title: Risk factors and predictors of mortality in children after ejection from motor vehicle crashes.
abstract: OBJECTIVE
  Mortality after ejection from a motor vehicle crash (MVC) has been studied extensively in adults. The magnitude of this problem in children is relatively unknown. We retrospectively examined fatalities resulting from ejection after MVC in the state of Pennsylvania to define risk factors and predictors of mortality in children.
  
  
  METHODS
  The records for all patients 0 to 16 years of age involved in an MVC and entered in the Pennsylvania Trauma Outcome Study between 1993 and 1997 were reviewed. We examined mortality, length of hospitalization, major injuries sustained, and impact of safety restraint devices. Significant differences were determined using chi2 test.
  
  
  RESULTS
  There were 2,298 children involved in MVCs during this period; 189 were ejected. A total of 77% of the ejected passengers were greater than 10 years of age, 16% were 0 to 4 years of age, and 7% were 5 to 9 years of age. Overall, 88% of the ejected occupants were unrestrained. Ejection nearly tripled the overall mortality rate and significantly increased the Injury Severity Score for each age group. Infants and children 0 to 4 years of age had the highest fatality rate despite having a lower Injury Severity Score than all other age groups. Head injuries accounted for the majority of deaths in all age groups. Children older than 10 years of age had a higher incidence of associated chest, abdominal, and pelvic injuries.
  
  
  CONCLUSIONS
  Our data show that most children ejected from MVCs were either unrestrained or improperly restrained. Head injuries were the most common cause of death in all age groups. Greater public awareness through educational programs targeting parents and children at risk may reduce this serious problem.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pennsylvania, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Scheidler
authors.forename: B L
authors.initials: BL
authors.lastname: Shultz
authors.forename: L
authors.initials: L
authors.lastname: Schall
authors.forename: H R
authors.initials: HR
authors.lastname: Ford
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000517:prevention & control; D000293:Adolescent; D017677:Age Distribution; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D006266:Health Education; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D010290:Parents / Q000193:education; D010414:Pennsylvania / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012622:Seat Belts / Q000706:statistics & numerical data