ATV (quad bike) injuries in New Zealand children: their extent and severity

Aims Primary: To ascertain how many New Zealand (NZ) children are being injured or killed as the result of all-terrain vehicle (ATV) injuries and to define the nature and severity of their injuries. Secondary: to examine the effect of age, weight, helmet use, and ATV size on injury severity and to compare the demographics of injury in NZ to other countries. Methods A retrospective review was undertaken of 643 cases of children less than 16 years old hospitalised between 2000-2006 due to possible ATV-related injury. New Zealand Health Information Statistics (NZHIS) identified the cases through discharge information, supplemented by a search of Auckland's Paediatric Intensive Care trauma database. Only confirmed ATV injuries were included. Results: Records were unavailable for 150 cases (26%). There were 218 confirmed cases of ATV injury. Mechanisms of injury were: a fall from the ATV, 105 cases (48%), a collision, 59 cases (31%), rolling 31 cases (14%). Mean age was 9.9 years (SD 3.9) with 133 (61%) under 12 years, and 32 (15%) 5 years and under. The child was the driver in 116 cases (53%) and the passenger in 61 cases (28%). Male to female ratio was 2: 1. Mean injury severity score was 7.9 (SD 5.2). Median (IQR) length of stay was 2 days (1-4). Helmet use not stated in 62%, with only 30 cases (14%) identified as wearing helmets. The majority of injuries were orthopaedic, soft tissue injuries and head injuries. Multiple injuries occurred in 74 cases (34%). One hundred and eleven children (51%) required a general anaesthetic. Seventeen (7.8%) children required admission to intensive care. Six (2.8%) children were left with a permanent disability. Sixteen children died. There was no correlation between ISS and age or weight (Rho=-0.089, p=0.08 and Rho=0.49, p=0.79 respectively). The observed differences in ISS between helmet users and non-users, ATV drivers and passengers and size of ATV were not statistically significant. There was a trend towards reduced risk of head injury with helmet use RR=0.63 (95% CI 0.36-1.1), Chisquared=3.09, p=0.09. The mean age of injured NZ children was lower than other countries and length of hospital stay was shorter. Gender distribution, injury type, and severity were similar to elsewhere. Conclusions ATVs are potentially lethal and have the capacity to inflict significant harm. It is clear that it is not appropriate for a young child to ride an adult sized ATV due to the risk of serious injury and death. Public debate is needed as to whether education or legislation is the answer.