{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T18:05:58Z","timestamp":1784138758668,"version":"3.55.0"},"reference-count":21,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2026,7,7]]},"abstract":"\n Background<\/jats:title>\n Effective 1 July 2022, the state of Iowa enacted House File 2130, authorising the use of All-Terrain and Utility Task Vehicles (ATV\/UTV) on secondary roadways and state highways. Widely recognised safety guidelines identify roadway operation on both paved and unpaved surfaces as a significant risk factor for injuries and fatalities. We hypothesised that this legislation would be associated with increased ATV\/UTV-related trauma, greater injury severity and worse clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective study reviewed ATV\/UTV crashes reported by the Department of Transportation, admissions for crash-related injuries at a level 1 trauma centre and statewide hospital admissions from 1 January 2020 to 31 December 2024. Crash counts and circumstances were analysed. Demographics, comorbidities, substance use, injury characteristics, hospital course, complications and hospitalisation costs were collected and compared pre and post-legislation. A p<0.05 was considered significant.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n There were 241 crashes prelegislation and 339 postlegislation, a 40.7% increase. Crashes on concrete surfaces (61.1% vs 48.5%; p=0.004) and state routes (7.1% vs 1.7%; p=0.047) rose significantly. Fatal crashes doubled postlegislation (11.8% vs 6.2%; p=0.008). Trauma centre admissions increased by 11%. Abdominal (26.1% vs 12.9%; p=0.001), chest (37.7% vs 27.4%; p=0.032) and upper extremity injuries (67.6% vs 45.2%; p<0.001) also rose. Unplanned reoperations and intensive care unit admissions increased to 7.2% from 0.5% (p<0.001). Adjusted hospitalisation costs rose (US$50 820 vs US$38 021; p<0.011).<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Implementation of House File-2130 was associated with increased ATV\/UTV crashes, more severe injuries, higher mortality, greater need for unplanned interventions and elevated hospitalisation costs.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Prospective, multicentre studies and real-time surveillance systems would further strengthen evaluation of the public health impact of legislative changes and guide evidence-based policy development.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/ip-2026-046243","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:25:27Z","timestamp":1784136327000},"page":"ip-2026-046243","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Price to pay for freedom to ride: deregulation of All-Terrain and Utility Task Vehicles operation is associated with increased crashes and healthcare costs in Iowa, USA \u2013 a retrospective cohort study"],"prefix":"10.1136","author":[{"given":"Luke","family":"Vaske","sequence":"first","affiliation":[{"name":"Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadaf","family":"Akbari","sequence":"additional","affiliation":[{"name":"Acute Care Surgery Division, Department of Surgery, The University of Iowa, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5931-2143","authenticated-orcid":false,"given":"Colette","family":"Galet","sequence":"additional","affiliation":[{"name":"Acute Care Surgery Division, Department of Surgery, The University of Iowa, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Mcgonagill","sequence":"additional","affiliation":[{"name":"Acute Care Surgery Division, Department of Surgery, The University of Iowa, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionne A","family":"Skeete","sequence":"additional","affiliation":[{"name":"Acute Care Surgery Division, Department of Surgery, The University of Iowa, Iowa City, Iowa, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026071510251601000_ip-2026-046243v1.1","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-059279","article-title":"American Academy of Pediatrics Recommendations for the Prevention of Pediatric ATV-Related Deaths and Injuries","volume":"150","author":"Jennissen","year":"2022","journal-title":"Pediatrics"},{"key":"2026071510251601000_ip-2026-046243v1.2","unstructured":"Zhang C . 2024 report of deaths and injuries involving off-highway vehicles with more than two wheels. 2025."},{"key":"2026071510251601000_ip-2026-046243v1.3","unstructured":"Polaris . Owner\u2019s manual. 2025."},{"key":"2026071510251601000_ip-2026-046243v1.4","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.jemermed.2022.02.005","article-title":"All-Terrain Vehicle-Related Emergency Department Visits: Interaction of Sex and Age, NEISS, 2019","volume":"62","author":"Wiener","year":"2022","journal-title":"J Emerg Med"},{"key":"2026071510251601000_ip-2026-046243v1.5","unstructured":"Statista . Share of Americans who own an ATV (all-terrain vehicle) in 2018, by age, 2018. Available: https:\/\/www.statista.com\/statistics\/228874\/people-living-in-households-that-own-an-atv-all-terrain-vehicle-usa"},{"key":"2026071510251601000_ip-2026-046243v1.6","doi-asserted-by":"crossref","DOI":"10.2196\/15477","article-title":"Assessing the Emergent Public Health Concern of All-Terrain Vehicle Injuries in Rural and Agricultural Environments: Initial Review of Available National Datasets in the United States","volume":"6","author":"Weichelt","year":"2020","journal-title":"JMIR Public Health Surveill"},{"key":"2026071510251601000_ip-2026-046243v1.7","unstructured":"Huber B . Despite high death toll, push is on to open more public roads to ATVs. 2014. Available: http:\/\/www.fairwarning.org\/2014\/03\/despite-high-death-toll-push-ison-to-open-more-public-roads-to-atvs\/ [Accessed 6 Nov 2025]."},{"key":"2026071510251601000_ip-2026-046243v1.8","doi-asserted-by":"publisher","DOI":"10.1080\/15389588.2012.675110"},{"key":"2026071510251601000_ip-2026-046243v1.9","unstructured":"Reynolds K . House File 2130, an act relating to registered all-terrain vehicles and off-road utility vehicles, and making penalties applicable. Eighty-Ninth General Assembly 2022."},{"key":"2026071510251601000_ip-2026-046243v1.10","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1016\/j.injury.2018.08.018","article-title":"Upper extremity injuries associated with all terrain vehicle accidents: A multicenter experience and case review","volume":"49","author":"Reid","year":"2018","journal-title":"Injury"},{"key":"2026071510251601000_ip-2026-046243v1.11","first-page":"225","article-title":"Orthopaedic Injuries from All-Terrain Vehicles: An Epidemiological Account and Review of Legislation","volume":"32","author":"Sandler","year":"2023","journal-title":"J Surg Orthop Adv"},{"key":"2026071510251601000_ip-2026-046243v1.12","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.ijscr.2012.01.012","article-title":"Spectrum of all-terrain vehicle injuries in adults: A case series and review of the literature","volume":"3","author":"Concannon","year":"2012","journal-title":"Int J Surg Case Rep"},{"key":"2026071510251601000_ip-2026-046243v1.13","doi-asserted-by":"crossref","first-page":"219","DOI":"10.5435\/00124635-201104000-00006","article-title":"Orthopaedic aspects of all-terrain vehicle-related injury","volume":"19","author":"Sawyer","year":"2011","journal-title":"J Am Acad Orthop Surg"},{"key":"2026071510251601000_ip-2026-046243v1.14","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1007\/s00247-009-1213-x","article-title":"Imaging findings in 512 children following all-terrain vehicle injuries","volume":"39","author":"Shah","year":"2009","journal-title":"Pediatr Radiol"},{"key":"2026071510251601000_ip-2026-046243v1.15","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000229814.08289.9a"},{"key":"2026071510251601000_ip-2026-046243v1.16","unstructured":"Transportation, I.D.o. Available: https:\/\/icat.iowadot.gov\/ [Accessed 1 Jun 2025]."},{"key":"2026071510251601000_ip-2026-046243v1.17","doi-asserted-by":"crossref","DOI":"10.1186\/s40621-024-00516-2","article-title":"The association between county ordinances allowing off-road vehicles on public roads and crash rates","volume":"11","author":"Monson","year":"2024","journal-title":"Inj Epidemiol"},{"key":"2026071510251601000_ip-2026-046243v1.18","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1080\/15389588.2015.1057280","article-title":"All-terrain vehicle fatalities on paved roads, unpaved roads, and off-road: Evidence for informed roadway safety warnings and legislation","volume":"17","author":"Denning","year":"2016","journal-title":"Traffic Inj Prev"},{"key":"2026071510251601000_ip-2026-046243v1.19","doi-asserted-by":"crossref","DOI":"10.1016\/j.focus.2025.100335","article-title":"An Analysis of ATV and UTV-Related Injuries Pre- and Post-Enactment of West Virginia Senate Bill 690","volume":"4","author":"Rudisill","year":"2025","journal-title":"AJPM Focus"},{"key":"2026071510251601000_ip-2026-046243v1.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsr.2014.05.001"},{"key":"2026071510251601000_ip-2026-046243v1.21","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.aott.2017.06.003","article-title":"Pediatric all-terrain vehicle (ATV) injuries: An epidemic of cost and grief","volume":"51","author":"Strohecker","year":"2017","journal-title":"Acta Orthop Traumatol Turc"}],"container-title":["Injury Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ip-2026-046243","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:25:31Z","timestamp":1784136331000},"score":1,"resource":{"primary":{"URL":"https:\/\/injuryprevention.bmj.com\/lookup\/doi\/10.1136\/ip-2026-046243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":21,"alternative-id":["10.1136\/ip-2026-046243"],"URL":"https:\/\/doi.org\/10.1136\/ip-2026-046243","relation":{},"ISSN":["1353-8047","1475-5785"],"issn-type":[{"value":"1353-8047","type":"print"},{"value":"1475-5785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]}}}