The growing popularity of all-terrain vehicles (ATVs) has contributed to a rise in the number of injuries and fatalities nationwide. The Consumer Product Safety Commission reported 8,104 fatalities from 1982 to 2006 and over 146,600 emergency room-treated visits in 2006 with children 16 years of age and younger comprising roughly 29 per cent in both categories. To investigate the epidemiology and outcome of ATV-related injuries and to explore variables contributing to morbidity and mortality, we conducted a single-center, retrospective study of ATV-injured patients presenting to trauma emergency between 2003 and 2007 at a Level II trauma center. In summary, we witnessed an upward trend in the incidence of ATV injuries during this 5-year span. With 156 documented cases, adolescents aged 17 to 20 years represented the largest group (19.2%), whereas children 16 years of age and younger contributed to 12.8 per cent. Overall mortality rate was 0.64 per cent. Positive blood alcohol concentration was detected in 21 per cent. Individuals using protective gear were 1.4 and four times less likely to suffer loss of consciousness and Glasgow Coma Scale score 8 or less, respectively, compared with those without protection. Abrasions, concussions, fractures, and other life-threatening solid organ injuries were documented in virtually every organ system. With such poor outcomes, we conclude that riding an ATV is an inherently dangerous activity. To minimize the burden of injury, riders are encouraged to develop competency through training courses, compliance with safety precautions, and modification of high-risk behaviors.