Children especially vulnerable to ATV-related injuries, study finds

Children are especially vulnerable to injuries from the use of ATVs, also known as quads, according to a study published in BMJ Open.

Although children comprise only about 15% of ATV riders, the researchers found that they comprise more than one in four injuries or deaths resulting from ATV incidents.

Co-author Haissam S. Elzaim, MS, MD, PhD, a general orthopedic surgeon at the DHR Health Orthopedic Institute, a level one trauma center in Edinburg, Texas, told Healio that the idea for the study came from his firsthand experience treating such injuries.

“It always kind of broke my heart when I see these kids come in with these really severe injuries from ATV-related accidents,” Elzaim said. “I was curious to see [how] our statistics compared to, you know, the rest of the nation.”

He recalled one such ATV incident that he treated at the center, in which a 14-year-old girl came in with an exposed open femur fracture.

“We saw a lot of soft tissue loss, muscle loss, skin loss, exposed bone,” Elzaim said. “That poor young girl, we had to take her back to the operating room at least four or five times to clean up the wound over and over before we repaired the bone. Every time we went in, there was still dirt and grass ... there's a lot of debris that gets embedded in the wounds.”

Elzaim and colleagues sought to determine if injuries from ATVs were more severe than those associated with motorbikes and cars in the Rio Grande Valley region of Texas, an area where the vehicles are often used for work and play.

The researchers examined local medical records of all patients who came in with ATV, car and motorcycle accidents. They then examined factors including age of patients, the severity of the injuries, the length of stay cost and whether or not the patient had insurance. Any patients aged younger than 14 years were categorized as children.

In the years between 2015 and August 2020, the researchers counted 3,626 car injuries, 200 motorbike injuries, and 116 ATV injuries treated at the trauma center. Of these 3,942 total injuries, children comprised only 12% of the entire sample but accounted for 38% of ATV injuries, compared with 12% of car accident injuries and 7% of motorbike injuries.

The results, Elzaim said, were “expected,” as were more of the qualitative findings.

“When we encounter these cases, most of [our patients] did not have any insurance, or they did have Medicaid, and of course, no protective equipment,” Elzaim said.

The responsibility to protect children from these incidents, he added, falls to parents.

“Parents need to understand that these are not toys,” Elzaim said. “We can't just buy a 100-horsepower, 500-pound machine, and give it to a kid and say, ‘Hey, go out there on the ranch and run around.’ A lot of accidents happen on [a family’s] own roads, or when they get on the road and get hit by a car. So, they need to understand that these are dangerous machines. You cannot just get on them unattended and unsupervised.”

The authors advocated for education campaigns promoting ATV safety, including promoting protective equipment and riding with insurance, “in case accidents happen,” Elzaim said.

“Education should go beyond pediatricians or family doctors,” Elzaim said. “I think [it should be taught in] schools, especially in rural areas where we know these accidents usually happen, where people have access to these ATVs on the ranches and farmland. This would be a public awareness campaign, because the problem has been going on for years and nothing has happened.”

He added that it was crucial to reinforce to children how permanent the damage could be.

“They're going to have to live with the results of an ATV injury for the rest of their life,” Elzaim said.

References:

Elzaim HS, et al. BMJ Open. 2022;doi:10.1136/bmjopen-2021-054289.