Children at Risk for Serious Head and Leg Injuries in ATV Crashes, Say UAMS/ACH Researchers

By Jon Parham

The study, believed to be the largest study of ATV injuries in children, was published in the July issue of Pediatric Radiology. It showed injuries to the head and/or extremities accounted for more than 80 percent of the injuries to 512 children hurt in ATV accidents that were treated at UAMS-affiliate Arkansas Children’s Hospital (ACH).

Documented over a 10-year period from 1998-2007, the odds that an injury to an extremity would cause long-term disability were almost the same as for a head injury, reported the research team of radiologists and a trauma program coordinator.

While head injuries occurred in 48 percent of the injuries, 34 percent had injuries to the arms and legs, followed by torso organ injuries (19 percent) and spine fractures (4.5 percent). Children with head injuries were calculated to be 3.4 times more likely to be killed or suffer a long-term disability than those with no head injury while those with leg fractures were 3.3 times more likely to be killed or suffer a long-term disability.

“Wearing a helmet while riding an ATV has been shown to reduce serious head injuries. Injuries to the legs, arms or spine can lead to permanent disabilities or disfigurement just as a head injury could, and a helmet won’t protect the spine or legs,” said lead author Chetan C. Shah, MD, MBA, a radiologist for the Department of Radiology in the UAMS College of Medicine and the ACH Department of Pediatric Radiology. “My best advice to parents is to not allow a child under 16 to ride an ATV.”

ATV-related injuries in children in the United States have been increasing. More than a quarter of the 150,990 emergency room visits for ATV-related injuries in 2007 were by children younger than 16, according to the U.S. Consumer Product Safety Commission. A previous government report showed a 94 percent increase in ATV-related injuries in children between 1993 and 2001. The researchers noted that ATV injuries are the third most common cause of injury resulting in hospital admission at ACH.

For the study, researchers reviewed patient records and images of the injuries, including computed tomography (CT) and magnetic resonance imaging (MRI) scans. The injuries were categorized by location and severity. Outcomes were classified as complete recovery, short-term disability, long-term disability that required follow-up visits after six months, death, or no follow-up available.

Of the 512 cases, six children (1.2 percent) died from their injuries. Twenty-eight percent had a long-term disability while 46 percent had a short-term disability.

While serious and life-threatening injuries can occur with head and spinal injuries – including brain injuries, skull fractures or paralysis – Shah said he was most surprised at the unique pattern of serious foot injuries. Though leg injuries were more common than foot injuries, foot injuries were more likely to cause long-term disability.

Sixty percent of the 18 foot injuries recorded as part of 172 injuries to the arms and/or legs resulted in long-term disability, including nine partial foot amputations. This is compared to the 30 percent and 40 percent of the more common injuries to the leg bones.

An X-ray printed in the study showed the right foot of a 27-month old girl who was put on a child-sized ATV and accidentally hit the throttle. When she fell off, her right foot caught on the chain wheel, amputating all five toes.

Leg injuries in children can leave them particularly susceptible to long-term disability, Shah said, since the child’s bones are still growing.

“When the growth plate in the bone is injured, that leg may not grow as much as the other leg,” Shah said. “This could lead to a permanent limp and affect the child’s ability to participate in some activities, including sports.”

The data showed boys accounted for 68 percent of the ATV injuries. The average age of injured girls (10.7) was younger than boys (12). The injured child was usually the driver (73 percent) instead of a passenger on the ATV. However, both drivers and passengers were equally likely to suffer long-term disability.

According to current state law, a person under 12 may not operate an ATV unless with a person 18 or older, or on a parent’s land or with the permission of the land owner. (

The American Academy of Pediatrics and the American Academy of Orthopedic Surgeons have recommended legislation in all states to prohibit the use of ATVs by children younger than 16.

Joining Shah in the study were Raghu H. Ramakrishnaiah, M.D., an instructor in the Department of Radiology; Sadaf T. Bhutta, M.D., an assistant professor of radiology in the UAMS College of Medicine; Donna N. Parnell-Beasley, R.N., ACH trauma program coordinator; and S. Bruce Greenberg, M.D., a professor of radiology and pediatrics in the UAMS College of Medicine, who mentored Shah.

The Injury Prevention Center, a partnership between Arkansas Children’s Hospital and the University of Arkansas for Medical Sciences, is the only multi-faceted injury prevention program in Arkansas. Its mission is to reduce child injury, death and disability in Arkansas through service, education, innovative research and advocacy.  Key areas of focus include teen driving, all-terrain vehicle safety, car passenger seat safety, water safety, home safety, pedestrian safety and bike safety. The center’s team of experts works with partners throughout the state to educate families on effective prevention strategies, reinforcing the fact that it only takes only a moment to lose your life due to an injury, but it also only takes a moment to practice safety and prevention. For more information on the Injury Prevention Center at ACH and UAMS, call (501) 364-3400 or visit