title: A prospective study of children aged <16 years in motor vehicle collisions in Norway: severe injuries are observed predominantly in older children and are associated with restraint misuse.
abstract: OBJECTIVE
  The implementation of the compulsory wearing of seat belts (SBs) for children and improvements in child restraint systems have reduced the number of deaths and severe injuries among children involved in motor vehicle (MV) collisions (MVCs). Establishing the characteristics predictive of such injuries may provide the basis for targeted safety campaigns and lead to a further reduction in mortality and morbidity among children involved in MVCs. This study performed a multidisciplinary investigation among child occupants involved in MVCs to elucidate injury mechanisms, evaluate the safety measures used and determine the characteristics that are predictive of injury.
  
  
  METHODS
  A prospective study was conducted of all child occupants aged <16 years involved in severe MVCs in south-eastern Norway during 2009-2013. The exterior and interior of the MVs were investigated and the injured children were medically examined. Supplementary information was obtained from witnesses, the crash victims, police reports, medical records and reconstructions. Each case was reviewed by a multidisciplinary team to assess the mechanism of injury.
  
  
  RESULTS
  In total, 158 child occupants involved in 100 MVCs were investigated, of which 27 (17%) exhibited Abbreviated Injury Scale (AIS) scores of 2+ injuries and 15 (9%) exhibited AIS 3+ injuries. None of the children died. Of those with AIS 2+ injuries (n=27), 89% (n=24) were involved in frontal impact collisions and 11% (3/27) were involved in side impacts. Multivariate analysis revealed that restraint misuse, age, the prevailing lighting conditions and ΔV were all independently correlated with AIS 2+ injuries. Safety errors were found in 74% (20/27) of those with AIS 2+ injuries and 93% (14/15) of those with AIS 3+ injuries. The most common safety error was misuse of restraints, and in particular loose and/or improperly positioned SBs.
  
  
  CONCLUSIONS
  The risk of injury among child occupants is significantly higher when the child occupants are exposed to safety errors within the interior of the vehicle. Future campaigns should focus on the prevention of restraint misuse and unsecured objects in the passenger compartment or boot.
authors.affiliation: Department of Forensic Pathology and Clinical Forensic Medicine, Norwegian Institute of Public Health and Faculty of Medicine, University of Oslo, Oslo, Norway. Electronic address: masr@fhi.no.
authors.forename: Marianne
authors.initials: M
authors.lastname: Skjerven-Martinsen
authors.affiliation: Department of Traumatology, Oslo University Hospital, Oslo, Norway; Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway.
authors.forename: Paal Aksel
authors.initials: PA
authors.lastname: Naess
authors.affiliation: Prehospital Division, Oslo University Hospital, Oslo, Norway.
authors.forename: Trond Boye
authors.initials: TB
authors.lastname: Hansen
authors.affiliation: Department of Traumatology, Oslo University Hospital, Oslo, Norway.
authors.forename: Christine
authors.initials: C
authors.lastname: Gaarder
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Inggard
authors.initials: I
authors.lastname: Lereim
authors.affiliation: Department of Forensic Pathology and Clinical Forensic Medicine, Norwegian Institute of Public Health and Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Stray-Pedersen
mesh_terms: D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D057207:Child Restraint Systems; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009664:Norway; D011446:Prospective Studies; D012307:Risk Factors; D012449:Safety; D012622:Seat Belts / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: Child restraint systems; Injury mechanism; Motor vehicle; Pediatric