Research articleFatal All-Terrain Vehicle Crashes: Injury Types and Alcohol Use
Introduction
Historically, among all states West Virginia has had the highest population-based mortality rate (0.70 deaths per 100,000 population) resulting from all-terrain vehicle (ATV) incidents, and an overall rate approximately eight times higher than the national rate.1, 2 Age, gender, ethnicity, education, and the rural nature of a state were implicated as important contributors to observed rate differences.2 To curtail these preventable deaths, West Virginia enacted its first ATV legislation in 2004.3 The primary provisions of the law prohibit ATV operation on public roads with a center line or more than two lanes except for the purpose of crossing and require helmet use and training for ATV riders aged <18 years.
Overall, the law does not yet appear to have had an impact in reducing ATV mortality. In fact, the average number of deaths increased from 24 per year during 2000–2003 to 41 per year during 2004–2006. In a recent analysis of West Virginia ATV deaths during 1999–2006, the mortality rate had more than doubled that of the 1990s, rising to 1.5 deaths per 100,000 population.4 That study also concluded that adolescence, the operation of ATVs in traffic, lower economic status, a lower level of education, and single marital status were associated with significantly higher rates. During that 8-year period, West Virginia accounted for >5% of all ATV-related deaths reported to the U.S. Consumer Product Safety Commission but for <0.5% of the U.S. population.5
Further evaluation of ATV crash circumstances and risk factors is needed to identify weaknesses in the initial West Virginia ATV legislation and to support future prevention efforts. Objectives of this study were to describe the types of injuries resulting in death as a function of traffic versus nontraffic ATV crashes from 2004 to 2006. Also evaluated were alcohol and drug use patterns as well as helmet use after enactment of the law.
Section snippets
Case Identification and Data Sources
In 2007, cases were identified by searching the electronic database of vital records at the Health Statistics Center of the West Virginia Department of Health and Human Resources for 2004–2006 death certificates with ICD-10 codes correlating to occupants of an ATV who were injured during traffic or nontraffic crashes (i.e., V86.0, V86.1, V86.3, V86.5, V86.6, and V86.9).6 Traffic crashes were defined as those occurring on a public highway, while nontraffic crashes were those occurring entirely
Crash Circumstances
A total of 112 decedents met the case definition. Boys and men accounted for 101 (90.2%) of all fatalities. The age range was 8–88 years (mean=35 years, median=29 years). Among all decedents, 54 (48.2%) were involved in traffic crashes. Traffic crashes were more common among people aged <30 years, with a trend of significantly reduced percentage of traffic fatalities occurring among successively older age groups (p=0.01). Nearly all (92%) decedents were the ATV operator, regardless of whether
Discussion
Two distinct types of fatal ATV crashes were identified through this investigation. First, crashes occurring in traffic resulted primarily from collisions and were associated with fatal head injuries. Second, nontraffic crashes were most commonly caused by ATV rollover and were associated with fatal compression injuries of the thorax and abdomen. The strong correlation between rollover and fatal compression provides evidence that helmet use would not necessarily have afforded adequate
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