Rate and Outcomes of TBI among Patients with ATV-Related Injuries: A Hospital-Based Non-Concurrent Cohort Study

Abstract

Objective: The growing use of all-terrain vehicles (ATVs) has resulted in a rise in traumatic injuries, particularly traumatic brain injury (TBI) cases. This study estimated the TBI rate and its association with hospital outcomes among ATV-related admissions at the Puerto Rico Trauma Hospital (PRTH). Methods: This IRB-approved non-concurrent cohort study of ATV-related admissions at the PRTH from 2000 to 2022 categorized patients based on admission Glasgow Coma Scale (GCS) scores into TBI (GCS 3-12) and non-TBI (GCS 13-15) groups. We evaluated sociodemographic characteristics, injury profiles, and hospital outcomes using Pearson’s chi-square test, Wilcoxon rank-sum test, and regression models. Results: Among 581 patients with ATV-related admissions, 80% were men in their mid twenties. The TBI rate was 33.7%. Although ATV-related hospitalizations declined significantly over time, the TBI rate showed a weak, non-significant upward trend. ATV-related patients with TBI faced significantly higher risk of in-hospital mortality (ARR: 11.71; 95%-CI: 4.41-31.08), post-discharge care facility admissions (AOR: 4.01; 95%-CI: 1.42-11.37), and longer hospitalizations (AIRR: 1.57; 95%-CI: 1.28 1.94). Additionally, adjusted predicted mean hospital costs were significantly higher for TBI patients than non-TBI patients ($65,925 vs. $26,793; p=0.009). Conclusion: ATV-related admissions frequently involve TBIs, characterized by more severe injuries, significant in hospital mortality risk, longer hospitalization, elevated hospital costs, and required post-discharge care. These findings highlight the need for targeted clinical care and preventive strategies to mitigate the frequency and severity of TBIs in ATV-related trauma.