G.H. Gershner1,2, C.M. Dalton1,2, H.C. Grubbs1,2, K. Stewart2, C.J. Hunter1,2 1University Of Oklahoma College Of Medicine, Pediatric Surgery, Oklahoma City, OK, USA 2University Of Oklahoma College Of Medicine, Surgery, Oklahoma City, OK, USA
Introduction:
Motor vehicle collisions are one of the leading causes of morbidity and mortality in the pediatric population. Risk of serious injury has been shown to be decreased for children who are properly restrained in either appropriately sized child restraints like car seats or booster seats, or with proper shoulder/lap belt usage. Despite several attempts to change the current statute, Oklahoma is currently the only state without a mandate for children age 8-17 years to wear a restraint of any kind when in the rear seat of a vehicle. Given this gap in the law, we hypothesized that this population will have an overall lower restraint usage and higher injury severity scores (ISS) when compared to national data.
Methods:
This was a retrospective study utilizing data from the Trauma Quality Program (TQP) database, years 2017-2022, and the University of Oklahoma Trauma Registry (OTR) from years 2021-2023. Children age 0-17 injured in a motor vehicle crash with restraint information available were selected for analysis. Children were divided into two groups, ages 0-7 and ages 8-17. For this comparison we focused on children age 8-17. We examined percentage of restraint usage and type of restraint used. Additionally, we examined ISS and crude mortality.
Results:
In the OTR Data, a total of 1,046 cases were found (0-7 n=305, 8-17 n= 741). In the TQP data, a total of 101,797 cases were found (0-7 n=24,836, 8-17 n=76,961). In our target cohort of children 8-17 years old, 234 (31.6%) were found to have no restraint in OK, while 31,736 (41.2%) were found to have no restraint in TQP (p<0.0001). The proportion of patients with an ISS≥16 from TQP (22.4%) was more the twice that of OTR patients (10.1%) (p<0.0001). The mean ISS for the OTR data was 5.6 (SD 8.2), while in TQP it was 10.7 (SD 10.3). Of the 741 cases in the OTR, 2 died (0.3%) compared to 1708 (2.2%) among children reported to TQP (p=0.0003).
Conclusion:
Contrary to our hypothesis, Oklahoman children age 8-17 years were less likely to be unrestrained compared to national data despite a lack of legal statue or mandate. We additionally observed a lower average ISS and lower mortality. Our study is limited due to deaths on scene not being recorded into either database. Additionally, the elevated ISS distribution of the TQP dataset is likely at least partly due to the higher requirement for reporting, whereas the OTR captures all traumas, however the small number of OTR deaths precluded multivariable adjustment. Further examination into height/weight mismatching with restraint type, regionality, difference between front and rear belt usage, and examining of death on scene data could help define these results.