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Effect of appropriate restraint use on pediatric injury outcomes in motor vehicle crashes from US Trauma Quality
Gretchen H Baker1, Angela L Harden1, Mary E Cole1
1Injury Biomechanics Research Center, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University Medical Center, Columbus, Ohio.
Insights
Using appropriate child restraint systems (CRS) significantly reduces severe injuries in motor vehicle crashes (MVCs). Inappropriate or no restraint use increases the risk of serious harm, especially for younger children.
Area of Science:
- Trauma research
- Pediatric safety
- Public health
Background:
- Motor vehicle crashes (MVCs) are a leading cause of injury in children.
- Appropriate use of child restraint systems (CRS) is crucial for mitigating injury severity.
- Previous studies highlight the importance of correct CRS selection based on child demographics.
Purpose of the Study:
- To evaluate the impact of appropriate versus inappropriate CRS use on pediatric injury outcomes in MVCs.
- To analyze injury patterns associated with different restraint types and age groups.
- To quantify the risk of severe injury (MAIS 3+) related to restraint misuse.
Main Methods:
- Analysis of US Trauma Quality Programs Participant Use File (TQP PUF) data from 2018-2022.
- Inclusion of children aged 1-13 years involved in MVCs, identified via ICD-10 codes.
- Definition of appropriate restraint use based on child's age, height, weight, and restraint type, referencing AAP guidelines.
- Logistic regression and odds ratios used to compare injury outcomes (MAIS 3+ vs. MAIS 1-2) between appropriate and inappropriate restraint groups.
Main Results:
- Nearly 40% of children were unrestrained, and over 18% used inappropriate restraints, with misuse increasing with age (1-7 years).
- Unrestrained children had 1.56 times higher odds of sustaining severe injuries (MAIS 3+) compared to those using appropriate restraints.
- Specific injuries to the head, thorax, abdomen, spine, and extremities showed significantly higher odds of severity (MAIS 3+) when unrestrained.
Conclusions:
- The study confirms that using age and size-appropriate child restraints significantly lowers the risk of severe injury in MVCs.
- Findings underscore the critical need for improved adherence to appropriate restraint use, particularly for children aged 4-10 years.
- Public health initiatives should focus on educating caregivers about correct CRS selection and usage to enhance child safety during travel.
Objective:
Use of appropriate child restraint systems (CRS) based on a child's age and size is important to reduce the risk of injury in motor vehicle crashes (MVCs). The aim of this work was to assess the influence of appropriate versus inappropriate restraint use on pediatric injury outcomes in MVCs using the US Trauma Quality Programs Participant Use File (TQP PUF).
Methods:
Trauma registry data were obtained for TQP PUF admission years 2018-2022, and individuals 1-13 years involved in MVCs were identified using ICD-10 external cause of injury codes. Use of an appropriate versus inappropriate restraint was defined using the child's age, height, and weight in addition to the Child Restraint and Protective Devices variables. Ranges of appropriate child age, height, and weight for each restraint type (rear-facing CRS, forward-facing CRS, booster, seat belt only, or unrestrained) were defined using current best-practice recommendations from the American Academy of Pediatrics and typical CRS product allowable age, height, and weight ranges. Abbreviated Injury Scale (AIS) outcomes were used to identify maximum AIS (MAIS) 3+ (serious to maximal) versus 1-2 (minor to moderate) outcomes for the whole body and individual body regions. Logistic regression was used to evaluate relationships between age and use of appropriate restraints, and odds ratios were used to compare injury outcomes between use of appropriate versus inappropriate restraints.
Results:
39,993 occupants admitted to trauma centers between 1 and 13 yr were evaluated. Overall, 39.10% of children were unrestrained and an additional 18.73% utilized an inappropriate restraint type, and this varied by age. For children 1-7 yr, the odds of utilizing an inappropriate versus appropriate restraint type increased by 1.46 times with each 1-year increase in age, increasing from 6.29% at 1 yr to 39.36% at 7 yr. 40.5% of occupants sustained MAIS 3+ injuries, and unrestrained children had 1.56 (95% CI [1.49, 1.64]) times increased odds to sustain MAIS 3+ versus MAIS 1-2 injuries compared to use of appropriate restraints. Head injuries were the most frequently injured body region (46.0% of all discrete injuries); however, the relative proportion of head injuries compared to other body regions decreased with age. Odds of sustaining a MAIS 3+ versus MAIS 1-2 injury were higher when unrestrained compared to appropriate restraint use when considering injuries to the head (OR = 1.33, 95% CI [1.25, 1.42]), thorax (OR = 1.71, 95% CI [1.56,1.86]), abdomen (OR = 1.52, 95% CI [1.37, 1.68]), spine (OR = 1.54, 95% CI [1.25, 1.90]), and extremities (OR = 1.87, 95% CI [1.73, 2.01]).
Conclusions:
The odds ratios for sustaining a MAIS 3+ versus 1-2 injury when unrestrained compared to appropriate restraints confirm the importance of utilizing appropriate restraint types based on a child's age and size. Continued efforts to increase appropriate restraint use for children, especially between 4-10 yr, would be beneficial.
