# 518. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.
Jeffrey R. Sawyer, MD, Campbell Clinic, 1400 S. Germantown Road, Germantown, TN 38138; 901-759-3254; e-mail: jsawyer@campbellclinic.com.
This is a timely article for my part of the country where ATV’s are primarily summer vehicles as opposed to the South and we are currently seeing these injuries. While this is a database review not including less morbid injuries not requiring hospitalization, spine injuries appear to be increasing; despite regulatory safety advances made which include the elimination of three-wheel vehicles. While male injuries outnumber females, females and younger children appear to be more at risk for spinal injuries. This is felt to be related to vehicle-rider mismatch when roll-over occurs due to insufficient strength to right the vehicle.
The authors strongly recommend assessment of these patients for “associated injuries.” In our region, they most often ride in rural areas and care may be initiated in emergency rooms with limited staff and/or physician extenders. The orthopedist may be the only specialist called in. While the most common injury is a long bone fracture, potentially fatal head and intrathoracic injuries must be investigated and ruled out prior to addressing obvious fractures.
The authors acknowledge that protective equipment, such as helmets, chest guard and wrist guards should reduce injury. Their research is being shared with the Pediatric Orthopaedic Society of North America to establish guidelines for young drivers. Because they treat many of the patients injured in ATV accidents, orthopedist as a public service have an opportunity to play a pivotal role in the education of patients, families, and communities.
– Alvin H. Crawford, MD
Professor of
Pediatric Orthopedic Surgery
Cincinnati Children’s Hospital Medical
Center