title: Emergency department transport rates of children from the scene of motor vehicle collisions: do booster seats make a difference?
abstract: BACKGROUND
  Motor vehicle collisions (MVCs) are the leading cause of death and disability among children older than 1 year. Many states currently mandate all children between the ages of 4 and 8 years be restrained in booster seats. The implementation of a booster-seat law is generally thought to decrease the occurrence of injury to children. We hypothesized that appropriate restraint with booster seats would also cause a decrease in emergency department (ED) visits compared with children who were unrestrained. This is an important measure as ED visits are a surrogate marker for injury.
  
  
  OBJECTIVE
  The main purpose of this study was to look at the rate of ED visits between children in booster seats compared with those in other or no restraint systems involved in MVCs. Injury severity was compared across restraint types as a secondary outcome of booster-seat use after the implementation of a state law.
  
  
  METHODS
  A prospective observational study was performed including all children 4 to 8 years old involved in MVCs to which emergency medical services was dispatched. Ambulance services used a novel on-scene computer charting system for all MVC-related encounters to collect age, sex, child-restraint system, Glasgow Coma Scale score, injuries, and final disposition.
  
  
  RESULTS
  One hundred fifty-nine children were studied with 58 children (35.6%) in booster seats, 73 children in seatbelts alone (45.2%), and 28 children (19.1%) in no restraint system. 76 children (47.7%), 74 by emergency medical services and 2 by private vehicle, were transported to the ED with no significant difference between restraint use (P = 0.534). Utilization of a restraint system did not significantly impact MVC injury severity. However, of those children who either died (n = 2) or had an on-scene decreased Glasgow Coma Scale score (n = 6), 75% (6/8) were not restrained in a booster seat.
  
  
  CONCLUSIONS
  The use of booster-seat restraints does not appear to be associated with whether a child will be transported to the ED for trauma evaluation.
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Darlene R
authors.initials: DR
authors.lastname: House
authors.forename: Gretchen
authors.initials: G
authors.lastname: Huffman
authors.forename: Jennifer D H
authors.initials: JD
authors.lastname: Walthall
mesh_terms: D000063:Accidents, Traffic; D002648:Child; D057207:Child Restraint Systems / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D018986:Motor Vehicles; D011446:Prospective Studies; D012622:Seat Belts / Q000706:statistics & numerical data; D014187:Transportation of Patients / Q000706:statistics & numerical data*