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Published on: September 21, 2017
Suboptimal restraint affects the pattern of abdominal injuries in children involved in motor vehicle crashes
Nicolas Lutz1, Kristy B Arbogast, Rebecca A Cornejo
1Department of Pediatric General and Thoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
Insights
Children using suboptimal restraints in car crashes are four times more likely to suffer hollow visceral injuries than solid visceral injuries. Proper restraint positioning is key to preventing these serious abdominal injuries.
Area of Science:
- Pediatric trauma
- Occupant protection
- Injury biomechanics
Background:
- Seat belt use in children involved in motor vehicle crashes is associated with both solid and hollow visceral abdominal injuries.
- The specific relationship between restraint types and abdominal injury patterns remains unclear.
Purpose of the Study:
- To investigate the association between restraint type and the pattern of abdominal injuries in children involved in motor vehicle crashes.
- To determine if optimal restraint use influences the likelihood of hollow versus solid visceral injuries.
Main Methods:
- A probability sample of 13,558 restrained children (aged 0-15) from 1998-2002 was analyzed.
- Data linked insurance claims, telephone surveys, and crash investigations.
- Injuries were categorized as hollow visceral (HV) or solid visceral based on AIS score (>=2), and restraints as optimal (OR) or suboptimal (S-OR).
Main Results:
- 78 children sustained significant abdominal injuries.
- Suboptimally restrained children had a significantly higher risk of hollow visceral injury (Odds Ratio, 4.14; P <.01) compared to optimally restrained children.
- Hollow visceral injuries occurred in 9 OR and 29 S-OR children; solid visceral injuries in 18 OR and 14 S-OR children.
Conclusions:
- Suboptimally restrained children were four times more likely to sustain hollow visceral injuries than solid visceral injuries compared to optimally restrained children.
- Improper restraint positioning may be a direct mechanism for hollow viscus injuries in pediatric motor vehicle crashes.
Background:
Both solid and hollow visceral abdominal injuries have been associated with the use of seat belts in children involved in motor vehicle crashes. The relationship between the types of restraint used and the pattern of abdominal injury is unknown.
Methods:
A probability sample of restrained children involved in crashes was enrolled in an ongoing crash surveillance system (1998 through 2002) linking insurance claims data to telephone survey and crash investigation data. Significant abdominal injuries were considered when the Abbreviated Injury Scale (AIS) score was > or =2 and were defined as hollow visceral (HV; intestine, bladder), or solid visceral (liver, spleen, pancreas, kidney). Restraint type was categorized as optimal restraint (OR) or suboptimal restraint (S-OR) based on the child's age and size.
Results:
For the 33 months of review, interviews were obtained for 13,558 restrained children aged 0 to 15 years, of which, 56% were OR (n = 7,591) and 44% were S-OR (n = 5,967). A significant abdominal injury was recorded in 78 children. A hollow visceral injury was recorded in 38 (9 OR and 29 S-OR), and a solid visceral injury in 32 (18 OR and 14 S-OR). Both hollow and solid visceral injuries were present in 8 children (2 OR and 6 S-OR). Suboptimally restrained children had a higher risk for hollow visceral injury when compared with optimally restrained children (Odds Ratio, 4.14 [95% Confidence Interval 1.33 to 13.22, P <.01]).
Conclusions:
Among restrained children with intraabdominal injuries, those who were suboptimally restrained were 4 times more likely to have a hollow visceral than a solid visceral injury when compared with those who were optimally restrained. This suggests that the mechanism of injury for hollow viscus may be directly related to the improper positioning of the restraint.
