title: Does restraint status in motor vehicle crash with rollover predict the need for trauma team presence on arrival? An ATOMAC study.
abstract: OBJECTIVE
  Restraint status has not been combined with mechanistic criteria for trauma team activation. This study aims to assess the relationship between motor vehicle crash rollover (MVC-R) mechanism with and without proper restraint and need for trauma team activation.
  
  
  METHODS
  Patients <16years old involved in an MVC-R between November 2007 and November 2012 at 6 Level 1 pediatric trauma centers were included. Restraint status, the need for transfusion or intervention in the emergency department (ED), hospital and intensive care length of stay and mortality were assessed.
  
  
  RESULTS
  Of 690 cases reviewed, 48% were improperly restrained. Improperly restrained children were more likely to require intubation (OR 10.24; 95% CI 2.42 to 91.69), receive blood in the ED (OR 4.06; 95% CI 1.43 to 14.17) and require intensive care (ICU) (OR; 3.11; 95% CI 1.96 to 4.93) than the properly restrained group. The improperly restrained group had a longer hospital length of stay (p<0.001), and a higher mortality (3.4% vs. 0.8%; OR 4.09; 95% CI 1.07 to 23.02) than the properly restrained group.
  
  
  CONCLUSIONS
  Unrestrained children in MVC-R had higher injury severity and were significantly more likely to need urgent interventions compared to properly restrained children. This supports a modification to include restraint status with the rollover criterion for trauma team activation.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR, USA.
authors.forename: John
authors.initials: J
authors.lastname: Recicar
authors.affiliation: Trauma Services, Dell Children's Medical Center of Central Texas, Austin TX, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Barczyk
authors.affiliation: Trauma Services, Dell Children's Medical Center of Central Texas, Austin TX, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Duzinski
authors.affiliation: Trauma Services, Dell Children's Medical Center of Central Texas, Austin TX, USA.
authors.forename: Karla A
authors.initials: KA
authors.lastname: Lawson
authors.affiliation: Trauma Services, Dell Children's Medical Center of Central Texas, Austin TX, USA.
authors.forename: Nilda M
authors.initials: NM
authors.lastname: Garcia
authors.affiliation: Department of Surgery, The Children's Hospital at OU Medical Center, Oklahoma City, OK, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Letton
authors.affiliation: Department of Surgery, The Children's Hospital at OU Medical Center, Oklahoma City, OK, USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Raines
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Eubanks
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA.
authors.forename: Nima
authors.initials: N
authors.lastname: Azarakhsh
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Grimes
authors.affiliation: Department of Surgery and Level 1 Pediatric Trauma Center, Phoenix Children's Hospital, Phoenix, AZ, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Notrica
authors.affiliation: Department of Surgery and Level 1 Pediatric Trauma Center, Phoenix Children's Hospital, Phoenix, AZ, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Garcia-Fillon
authors.affiliation: Department of Surgery and Trauma Services, Children's Medical Center Dallas, Dallas, TX, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Alder
authors.affiliation: Department of Surgery and Trauma Services, Children's Medical Center Dallas, Dallas, TX, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Greenwell
authors.affiliation: Department of Surgery and Trauma Services, Children's Medical Center Dallas, Dallas, TX, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Megison
authors.affiliation: University of Arkansas for Medical Sciences, Department of Pediatrics, Division of Biostatistics, Little Rock, AR, USA.
authors.forename: Mallikarjuna
authors.initials: M
authors.lastname: Rettiganti
authors.affiliation: University of Arkansas for Medical Sciences, Department of Pediatrics, Division of Biostatistics, Little Rock, AR, USA.
authors.forename: Chunqiao
authors.initials: C
authors.lastname: Luo
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR, USA. Electronic address: rtmaxson@uams.edu.
authors.forename: Robert Todd
authors.initials: RT
authors.lastname: Maxson
mesh_terms: D000063:Accidents, Traffic; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D018986:Motor Vehicles; D010348:Patient Care Team; D012189:Retrospective Studies; D012622:Seat Belts; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*
keywords: Mechanistic criteria; Pediatric trauma; Rollover crash