All-terrain vehicle-related central nervous system injuries in Oklahoma.
Determine the statewide, population-based incidence and epidemiology of all-terrain vehicle (ATV)-related severe central nervous system (CNS) injuries in Oklahoma. Hospitalized and fatal traumatic brain injuries and spinal cord injuries are reportable conditions in Oklahoma. Professionally trained staff reviewed all medical examiner and hospital medical records. From 1992 through 2002 there were 391 persons hospitalized (n=353) or died (n=38) from an ATV-related neurologic injury (average annual rate 1.1/100,000 population), including 369 traumatic brain injuries and 18 spinal cord injuries and 4 persons with both injuries. These accounted for 1% of total CNS injuries in Oklahoma. Forty-five percent of persons who died were under 16 years of age. An average of 23 ATV-related injuries per year occurred before 1998; the number of cases doubled in 1999 and 2000 (mean=46) and tripled in 2002 and 2003 (mean=69). Rates were highest among males 15-24 (4.1/100,000) and 5-14 (3.8/100,000) and among whites (1.2/100,000). Persons who collided with a stationary or moving object were significantly more likely to suffer a fatal traumatic brain injury than those in non-collision events (OR 3.0, 95% CI 1.4, 6.8). Rollover of the ATV occurred in 38% of ATV incidents, and in 28% of traumatic brain injury fatalities, it occurred without a preceding collision. ATV use can result in significant neurologic morbidity and mortality, especially among children and young adults. Heightened public awareness and parental education on the dangers of these vehicles is imperative. State legislation restricting the use of ATVs among children under the age of 16 years is recommended. Vehicle design changes such as lowering the center of gravity and installing rollover protective structures should be considered.