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Influence of restraining devices on patterns of pediatric facial trauma in motor vehicle collisions
R X Murphy1, K L Birmingham, W J Okunski
1Department of Surgery, Lehigh Valley Hosptal, Allentown, PA, USA. robert.murphy@lvh.com
Insights
Many children in Pennsylvania motor vehicle collisions were unrestrained, despite laws. Facial fractures increased with age, particularly in older, unrestrained children, highlighting a critical safety gap.
Area of Science:
- Pediatric Trauma
- Public Health
- Injury Prevention
Background:
- Pennsylvania law mandates car seats for children under 4 and seatbelts for front-seat passengers.
- Child passenger safety remains a significant public health concern, with varying adherence to safety regulations.
- Facial injuries are common in pediatric motor vehicle collisions (MVCs).
Purpose of the Study:
- To investigate the association between the use of child restraints and facial injury patterns in pediatric MVC survivors.
- To analyze the impact of age on the incidence of facial fractures in children involved in MVCs.
- To evaluate the effectiveness of current child passenger safety legislation in preventing facial injuries.
Main Methods:
- Retrospective analysis of 412 pediatric patients (≤15 years) from the Pennsylvania Trauma Outcome Study database (1990-1995).
- Data collected on facial injuries (fractures, lacerations) and restraint use (car seat, seatbelt).
- Statistical analysis using chi-square and Fisher's exact tests to determine significance.
Main Results:
- Only 17 children used car seats, and 121 used seatbelts out of 412 pediatric MVC patients.
- 30 children sustained facial fractures, and 50 had facial lacerations.
- Facial fracture incidence significantly increased with age (p < 0.001); older children (5-15 years) were more likely to be unrestrained and sustain fractures.
Conclusions:
- A high percentage of pediatric MVC patients were unrestrained, indicating poor compliance with safety laws.
- Age is a significant factor in the severity of facial injuries, with older children facing higher risks.
- Enhanced enforcement and education are crucial to improve restraint use and reduce pediatric facial injuries in MVCs.
Abstract:
In the Commonwealth of Pennsylvania, it is required that all children under the age of 4 years be restrained by an infant seat or car seat appropriate for their age and weight. Furthermore, all individuals riding in the front seat must be restrained by a seatbelt. This study examined the relationship between patterns of facial injuries and the use of restraining devices in the pediatric population. A retrospective analysis was performed on motor vehicle collision data submitted to the Pennsylvania Trauma Outcome Study database from 1990 through 1995. Criteria for submission included trauma patients who were admitted to the Intensive Care Unit, those who died during hospitalization, those who were hospitalized for more than 72 hours, or those who were transferred in or out of the receiving hospital. A subset of 412 pediatric patients, 15 years of age or younger, was analyzed for patterns of facial injury and the presence or absence of restraining devices. Restraining devices were categorized as a car seat or a seatbelt. Statistical analysis was performed using chi-square and Fisher's exact tests. Of the 412 pediatric patients, only 17 children were restrained with a car seat and 121 were wearing a seatbelt. A total of 30 children sustained facial fractures, and 50 children suffered facial lacerations. There was a statistically significant increase in the incidence of facial fractures with increasing age of the child (p < 0.001). Of children with facial fractures, 70 percent of those 5 to 12 years old and 90 percent of those 13 to 15 years old were unrestrained (p = 0.166). In conclusion, despite legislation mandating the use of restraints, a large proportion of children involved in motor vehicle collisions were unrestrained. Furthermore, there seems to be a direct relationship between the age of a child and the incidence of facial fractures sustained in motor vehicle collisions.
