Our purpose is to identify injury patterns in children suffering all-terrain vehicle (ATV) accidents & correlate with outcome.

455 consecutive children following ATV accidents admitted to a tertiary care pediatric hospital had medical records and all imaging studies reviewed. Children mean age was 11.4 years (SD 4.3 yr) and included 318 males and 137 females. χ2 was used for statistical analysis.

Head injuries detected by CT or MRI included: skull fractures 77, extra axial hemorrhage 62 & brain injuries 53. Skull fractures, extra axial hemorrhage & brain injuries were all associated (p<.01). 5 of the 6 fatalities had head injuries. Orbit fractures detected by CT were present in 40 children and associated with brain injury (p<.05). Non-orbit facial fractures were not associated with brain injury (p<.2). Spinal cord injuries were present in 3 of 12 children with spine fractures. Spinal cord injuries were present in 2 children without a fracture. The lung was the most frequently injured torso organ with pulmonary contusions present in 32 children. Hemo/pneumothorax & chest wall fractures were associated with chest contusions (p<.001). Three children with pulmonary contusions & pneumothoraces died. Abdomen organs with contusions included: spleen 23, liver 21, kidneys 12 & pancreas 8. Multiorgan torso injuries were common (e.g. 23 spleen contusion patients had associated injuries in: chest 9, kidneys 5, pancreas 3 & liver 2). Extremity fractures occurred in 159 children with the most common locations being the femur 55 & leg bones 51. Lower extremity fractures were associated with long term disability (p<.025). There were 11 amputations including 9 partial foot amputations.

Head, torso & extremity injuries are common in children suffering ATV injuries. Cranial & orbit fractures are associated with brain injuries & extra axial hemorrhage. Torso injuries frequently involve multiple organs. Extremity fractures are the most common radiographic detected injuries & lower extremity fractures are associated with long term disability.

This is the largest series of imaging findings in children suffering ATV injuries & shows the spectrum of injuries and important associations.