title: The Effects of Restraint Type on Pattern of Spine Injury in Children.
abstract: BACKGROUND
  While the use of vehicular restraints has reduced the morbidity and mortality of children involved in motor vehicle collisions (MVC), to our knowledge, no study has examined the relationship between restraint type and patterns of pediatric spinal injuries. The purpose of this study is to evaluate this association and review the spinal injuries sustained in children involved in MVC.
  
  
  METHODS
  We completed an IRB-approved, retrospective chart review of all patients below 10 years of age presenting to a level 1 pediatric trauma hospital with spine injuries sustained in MVC from 2003 to 2011. We reviewed prehospital data, medical records, and radiographs to establish the restraint type and characterize the spinal injuries sustained.
  
  
  RESULTS
  A total of 97 patients were identified with spinal trauma secondary to MVC with appropriate and documentation of restraint type. Results are reported regardless of whether the restraint employed was properly used per established guidelines. Car seat/booster seat (C/B) patients sustained significantly higher rates of cervical spine (62%) and ligamentous (62%) injuries than the 2-point (2P) (10%) and 3-point (3P) restraint (24%) groups (P<0.001). Two-point and 3P restraint use was associated with significantly higher rates of thoracolumbar injuries (67% and 62%, respectively) than the C/B (14%) and unrestrained (0%) groups (P<0.001). Two-point and 3P passengers also had a higher rate of flexion-distraction injuries (P<0.001). Patients in the unrestrained group sustained a significantly higher rate of cervical spine (80%) and ligamentous (40%) injuries than the 2P and 3P groups (P<0.001). No differences were found in the type or location of injury between the 2P and 3P groups. Significant differences in proper restraint use were identified between age groups with younger children demonstrating higher rates of proper restraint use (P<0.01).
  
  
  CONCLUSIONS
  Two-point or 3P seatbelt use is associated with lower rates of cervical spine trauma but higher rates of thoracic and lumbar trauma, particularly flexion-distraction injuries, when compared with car or booster seats. Children in C/B and those who are unrestrained sustain high rates of cervical spine injury.
  
  
  METHODS
  Level III-prognostic study.
authors.affiliation: *Orthopedic Surgery Service, Tripler Army Medical Center, Honolulu, HI †Department of Orthopedics, Texas Scottish Rite Hospital for Children and Children's Medical Center, Dallas, TX.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Ernat
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Knox
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wimberly
authors.forename: Anthony I
authors.initials: AI
authors.lastname: Riccio
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D002648:Child; D057207:Child Restraint Systems / Q000592:standards / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D011859:Radiography / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000145:classification / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D013781:Texas / Q000453:epidemiology