Risk factors and predictors of mortality in children after ejection from motor vehicle crashes

Purpose: Mortality after ejection from a motor vehicle crash (MVC) has been studied extensively in adults, The magnitude of this problem in children i s relatively unknown. We retrospectively examined fatalities resulting from ejection after MVC in the state of Pennsylvania to define risk factors and predictors of mortality in children, Methods: The records for all patients 0 to 16 years of age involved in an M VC and entered in the Pennsylvania Trauma Outcome Study between 1993 and 19 97 were reviewed, We examined mortality, length of hospitalization, major i njuries sustained, and impact of safety restraint devices, Significant diff erences were determined using chi (2) test. Results: There were 2,298 children involved in MVCs during this period; 189 were ejected. A total of 77% of the ejected passengers were greater than 1 0 years of age, 16% were 0 to 4 years of age, and 7% were 5 to 9 years of a ge. Overall, 88% of the ejected occupants were unrestrained, Ejection nearl y tripled the overall mortality rate and significantly increased the Injury Severity Score for each age group, Infants and children 0 to 4 years of ag e had the highest fatality rate despite. having a lower Injury Severity Sco re than all other age groups, Head injuries accounted for the majority of d eaths in all age groups, Children older than 10 years of age had a higher i ncidence of associated chest, abdominal, and pelvic injuries. Conclusion: Our data show that most children ejected from MVCs were either unrestrained or improperly restrained, Head injuries were the most common c ause of death in all age groups. Greater public awareness through education al programs targeting parents and children at risk may reduce this serious problem.