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The Effects of Restraint Type on Pattern of Spine Injury in Children
Justin J Ernat1, Jeffrey B Knox, Robert L Wimberly
1*Orthopedic Surgery Service, Tripler Army Medical Center, Honolulu, HI †Department of Orthopedics, Texas Scottish Rite Hospital for Children and Children's Medical Center, Dallas, TX.
Insights
Child restraint type impacts spinal injury patterns in motor vehicle collisions. Car/booster seats and unrestrained children face higher cervical spine injury risks, while seatbelts increase thoracolumbar and flexion-distraction injuries.
Area of Science:
- Pediatric trauma
- Spinal cord injury
- Motor vehicle safety
Background:
- Vehicular restraints significantly reduce child morbidity and mortality in motor vehicle collisions (MVC).
- Limited research exists on the specific association between restraint type and pediatric spinal injury patterns.
- Understanding these patterns is crucial for improving child passenger safety.
Purpose of the Study:
- To investigate the relationship between different vehicular restraint types and the patterns of pediatric spinal injuries sustained in MVCs.
- To characterize the types and locations of spinal injuries based on restraint usage.
Main Methods:
- Retrospective chart review of pediatric patients (<10 years) with spine injuries from MVCs (2003-2011).
- Analysis of prehospital data, medical records, and radiographs to determine restraint type and injury characteristics.
- Inclusion of data regardless of proper restraint use.
Main Results:
- Car/booster seat (C/B) users showed higher rates of cervical spine (62%) and ligamentous (62%) injuries compared to 2-point (2P) and 3-point (3P) restraints.
- 2P and 3P restraint users had higher rates of thoracolumbar injuries (67%, 62%) and flexion-distraction injuries than C/B and unrestrained groups.
- Unrestrained children sustained the highest rate of cervical spine injuries (80%).
Conclusions:
- 2P or 3P seatbelt use is linked to fewer cervical spine injuries but more thoracic/lumbar and flexion-distraction injuries than car/booster seats.
- Children in car/booster seats or unrestrained are at high risk for cervical spine injuries.
- Restraint type significantly influences the pattern and severity of pediatric spinal trauma in MVCs.
Introduction:
While the use of vehicular restraints has reduced the morbidity and mortality of children involved in motor vehicle collisions (MVC), to our knowledge, no study has examined the relationship between restraint type and patterns of pediatric spinal injuries. The purpose of this study is to evaluate this association and review the spinal injuries sustained in children involved in MVC.
Methods:
We completed an IRB-approved, retrospective chart review of all patients below 10 years of age presenting to a level 1 pediatric trauma hospital with spine injuries sustained in MVC from 2003 to 2011. We reviewed prehospital data, medical records, and radiographs to establish the restraint type and characterize the spinal injuries sustained.
Results:
A total of 97 patients were identified with spinal trauma secondary to MVC with appropriate and documentation of restraint type. Results are reported regardless of whether the restraint employed was properly used per established guidelines. Car seat/booster seat (C/B) patients sustained significantly higher rates of cervical spine (62%) and ligamentous (62%) injuries than the 2-point (2P) (10%) and 3-point (3P) restraint (24%) groups (P<0.001). Two-point and 3P restraint use was associated with significantly higher rates of thoracolumbar injuries (67% and 62%, respectively) than the C/B (14%) and unrestrained (0%) groups (P<0.001). Two-point and 3P passengers also had a higher rate of flexion-distraction injuries (P<0.001). Patients in the unrestrained group sustained a significantly higher rate of cervical spine (80%) and ligamentous (40%) injuries than the 2P and 3P groups (P<0.001). No differences were found in the type or location of injury between the 2P and 3P groups. Significant differences in proper restraint use were identified between age groups with younger children demonstrating higher rates of proper restraint use (P<0.01).
Conclusions:
Two-point or 3P seatbelt use is associated with lower rates of cervical spine trauma but higher rates of thoracic and lumbar trauma, particularly flexion-distraction injuries, when compared with car or booster seats. Children in C/B and those who are unrestrained sustain high rates of cervical spine injury.
Level Of Evidence:
Level III-prognostic study.
