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Cole Wymore, BS
Brooke Askelsen, Undergraduate
Jessica Halyko, MPAS
Jacob Bliss, MPAS
Delanie Moeggenberg, BA
Parker Sternhagen, Un dergraduate
Junlin Liao, PhD
Pam Hoogerwerf, BA
Brenda Vergara, No Degree
Charles Jennissen, MD

Most deaths related to all-terrain vehicles (ATVs) occur on public roads with the majority being single vehicle crashes. Manufacturers state ATVS are not designed for public roads and warn against this use. Still, municipalities, counties and states across the country are passing legislation allowing increased use of ATVs on public roads. Our objective was to examine rural adolescent’s use, knowledge and attitudes related to ATVs on public roads.

Attendees of the 2024 Iowa FFA (formerly Future Farmers of America) Leadership Conference were anonymously surveyed at the University of Iowa Stead Family Children’s Hospital safety booth. Descriptive, contingency table and logistic regression analyses were performed using Stata 15.1 (StataCorp, College Station, TX).

1,029 FFA members 13-18 years of age participated. About two-thirds were 14-17 years. One-half lived on a farm, one-fifth were from the country/not a farm, and 30% lived in a town. The vast majority (96%) were non-Hispanic White. Two-thirds of respondent’s families owned an ATV and 86% had driven/ridden an ATV. Of those who had driven/ridden an ATV, 91% had driven/ridden on an unpaved public road (44% reported doing so at least weekly) and 77% had been on a paved road (25% reported doing so at least weekly). Males and owners of ATVs had greater odds of having driven/ridden on unpaved public roads and of driving/riding on them more frequently. Males, older teens, and ATV owners had higher odds of driving/riding on paved roads and of doing so more frequently. Overall, 69% and 63% stated it was safe to drive ATVs on unpaved and paved public roads, respectively, while 69% and 43% stated ATVs were designed for unpaved and paved roads, respectively. Males (1.7x), older teens (1.6x) and those that had ridden on public roads (3.4x) all had greater odds of stating it was safe to drive ATVs on both unpaved and paved roads than their comparative peers. Less than half agreed that most ATV deaths occur on public roads. Over half agreed to assertions that ATV manufacturers state ATVs are safe on unpaved (58%) and paved (51%) public roads. Generally, males, older teens, ATV riders, those who had ridden on public roads and more frequent riders all had greater proportions that held these misconceptions. Only 18% knew one had to be 18 years old to legally drive on Iowa county roads with an ATV.

A high proportion of study participants had driven/ridden an ATV and most had been on public roads. The majority held misconceptions and believed falsehoods related to ATVs on public roads with higher proportions of frequent riders and those that had driven/ridden on public roads having these beliefs. Targeted education and enforced legislation prohibiting use on public roads may be critical in decreasing ATV-related deaths and injuries.

1. Describe present practices of rural adolescents regarding driving ATVs on public roads.
2. Discuss the attitudes rural adolescents have related to the driving of ATVs on public roads.
3. State at least three demographic groups that had higher proportions who held misconceptions and falsehoods related to ATVs on public roads.

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Phyllis Agran, MD
Diane Winn, RN, MPH
Soheil Saadat, MD, PhD, MPH
Jaya Bhalla, BS
Van Nguyen Greco, MD
Nakia C. Best, RN, PhD
Shahram Lotfipour, MD, MPH

Drowning, the leading cause of unintentional injury death among California children less than 5 years averaged 49 annual fatalities for the years 2010-2021. The California Pool Safety Act aims to reduce fatalities by requiring safety measures around residential pools. This study was designed to analyze annual fatality rates and drowning incidents in California among 1-4-year-old children from 2017 to 2021.

Data for this study were obtained from the EpiCenter California Injury Data Online website. This is a comprehensive source of injury data limited to California residents. EpiCenter data includes fatalities, injury hospitalizations, and emergency department (ED) visits. Drowning fatalities were identified from the California Department of Public Health using ICD-10 cause-of-death codes appearing in the underlying cause-of-death field as follows: W65–W74, X71, X92, Y21, W65–W74, X71, X92, and Y21. Fatality rates were calculated from the California Department of Finance’s Report P-3: Complete State and County Projections Dataset (Baseline 2019 Population Projections; Vintage 2020 Release).

Over the five-year study period, 4,166 drowning incidents were identified; 234 were fatalities, 846 were hospitalizations, and 3,086 were ED visits. The observed difference in fatality rates from 2017 to 2021 failed to achieve statistical significance (p= 0.875). Location-based analysis of the 234 fatal drowning incidents revealed that pools were the most common injury site, accounting for 65% of the cases. The case fatality ratio for the 1-year-old age group stood at 7.86% (6.32% to 9.64%), which was higher than other age groups (p<0.001).

Drowning remains the leading cause of unintentional injury-related death among California children 1-4 years of age, as the annual rate of fatality over the five-year study period did not decline. While the EpiCenter California Injury Data Online website is excellent for analyzing annual rates of drowning incidents among California residents over time, it is limited in providing insight into modifiable risk factors and event circumstances that can further inform prevention. The development of robust integrated fatal and nonfatal local, state, and national systematic data collection systems can aid in moving the needle in decreasing pool fatalities among young children.

University of California Irvine IRB #1735

1. Drowning fatality rates among 1-4 year-old California children has not declined in the last 5 years, despite enactment of the updated 2017 Pool Safety Law.
2. The state database based on vital statistics and hospital discharge data is limited in addressing event circumstances.
3. Integrated fatal and nonfatal systematic data collection will contribute to improved prevention strategies.

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Víctor de Cos, BS
Anthony Galvez, BA
Alexandra S. Rooney, MA
Alicia Sykes, MD
Andrea Krzyzaniak, MA
David Lazar, MD
Hari Thangarajah, MD, MPH
Vishal Bansal, MD
Michael Sise, MD
Romeo C. Ignacio, MD, MS, MPath, FACS, FAAP

The purpose of our study is to assess neighborhood socioeconomic disadvantage (NSD) as a risk factor for window falls (WF) in children.

A single institution retrospective review was performed of patients ?18 years old with fall injuries treated at a Level I trauma center between 2018 and 2021. Demographic, injury, and NSD characteristics which were collected from a trauma registry were analyzed and compared between WF versus non-window falls. Area Deprivation Index (ADI) was used to measure NSD levels based on patients' home address 9-digit zip code, with greater NSD being defined as ADI quintiles 4 and 5. Property type was used to compare falls that took place at single-family homes versus apartment buildings

Among 1545 pediatric fall injuries, 194 were WF, of which 60 % were male and 46 % were Hispanic. WF patients were younger than NWF patients (median age WF 3.2 vs. age 4.3, p<0.047). WF patients were more likely to have a depressed Glasgow Coma Scale (GCS score ?12, WF 9 % vs. 3 %) and sustain greater head/neck injuries (median AIS 3vs. AIS 2, p<0.001) when compared to NWF. WF patients had longer hospital and ICU lengths of stay than NWF patients (p<0.001 and p<0.001, respectively). WF patients were more likely to live in areas of greater NSD than NWF patients (53 % vs. 35 %, p<0.001), and 73 % of all WF patients lived in apartments or condominiums.

Window fall injuries were associated with lower GCS, greater severity of head/neck injuries, and longer hospital and ICU length of stay than non-window falls. ADI research can provide meaningful data for targeted injury prevention programs in areas where children are at higher risk of window falls.

1. The definition of Area Deprivation Index
2. The association of area deprivation of index to window fall in children
3. How ADI can be used for targeted injury prevention programs

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Brent M. Troy, MD, MPH
Maneesha Agarwal, MD
Allison F. Linden, MD, MPH
Andrew Jergel, MPH
Anthony J. Giarrusso, MCP
Kiesha Fraser Doh, MD

Unintentional injuries, including traumatic brain injuries (TBI) sustained during activities where helmet usage is recommended (AWHUR), are a leading cause of pediatric morbidity and mortality in the US. While advocacy and education are proven measures to address sport safety, community resources in a child’s neighborhood also have a large impact on health. Our objective was to evaluate injuries sustained during AWHUR, and correlate with community resources, utilizing the Child Opportunity Index (COI) in conjunction with geographical information system (GIS) mapping.

Utilizing the trauma registry at two pediatric trauma centers in a major metropolitan area from 2018 to 2022, we performed a retrospective chart review and GIS mapping on patients with injuries sustained during AWHUR. The data was analyzed in association with COI data. Inclusion criteria was children 0 to 17 years old who presented with AWHUR-associated injuries. Data extracted from the trauma registry included: mechanism, demographics, insurance status, helmet usage, head injury and Injury Severity Score (ISS). Data was then overlayed with the COI to assess community resources including education, housing, environmental, and socioeconomic factors in relation to injury characteristics.

1425 children were analyzed over the 5-year period. The most common injury mechanisms included: bicycle 34.0%, ATV 18.2%, skateboard 13.3%, scooter 9.2%, and dirt-bike 7.4% (p<0.001). 381 children were in low or very low COI neighborhoods versus 784 children in high or very high COI neighborhoods. Most patients in very low and low COI were publicly insured, respectively 81.9% and 63.2%; while 65.8% of high COI injured patients were privately insured patients (p<0.001).

Low COI was associated with higher rates of being unhelmeted (78.4%) versus children from very high COI [48.4% (p<0.001)]. The odds of helmet usage in areas of high COI was 1.96 the odds of helmet usage in low COI. For those injured while wearing a helmet, the odds of higher ISS was 34% less likely than the odds of those who were unhelmeted at time of injury. Additionally, GIS mapping identified specific communities with higher injury rates and lower helmet use in relation to low and very low COI.

Children with lower COI were more likely to be publicly insured and unhelmeted at time of injury. Overlapping injury data and COI better identified high risk communities where low resources may contribute to injury severity. This data can be used to inform injury prevention efforts and highlights the importance of community factors.

1. Unhelmeted injuries were more often in areas of low COI.
2. Mapping identified specific areas with low COI and poor helmet utilization that can be an area of focus for prevention measures.
3. Wearing a helmet was associated with a lower Injury Severity Score.

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Shea Buckley, MEd, BCBA, CPST
Maneesha Agarwal, MD, FAAP
Mindy Scheithauer, PhD, BCBA-D

Autism is a common neurodevelopmental condition that impacts 1 in 36 children. Behavioral concerns are common among autistic youth and may be dangerous and a significant source of stress for families, particularly when exhibited while driving. When children with behavioral concerns are able to leave their safety car seat/harness/seat and travel around the vehicle when it is in motion, the risk of motor vehicle collision is increased. Particularly concerning behaviors may include aggression towards the driver, destruction to the vehicle, or vehicle elopement. Helping families identify appropriate devices to prevent the child from leaving their seat is a crucial strategy to prevent injury. When implementing this, other aspects of autism spectrum disorder (e.g., sensory sensitivities, communication deficits) are important to consider to maximize access to care and success of recommendations.

We developed a Child Passenger Safety Program tailored for autistic youth. The program is housed in a specialized autism clinic in the southeastern United States with a Board Certified Behavior Analyst certified as a Child Passenger Safety Technician with support from an occupational therapist. An initial assessment evaluates need and collects information about behavioral concerns. The therapist then provides recommendations and guides the caregiver through applying for and receiving appropriate reimbursement (when available) for an appropriate safety device. A subsequent appointment is scheduled for installation and follow-up on recommendations.

Over 9 months, the program has received 146 referrals and seen 45 unique patients. Of those 45 patients, we successfully installed 38 had safety devices. Based on a caregiver-completed questionnaire from patients seen in the program, the most common behavioral concerns in the car were elopement (100%), aggression (91%), and disruption (89%). 86% of caregivers endorsed difficulty transporting their child with one caregiver; 91% avoided taking their child places; and 63% missed appointments due to behavioral concerns. Most caregivers stopped a moving vehicle due to their child’s behavior (94%); 69% reported injuries from these behaviors; and 60% reported damage to the vehicle. Thus far, the program has been sustained financially through coverage from the child advocacy department of the affiliated children’s hospital and external philanthropic funds. Documented programmatic barriers include: the need for multidisciplinary collaboration for insurance to pay for devices, identifying devices for older clients, time-commitment to maintain the program (e.g., scheduling, following up on paperwork), and lack of CPT codes to cover the service.

There is a high need for programs that target transportation safety for autistic youth. By involving therapists that specialize in autism and tailoring appointment appropriately, we have successfully installed safety devices for this population. Future directions include improving the clinic’s financial sustainability, assessing acceptability, and evaluating efficacy with pre/post measures of car safety.

1. Attendees will be able to describe why autistic youth may exhibit a high rate of behaviors that create safety issues during transportation.
2. Attendees will describe how antecedent-based strategies (such as installing safety devices in a car) may reduce safety issues.
3. Attendees will identify barriers to sustaining programs related to transportation safety for autistic youth.

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Parker Sternhagen, Undergraduate
Christopher Monson, MD
Gerene Denning, PhD
Charles Jennissen, MD

Side-by-side vehicles, termed recreational off-highway vehicles (ROVs) but often referred to as utility task vehicles (UTVs), have become increasingly popular and have outsold all-terrain vehicles (ATVs) in recent years. Few investigative reports regarding these vehicles have been published. Our study objective was to describe the epidemiology of UTV crashes and injuries in Iowa.

A comprehensive database was created of UTV crashes and injuries by combining data from the Iowa Department of Transportation, State Trauma Registry and Department of Natural Resources, as well as from newspaper articles from 2002-2019. Data of individuals were matched by patient name, gender, date of birth, crash date, and the county where the crash occurred using Link Plus Version 2.0. Frequencies and contingency table analyses were performed with SPSS (Version 29).

UTV crashes involving 448 injured individuals were identified with increasing numbers during the study period. Children <16 years were 31% of the total and 16–17-year-olds were 8.3%. Two-thirds (69%) were male. Passengers were one-third and operators two-thirds of those injured. Only 10 % and 32% were wearing a helmet and a seatbelt, respectively. Of those tested, 13% were positive for alcohol. One-fifth involved a collision with another motor vehicle, 11% were collisions with an object, and most (70%) were non-collision events (rollover/ejection). In nearly two-thirds of the cases the victim fell or was thrown from the vehicle and in a quarter the person was hit or pinned by the vehicle. For those with known location, over three-fifths (61%) occurred on public roadways. In 6% of cases, the individual died. For those with injury data, victims with abnormal Glasgow Coma Scale scores and Injury Severity Scale scores >15 both had increased days in the hospital (p=0.004) and intensive care unit (p<0.001), and crashes on roadways were associated with worse GCS scores (p=0.008). Children <16 years in UTV crashes had higher proportions than those older of being a passenger rather than the driver (52% vs 24%, p<0.001), having the crash occur in the summer (58% vs 38%, p<0.001), having been in a non-collision event such as a rollover or ejection (77% vs 66%, p=0.019), and of being hit/pinned by the vehicle (41% vs 19%, p<0.001). Children had lower proportions than those ?16 years of being involved in a crash on public roadways (52% vs 65%, p=0.019), having alcohol involved (0% vs 18%, p<0.001), and having a nighttime crash (9% vs 31%, p<0.001). Those who were hit or pinned by the vehicle had higher proportions who were in a non-collision event (37% vs 8%, p<0.001) and were off-road (55% vs 9%, p<0.001). Victims thrown or ejected had higher proportions that were hit or pinned by the vehicle (42% vs 10%, p<0.001).

UTV crashes and injuries are increasing in frequency and often associated with severe injuries. Driving on public roads and not wearing a seat belt were associated with more severe outcomes/injuries.

1. Describe factors that put individuals, especially children, at risk when on a UTV.
2. Discuss why UTVs are at particular risk for crash and injury on public roads.
3. State at least 3 safety practices that decrease the risk of crash and injury when on UTVs.