Child Restraint System Use and Injury Severity in Pediatric Motor Vehicle Collisions: Insights From the NTDB

BackgroundMotor vehicle collisions (MVCs) are the second leading cause of childhood mortality in the US, and child restraint systems (CRS) remain underutilized. We examine differences in demographics and clinical characteristics in pediatric patients presenting to the emergency department (ED) after MVCs with or without CRS.MethodsWe identified MVC trauma patients reported within the National Trauma Data Bank (NTDB) < 8 years of age and height/weight CRS-eligible. Bivariate descriptive analyses, interquartile range for continuous variables and a chi-square test of proportions tested differences of categorical variables of CRS strata. Sensitivity analysis was used in patients that were age appropriate for car and booster seats.ResultsIn all patients, median age for those without CRS was older (6 years, IQR 4-7) than those with CRS (4 years, IQR 2-5, P < 0.0001). A lower proportion of Black patients had CRS compared to White (24.0% vs 32.6%, P < 0.0001). For those with CRS, the highest proportion were boosters (38.7%). Injury severity score (ISS) was higher in the non-CRS group (8, IQR 4-14) than CRS (5, IQR 2-11, P < 0.0001). A larger proportion of CRS patients were discharged home from ED (26.8% vs 18.5%). Racial disparities persisted in older patients, with fewer booster-eligible Black children in CRS (30.0% vs 17.9%, P < 0.001).ConclusionsThis study demonstrates that older and Black children were less likely to be in a CRS, and that those who were not in CRS were more severely injured. Our study serves as the foundation for research to mitigate disparities, and outreach related to CRS improvements.