Pediatric spinal injury patterns and management in all-terrain vehicle and dirt bike crashes, 2010–2019

Jackson H. AllenVanderbilt University School of Medicine;

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Aaron M. Yengo-KahnDepartments of Neurological Surgery and

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Michael J. CoolsDepartments of Neurological Surgery and

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Amber GreenoPediatric Surgery, Vanderbilt University Medical Center; and

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Muhammad Owais Abdul GhaniPediatric Surgery, Vanderbilt University Medical Center; and

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Purnima UnniPediatric Surgery, Vanderbilt University Medical Center; and

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Jeffrey E. MartusDepartment of Orthopedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children’s Hospital, Nashville, Tennessee

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Harold N. Lovvorn IIIPediatric Surgery, Vanderbilt University Medical Center; and

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Christopher M. BonfieldDepartments of Neurological Surgery and

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OBJECTIVE

Pediatric spinal injuries in all-terrain vehicle (ATV) and dirt bike crashes are relatively uncommon but may be associated with significant morbidity. There are no recent studies examining these injuries, their management, and outcomes. Therefore, a retrospective study was performed to characterize pediatric spinal injuries related to ATV and dirt bike crashes over the last decade.

METHODS

Data on all patients involved in ATV or dirt bike crashes evaluated at a regional level 1 pediatric trauma center over a 10-year period (2010–2019) were analyzed. Descriptive statistics were analyzed and chi-square, Fisher exact, and Mann-Whitney U-tests were performed comparing the demographics, injury characteristics, and clinical outcomes in patients with versus those without spinal injuries.

RESULTS

Of 680 patients evaluated, 35 (5.1%) were diagnosed with spinal injuries. Over the study period, both spinal injuries and emergency department visits related to ATV or dirt bike crashes increased in frequency. All spinal injuries were initially diagnosed on CT scans, and 57.9% underwent spinal MRI. Injuries were most commonly thoracic (50%), followed by cervical (36.8%). The injuries of most patients were classified as American Spinal Injury Association (ASIA) grade E on presentation (86.8%), while 2 (5.3%) had complete spinal cord injuries (ASIA grade A) and 3 patients (8.6%) were ASIA grade B–D. Operative management was required for 13 patients (28.9%). Nonoperative management was used in 71.1% of injuries, including bracing in 33% of all injuries. Patients with spinal injuries were older than those without (13.4 ± 3.35 vs 11.5 ± 3.79 years, p = 0.003). Spinal injuries occurred via similar crash mechanisms (p = 0.48) and in similar locations (p = 0.29) to nonspinal injuries. Patients with spinal injuries more frequently required admission to the intensive care unit (ICU; 34.2% vs 14.6%, p = 0.011) and had longer hospital stays (mean 4.7 ± 5.5 vs 2.7 ± 4.0 days, p = 0.0025).

CONCLUSIONS

Although infrequent among young ATV and dirt bike riders, spinal injuries are associated with longer hospital stays, increased ICU use, and required operative intervention in 29%. Increasing awareness among ATV and dirt bike riders about the severity of riding-related injuries may encourage safer riding behaviors.

ABBREVIATIONS

ASIA = American Spinal Injury Association; ATV = all-terrain vehicle; ED = emergency department; GCS = Glasgow Coma Scale; ICU = intensive care unit; ISS = Injury Severity Score; SLICS = Subaxial Injury Classification and Severity Scale; TLICS = Thoracolumbar Injury Classification and Severity Scale; TLSO = thoracic lumbar sacral orthosis.
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Image from Tran et al. (pp 394–399).

  • 1

    Cvijanovich NZ, Cook LJ, Mann NC, Dean JM. A population-based assessment of pediatric all-terrain vehicle injuries. Pediatrics. 2001;108(3):631635.

  • 2

    All-terrain vehicle injury prevention: two-, three-, and four-wheeled unlicensed motor vehicles. Pediatrics. 2000;105(6):13521354.

  • 3

    American Academy of Orthopaedic Surgeons Position Statement. Published online 2015. Accessed July 14, 2022. https://www.aaos.org/contentassets/1cd7f41417ec4dd4b5c4c48532183b96/1101---all-terrain-vehicles.pdf

    • Search Google Scholar
    • Export Citation
  • 4

    Topping J. 2020 Report of deaths and injuries involving off highway vehicles with more than two wheels. Consumer Product Safety Commission. Accessed July 14, 2022. https://www.cpsc.gov/s3fs-public/2020_Report_of_Deaths_and_Injuries_Invovling_Off_HighwayVehicles.pdf

    • Search Google Scholar
    • Export Citation
  • 5

    Jordan RW Jr, Beckmann NM, Johnston JH, Johnston SK, Zhang X, Chinapuvvula NR. Characterization of all-terrain vehicle-related thoracolumbar spine injury patterns in children using the AOSpine classification system. Emerg Radiol. 2020;27(4):383391.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Yanchar NL, Kennedy R, Russell C. ATVs: motorized toys or vehicles for children? Inj Prev. 2006;12(1):3034.

  • 7

    Mangano FT, Menendez JA, Smyth MD, Leonard JR, Narayan P, Park TS. Pediatric neurosurgical injuries associated with all-terrain vehicle accidents: a 10-year experience at St. Louis Children’s Hospital. J Neurosurg. 2006;105(1 suppl):25.

    • Search Google Scholar
    • Export Citation
  • 8

    Sawyer JR, Bernard MS, Schroeder RJ, Kelly DM, Warnersurname WC Jr. Trends in all-terrain vehicle-related spinal injuries in children and adolescents. J Pediatr Orthop. 2011;31(6):623627.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Stiles PJ, Helmer SD, Drake RM, Haan JM. All-terrain vehicle accidents in children. Am Surg. 2015;81(1):103105.

  • 10

    Humphries RL, Stone CK, Stapczynski JS, Florea S. An assessment of pediatric all-terrain vehicle injuries. Pediatr Emerg Care. 2006;22(7):491494.

  • 11

    Sandler G, Soundappan SSV, Manglick MP, et al. Pediatric "off-road vehicle" trauma: determinants of injury severity and type. Pediatr Emerg Care. 2012;28(12):13281333.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Lister DG, Carl J III, Morgan JH III, et al. Pediatric all-terrain vehicle trauma: a 5-year statewide experience. J Pediatr Surg. 1998;33(7):10811083.

  • 13

    Lynch JM, Gardner MJ, Worsey J. The continuing problem of all-terrain vehicle injuries in children. J Pediatr Surg. 1998;33(2):329332.

  • 14

    Kute B, Nyland JA, Roberts CS, Hartwick-Barnes V. Recreational all-terrain vehicle injuries among children: an 11-year review of a Central Kentucky level I pediatric trauma center database. J Pediatr Orthop. 2007;27(8):851855.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Garay M, Hess J, Armstrong D, Hennrikus W. Pediatric ATV injuries in a statewide sample: 2004 to 2014. Pediatrics. 2017;140(2):e20170945.

  • 16

    Sawyer JR, Beebe M, Creek AT, Yantis M, Kelly DM, Warner WC Jr. Age-related patterns of spine injury in children involved in all-terrain vehicle accidents. J Pediatr Orthop. 2012;32(5):435439.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377381.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Li D, Jatana KR, Kistamgari S, Smith GA. Nonfatal all-terrain vehicle-related head and neck injuries to children treated in US emergency departments. Clin Pediatr (Phila). 2020;59(13):11411149.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Robertson A, Branfoot T, Barlow IF, Giannoudis PV. Spinal injury patterns resulting from car and motorcycle accidents. Spine (Phila Pa 1976). 2002;27(24):28252830.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Medina O, Singla V, Liu C, Fukunaga D, Rolfe K. Patterns of spinal cord injury in automobiles versus motorcycles and bicycles. Spinal Cord Ser Cases. 2020;6(1):75.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Fakharian E, Mohammadzadeh M, Saberi HR, et al. Spinal injury resulting from car accident: focus to prevention. Asian J Neurosurg. 2017;12(2):180184.

  • 22

    Pintar FA, Yoganandan N, Maiman DJ, Scarboro M, Rudd RW. Thoracolumbar spine fractures in frontal impact crashes. Ann Adv Automot Med. 2012;56:277283.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Aitken ME, Graham CJ, Killingsworth JB, Mullins SH, Parnell DN, Dick RM. All-terrain vehicle injury in children: strategies for prevention. Inj Prev. 2004;10(5):303307.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Towner E, Dowswell T. Community-based childhood injury prevention interventions: what works? Health Promot Int. 2002;17(3):273284.

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