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Prevention of all-terrain vehicle injuries

A systematic review from The Eastern Association for the Surgery of Trauma

Rattan, Rishi MD; Joseph, D’Andrea K. MD; Dente, Christopher J. MD; Klein, Eric N. MD; Kimbrough, Mary K. MD; Nguyen, Jonathan DO; Simmons, Jon D. MD; O’Keeffe, Terence MD; Crandall, Marie MD

Journal of Trauma and Acute Care Surgery: June 2018 - Volume 84 - Issue 6 - p 1017–1026
doi: 10.1097/TA.0000000000001828

BACKGROUND Despite increasing usage since their introduction, there exist no evidence-based guidelines on all-terrain vehicles (ATVs) and injury prevention. While the power and speed of these vehicles has increased over time, advancements in ATV safety have been rare.

METHODS A priori questions about ATV injury pattern and the effect of helmet and safety equipment use and legislation mandating use were developed. A query of MEDLINE, PubMed, Cochrane Library, and Embase for all-terrain vehicle injury was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. Grading of Recommendations Assessment, Development, and Evaluation methodology was used to perform a systematic review and create recommendations.

RESULTS Twenty-eight studies were included. Helmet use reduced traumatic brain injury (TBI). However, studies examining whether legislation mandating helmet use reduced TBI had mixed results. When ATV safety legislation was enforced, overall injury rates and mortality decreased. However, enforcement varied widely and lack of enforcement led to decreased compliance with legislation and mixed results. There was not enough evidence to determine the effectiveness of non–helmet-protective equipment.

CONCLUSION Helmet use when riding an ATV reduced the rate of TBI. ATV safety legislation, when enforced, also reduced morbidity and mortality. Compliance with laws is often low, however, possibly due to poor enforcement. We recommend helmet use when riding on an ATV to reduce TBI. We conditionally recommend implementing ATV safety legislation as a means to reduce ATV injuries, noting that enforcement must go hand in hand with enactment to ensure compliance.

From the DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine (R.R.), Miami, Florida; Department of Surgery, New York University Winthrop (D.K.J.), Mineola, New York; Department of Surgery, Emory University School of Medicine (C.J.D.), Atlanta, Georgia; Department of Surgery, Hofstra University Zucker School of Medicine (E.N.K.), East Garden, New York; Department of Surgery, University of Arkansas for Medical Sciences (M.K.K.), Little Rock, Arkansas; Department of Surgery, Morehouse School of Medicine (J.N.), Atlanta, Georgia; Department of Surgery, University of South Alabama School of Medicine (J.D.S.), Mobile, Alabama; Department of Surgery, University of Arizona (T.O.), Tucson, Arizona; and Department of Surgery, University of Florida College of Medicine Jacksonville (M.C.), Jacksonville, Florida.

Submitted: January 1, 2018, Accepted: January 13, 2018, Published online: January 31, 2018.

Presented at: 29th Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, January 12–18, 2014 in Naples, FL.

Address for reprints: Rishi Rattan, MD, 1800 NW 10th Ave, Ste T215 (D-40), Miami, FL 33136; email:

© 2018 Lippincott Williams & Wilkins, Inc.