title: Road traffic injuries among children and adolescents in Singapore - Who is at greatest risk?
abstract: BACKGROUND
  Pediatric road traffic injuries remain a significant cause of death and disability in many countries in Asia, despite the implementation of road traffic safety laws. We aim to describe the injuries, the use of restraints among road users, and risk factors associated with severe injuries for children in Singapore.
  
  
  METHODS
  We performed a retrospective chart review of road traffic injuries presenting to the only two pediatric tertiary care hospitals in Singapore, from January 2012 to April 2016. We included children <16years old presenting to the emergency departments within 24h after injury (pedestrian, bicycle, motorcycle, motor vehicle). We calculated the frequencies for specific injury mechanisms, injury severity scores (ISS), and in-hospital outcomes of severe injuries (death, urgent resuscitation and emergent surgery). We performed a multivariate logistic regression to determine risk factors associated with severe injury.
  
  
  RESULTS
  There were 2468 patients during the study period. The mean age was 7.9 years (SD 4.7); 60.1% of road injuries involved motor vehicle occupants (1483/2468). Most bicyclist/motorcyclists were not wearing helmets (70.0%, 245/350) and 51.1% of motor vehicle passengers (758/1483) were not restrained. Compared to motor vehicle passengers, pedestrians (adjusted OR 2.38, 95% CI 1.41-3.99), bicyclists (adjusted OR 2.12, 95% CI 1.04-4.32) and motorcyclists (adjusted OR 6.09, 95% CI 2.04-18.24) were more likely to sustain severe injuries.
  
  
  CONCLUSIONS
  Child pedestrians, bicyclists and motorcyclists are especially vulnerable for severe injures. Further injury prevention efforts must focus on the enforcement of legislation to protect these high-risk groups.
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore. Electronic address: Chong.Shu-Ling@kkh.com.sg.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chong
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore. Electronic address: arif.tyebally@singhealth.com.sg.
authors.forename: Arif
authors.initials: A
authors.lastname: Tyebally
authors.affiliation: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore. Electronic address: chewsuyah@gmail.com.
authors.forename: Su Yah
authors.initials: SY
authors.lastname: Chew
authors.affiliation: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore. Electronic address: yang_chern_lim@nuhs.edu.sg.
authors.forename: Yang Chern
authors.initials: YC
authors.lastname: Lim
authors.affiliation: Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore. Electronic address: jasmine.feng.xy@kkh.com.sg.
authors.forename: Xun Yi
authors.initials: XY
authors.lastname: Feng
authors.affiliation: Department of Emergency Medicine, National University Health System, Singapore. Electronic address: shizukadorae@yahoo.com.sg.
authors.forename: Sock Teng
authors.initials: ST
authors.lastname: Chin
authors.affiliation: Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States. Electronic address: Lois.Lee@childrens.harvard.edu.
authors.forename: Lois K
authors.initials: LK
authors.lastname: Lee
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D018986:Motor Vehicles / Q000706:statistics & numerical data; D000069636:Pedestrians / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000517:prevention & control
keywords: Child; Motor vehicle crash; Restraint; Road traffic accidents