title: Suboptimal restraint affects the pattern of abdominal injuries in children involved in motor vehicle crashes.
abstract: BACKGROUND
  Both solid and hollow visceral abdominal injuries have been associated with the use of seat belts in children involved in motor vehicle crashes. The relationship between the types of restraint used and the pattern of abdominal injury is unknown.
  
  
  METHODS
  A probability sample of restrained children involved in crashes was enrolled in an ongoing crash surveillance system (1998 through 2002) linking insurance claims data to telephone survey and crash investigation data. Significant abdominal injuries were considered when the Abbreviated Injury Scale (AIS) score was > or =2 and were defined as hollow visceral (HV; intestine, bladder), or solid visceral (liver, spleen, pancreas, kidney). Restraint type was categorized as optimal restraint (OR) or suboptimal restraint (S-OR) based on the child's age and size.
  
  
  RESULTS
  For the 33 months of review, interviews were obtained for 13,558 restrained children aged 0 to 15 years, of which, 56% were OR (n = 7,591) and 44% were S-OR (n = 5,967). A significant abdominal injury was recorded in 78 children. A hollow visceral injury was recorded in 38 (9 OR and 29 S-OR), and a solid visceral injury in 32 (18 OR and 14 S-OR). Both hollow and solid visceral injuries were present in 8 children (2 OR and 6 S-OR). Suboptimally restrained children had a higher risk for hollow visceral injury when compared with optimally restrained children (Odds Ratio, 4.14 [95% Confidence Interval 1.33 to 13.22, P <.01]).
  
  
  CONCLUSIONS
  Among restrained children with intraabdominal injuries, those who were suboptimally restrained were 4 times more likely to have a hollow visceral than a solid visceral injury when compared with those who were optimally restrained. This suggests that the mechanism of injury for hollow viscus may be directly related to the improper positioning of the restraint.
authors.affiliation: Department of Pediatric General and Thoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lutz
authors.forename: Kristy B
authors.initials: KB
authors.lastname: Arbogast
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Cornejo
authors.forename: Flaura K
authors.initials: FK
authors.lastname: Winston
authors.forename: Dennis R
authors.initials: DR
authors.lastname: Durbin
authors.forename: Michael L
authors.initials: ML
authors.lastname: Nance
mesh_terms: D015998:Abbreviated Injury Scale; D000007:Abdominal Injuries / Q000453:epidemiology*; D000063:Accidents, Traffic / Q000706:statistics & numerical data / Q000639:trends; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D015370:Infant Equipment / Q000706:statistics & numerical data; D007231:Infant, Newborn; D018986:Motor Vehicles / Q000706:statistics & numerical data; D011482:Protective Devices / Q000706:statistics & numerical data; D012622:Seat Belts / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000453:epidemiology