A comparison of injuries, crashes, and outcomes for pediatric rear occupants in traffic motor vehicle collisions.
BACKGROUND
This study was initiated was initiated to describe pediatric rear-occupant motor vehicle collision (MVC) injuries, including injury patterns and outcomes as well as characteristics associated with severe injury to the head and abdomen.


METHODS
A retrospective cohort of severely injured (Injury Severity Score [ISS] > 12) pediatric (age <18 years) patients involved in a traffic MVC as a rear occupant and treated at one of two Ontario trauma centers (2001-2010) was studied was studied. Demographic, injury, crash and outcome data were obtained from the trauma registries. Data were statistically compared by two pediatric age groups: children (0-8 years; requiring a child or booster seat) versus adolescents (9-17 years; requiring a lap-shoulder belt).


RESULTS
There were 36 children (34%) and 70 adolescents (66%) severely injured as rear occupants in MVCs. Despite similar ISS (p = 0.716) and mortality rates (p = 0.680) between age groups, there were significant differences in injury patterns and risk factors. Children were more likely to have severe head injuries (78% vs. 39%, p < 0.001) associated with a lack of an age-appropriate child restraints (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1-10.8; p = 0.029), middle seating (OR, 6.2; 95% CI, 1.5-26.1; p = 0.013), and side-impact crashes (p = 0.007). Adolescents were more likely to have severe abdominal injuries (23% vs. 6%, p < 0.001) associated with the use of lap-shoulder belts (OR, 3.8; 95% CI, 1.1-13.3; p = 0.034), single-vehicle MVCs (p = 0.007), and vehicle extrications (p = 0.035).


CONCLUSIONS
While safer than the front seat for children, additional study is needed on the restraint systems and the potential for injury to pediatric rear occupants in an MVC. Our data suggest that pediatric age groups differ in injuries, risk factors, and MVC impacts. Recommendations for improved protection of child occupants and preferred seating positions are required.


METHODS
Epidemiologic study, level III.
Trauma Program, London Health Sciences Centre, London, Ontario, Canada. tanya.charyk@lhsc.on.ca
Tanya
T
Charyk Stewart
Kevin
K
McClafferty
Michael
M
Shkrum
Jean-Louis
JL
Comeau
Jason
J
Gilliland
Douglas D
DD
Fraser
D000007:Abdominal Injuries / Q000453:epidemiology / Q000209:etiology; D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000367:Age Factors; D001336:Automobiles / Q000706:statistics & numerical data; D002648:Child; D057207:Child Restraint Systems / Q000706:statistics & numerical data; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018986:Motor Vehicles / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012622:Seat Belts / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology*