Understanding risk factor patterns in ATV fatalities: A recursive partitioning approach.

INTRODUCTION Although there are hundreds of ATV-related deaths each year in the United States, contributing factors have not been clearly identified. The purpose of this study was to investigate associations between factors contributing to ATV fatalities using the agent-host-environment epidemiological triangle. METHOD Incident reports of ATV fatalities occurring between 2011 and 2013 were obtained from the United States Consumer Product Safety Commission (CPSC). Narrative reports included details of the decedent and a description of the ATV crash. A chi-square automatic interaction detector (CHAID) analysis was performed for three major risk factors representing each facet of the epidemiologic triangle: helmet use (host), type of crash (agent), and location where death occurred (environment). The output of the CHAID analysis is a classification tree that models the relationship between the predictor variables and a single outcome variable. RESULTS A total of 1193 ATV fatalities were reported to the CPSC during the 3-year study period. In cases with known helmet and/or drug and alcohol use status, descriptive statistics indicated helmets were not worn in 88% of fatalities and use of alcohol or drugs was present in 84% of fatalities. Reoccurring factors within the CHAID analysis included age, helmet use, geographic region of the country, and location (e.g., farm, street, home, etc.) at the time of death. Within the three CHAID models, there were seven significant partitions related to host, one related to agent, and eight related to the environment. CONCLUSIONS This research provides a model for understanding the relationship between risk factors and fatalities. The combination of the CHAID analysis method and the epidemiologic triangle allows for visualization of the interaction between host-agent-environment factors and fatalities. PRACTICAL APPLICATIONS By modeling and characterizing risk factors associated with ATV fatalities, future work can focus on developing solutions targeted to specific factions of ATV users.

[1]  Guohua Li,et al.  Effects of minimum legal drinking age on alcohol and marijuana use: evidence from toxicological testing data for fatally injured drivers aged 16 to 25 years , 2015, Injury Epidemiology.

[2]  Stephan Milosavljevic,et al.  All terrain vehicle loss of control events in agriculture: Contribution of pitch, roll and velocity , 2010, Ergonomics.

[3]  Bruce A. Lawrence,et al.  ATV and Bicycle Deaths and Associated Costs in the United States, 2000–2005 , 2009, Public health reports.

[4]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[5]  James C. Helmkamp,et al.  ATV Deaths Among Older Adults in West Virginia: Evidence Suggesting that “60 is the New 40!” , 2009, Southern medical journal.

[6]  Joan M Mazur,et al.  Cost Effectiveness of Wearing Head Protection on All-Terrain Vehicles , 2009, Journal of agromedicine.

[7]  C. Finch,et al.  From monocausality to systems thinking: a complementary and alternative conceptual approach for better understanding the development and prevention of sports injury , 2015, Injury Epidemiology.

[8]  J. Helmkamp.  All-terrain vehicle-related deaths among the West Virginia elderly, 1985 to 1998. , 1999, American journal of public health.

[9]  Michael H Catenacci,et al.  Changes in the epidemiology of all-terrain vehicle accidents. , 2009, Southern medical journal.

[10]  C. Runyan.  Introduction: back to the future--revisiting Haddon's conceptualization of injury epidemiology and prevention. , 2003, Epidemiologic reviews.

[11]  Elizabeth Stranges,et al.  Emergency Department Visits and Inpatient Hospital Stays for All-Terrain-Vehicle-Related Injuries, 2009 , 2012 .

[12]  M. Mazis,et al.  Informing Buyers of Risks: Analysis of the Marketing and Regulation of All Terrain Vehicles , 1996 .

[13]  G B Rodgers,et al.  Risk factors for all-terrain vehicle injuries: a national case-control study. , 2001, American journal of epidemiology.

[14]  E Michael Goldcamp,et al.  Nonfatal all-terrain vehicle-related injuries to youths living on farms in the United States, 2001. , 2006, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[15]  Gregory B Rodgers,et al.  Factors associated with the all-terrain vehicle mortality rate in the United States: an analysis of state-level data. , 2008, Accident; analysis and prevention.

[16]  J C Helmkamp,et al.  Occupational all-terrain vehicle deaths among workers 18 years and older in the United States, 1992-2007. , 2011, Journal of agricultural safety and health.

[17]  A. McIntosh,et al.  Reducing all terrain vehicle injuries (ATVs) and deaths: a way ahead , 2013 .

[18]  Mary E Aitken,et al.  State-Specific ATV-Related Fatality Rates: An Update in the New Millennium , 2012, Public health reports.

[19]  W. Haddon.  The changing approach to the epidemiology, prevention, and amelioration of trauma: the transition to approaches etiologically rather than descriptively based. , 1968, American journal of public health and the nation's health.

[20]  J. Tallon,et al.  Major injury associated with all-terrain vehicle use in Nova Scotia: a 5-year review. , 2002, CJEM.

[21]  C. Simons,et al.  Current helmet and protective equipment usage among previously injured ATV and motorcycle riders , 2004, Injury Prevention.

[22]  Dale Steinhardt,et al.  All-terrain vehicle crashes and associated injuries in north Queensland: findings from the Rural and Remote Road Safety Study. , 2009, The Australian journal of rural health.

[23]  John Nyland,et al.  Risk factors and musculoskeletal injuries associated with all-terrain vehicle accidents. , 2009, The Journal of emergency medicine.