title: Crash analysis of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts.
abstract: BACKGROUND
  The mechanism, crash characteristics, and spectrum of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts have not been described.
  
  
  METHODS
  We identified in two databases children who sustained lower extremity injuries while restrained in forward-facing car seats. To identify the mechanism, we analyzed crash reconstructions from three frontal-impact cases from the Crash Injury Research and Engineering Network. To further describe the crash and injury characteristics we evaluated children between 1 and 4 years of age with lower extremity injuries from front or rear impacts in the National Automotive Sampling System (NASS) Crashworthiness Data System (CDS) database.
  
  
  RESULTS
  Crash reconstruction data demonstrated that the likely mechanism of lower extremity injury was contact between the legs and the front seatbacks. In the CDS database, we identified 15 children with lower extremity injuries in a forward-facing child seat, usually (13 out of 15) placed in the rear seat, incurred in frontal impacts (11 out of 15). Several (5 out of 15) children were in unbelted or improperly secured forward-facing car seats. Injury Severity Scores varied widely (5-50).
  
  
  CONCLUSIONS
  Children in forward-facing car seats involved in severe front or rear crashes may incur a range of lower extremity injury from impact with the car interior component in front of them. Crash scene photography can provide useful information about anatomic sites at risk for injury and alert emergency department providers to possible subtle injury.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA.
authors.forename: Tellen D
authors.initials: TD
authors.lastname: Bennett
authors.forename: Robert
authors.initials: R
authors.lastname: Kaufman
authors.forename: Melissa
authors.initials: M
authors.lastname: Schiff
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
authors.forename: Linda
authors.initials: L
authors.lastname: Quan
mesh_terms: D000063:Accidents, Traffic; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis; D006801:Humans; D007223:Infant; D015370:Infant Equipment; D015601:Injury Severity Score; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D011482:Protective Devices; D014947:Wounds and Injuries / Q000145:classification*