This study analyzed 345 patients with ATV-related injuries from 2002-2009 to better understand crash mechanisms and factors related to passengers. Rollovers (42%) and collisions (20%) were common mechanisms. Passengers increased risks of rollovers, especially backward rollovers on slopes, and falls/ejections to the rear. Rearward ejections were linked to more severe head injuries. Strict enforcement of no-passenger rules could help reduce crashes and injuries. Improved data collection and educational approaches targeting passenger dangers were recommended.
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ATV Safety Summit: State Legislation (Enforcement) - The Effect of Passengers on ATV Crash Mechanisms, Injuries
1. The Effect of Passengers on All-Terrain
Vehicle Crash Mechanisms and Injuries
Charles Jennissen, MD
Gerene Denning, PhD
Kari Harding, PhD
Department of Emergency Medicine,
University of Iowa Carver College of Medicine
1
2. Background
105,000
Adult The incidence of ATV-
90,000 Pediatric (< 16 years old) related injuries and
deaths has escalated
75,000 over the past 15 years
60,000
Roughly 1/3 are children
45,000 <16 years of age
30,000 Well-over ½ are under
24 years of age
15,000
0
Year
Data from the National Electronic Injury Surveillance System (NEISS)
2
3. Background
In fact, more children die from ATV-related
events than from bicycle crashes.
Helmkamp JC, Aitken ME, Lawrence BA. ATV and bicycle deaths and associated costs in the United States, 2000-2005. Public
Health Rep. 2009;124(3):409-418.
3
4. Background
833 ATV-related deaths in the U.S. in
2006.
Since 1982, children < 16 yrs have
comprised just over a quarter of ATV
crash fatalities.
US Consumer Product Safety Commission: 2010 Annual Report of ATV Deaths and Injuries.
4
5. Purpose
While common types of ATV-
related injuries have been
described, the circumstances
under which they occur are
poorly defined in the literature.
The objective of the study was
to better understand the
mechanisms and contributing
factors of ATV-related injuries,
especially related to the
presence of passengers.
5
6. Methods
A retrospective chart analysis of all patients entered into the
University of Iowa Hospitals and Clinics Trauma Registry
with ATV-related injuries from 2002-2009.
Potential subjects coded as having had an off-road vehicle
incident were identified.
Vehicles other than traditional 3 or 4-wheeled ATVs
(motorbikes, scooters, utility vehicles, etc.) were excluded.
A systematic review of each medical chart was performed.
Details of injury events, potential contributing factors, and
resulting injuries were determined and evaluated.
6
7. Results
345 ATV-related cases Patients with ATV Injuries by Gender
were identified. Male
79%
Female
• 79 % of patients were males.
21%
Patients with ATV Injuries by Age
• 32 % were children <18 years
of age. Adults
68%
Children
(<18)
32%
7
8. Documentation
Medical Record Documentation of Contributing Factors
Seating Position 97.1%
Helmet Use 94.8%
Time of Day 92.2%
4 vs. 3 Wheels 90.3%
Contributing Factors
Road/trail/offroad 50.3%
Slope of Terrain 39.4%
Speed 35.3%
Surface Type 33.2%
Path(straight/turning) 7.7%
ATV Size 2.4%
ATV Model 0.9%
Electronic Device Use 0.0%
Weather 0.0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of Medical Records that Featured Documentation
8
9. Passengers
• 20 % of victims were passengers or had passengers with
them on the ATV.
Patients with ATV Injuries by Seating
Driver Alone
77%
Driver with
Passenger
or Passenger
Unknown 20%
3%
Other
0%
9
10. Passengers
• Females were more likely to be passengers (p<.0001).
Seating Position by Gender
Driver
100%
80% Passenger
% of Each Gender
60%
40%
20%
0%
Male Female
10
11. Helmet Use
• 21 % of all patients were reportedly wearing helmets.
Helmet Use by ATV Crash Victims
No Helmet
74%
Helmet
21%
Unknown
5%
11
12. Helmet Use
• Drivers were more likely to wear helmets than passengers (22.5% vs.6.1%) (p<0.01).
Helmet Use by Age, Gender, & Seating Position
40%
38%
% of Pts Documented as Wearing Helmets
35%
29%
30%
25%
22%
20%
15%
10% 8% 8%
8%
6%
5%
0%
0%
Male, <16 y.o. Female, <16 Male, ≥16 y.o. Female, ≥16 Male, <16 y.o. Female, <16 Male, ≥16 y.o. Female, ≥16
Driver y.o. Driver Driver y.o. Driver Passenger y.o. Passenger Passenger y.o. Passenger
Age, Gender, & Seating Position
12
13. Crash Mechanism
• Crash Mechanism
– Rollovers (42%) were the most common mechanism of injury.
– Collision with an object (20%) and ejection/fall from the machine (13%)
were also common.
– Collision with another ATV occurred in 7%.
• The victim was struck by the ATV in 21% and pinned in 9% of
the cases.
13
14. Rollovers while Turning
• Turning or spinning the ATV was more likely to result in a
rollover compared to all other/unknown direction of travel.
(p=0.085)
http://www.atvconnection.com/Features/Feature_Articles/ATV-Riding-Techniques.cfm
14
15. Rollovers on Sloped Terrain
• ATV rollovers on sloped terrain were more likely to have
passengers
– Than rollovers on Other and Unknown terrain (p=0.18)
– Than Non-rollovers (p=0.13)
%Drivers
% Drivers +Passengers
Rollovers Total only Passengers %Other
Sloped terrain 69 69.6% 27.5% 2.9%
Other and
unknown terrain 121 77.7% 18.2% 4.1%
Non-rollovers 155 78.71% 18.71% 2.58%
15
16. Backward Rollovers
• Backward rollovers were almost twice as likely to have passengers as
all other rollovers (p=0.09, OR = 2.0, [0.9-4.2])
– Also, more likely to have passengers than non-rollovers (p=0.06)
• Forward rollovers appeared less likely to have passengers than all
other rollovers (p=0.27)
%Drivers
Type of % Drivers +Passengers
Rollover Total only Passengers %Other
Unspecified 85 74.1% 21.18% 4.71%
Sideways 40 80.0% 17.5% 2.5%
Backwards 44 65.9% 31.82% 2.27%
Forwards 21 85.7% 9.52% 4.76%
All non-
rollovers 155 74.0% 23.00% 3.00%
16
17. Falls/Ejection to the Rear
ATVs with passengers were over seven times more likely to result in
a Fall/Ejection to the rear than other types of ejections (p<0.01, OR 7.8
[2.6-23.3]).
– Falls/Ejection to the rear were more likely to have passengers than non-
ejections (p<0.01).
% Driver +
% Driver Passengers
Type of Ejection Total Alone Passengers % Other
Self Ejection 9 100% 0% 0%
Thrown over
Handlebars 46 89.1% 8.7% 2.2
Fall/ejected to Side 34 73.5% 26.5% 0%
Fall/Ejected from
Rear 17 35.3% 58.8% 5.9%
Unspecified
Ejection 68 75.0% 20.6% 4.4%
Not Reported as
Ejected 171 77.2% 19.3% 3.5%
17
18. Ejections over Handlebars/Self Ejection
Ejections over the handlebars (forward) and self ejections were less
likely if there were passengers than other types of ejections. (p=0.02,
OR = 0.2 [0.1-0.6])
– Thrown over handlebars (forward) were less likely to have passengers
than non-ejections. (p = 0.12)
% Driver +
% Driver Passengers
Type of Ejection Total Alone Passengers % Other
Self Ejection 9 100% 0% 0%
Thrown over
Handlebars 46 89.1% 8.7% 2.2
Fall/ejected to Side 34 73.5% 26.5% 0%
Fall/Ejected from
Rear 17 35.3% 58.8% 5.9%
Unspecified
Ejection 68 75.0% 20.6% 4.4%
Not Reported as
Ejected 171 77.2% 19.3% 3.5%
18
19. Head Injury after Ejection
• Those ejected to the rear had the lowest GCS scores.
• Falls to the rear had lower GCS scores than Falls to the side
(p = 0.19).
Glasgow Coma Scale by Ejection Subtype
15
Average Glasgow Coma Scale
14.5
14
13.5
13
12.5
12
Ejection Thrown over Thrown/ Fall/ slip to Thrown/ Fall from Self ejection
Unspecified handlebars ejected to side ejected from rear
side rear
Ejection Subtype
19
20. Head Injury after Ejection
• Of those ejected, patients falling or ejected to the rear had the
worst head injury scores.
• Falls to the rear had higher head injury scores than Falls to the
side (p = 0.13).
MAX HEAD by Ejection Subtype
1.9
Average MAX HEAD
1.7
1.5
1.3
1.1
0.11
0.9
Ejection Thrown over Thrown/ Fall/ slip to Thrown/ Fall from rear Self ejection
Unspecified handlebars ejected to side ejected from
side rear
Ejection Subtype
20
21. Extremity Injury after Ejection
• Patients who had self ejected or were thrown/fell to the side
experienced the worst extremity injuries (p=<.05).
– Those who had self ejected had significantly worse extremity injury scores
than all other types of ejection except Fall/slip to the side (p=<.05).
MAX Extremity Score by Ejection Subtype
2.2
Average MAX EXTREM
1.7
1.2
0.7
0.2
Ejection Thrown Thrown/ Fall/ slip to Thrown/ Fall from Self
Unspecified over ejected to side ejected rear ejection
handlebars side from rear
Ejection Subtype
21
22. Conclusions
• Passengers on ATVs may be
at greater risk for rollovers
and fall/ejection to the rear.
• Rearward falls/ejections
appear to increase the risk of
severe head injuries.
• A strict and enforced “no
passenger” rule would help
decrease the likelihood of
some ATV crashes and injury
severity.
22
23. Future Directions
Improve crash and injury surveillance in the
emergency department:
• A multicenter ATV research network.
• Collect data prospectively.
• Standardized collection tool.
Educational and training approaches to increase user
knowledge about the danger of riding with
passengers.
Engineering approaches to limit seat length and
minimize likelihood of passengers.
No passenger legislation for both private and public
lands in every state.
23
Thrown over handlebars Compared to non-ejections p = 0.12 Fall/ejected to side Compared to non-ejections p= 0.4 Fall/ejected to rear Compared to non-ejections p=<.01 Unspecified ejections Compared to non-ejections p = 0.79
Thrown over handlebars Compared to non-ejections p = 0.12 Fall/ejected to side Compared to non-ejections p= 0.4 Fall/ejected to rear Compared to non-ejections p=<.01 Unspecified ejections Compared to non-ejections p = 0.79
-The Max Head Injury table is incorrect for the mean for self ejection. The mean is 0.11 not 1. Updated graph in next slide -compared to self ejection, ejection unspecified (p=0.0016), thrown over handle bars (p=0.0532), and thrown/ejected to side p=(0.0453) are statistically different
-The Max Head Injury table is incorrect for the mean for self ejection. The mean is 0.11 not 1. Updated graph in next slide -compared to self ejection, ejection unspecified (p=0.0016), thrown over handle bars (p=0.0532), and thrown/ejected to side p=(0.0453) are statistically different
-compared to self ejection, all are p<.05 except fall slip to side and throw/ejected to side