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CHICAGO -- Children who drive or ride in off-road all-terrain vehicles (ATVs) and are involved in accidents often have injuries to their chest -- most often pulmonary damage, researchers reported here at the annual meeting of the Radiological Society of North America.
In a retrospective review of these accident patients, , a radiology resident at the McGovern ľֱ School at the University of Texas Health Science Center in Houston, said that 455 of them -- age up to 18 -- were admitted after ATV accidents, 102 of whom (22%) had chest injuries.
"Chest injuries are a relatively common occurrence in children following ATV accidents, which remain a significant public health issue in terms of morbidity and mortality," Hagedorn said. "Patients with chest injuries were more likely to require ICU care and to have a longer hospital stay.
"The sheer incidence of chest injuries in pediatric patients evaluated after ATV accidents is rather alarming, and are not necessarily the type of injuries patients and their families give much forethought to when considering the risks of ATV use."
The most common chest injury identified in the study was pulmonary contusion, which was observed in 61% of patients. Other chest injuries included pneumothorax in 45% of the children and rib fractures in 34%.
Forty percent of patients with chest injuries required care in the intensive care unit, compared with 22% of patients without chest injuries. Patients with chest injuries also had longer hospital stays. Eight children with chest injuries died. The report covered the years 1992 to 2013.
"While this study only highlights a specific subset of potential injuries, their incidence and clinical significance cannot be overlooked," Hagedorn said. "Other studies have demonstrated the prevalence of orthopedic and neurologic injuries, and the most recent Consumer Product Safety Commission (CPSC) report estimates that 23% of ATV-related fatalities since 1982 have occurred in children younger than 16."
The main causes of chest injury included rollovers, which accounted for 43% of the accidents; running into the landscape in 20% of the cases; and falls from the vehicle, which made up 16% of the reasons the children were brought to the hospital. The injured child was the driver of the ATV in 41 cases, and the passenger, in 33 cases. In the remaining 28 cases, it was unknown whether the injured child was the driver or passenger. Patients with chest injuries were, on average, 13 years old.
According to the CPSC, in the United States in 2014, a total of 24,800 children under the age of 16 were treated in hospital emergency rooms nationwide for ATV-related injuries -- a number that represents more than 25% of all ATV-related injuries treated that year. And while the American Academy of Pediatrics recommends that children under the age of 16 be prohibited from riding ATVs, regulations vary from state-to-state.
"Our study further supports the need for increased public awareness of the risks -- and potentially devastating consequences -- of ATV use among children," Hagedorn said.
Asked for his opinion of the study, director of pediatric trauma at Staten Island University Hospital in New York, told ľֱ: "Symptomatic patients should have x-rays and be treated. However, asymptomatic patients probably do not need to be screened for chest injury unless the mechanism warrants it.
"No one needs a chest CT scan unless aortic issues or severe respiratory problems need to be ruled out -- that is, symptomatic patients."
Disclosures
Hagedorn and Price reported having no relevant relationship with industry.
Primary Source
Radiological Society of North America
Hagedorn K et al, " Characterization of all-terrain vehicle-related chest injury patterns in children" RSNA 2016.