Background/Aims Off-road vehicles are an important cause of paediatric injury and mortality. Our aim was to characterise and compare off-road motorcycle and quad-bike crashes in New South Wales, Australia.

Methods We undertook a retrospective, cross-sectional study using linked data for hospitalised children 0–16 years, from 2001–2018 following an injury sustained in an off-road motorcycle or quad-bike crash. Motorcycle and quad-bike injuries were compared regarding: demographics; incidence; body region injured and type of injury; injury severity; length of stay and mortality.

Results There were 6624 crashes resulting in hospitalisation; 5156 involving motorbikes (77.8%) and 1468 involving quad-bikes (22.2%). There were 10 fatalities (6 motorcycles, 4 quad-bikes). The rates of injury declined over the study period for motorcycles, but not for quad-bikes.

The limbs were the most commonly affected body region across the sample. Motorcycle riders were more likely than quad-bike riders to have lower limb injuries (OR 1.49, p<0.001) but less likely to have head/neck (OR 0.616, p<0.001), abdominal (OR 0.778, p=0.007) and thoracic (OR 0.745, p=0.003) injuries. Quad-bike crashes had higher injury severity (mean International Classification Injury Severity Score: 0.975 vs 0.977, p=0.03) and longer hospital stay (mean 2.42 days vs 2.09 days, p=0.01).

Conclusions There are significant differences between quad-bike and motorcycle crashes in injury type and affected body region. While quad-bike injuries in children were more severe, there were almost 4 times more hospitalisations from motorcycles overall. The overall larger burden of motorcycle crashes suggests a greater focus of injury prevention countermeasures for two-wheeled riders is needed.