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Airbags and children: a spectrum of C-spine injuries
J F Giguère1, D St-Vil, A Turmel
1Division of Pediatric General Surgery and Neurosurgery, Hôpital Sainte-Justine, Montreal, Quebec, Canada.
Insights
Airbag deployment can cause severe cervical spine injuries in children, even when properly restrained. These injuries range from burns and whiplash to fatal atlanto-occipital dislocation, highlighting the need for rear seating for young children.
Area of Science:
- Pediatric Traumatology
- Automotive Safety Engineering
- Forensic Pathology
Background:
- Motor vehicle accidents (MVA) involving airbags have led to over 30 reported child fatalities.
- Improper restraint or rear-facing car seats are associated with increased risk.
- Properly restrained children in the front seat can still sustain significant injuries.
Observation:
- Case 1: A 10-year-old seat-belted child sustained hyphema, corneal abrasion, and facial burns from airbag deployment.
- Case 2: A 4-year-old lap-belted child experienced atlanto-occipital dislocation and spinal cord transection, resulting in death.
- Case 3: A 3-year-old in a forward-facing seat developed subarachnoid hemorrhage and ligamentous injury, a precursor to atlanto-occipital dislocation.
Findings:
- Airbags deploy at high velocity (300 km/h), releasing hot gas.
- Mechanisms of injury include direct thermal contact and direct energy transfer to the head and neck.
- A spectrum of cervical spine (C-spine) injuries, including severe trauma, can result from airbag deployment in children.
Implications:
- These findings support recommendations for children under 12 to occupy rear seats in vehicles with dual airbags.
- Enhanced understanding of airbag-related pediatric trauma is crucial for safety guidelines.
- Further research into airbag safety systems for pediatric occupants is warranted.
Abstract:
Over 30 children who were improperly restrained or in rear facing safety seats have been reported killed in motor vehicle accidents (MVA) involving airbags. The authors report one minor and two major injuries in properly restrained children in the front passenger seat. In case 1, A 10-year-old seat-belted boy was involved in an MVA (40 km/h) with deployment of both airbags. Physical examination findings showed right hyphema with corneal abrasion, right cheek abrasion and minimal cervical tenderness. C-spine x-ray was normal. He was treated for whiplash and facial burns resulting from contact with hot gas released by the airbags and discharged. In case 2, a 4-year-old boy wearing a lapbelt was in a MVA (20 km/h) with airbag deployment. On arrival, his Glasgow coma score was 3 and he was hemodynamically unstable. Secondary survey after stabilization showed left neck abrasions and ecchymoses, quadraplegia, priapism, and absent rectal tone. C-spine x-ray showed atlanto-occipital dislocation with possible complete spinal cord transection at C1. Aggressive maneuvers were withheld, and the patient was pronounced dead. Autopsy findings confirmed the clinical diagnosis. In case 3, a 3-year-old boy in a forward-facing safety seat was in a MVA (60 km/h) with air bag deployment. The patient was fully awake. C-spine x-rays were normal. Because of fluctuating level of consciousness, he underwent head computed tomography (CT) scan, which demonstrated a posterior fossa subarachnoid hemorrhage and a hematoma posterior to the odontoid, suggesting a ligamentous tear. He remained asymptomatic and was discharged on day 6. A head CT scan at 1 month showed a periosteal reaction in the area of the alar ligament suggestive of partial ligamentous avulsion; this injury was the forerunner of atlanto-occipital dislocation. Airbags deploy by releasing a hot effluent at 300 km/h. Mechanisms of injury include direct contact of hot gas with facial skin and energy transmitted directly from the airbag system to the child's head and neck. These cases illustrate a spectrum of C-spine injuries caused by airbag deployment and support the recommendation that children under 12 years of age travelling in a car equipped with dual airbags be seated in the back.