The Burden of Upper Extremity Injuries from All-Terrain Vehicle Use: A 10-Year Analysis of the Paediatric Population

Background: All-terrain vehicles (ATVs) are an increasingly popular motor vehicle used for both recreation and work in the United States. However, their accessibility has raised safety concerns, particularly within the paediatric population, as ATVs have been linked to a variety of injuries in children. This study aimed to characterise ATV-related upper extremity injuries in paediatric patients.

Methods: Data were collected from the National Electronic Injury Surveillance System (NEISS) database for all ATV-related upper extremity injuries in patients aged 0–17 years between 2014 and 2023. Demographic characteristics included patient age, sex and race. Features of the injuries, such as the segment of the upper extremity affected, type of injury and patient disposition, were also recorded. Descriptive and comparative analyses were performed to identify patient profiles and injury trends.

Results: Over the 10 years, 2,865 paediatric patients presented to emergency departments for an ATV-related injury (corresponding to 3,612 total injuries) reported to the NEISS. Of these, 2,529 patients sustained upper extremity injuries (corresponding to 2,718 injuries; 106,126 injuries nationwide). The vast majority (88.3%) of the patients presented with upper extremity injuries, and 75.2% of all injuries involved the upper extremity. Nearly half (46.4%) of injuries occurred between 2020 and 2023. The mean patient age was 11.6 years, and adolescents sustained the plurality of injuries (p < 0.0001). Males (65.6%) and white individuals (61.4%) represented significantly greater proportions of patients (p < 0.0001). The ‘lower arm’ was most frequently injured (p < 0.0001), and fractures represented the majority of injuries (p < 0.0001). The vast majority of patients (86%) were discharged from the emergency department (p < 0.0001).

Conclusions: ATV use represents a substantial upper extremity injury risk to the paediatric population, with a recent increase since 2020. Implementation of stricter age requirements, safety equipment and training programs could mitigate these preventable injuries.

Level of Evidence: Level IV (Therapeutic)