AIRBAGS AND CHILDREN - A SPECTRUM OF C-SPINE INJURIES

Over 30 children who were improperly restrained or in rear facing safe ty seats have been reported killed in motor vehicle accidents (MVA) in volving airbags. The authors report one minor and two major injuries i n properly restrained children in the front passenger seat. In case 1, A 10-year-old seat-belted boy was involved in an MVA (40 km/h) with d eployment of both airbags. Physical examination findings showed right hyphema with corneal abrasion, right cheek abrasion and minimal cervic al tenderness C-spine x-ray was normal. He was treated for whiplash an d facial burns resulting from contact with hot gas released by the air bags and discharged In case 2, a 4-year-old boy wearing a lapbelt was in a MVA (20 km/h) with airbag development. On arrival, his Glasgow co ma score was 3 and he was hemodynamically unstable. Secondary survey a fter stabilization showed left neck abrasions and ecchymoses, quadrapl egia, priapism, and absent rectal tone. C-spine x-ray showed atlanto-o ccipital dislocation with possible complete spinal cord transection at C-1. Aggressive maneuvers were withheld and the patient was pronounce d dead. Autopsy findings confirmed the clinical diagnosis. In case 3, a 3-year-old boy in a forward-facing safety seat was in a MVA (60 km/h ) with air bag deployment The patient was fully awake. C-spine x-rays were normal. Because of fluctuating level of consciousness, he underwe nt head computed tomography (CT) scan, which demonstrated a posterior fossa subarachnoid hemorrhage and a hematoma posterior to the odontoid , suggesting a ligamentous tear. He remained asymptomatic and was disc harged on day 6. A head CT scan at 1 month showed a periosteal reactio n in the area of the alar ligament suggestive of partial ligamentous a vulsion; this injury was the forerunner of atlanto-occipital dislocati on. Airbags deploy by releasing a hot effluent at 300 km/h. Mechanisms of injury include direct contact of hot gas with facial skin and ener gy transmitted directly from the airbag system to the child's head and neck. These cases illustrate a spectrum of C-spin injuries caused by airbag deployment and support the recommendation that children under 1 2 years of age travelling in a car equipped with dual airbags be seate d in the back.