Statement of purpose Head trauma is the leading cause of death and serious injury from all-terrain vehicle (ATV) crashes. The study objective was to better understand the relationship between speed and ATV crash-related brain injuries.

Methods/approach A retrospective chart review and analysis was performed of trauma registry patients with ATV-related injuries at the University of Iowa Hospitals and Clinics from 2002–2013.

Results 560 cases were identified; 77% were male and 32% were children <18 years of age. Rollovers (45%) were most common, followed by striking an object (22%) and ejection/fall (13%). Collisions with a motorised vehicle occurred in 8% of patients. Speeds >20 mph were associated with higher Max Head Abbreviated Injury Scale (AIS) scores than those ≤20 mph (p = 0.05). Crashes with speeds >30 mph had higher Max Head AIS scores than those ≤30 mph (p = 0.014). Higher speeds were also associated with a trend towards lower patient Glasgow Coma Scale (GCS) scores. Only about 20% of victims overall were wearing a helmet. Competitive racers, although helmeted, had more severe head injuries than all other victims. Competitive racers had lower GCS scores than their helmeted non-racing peers (p < 0.05). Non-racers without helmets had lower GCS scores than their helmeted peers (p = 0.003).

Conclusions Higher speed appears associated with greater head injury risk in ATV crashes. Although helmets are protective, there may be ATV crash speeds or mechanisms of brain injury at higher speeds that reduce helmet effectiveness.

Significance and contributions This study suggests that the present maximum speed limitations for many youth size ATVs (30 mph) is not safe and puts the child at increased risk for head injury. All ATVs should have a code-protected, tamper-proof speed governor. This would particularly assist parents and employers in protecting youth and employees from the serious risks associated with high operating speeds.