Post on 05-Dec-2014
description
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The Effect of Passengers on All-Terrain Vehicle Crash Mechanisms and Injuries
Charles Jennissen, MDGerene Denning, PhD
Kari Harding, PhDDepartment of Emergency Medicine,
University of Iowa Carver College of Medicine
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Background
The incidence of ATV-related injuries and deaths has escalated over the past 15 years
Roughly 1/3 are children <16 years of age
Well-over ½ are under 24 years of age
0
15,000
30,000
45,000
60,000
75,000
90,000
105,000Adult
Pediatric (< 16 years old)
Year
Data from the National Electronic Injury Surveillance System (NEISS)
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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.
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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.
Background
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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.
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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.
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Results
345 ATV-related cases were identified.
• 79 % of patients were males.
• 32 % were children <18 years of age.
Patients with ATV Injuries by Gender
Female21%
Male79%
Patients with ATV Injuries by Age
Adults68%
Children (<18)32%
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0.0%0.0%
0.9%
2.4%7.7%
33.2%35.3%
39.4%50.3%
90.3%92.2%
94.8%97.1%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percent of Medical Records that Featured Documentation
WeatherElectronic Device Use
ATV ModelATV Size
Path(straight/turning)Surface Type
SpeedSlope of Terrain
Road/trail/offroad4 vs. 3 Wheels
Time of DayHelmet Use
Seating Position
Cont
ributi
ng F
acto
rs
Medical Record Documentation of Contributing Factors
Documentation
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Passengers
• 20 % of victims were passengers or had passengers with them on the ATV.
Patients with ATV Injuries by Seating
Driver Alone77%
Driver with Passenger
or Passenger20%Unknown
3%
Other0%
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Passengers
• Females were more likely to be passengers (p<.0001).
0%20%40%60%80%
100%
% of
Each
Gen
der
Male Female
Seating Position by Gender
Driver
Passenger
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Helmet Use
• 21 % of all patients were reportedly wearing helmets.
Helmet Use by ATV Crash Victims
No Helmet74%
Helmet21%
Unknown5%
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Helmet Use
• Drivers were more likely to wear helmets than passengers (22.5% vs.6.1%) (p<0.01).
38%
29%
22%
8% 8%6%
0%
8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
% o
f Pts
Doc
umen
ted
as W
eari
ng H
elm
ets
Male, <16 y.o.Driver
Female, <16y.o. Driver
Male, ≥16 y.o.Driver
Female, ≥16y.o. Driver
Male, <16 y.o.Passenger
Female, <16y.o. Passenger
Male, ≥16 y.o.Passenger
Female, ≥16y.o. Passenger
Age, Gender, & Seating Position
Helmet Use by Age, Gender, & Seating Position
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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.
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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
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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)
Rollovers Total% Drivers
only
%Drivers +Passengers
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%
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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)
Type of Rollover Total
% Drivers only
%Drivers +Passengers
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%
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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).
Type of Ejection Total% Driver
Alone
% Driver + Passengers 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%
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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)
Type of Ejection Total% Driver
Alone
% Driver + Passengers 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%
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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).
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12.5
13
13.5
14
14.5
15
Ave
rage
Gla
sgow
Com
a Sc
ale
EjectionUnspecified
Thrown overhandlebars
Thrown/ejected to
side
Fall/ slip toside
Thrown/ejected from
rear
Fall fromrear
Self ejection
Ejection Subtype
Glasgow Coma Scale by Ejection Subtype
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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).
0.9
1.1
1.3
1.5
1.7
1.9
Ave
rage
MA
X H
EAD
EjectionUnspecified
Thrown overhandlebars
Thrown/ejected to
side
Fall/ slip toside
Thrown/ejected from
rear
Fall from rear Self ejection
Ejection Subtype
MAX HEAD by Ejection Subtype
0.11
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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).
0.2
0.7
1.2
1.7
2.2
Ave
rage
MA
X EX
TREM
EjectionUnspecified
Thrownover
handlebars
Thrown/ejected to
side
Fall/ slip toside
Thrown/ejected
from rear
Fall fromrear
Selfejection
Ejection Subtype
MAX Extremity Score by Ejection Subtype
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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.
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Future DirectionsImprove 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.
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Questions?