J. Santos1, A. Grigorian1, M. Schellenberg2, K. Matsushima2, M. Martin2, J. Nahmias1, K. Inaba2 1University Of California – Irvine, Division Of Trauma, Burns, Critical Care & Acute Care Surgery, Orange, CA, USA 2University Of Southern California, Division Of Trauma, Emergency Surgery And Surgical Critical Care, Los Angeles, CA, USA
Introduction:
Current American Academy of Pediatrics (AAP) guidelines recommend the use of child safety/booster seats for children under 145 centimeters and ≤ 12-years-old. However, national adherence to this recommendation and clinical outcomes for children under 145 centimeters involved in a motor vehicle crash (MVC) are unknown. We hypothesized that children ≤ 12-years-old and <145 centimeters in height involved in MVCs have a lower rate of serious injuries if a safety/booster seat is used, compared to children without a safety/booster seat.
Methods:
The 2017-2019 Trauma Quality Improvement Program database was queried for patients ≤ 12-years-old and <145 cm presenting after MVC. A serious injury was defined by abbreviated injury scale grade ≥ 3 for any body-region (head, face, neck, thorax, abdomen, spine, upper or lower extremity, external). High-risk mechanism was defined by the Centers for Disease Control and Prevention and the American College of Surgeons-Committee on Trauma as death in same vehicle, ejection from vehicle, major vehicle intrusion including roof, or crash vehicle telemetry data consistent with high-risk injury.
Results:
From 8,259 cases, 3,422 (41.4%) used a safety/booster seat. The most common serious injury was to the head (24.5%). The safety/booster seat group had a similar overall rate of serious traumatic injuries (44.3% vs. 46.3%, p=0.074) as well as mortality (2.6% vs. 2.4%, p=0.534) compared to the no safety/booster seat cohort. In a subset analysis of high-risk MVCs, the overall use of safety/booster seats was 56.3%. The rate of a serious traumatic injury (53.6% vs. 62.1%, p=0.017) and invasive intervention/procedure (15.8% vs. 21.6%, p=0.039) was lower in those using a safety/booster seat compared to those without a safety/booster seat.
Conclusion:
Despite AAP recommendations, national-wide less than half of children ≤ 12-years-old and <145 centimeters in height used safety/booster seats. Pediatric patients involved in a high-risk MVC suffer more serious injury and are more likely to require surgical intervention without a safety/booster seat. A public health program to increase adherence to safety/booster seat use within this population appears warranted.