Trends in All-Terrain Vehicle and Dirt Bike Pediatric Orthopaedic Injuries in the United States From 2004 to 2023: A 20-Year National Review Demonstrating a Persistent Public Policy Concern.
Academic Article
Overview
abstract
INTRODUCTION: Off-highway vehicles, including two-wheeled dirt bikes and three-wheeled or four-wheeled all-terrain vehicles (ATVs), disproportionately affect the pediatric population, owing to poor regulation and a mismatch between vehicle and rider size. The purpose of this study was to analyze trends in ATV-related and dirt bike-related pediatric orthopaedic injuries, age-specific and vehicle-specific injury differences, and risk factors of hospitalization. METHODS: A retrospective query of patients aged 0 to 21 years in the National Electronic Injury Surveillance System, a nationally representative database of 102 emergency departments in the United States, yielded a national estimate of 385,678 and 293,171 pediatric orthopaedic injuries related to ATVs and dirt bikes, respectively. Simple linear regression characterized injury trends, incidence rate ratios compared orthopaedic injuries in age-specific and vehicle-specific cohorts, and multivariable logistic regression identified risk factors of hospitalization. RESULTS: An average annual incidence rate of 213.6 ± 64.8 and 162.4 ± 41.7 pediatric orthopaedic injuries per 1 million person-years was caused by ATVs and dirt bikes, respectively. ATV-related pediatric orthopaedic injuries decreased by 1,651 injuries per year (P < 0.001) from 2004 to 2013, but stabilized (P = 0.302) from 2014 to 2023. Dirt bike-related pediatric orthopaedic injuries decreased by 979 injuries per year (P < 0.001) from 2004 to 2013 but increased by 389 injuries per year (P = 0.035) from 2014 to 2023. Most injuries were fractures (63.2%) and those to the upper extremity (55.7%). Dirt bike injuries had more fractures and lower extremity injuries, but fewer spine/pelvis injuries and hospitalizations than ATV injuries. Adolescents experienced an overall incidence rate ratio of orthopaedic injury of 1.13 (P < 0.001) compared with children. Patients with ATV injuries had 28% higher odds of hospitalization (P < 0.001). CONCLUSION: The persistence of OHV-related orthopaedic injuries highlights the need for stricter regulations, including a minimum operator age of 16 years, speed restrictions, mandatory safety training, and increased protective equipment use.
