title: Restraint status improves the predictive value of motor vehicle crash criteria for pediatric trauma team activation.
abstract: BACKGROUND
  Most trauma centers incorporate mechanistic criteria (MC) into their algorithm for trauma team activation (TTA). We hypothesized that characteristics of the crash are less reliable than restraint status in predicting significant injury and the need for TTA.
  
  
  METHODS
  We identified 271 patients (age, <15 y) admitted with a diagnosis of motor vehicle crash. Mechanistic criteria and restraint status of each patient were recorded. Both MC and MC plus restraint status were evaluated as separate measures for appropriately predicting TTA based on treatment outcomes and injury scores.
  
  
  RESULTS
  Improper restraint alone predicted a need for TTA with an odds ratios of 2.69 (P = .002). MC plus improper restraint predicted the need for TTA with an odds ratio of 2.52 (P = .002). In contrast, the odds ratio when using MC alone was 1.65 (P = .16). When the 5 MC were evaluated individually as predictive of TTA, ejection, death of occupant, and intrusion more than 18 inches were statistically significant.
  
  
  CONCLUSIONS
  Improper restraint is an independent predictor of necessitating TTA in this single-institution study.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, 1 Children's Way, Slot 837, Little Rock, AR 72202, USA. bozeman_andrew@yahoo.com
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Bozeman
authors.forename: Melvin S
authors.initials: MS
authors.lastname: Dassinger
authors.forename: John F
authors.initials: JF
authors.lastname: Recicar
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Smith
authors.forename: Mallikarjuna R
authors.initials: MR
authors.lastname: Rettiganti
authors.forename: Todd G
authors.initials: TG
authors.lastname: Nick
authors.forename: Robert T
authors.initials: RT
authors.lastname: Maxson
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D002648:Child; D057207:Child Restraint Systems; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010348:Patient Care Team; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*