Background All-terrain vehicle (ATV) crashes have long been recognised as a public health concern, with >800 deaths and more than 400,000 injuries each year in the U.S. alone. Recreational off-highway vehicles (ROVs) have more recently been growing in popularity, but little is currently known about the impact of their use. Our objective was to determine the epidemiology, mechanisms and risk factors for ROV crashes and injuries.

Methods Descriptive and comparative analyses were performed using data from the Consumer Product Safety Commission ROV database (2003–2011).

Results The database contained 428 crashes (899 occupants). Occupants were 68% male, 31% < 16 years old, and 52% passengers. Five percent of occupants were helmeted and 27% were restrained. Half of the operators were positive for alcohol and 9% for drugs. For crashes, 53% were on roads, 12% were occupational, and 63% occurred at speeds <20 mph. The primary crash mechanism was a non-collision event, predominately rollovers with 95% being sideway rollovers and 81% of sideway rollovers occurring during a turn. Many crashes occurred on dry surfaces (84%), in good weather (94%), and/or on flat surfaces (63%) or gentle slopes (15%). For injuries, 22% were moderate to severe and 36% were fatal. Fifteen percent of occupants were partially ejected and 51% were fully ejected. Fatal crashes were 4 times more likely to involve an operator’s death than a passenger’s, rollovers increased the odds of being ejected by 13-fold, and both ejection and being pinned by the vehicle increased the likelihood of death by over 10-fold and 20-fold, respectively.

Conclusions These data provide important insights into ROV use and related crashes. Although likely to be more stable than ATVs, ROV rollovers, including at low speeds, appear to be the major crash mechanism, most often in a turn. Being unrestrained in a rollover with subsequent ejection and pinning by the ROV were the most significant risk factors for severe injury and death.