SCIENTIFIC ATV Crashes in West Virginia: Helmet Compliance and Substance Abuse
AUTHORS: Martin E. Weisse, MD 1
Jeffrey D. Lancaster, MD 1 Richard W. Brant, MD 1 Nicholas Mains, DO 1
1
Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA
CORRESPONDING AUTHOR: Martin E. Weisse mweisse @ hsc. wvu. edu
DISCLOSURES: None
ETHICS STATEMENT:
The West Virginia University Institutional Review Board granted approval to examine all ATV crash data.
FUNDING: None
INTRODUCTION
All-terrain vehicles( ATV) have been in use since the 1970s primarily as recreational vehicles for trail riding, although they have a host of other useful and creative uses. The first four-wheeled ATVs were manufactured in the early 1980s as recreational vehicles. Over the last 10 years, more than 200,000 ATVs have been sold annually in the United States( US). 1 From 1985 to 1988 when three-wheelers were the predominant ATV, there were an average of 266 deaths per year in the US. In the 10 years after the three-wheeler ban, there were 223 deaths / year, and in the most recent complete 10-year reporting period from 2007- 2016, there have been 651 deaths per year. 2
ABSTRACT
INTRODUCTION
West Virginia has had an exceedingly high rate of deaths due to all-terrain vehicle( ATV) accidents over the last several decades. Likely contributors to the high mortality include poor helmet compliance and substance use.
MATERIALS & METHODS
Using West Virginia University’ s Jon Michael Moore Trauma Center registry, ATV crash data from 2008-2020 were reviewed to analyze outcomes for patients aged 0 to 17 years and adults.
RESULTS
Three thousand thirty-seven crash victims were seen in the trauma center. Of these, 738( 24.3 %) were pediatric patients aged 1 year to 17 years. Helmet use was noted in 41.7 % of all patients; children under the age of 4 years( 6.2 %) were the least likely group to wear helmets. Of the pediatric patients, there were four fatalities and only one of these was wearing a helmet at the time of the accident. Helmet use in adult patients was 17.7 %; the highest rate
West Virginia( WV) is ranked as the 39th of the 50 US states by population, 3 yet ranked third in ATV sales in 2011. 4 It is therefore not surprising that WV has the second most ATV deaths in the US during this reporting period despite its relatively small population. 2 We examined patient demographics and the circumstances surrounding ATV crashes that presented to our trauma center over a 13-year period.
MATERIALS AND METHODS
West Virginia University’ s( WVU) Jon Michael Moore Trauma Center( JMMTC) is a Level 1 Trauma Center in Morgantown, WV. It cares for more than 4,500 trauma patients annually from WV and surrounding states as a tertiary care referral center. The JMMTC trauma registry captures over 200 data elements per patient. The WVU Institutional Review Board granted approval for our review. We queried the JMMTC trauma registry for all ATV crashrelated injuries seen between January 2008 and December 2020. This query included patient data such as demographic information, injury severity, helmet use and substance use. January 2008 was chosen as the start date, consistent with the was in the patients aged 18-25 and lowest in those older than 60. Of 26 deaths in the adult cohort, only one wore a helmet.
Substance use was also frequently associated with ATV injuries. In the pediatric patients, tetrahydrocannabinol( THC) was the most common substance found on urine drug screening( 46 cases). Twenty-five( 3.3 %) of the pediatric patients also had a detectable blood alcohol content with the youngest being 12 years. For adult patients, ethanol( EtOH) was the most frequently associated substance( 37.9 %) with THC being second( 13.4 %). Substance use of any kind was highest among adults aged 22-58.
CONCLUSION
Lack of helmet use and the presence of substance use are associated with increased mortality and severity of injury in ATV accidents across all ages. Additional research into helmet compliance behavior and the effectiveness of substance use education is needed. Injury prevention strategies addressing these risks should be enhanced.
deployment of EPIC electronic health record( EHR) in our hospital.
For the infrequent case when the database contained incomplete patient data regarding helmet use or substance use, review of individual patient EHRs was performed. Statistics including Chi-square with Yate’ s correction was used to examine the interdependence of variables such as helmet use, substance use, sex, and age with injury severity. Relative Risk and Odds Ratio were calculated to delineate the risk of severe injury or death associated with these contributing factors. These statistical analyses were performed using online calculators( Social Science Statistics) at www. socscistatistics. com.
RESULTS
During this 13-year period, there were 3,037 admissions to JMMTC for ATV crashes; 738 crash victims were 1 year
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