Factors Affecting Neurological Presentation and Severity in Pediatric Off-Highway Vehicle Accidents in Texas

Objectives The purpose was to evaluate the characteristics of off-highway vehicle (OHV) crashes correlated with neurological injury and accident severity in the pediatric population in El Paso, Texas. Methods A retrospective review of 213 patients who were victims of an OHV crash attended at a regional Level I trauma center from 2012 to 2020 was performed. OHVs were defined as vehicles designated for use outside public roads. Neurological outcomes included any traumatic brain injury (TBI) or a brain hemorrhage/hematoma. Severe injury was defined as a Glasgow Coma Scale less than 8, a length of stay longer than 7 days, a Pediatric Trauma Score lower than 8, and requiring pediatric intensive care unit admission. Bivariate and multivariate analyses by logistic regression models were conducted to determine the factors related to the neurological outcomes and accident severity. Results Of 213 OHV crash patients, 104 (48.8%) had TBI and 22 (10.3%) had brain hemorrhages or hematomas. Risk analyses demonstrated that children younger than age 6 years and occupants of recreational OHVs have a significantly higher risk of severe injuries. Off-highway motorcycles and all-terrain vehicles were risk factors for TBI, whereas helmets were a protective factor. Conclusions OHVs are associated with both TBIs and severe injuries. Stricter laws requiring helmets and forbidding children younger than 6 to ride are required, as modifying these factors could reduce the incidence of OHV crashes and their complications.