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Lower incidence of blunt cerebrovascular injury among young, properly restrained children: An ATOMAC multicenter
Todd A Nickoles1, Ruth A Lewit, David M Notrica
1From the Center for Trauma Care, Phoenix Children's (T.A.N., D.M.N, M.T., B.P.), Phoenix, Arizona; Department of Pediatric Surgery, Le Bonheur Children's Hospital (R.A.L., J.W.E.) Memphis, Tennessee; Division of Pediatric Surgery, Department of Surgery (R.A.L., J.W.E.), College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee ; Department of Surgery (D.M.N., B.P.), College of Medicine, University of Arizona, Phoenix, Arizona; Trauma Services, Children's Medical Center (M.R.), Dallas, Texas; Division of Pediatric Surgery (M.R.), University of Texas Southwestern Medical Center Dallas, Texas; Trauma Services, Oklahoma Children's Hospital (J.J.), OU Health, Oklahoma City, Oklahoma; Department of Surgery (J.J.), University of Oklahoma Health Science Center Oklahoma City, Oklahoma; Trauma Services, Arkansas Children's Hospital (R.T.M.), Little Rock, Arkansas; Department of Surgery (R.T.M.), University of Arkansas for Medical Sciences Little Rock, Arkansas; Department of Surgery, Dell Medical School (J.A.N., K.A.L.), University of Texas at Austin, Austin, Texas; and Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas (J.A.N.), Austin, Texas.
Insights
Proper restraint use significantly reduces blunt cerebrovascular injury (BCVI) risk in children under 12 after motor vehicle collisions (MVCs). Unrestrained children under 12 face a higher risk of BCVI following MVCs.
Area of Science:
- Pediatric Trauma
- Epidemiology
- Injury Prevention
Background:
- Motor vehicle collisions (MVCs) are a major cause of pediatric injury and death.
- Child safety seats and restraints are crucial in mitigating risks during travel.
- Blunt cerebrovascular injury (BCVI) is a rare but serious consequence of MVCs in children.
Purpose of the Study:
- To investigate the incidence of BCVI in children following MVCs.
- To compare BCVI rates between properly restrained and unrestrained children.
- To identify age-specific differences in BCVI risk related to restraint use.
Main Methods:
- Prospective, multi-institutional observational study (2017-2020).
- Included children (<15 years) with blunt head, face, or neck trauma from MVCs.
- Assessed BCVI diagnosis via imaging or neurological symptoms; compared restraint status.
Main Results:
- Of 521 children in MVCs, 10 (2.7%) were diagnosed with BCVI.
- In children <12 years, 0% of properly restrained vs. 3.2% of improperly restrained children had BCVI.
- In children 12-15 years, BCVI incidence was 5.5% (seat belts) vs. 2.8% (unrestrained).
Conclusions:
- Proper restraint significantly reduces BCVI risk in children under 12 after MVC.
- The protective effect of restraint was not observed in children aged 12-15.
- Restraint status is a critical factor for BCVI screening in young children involved in MVCs.
Background:
Motor vehicle collision (MVC) remains a leading cause of injury and death among children, but the proper use of child safety seats and restraints has lowered the risks associated with motor vehicle travel. Blunt cerebrovascular injury (BCVI) is rare but significant among children involved in MVC. This study reviewed the incidence of BCVI after MVC causing blunt injury to the head, face, or neck, comparing those that were properly restrained with those that were not.
Methods:
A prospective, multi-institutional observational study of children younger than 15 years who sustained blunt trauma to the head, face, or neck (Abbreviated Injury Scale score >0) and presented at one of six level I pediatric trauma centers from 2017 to 2020 was conducted. Diagnosis of BCVI was made either by imaging or neurological symptoms at 2-week follow-up. Restraint status among those involved in MVC was compared for each age group.
Results:
A total of 2,284 patients were enrolled at the 6 trauma centers. Of these, 521 (22.8%) were involved in an MVC. In this cohort, after excluding patients with missing data, 10 of 371 (2.7%) were diagnosed with a BCVI. For children younger than 12 years, none who were properly restrained suffered a BCVI (0 of 75 children), while 7 of 221 (3.2%) improperly restrained children suffered a BCVI. For children between 12 and 15 years of age, the incidence of BCVI was 2 of 36 (5.5%) for children in seat belts compared with 1 of 36 (2.8%) for unrestrained children.
Conclusion:
In this large multicenter prospectively screened pediatric cohort, the incidence of BCVI among properly restrained children under 12 years after MVC was infrequent, while the incidence was 3.2% among those without proper restraint. This effect was not seen among children older than 12 years. Restraint status in young children may be an important factor in BCVI screening.
Level Of Evidence:
Prognostic and Epidemiological; Level IV.
