Evaluation of 2019-2020 Pediatric ATV Injuries in a Children’s Hospital

Brannen Uhlman, MD Candidate
Michele H. Nichols, MD
William King, DrPH
Kathy W. Monroe, MD

All-terrain vehicles (ATVs) are a significant cause of morbidity and mortality in children. Annually, over 100 pediatric ATV-related fatalities and >30,000 emergency department (ED) visits occur in the US. The Consumer Product Safety Commission (CPSC) cited a significant decrease (38%) in ATV-related ED visits from 2009-2018. Our study objectives were to: evaluate changes in the number of ATV injury visits in a pre-covid vs covid time frame, provide a descriptive epidemiology of our ATV injury visits, understand the impact of median household income and population type on amount ATV injuries, and realize preventative strategies for education intervention.

A retrospective review of children < 16 years old (yo) presenting to our pediatric hospital ED who were coded for ATV injury during 2019-2020 was conducted. An ATV patient database was developed and managed using Excel. This study was approved by our institutional IRB. Student t test and z test for proportions were utilized for statistical comparisons. National Center for Health Statistics was used to compare county population types.

There were 405 pediatric ED visits for ATV injuries January 2019 – December 2020. Overall, 77% were white. Ages ranged from 1-16 yo with an average age 10 yo (S.D.= 3.9). In 1-4 yos, 66% were passengers, 30% drivers. After 5 yo, >50% were drivers. Most common insurances were Alabama Blue Cross (45%), Medicaid (40%). A significant increase in ATV injuries occurred between 2019 to 2020. By comparing seasons, we found increase in spring (30%), fall (72%), and winter (52%) 2020 compared to 2019. Orthopedic injuries were the most common (60%) while 12% of injuries were brain and/or spinal cord injuries.

We found 40% and 60% female vs male with no significant difference in gender distribution by disposition, and no significant difference in ages for admitted vs discharged (t= 0.93, p=0.3). The range of length of stay for the discharged was 1-9 hours (average 3.5 hours) and admitted was 0-70 days (average 5.2 days).

We found a bimodal distribution among the counties. With median household income, the peaks were $30,000-39,000 with 5.7 ATV injuries per 10,000 children and $70,000-79,999 with 6.3 injuries per 10,000 children. With population types, the peaks were "large fringe metropolitan" with 9.4 injuries per 10,000 children and “noncore” with 4.2 injuries per 10,000 children.

Most ATV injuries occurred in whites with 62% male, 39% female. Orthopedic injuries were most common. There was a bimodal distribution of injuries among the patients’ counties when evaluated by median income and population. Year 2020 had 2.2 times the rate of ED visits compared to 2019 (5.2 ATV injury visits per 1,000 ED visits in 2020 and 2.4 ATV injury visit per 1,000 ED visits (z=8.1, p<0.0001)). When comparing seasons, we found the greatest difference was fall 2020 (72% increase) vs 2019. The steady increase is the inverse of the national trend found by the CSPS.

To evaluate changes in the number of ATV injury visits in a pre-covid vs covid time frame, to provide a descriptive epidemiology of our ATV injury visits, to understand the impact of median household income and population type on amount ATV injuries, and to realize preventative strategies for education intervention.