Statement of purpose Increasingly popular, all-terrain vehicles (ATVs) continue to injure children disproportionately. This study examines ATV injuries in children who present to emergency departments (ED) in the US.

Methods/approach We studied 2009–2011 data from the HCUP Nationwide Emergency Department Sample (NEDS). The NEDS is the largest, all-payer ED database in the US and is comprised of a 20% stratified sample of hospital-based ED visits from over 950 hospitals in 30 states. NEDS can be used to generate national estimates, with weighted data representing approximately 130 million discharges annually. ATV-related injuries occurring in children <18 years of age were included. Demographics, ED disposition, and charges were examined.

Results A total 94,906 ATV-related ED visits were identified, occurring at a rate of 42.5/100,000 annually in children <18 years. 79.1 percent of these were <16 years, for whom ATV use is not generally recommended with a rate of 37.9 visits/ 100,000 annually. Out of all the visits, 92.6% were treated and released, 7.3% were admitted and 0.1% died in the ED. Males were over represented with 66.3%,56.8% had private insurance, 7.4% were uninsured and 32% received Medicaid. Majority reside in urban areas (58.3%), with 41.7% living in rural communities. There was a 9% decline from a 2009 rate of 46.7/100,000 and 34,659 ED visits (Confidence Interval [CI]: 31,742, 37,576) to a 2011 rate of 38.3/100,000 and 28,636 visits (CI: 26241, 31,032). ED visits were highest among the 15–17 year olds at 83/100,000; for 10–14 year olds, rates were at 65.3/100,000. While average charges per visit were $2,421, aggregate charges were $205 million.

Conclusions Despite a recent decline, ATV-related ED utilisation still accounts for substantial medical charges. These data are consistent with other studies but provide additional data on cost and injury burden.