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ATV Safety Summit: State Legislation (Enforcement) - The Effect of Passengers on ATV Crash Mechanisms, Injuries
 

ATV Safety Summit: State Legislation (Enforcement) - The Effect of Passengers on ATV Crash Mechanisms, Injuries

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Dr. Charles Jennissen, of the University of Iowa Department of Emergency Medicine presented this at CPSC's ATV Safety Summit Oct. 12, 2012. The study objective was to understand the effect of ...

Dr. Charles Jennissen, of the University of Iowa Department of Emergency Medicine presented this at CPSC's ATV Safety Summit Oct. 12, 2012. The study objective was to understand the effect of passengers on ATV-related crashes and injuries. Methods: A retrospective chart review was performed of ATV-related injuries from 2002-2009 at a university hospital. Results: 345 cases were identified of which 20% were passengers or drivers with passengers. Females and children were more likely to be passengers. Overall helmet use was low (~20%), and passengers were less likely than operators to wear helmets. There was a trend observed wherein passengers increased the likelihood of rollovers on sloped terrains, with backward rollovers the most likely to involve passengers. Victims who fell/were ejected to the rear were significantly more likely to have been on an ATV with passengers than were victims of other ejections or those not ejected, and also had more severe head injuries. Self-ejections and forward ejections appeared less likely with passengers. Patients who self-ejected had higher extremity injury scores than patients who fell/were ejected by other mechanisms, but had less severe head injuries. Conclusions: Passengers on ATVs may be at greater risk for fall/ejection to the rear and rearward falls/ejections appeared to increase the risk of head injury. Strict and well enforced "no passenger" laws could reduce risk of some ATV crashes and injuries.

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  • 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

ATV Safety Summit: State Legislation (Enforcement) - The Effect of Passengers on ATV Crash Mechanisms, Injuries ATV Safety Summit: State Legislation (Enforcement) - The Effect of Passengers on ATV Crash Mechanisms, Injuries Presentation Transcript

  • The Effect of Passengers on All-TerrainVehicle 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
  • Background105,000 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 YearData from the National Electronic Injury Surveillance System (NEISS) 2
  • 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
  • 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
  • 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
  • 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
  • Results345 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
  • 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
  • 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
  • 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
  • Helmet Use• 21 % of all patients were reportedly wearing helmets. Helmet Use by ATV Crash Victims No Helmet 74% Helmet 21% Unknown 5% 11
  • 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
  • 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
  • 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
  • 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 +PassengersRollovers Total only Passengers %OtherSloped terrain 69 69.6% 27.5% 2.9%Other andunknown terrain 121 77.7% 18.2% 4.1%Non-rollovers 155 78.71% 18.71% 2.58% 15
  • 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
  • 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 PassengersType of Ejection Total Alone Passengers % OtherSelf Ejection 9 100% 0% 0%Thrown overHandlebars 46 89.1% 8.7% 2.2Fall/ejected to Side 34 73.5% 26.5% 0%Fall/Ejected fromRear 17 35.3% 58.8% 5.9%UnspecifiedEjection 68 75.0% 20.6% 4.4%Not Reported asEjected 171 77.2% 19.3% 3.5% 17
  • 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 PassengersType of Ejection Total Alone Passengers % OtherSelf Ejection 9 100% 0% 0%Thrown overHandlebars 46 89.1% 8.7% 2.2Fall/ejected to Side 34 73.5% 26.5% 0%Fall/Ejected fromRear 17 35.3% 58.8% 5.9%UnspecifiedEjection 68 75.0% 20.6% 4.4%Not Reported asEjected 171 77.2% 19.3% 3.5% 18
  • 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
  • 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
  • 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
  • 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
  • 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
  • Questions? 24