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Patterns of severe injury in pediatric car crash victims: Crash Injury Research Engineering Network database
J Kristine Brown1, Yuezhou Jing, Stewart Wang
1Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
Insights
Children in lateral crashes face higher risks of severe head and chest injuries. Front-seat positions increase thoracic, abdominal, pelvic, and orthopedic injuries in motor vehicle crashes (MVCs).
Area of Science:
- Pediatric Trauma Research
- Injury Biomechanics
- Automotive Safety Engineering
Background:
- Motor vehicle crashes (MVCs) are a leading cause of pediatric trauma, accounting for 50% of cases.
- In vitro models using child crash dummies are common, but in vivo validation is crucial.
- Previous studies indicate higher injury severity in lateral crashes and front-seat positions, but specific patterns require characterization.
Purpose of the Study:
- To characterize specific injury patterns and crash characteristics in pediatric motor vehicle crash victims.
- To analyze the relationship between crash direction, restraint use, seat location, and injury severity.
- To provide data for improving child safety in vehicles.
Main Methods:
- Utilized data from the Crash Injury Research Engineering Network (CIREN) across 10 pediatric trauma centers.
- Analyzed 417 MVCs involving 2500 injuries, categorizing by crash direction (frontal/lateral), restraint use, and seat location.
- Injuries (Abbreviated Injury Scale [AIS] ≥ 3) were assessed for head, thorax, abdomen, pelvis, spine, and orthopedic regions using statistical analyses including Fisher's Exact test and logistic regression.
Main Results:
- Lateral-impact crashes were associated with significantly higher rates of severe head and thoracic injuries compared to frontal impacts.
- Frontal-impact crashes showed a higher likelihood of severe spine and orthopedic injuries.
- Front-seat occupants sustained more thoracic, abdominal, pelvic, and orthopedic injuries than rear-seat occupants. Seat belts significantly reduced pelvic and orthopedic injuries.
Conclusions:
- A distinct pattern of head and chest injuries occurs in children during lateral-impact MVCs.
- Children in front-seat positions experience higher overall injury severity.
- Enhanced lateral-impact safety measures and continued education on rear-seat positioning are recommended to reduce pediatric morbidity.
Background/Purpose:
Motor vehicle crashes (MVCs) account for 50% of pediatric trauma. Safety improvements are typically tested with child crash dummies using an in vitro model. The Crash Injury Research Engineering Network (CIREN) provides an in vivo validation process. Previous research suggest that children in lateral crashes or front-seat locations have higher Injury Severity Scale scores and lower Glasgow Coma Scale scores than those in frontal-impact crashes. However, specific injury patterns and crash characteristics have not been characterized.
Methods:
Data were collected from the CIREN multidisciplinary crash reconstruction network (10 pediatric trauma centers). Injuries were examined with regard to crash direction (frontal/lateral), restraint use, seat location, and change in velocity at impact (DeltaV). Injuries were limited to Abbreviated Injury Scale (AIS) scores of 3 or higher and included head, thoracic, abdominal, pelvic, spine, and long bone (orthopedic) injuries. Standard age groupings (0-4, 5-9, 10-14, and 15-18 years) were used. Statistical analyses used Fisher's Exact test and multiple logistic regressions.
Results:
Four hundred seventeen MVCs with 2500 injuries were analyzed (males = 219, females = 198). Controlling for DeltaV and age, children in lateral-impact crashes (n = 232) were significantly more likely to suffer severe injuries to the head and thorax as compared with children in frontal crashes (n = 185), who were more likely to suffer severe spine and orthopedic injuries. Children in a front-seat (n = 236) vs those in a back-seat (n = 169) position had more injuries to the thoracic (27% vs 17%), abdominal (21% vs 13%), pelvic (11% vs 1%), and orthopedic (28% vs 10%) regions (P < .05 for all). Seat belts were protective for pelvic (5% vs 12% unbelted) and orthopedic (15% vs 40%) injuries (odds ratio = 3, P < .01 for both).
Conclusion:
A reproducible pattern of injury is noted for children involved in lateral-impact crashes characterized by head and chest injuries. The Injury Severity Scale scores were higher for children in front-seat positions. Increased lateral-impact safety measures such as mandatory side curtain airbags may decrease morbidity. Furthermore, continued public education for positioning children in the back seat of cars is warranted.
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