title: Underutilization of occupant restraint systems in motor vehicle injury crashes: A quantitative analysis from Qatar.
abstract: BACKGROUND
  Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar.
  
  
  METHODS
  A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive.
  
  
  RESULTS
  Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49-2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31-7.38, P = .001) was significantly greater among unrestrained passengers.
  
  
  CONCLUSIONS
  The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar.
authors.affiliation: a Clinical Research, Hamad Trauma Center, Hamad General Hospital (HGH) , Doha , Qatar.|b Clinical Medicine, Weill Cornell Medical College , Doha , Qatar.|c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar.
authors.forename: Ayman
authors.initials: A
authors.lastname: El-Menyar
authors.affiliation: c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar.|d Injury Prevention Program, Hamad Trauma Center , HGH , Doha , Qatar.
authors.forename: Rafael
authors.initials: R
authors.lastname: Consunji
authors.affiliation: a Clinical Research, Hamad Trauma Center, Hamad General Hospital (HGH) , Doha , Qatar.|c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Asim
authors.affiliation: c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar.
authors.forename: Husham
authors.initials: H
authors.lastname: Abdelrahman
authors.affiliation: c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Zarour
authors.affiliation: c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar.
authors.forename: Ashok
authors.initials: A
authors.lastname: Parchani
authors.affiliation: c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar.
authors.forename: Ruben
authors.initials: R
authors.lastname: Peralta
authors.affiliation: c Trauma Surgery Section , Department of Surgery , HGH , Doha , Qatar.
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Thani
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017278:Air Bags / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011780:Qatar / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D012622:Seat Belts / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult
keywords: Qatar; airbag; motor vehicle crash; seat belt; unrestrained