Background/Aims Off-road motorcycles and quad-bikes are an important cause of paediatric injury and hospitalisation. A small subset of riders have multiple crashes and hospitalisations, which poses a significant burden on the individual and healthcare system. Our aim was to identify characteristics and differences between those injured only once and injury recidivists.

Methods A retrospective, cross-sectional study using linked data was performed of children 0–16 years in New South Wales, Australia, from 2001–2018, hospitalised due to injury from an off-road vehicle crash. Cox proportional hazard models were performed to estimate the hazard ratios for the likelihood of repeat hospital admissions.

Results Of the total 6624 hospitalisations, there were 202 repeated admissions in 184 patients, the recidivism rate was 3%. This included 24 repeat admissions from quad-bikes (in 23 patients) and 178 repeat admissions from motorcycles (in 161 patients). Males were more likely to be recidivists than females (HR:3.1, p<0.01). Both motorcycles and quad-bikes riders were more likely to be re-injured on the same vehicle type (motorcycle HR:2.4, p=0.003; quad-bike HR:4.2, p=<0.001). Living in remote or very remote areas was associated with increased risk of being admitted for a subsequent quad bike injury (HR:3.5, p=0.02). Other demographic factors, body region of injury, injury severity, or type of injury did not affect the likelihood of recidivism.

Conclusions Paediatric off-road riders are frequently re-injured on the same vehicle as their initial crash. A better understanding of the circumstances and contexts of these crashes may help to better target injury prevention counter-measures for recidivist riders.