Are there racial disparities in the use of restraints and outcomes in children after motor vehicle crashes?
BACKGROUND
This study determines whether racial/ethnic disparities exist with respect to restraint use and outcomes in pediatric motor vehicle crash passengers.


METHODS
A review of passengers (<16 years old) involved in motor vehicle crashes from the National Trauma Database from 2002 to 2006 was performed. Outcome measures were emergency surgery, morbidity, mortality, and length of stay (LOS).


RESULTS
A total of 37,375 patients were identified (mean age, 9.3 years; 95% confidence interval, 9.2-9.4 years; 59% male). Of the patients, 45.7% were restrained with the lowest use among African Americans, Hispanics, and Native Americans; 12.6% required emergency surgery; morbidity was 6.7%, and mortality, 5.8%. On multivariable analysis, race/ethnicity did not affect mortality or LOS. Higher Injury Severity Score (ISS) was associated with increased need for emergency operation, higher morbidity and mortality, and longer LOS. The use of restraints was associated with a lower ISS and a decreased risk for emergency surgery. The interaction between restraint use and ISS increased the need for emergency surgery, morbidity, and LOS.


CONCLUSIONS
Less than half of pediatric passengers in this study were restrained. The use of restraints was associated with a lower ISS, whereas a higher ISS was associated with increased need for emergency surgery, morbidity, mortality, and LOS. These data emphasize the need for increased education in preventive measures to minimize the risk of death and injury.
Department of Surgery at Harbor-UCLA Medical Center, Torrance, California 90509, USA. slleemd@yahoo.com
Steven L
SL
Lee
Arezou
A
Yaghoubian
Rebecca
R
Stark
Vanessa
V
Munoz
Amy H
AH
Kaji
D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004630:Emergencies / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012622:Seat Belts / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000208:ethnology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000601:surgery