Fiveyear Review of Regional AllTerrain Vehicle Injuries

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Five-year Review of RegionalAll-Terrain Vehicle
Injuries

• Julie Lorber, MDDepartment of SurgeryUniversity
  of North Dakota School of Medicine and Health
  Sciences

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U.S. Consumer Product Safety Commission
Report on All-Terrain Vehicle (ATV) Injuries
1982-2006

• United States
• 146,600 - ATV related injuries
• 27 ATV related injuries in lt 16 years
• 8,104 - ATV related deaths
• 29 deaths in age lt 16 years
• North Dakota
• 50 known ATV related deaths
• ATV injuries sporadically reported

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Purpose of Study

• Identify demographics of those injured and
  factors that correlate with all-terrain
  vehicle injuries.
• Identify cost to the healthcare system.
• Identify modifiable points in current legislation
  to decrease number, severity and cost of
  injuries related to all-terrain vehicles.

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North Dakota State Chapter 39-29 Operation of
Off-highway Vehicles

• Section 09
• No passengers are allowed, unless the ATV is
  designed for carrying a passenger.
• To operate an ATV a person 12 years of age to
  under 16 years of age must possess a driver's
  license or an ATV safety certificate.
• All riders under the age of 18 (passengers and
  operator) must wear a helmet.
• It is unlawful to operate under influence of
  intoxicating or controlled substance.

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North Dakota State Chapter 39-29 Penalties for
Unlawful ATV Use

• Violation of subdivision b, c, or g of subsection
  5 of section 39-29-09 is a class B misdemeanor.
• Violation of any other provision of section
  39-29-09 is an infraction for which a fee of
  twenty dollars must be assessed.
• Violation of section 39-29-02 is an infraction,
  for which a fee of fifty dollars must be
  assessed. If the individual provides proof of
  registration since the violation, the fee may be
  reduced by one-half.

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Hypothesis

• Failure to utilize a helmet in the operation
• of an all-terrain vehicle increases injury
• severity, length of stay and cost.

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Study Design

• Retrospective Review
• Trauma Registry and Medical Record
• January 1, 2003 December 31, 2007
• Two Regional Level 2 Trauma Centers
• - MeritCare Medical Center Fargo, North
  Dakota
• - Altru Health System Grand Forks, North
  Dakota
• Inclusion criterion injuries sustained as
  result of operation of all-terrain vehicle

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Statistical Analysis

• Descriptive statistics (median, range and
  percentages) for the demographic and clinical
  variables of the study population were
  calculated.
• Proportions were compared using Chi-square or
  Fishers exact tests.
• Wilcoxon rank-sum test and t-tests were used for
  continuous variables, p-values were one and
  two-sided, and p-value lt0.05 was significant.
• Statistical Analysis performed utilizing SAS
• software V9.1.3 (SAS Institute, Cary, NC
  25513)

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Variables Identified

• Gender
• Age
• Helmet Use
• Alcohol Level
• Injury Severity Score (ISS)
• Length of Stay (LOS)
• Intensive Care Days (ICU)
• Intubation event

• Mechanism of Injury
• Death Rate
• Diagnosis codes
• Procedure codes
• County of Injury
• -Rural or Urban
• Cost to facility
• Payor
• Discharge disposition

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Results

• Total number of patients 198
• Altru Hospital 89
• MeritCare Hospital 109
• Total number of injuries 703
• Total number of deaths n8 (4 death rate)

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Results

• Age range 2-82 years
• Stratified group
• -adolescents (2-17) and Adults (18-82)
• Males n147 (74)
• Females n51 (26)

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Results

• Intubation required n29
• Injury Severity Score 1-72
• Length of stay range 1-32 days (avg 4 days)
• ICU Days 1-26 days (avg 4 days)
• Discharge disposition
• 12 patients to long-term care facility
• Alcohol status documented n81 (38 reporting)
• Helmet status documented n161 (81 reporting)

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Gender Distribution - Adolescent versus
Adult
p0.002
Percentage
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Helmet Use - Adolescent versus Adult Population
p0.0004
Percentage
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Injury Severity Score versus Helmet Use
Percentage
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Injury Severity Score versus Helmet Use
p0.03
Percentage
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Total Number of Injuries By Category
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Major Injuries Total Population
Percentage
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Major Injuries - Adolescents versus Adults
percentage
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Injuries Types Among Adolescents
Helmet versus No Helmet
p0.04
Percentage
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Cost Analysis

• Cost data available for 98 of patients
• Total Cost over five years 2.26 million
• Range of costs per patient 210-133,000
• Average cost per patient 12,177

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Summary

• 198 patients - predominately non-helmeted males
• Over 700 injuries, death rate 4 (75
  non-helmeted)
• Intracranial injury was the second most common
  injury sustained.
• Helmet use was correlated with lower ISS.
• Failure to wear a helmet associated with higher
  number of intracranial and skull injuries.
• Increased length of stay and cost for
  head-injured adolescents.

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Study Limitations

• Retrospective Review
• Univariate analysis
• Sample size

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Conclusion

• The majority of patients involved in all-terrain
  vehicle injuries in our region do not wear
  helmets despite the fact that it is protective.
• Cost and length of stay for head-injured
  individuals is increased as compared to non-head
  injured patients.

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Acknowledgements

• Dr. Luis Garcia
• Dr. Abe Sahmoun
• Deb Syverson
• Deanna Kubitz

• Jennie Swartz
• Angie Vasek
• Melissa Glander
• Jolisa Jenstead
• Lorraine Roeter