All-terrain vehicle (ATV) crashes result in severe morbidity in trauma. Limited data on these injury patterns come from large urban academic centers, but studies show increased use of ATVs in small rural communities with fewer resources, where these injuries are more likely to be treated. This study uses injury patterns to determine impact on community trauma systems based on length of stay.
The trauma registry of a level II trauma center was reviewed for ATV crash patients from January 2015 to December 2020. Injury type and frequency were grouped by proportion and 95% confidence interval based on ‘score’ method, and co-incidences were first screened with Fisher’s exact test, with significant p-value<0.01. Factors influencing length of stay in hospital/ICU were analyzed in a linear model and log-transformed dependent variable with significance based on sequential nested likelihood ratio analysis. Descriptive statistics were back transformed.
Out of 7,787 trauma patients admitted during the study, 127 were involved in ATV crashes with 62 adults (age>18) and 65 pediatric patients. Injuries to skin/soft tissue and extremities were most common in both adult (68% and 42%, p<0.001) and pediatric (56% and 38%, p<0.001). Paired injuries included head bleeds with skull fractures (p<0.001) in both adults and pediatrics, pediatrics alone with spine and rib fractures (p=0.01). Length of stay in hospital increased for extremity injuries in both groups (mean (SD); adults 5.8 (2.4) vs 3.0 (2.2) days and pediatrics 4.0 (2.2) vs 2.6 (2.0) days, P=0.048). Pediatric patients had shorter overall hospital length of stay compared to adults (mean (SD); 3.1 (2.1) vs 3.9 (2.4) days respectively, P=0.009). Mortality was low with only a single adult death.
The findings from our retrospective study among ATV-related injuries on a community level II trauma center demonstrates skin/soft tissue injuries and extremity injuries were most common. We can also predict prolonged hospital length of stay in those with extremity injuries and those older than 18 years of age, requiring greater resources with longer hospital stay. No factors were predictive of longer ICU stays and mortality was very low with a single adult death in our population.