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Children in side-impact motor vehicle crashes: seating positions and injury mechanisms
Andrew Howard1, Linda Rothman, Alexandra Moses McKeag
1Hospital for Sick Children, Toronto, Canada. andrew.howard@sickkids.ca
Insights
Children in near-side car seats face higher risks of severe injury and fatality in side-impact crashes. The center seat offers statistically significant protection, especially for restrained children.
Area of Science:
- Pediatric injury biomechanics
- Automotive safety research
- Child occupant protection
Background:
- Side-impact car crashes pose significant risks to child occupants.
- Understanding injury mechanisms is crucial for improving child safety.
- The near-side seating position is a key area of concern.
Purpose of the Study:
- To describe injury mechanisms in children during side-impact collisions.
- To evaluate the specific dangers associated with near-side seating positions.
- To compare the safety of different seating positions for children.
Main Methods:
- Prospective study of children in severe car crashes in Canada.
- Retrospective analysis of Fatality Analysis Reporting System (FARS) data.
- Retrospective analysis of National Automotive Sampling System: Crashworthiness Data System (NASS CDS) data.
Main Results:
- Children in near-side positions sustained severe head, trunk, and limb injuries.
- Near-side occupants experienced higher injury severity scores (p = 0.024).
- Near-side seating significantly increased fatality risk (Fatality Risk Ratio 2.53 for restrained children).
Conclusions:
- Near-side seating is statistically less safe than center seating for children.
- Injuries can occur with or without compartment intrusion.
- Improving vehicle safety cages and utilizing inboard seating positions can enhance protection.
Background:
This study aimed to describe the injury mechanisms of children involved in side-impact car crashes, particularly as these relate to seating position, and to estimate the danger of the near-side seating position.
Methods:
A prospective two-center study of children involved in severe car crashes in Canada was conducted as well as a retrospective cohort study of children involved in crashes reported in the Fatality Analysis Reporting System (FARS) and the National Automotive Sampling System: Crashworthiness Data System (NASS CDS).
Results:
Children sitting at the side the car was struck (near-side position) sustained severe head, trunk, and limb injuries. Many of these injuries were attributable to direct intrusion, but some occurred without direct damage to the occupant compartment. Center-seat and far-side occupants had severe injuries only when unrestrained. Injury severity scores were higher for children seated on the near side, and this was statistically significant (p = 0.024) The analysis of Fatality Analysis Reporting System data showed that the risk of fatality was higher for children seated in the near-side position than for those in the center-seat position. The fatality risk ratio was 2.53 (95% confidence interval [CI], 2.08-3.07) for restrained children and 1.84 (95% CI, 1.57-2.17) for unrestrained children. Analysis of the NASS-CDS data showed that for restrained children, severe injury (ISS > or = 16) was more common among those on the near side (7 per 1,000 children) than among those in the center seat (2 per 1,000) or on the far-side seat (1 per 1,000) (p < 0.001).
Conclusions:
Severe injuries to near-side occupants occurred in both the presence and absence of compartment intrusion. A typical pattern of head, chest, and extremity injury similar to that seen among child pedestrians was observed among near-side child occupants in side-impact crashes. The center seat was statistically safer than the near-side seat, particularly for restrained child occupants. Scene information may be useful to trauma teams for the prediction of injury type and location. Avoiding intrusion and preventing the occupant from striking the vehicle wall are both important to side-impact protection for children. Improvement of the vehicle safety cage may protect against intrusion injuries. Seating two child occupants in inboard seating positions may provide additional protection against intrusion injuries, and also may protect against nonintrusion injuries.
