Patterns of severe injury in pediatric car crash victims: Crash Injury Research Engineering Network database

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Abstract

Background/Purpose

Motor vehicle crashes (MVCs) account for 50% of pediatric trauma. Safety improvements are typically tested with child crash dummies using an in vitro model. The Crash Injury Research Engineering Network (CIREN) provides an in vivo validation process. Previous research suggest that children in lateral crashes or front-seat locations have higher Injury Severity Scale scores and lower Glasgow Coma Scale scores than those in frontal-impact crashes. However, specific injury patterns and crash characteristics have not been characterized.

Methods

Data were collected from the CIREN multidisciplinary crash reconstruction network (10 pediatric trauma centers). Injuries were examined with regard to crash direction (frontal/lateral), restraint use, seat location, and change in velocity at impact (ΔV). Injuries were limited to Abbreviated Injury Scale (AIS) scores of 3 or higher and included head, thoracic, abdominal, pelvic, spine, and long bone (orthopedic) injuries. Standard age groupings (0-4, 5-9, 10-14, and 15-18 years) were used. Statistical analyses used Fisher's Exact test and multiple logistic regressions.

Results

Four hundred seventeen MVCs with 2500 injuries were analyzed (males = 219, females = 198). Controlling for ΔV and age, children in lateral-impact crashes (n = 232) were significantly more likely to suffer severe injuries to the head and thorax as compared with children in frontal crashes (n = 185), who were more likely to suffer severe spine and orthopedic injuries. Children in a front-seat (n = 236) vs those in a back-seat (n = 169) position had more injuries to the thoracic (27% vs 17%), abdominal (21% vs 13%), pelvic (11% vs 1%), and orthopedic (28% vs 10%) regions (P < .05 for all). Seat belts were protective for pelvic (5% vs 12% unbelted) and orthopedic (15% vs 40%) injuries (odds ratio = 3, P < .01 for both).

Conclusion

A reproducible pattern of injury is noted for children involved in lateral-impact crashes characterized by head and chest injuries. The Injury Severity Scale scores were higher for children in front-seat positions. Increased lateral-impact safety measures such as mandatory side curtain airbags may decrease morbidity. Furthermore, continued public education for positioning children in the back seat of cars is warranted.

Section snippets

Methods

The CIREN methodology has been described and validated in prior studies [5], [7]. The CIREN links crash reconstruction with medical data to provide in-depth assessments of biochemical forces leading to injury. Cohorts of patients are derived from people involved in MVCs who were cared for in 1 of 10 level 1–designated trauma centers (Table 1). Each hospital is part of the CIREN, a National Highway Traffic Safety Administration–sponsored program that investigates MVCs. From 1991 to 2004, all

Results

Four hundred seventeen children in MVCs with 2500 injuries were available to be analyzed (males = 219, females = 198). Mean GCS scores, ISS scores, and percentage of subsequent fatalities within each age group are shown in Table 3. For purposes of data analysis, unrestrained and improperly restrained children were grouped together. Prior analysis demonstrated that children in lateral crashes have increased ISS scores and decreased GCS scores as compared with those involved in frontal crashes.

Discussion

Motor vehicle crashes are the major cause of death and disability in the pediatric population [1]. Consequently, a vast amount of resources has been directed toward prevention and intervention strategies. Child crash test dummies have often been used for this purpose, providing an in vitro model by which to examine crash injury characteristics [4]. However, these models are limited in their ability to account for the wide spectrum of shapes and sizes in the pediatric population. Furthermore, a

Acknowledgment

This work was supported in part by DTNH90-Y-0735 and DTNH22-00-H37202 from the Crash Worthiness Research Division of the National Highway Traffic Safety Division.

References (20)

  • P.C. Dischinger et al.

    Effect of change in velocity on the development of medical complications in patients with multisystem trauma sustained in vehicular crashes

    Accid Anal Prev

    (1998)
  • J.N. Mikhail

    Side impact motor vehicle crashes: patterns of injury

    Int J Trauma Nurs

    (1995)
  • National Center For Injury Prevention and Control

    The injury fact book 2001-2002

    (2002)
  • D. Tuggle

    Resources for optimal care of the injured patient: 1999

    (1998)
  • National Automotive Sampling System

    Crash worthiness data system 1992-1994

    (1997)
  • C.P. Sherwood et al.

    Prediction of cervical spine injury risk for the 6-year-old child in frontal crashes

    Traffic Inj Prev

    (2003)
  • J.H. Siegel et al.

    Factors influencing the patterns of injuries and outcomes in car versus car crashes compared to sport utility, van, or pick up truck versus car crashes: Crash Injury Research Engineering Network Study

    J Trauma

    (2001)
  • Brown JK, Ehrlich PF, Sochor MS, et al. Factors influencing pediatric Injury Severity Score (ISS) and Glasgow Coma...
  • K.M. Orzechowski et al.

    Patterns of injury to restrained children in side impact motor vehicle crashes: the side impact syndrome

    J Trauma

    (2003)
  • SPSS Inc. SPSS base 10.0 for Windows user's guide. Chicago (IL); SPSS,...
There are more references available in the full text version of this article.

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Presented at the 52nd Annual Congress of British Association of Paediatric Surgeons, Dublin, Ireland, July 12-15, 2005.

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