While in clinic, a resident asked if another resident had heard about the three teenagers who were involved in an all-terrain vehicle (ATV) accident. The second resident said that he had heard about the accident and both remarked that it was tragic as the teens were in critical condition with uncertain prognoses. The attending physician asked the residents how they might have prevented such an accident. One resident said that she had never discussed ATVs with her patients and the second resident said that it would make sense to wear helmets. The faculty member showed the residents where to find American Academy of Pediatrics policy statements on the Internet and together they reviewed the current policy statement which recommends ATVs not be used until a teenager can drive a car plus other recommendations.
All-terrain vehicles are 3- or 4- wheeled vehicles designed for one rider to be used in rough-terrain situations. They became available in the 1970s in the United States and because of severe instability, the 3-wheeled variety has not been manufactured since the 1980s. From 1997-2001, the overall exposure to ATVs increased by 36-50% depending on the variable studied and the injuries increased 104%. A 2005 study found 5292 children were hospitalized because of ATV-related injuries over 2 years with 1% dying and an additional 5% needing discharge to long-term care. Adolescent males had the highest risk of injuries and regionally those in the South and Midwest had the highest injury rates. The total hospital cost for the 2 years of hospitalizations was > $74 million.
Another 2005 study of non-fatal ATV injuries estimated that ~109,000 children were evaluated in hospital emergency departments in the U.S. over 3 years for ATV injuries and there was a 39% increase during the study. Patients (12%) were admitted with teenage males being the highest rate of those injured. However, younger children were more likely to have facial injuries and older children were more likely to have lower extremity injuries.
The American Academy of Pediatrics (AAP) policy statement on All-Terrain Vehicle Injury Prevention recommends that:
- Children should not be allowed to operate an off-road vehicle until they are licensed to drive a car. No one < 16 years of age should operate an ATV.
- All safety equipment should be used by the rider at all times. Equipment to increase vehicle and driver visibility should be used such as reflectors, flags, etc.
- Street use of the ATV and use at night should never be allowed.
- Riders should ride alone and never carry a passenger. ATVs are designed for one person.
- ATVs should not be used after drinking alcohol.
During the 1990s, the State of West Virginia had the highest ATV-related deaths in the U.S. and therefore implemented an ATV law in 2004. After implementation, the number of ATV-related deaths continued to increase. The authors of a follow-up research study recommended changing the law to incorporate the AAP’s recommendations including:
- Requirement of a driver’s license, plus additional certification specific to ATV use.
- No operation of an ATV by children < 16 years.
- No operation of an ATV while under the influence of alcohol.
- No passengers on ATVs.
- No ATV operation at night.
The West Virginia authors also suggest that community and school-based education particularly for adolescents in poor communities, use of incentive-based programs such as reduced insurance premiums or safety problems, or extended warranties on helmets might provide help in reducing ATV-related injuries and deaths.
Questions for Further Discussion
1. What types of injuries do children with ATV-injuries have?
2. At what age can children operate lawn mowers?
3. At what age can children operate farm machinery?
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Age: Teenager
To Learn More
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American Academy of Pediatrics. All-Terrain Vehicle Injury Prevention: Two-, Three-, and Four-Wheeled Unlicensed Motor Vehicles. Pediatrics. 2000;105:1352-1354.
Killingsworth JB, Tilford JM, Parker JG, Graham JJ, Dick RM, Aitken ME. National hospitalization impact of pediatric all-terrain vehicle injuries. Pediatrics. 2005 Mar;115(3):e316-21.
Shults RA, Wiles SD, Vajani M, Helmkamp JC. All-terrain vehicle-related nonfatal injuries among young riders: United States, 2001-2003. Pediatrics. 2005 Nov;116(5):e608-12.
Centers for Disease Control and Prevention (CDC). All-terrain vehicle fatalities–West Virginia, 1999-2006. MMWR Morb Mortal Wkly Rep. 2008 Mar 28;57(12):312-5.
ACGME Competencies Highlighted by Case
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
14. Knowledge of study designs and statistical methods to appraisal clinical studies and other information on diagnostic and therapeutic effectiveness is applied.
15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.
16. Learning of students and other health care professionals is facilitated.
20. Respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development are demonstrated.
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital