title: The role of seating position in determining the injury pattern among unrestrained children involved in motor vehicle collisions presenting to a level I trauma center.
abstract: OBJECTIVE
  Seating position in motor vehicle collisions (MVC) plays a major role in determining the injury pattern in mainly restrained children. However, compliance with child seating and restraint laws is still suboptimal. The role of seating position in predicting injury patterns among unrestrained children has not been previously studied.
  
  
  METHODS
  Retrospective review based on the trauma registry of a level I trauma center in Riyadh, Saudi Arabia. Data collection was restricted to unrestrained children involved in MVC.
  
  
  METHODS
  Between July 2001 and March 2010, 274 records were identified. Detailed information about the collision, child seating position and the use of restraints was cross-verified using parental phone interviews.
  
  
  RESULTS
  Of the 274 identified records, cross-verification was possible for 89 (32.4%) unrestrained children, 64 boys and 25 girls, with a mean (SD) age of 83 (40) months. Of these children, 41 (46.1%) were front seated (FS), and 48 (53.9%) were back seated (BS). There were higher rates of rollover (52.1% vs 24.4%, P=.02), ejection (41.7% vs 22%, P=.05), and occupant death ratio (14.8 vs 4, P=.04) among BS children. However, the two groups did not differ in pediatric trauma scores, Glascow coma scale score, or age distribution. FS children were more likely to present with isolated head, neck or facial injuries (HNFI) (51.2% vs 25%, P=.01), whereas BS children were more likely to suffer long bone or pelvic fractures (LPF) (60.4% vs 36.6%, P=.025).
  
  
  CONCLUSIONS
  Injury pattern can vary according to seating position among unrestrained children presenting at trauma centers after MVC. While FS children are more likely to present with HNFI, BS children more often sustain LPF. BS children had similar trauma severity compared with FS children despite the higher-impact nature of their MVCs. While highlighting the value of proper restraints use and seating position, these results can be valuable in the initial assessment of traumatized children involved in MVC.
authors.affiliation: Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia. aaljazaeri@ksu.edu.sa
authors.forename: Ayman
authors.initials: A
authors.lastname: Al-Jazaeri
authors.forename: Mohammad
authors.initials: M
authors.lastname: Zamakhshary
authors.forename: Abdulrahma
authors.initials: A
authors.lastname: Al-Omair
authors.forename: Yasser
authors.initials: Y
authors.lastname: Al-Haddab
authors.forename: Othman
authors.initials: O
authors.lastname: Al-Jarallah
authors.forename: Raied
authors.initials: R
authors.lastname: Al-Qahtani
mesh_terms: D000063:Accidents, Traffic; D002648:Child; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011187:Posture; D012189:Retrospective Studies; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000453:epidemiology*