Influence of restraining devices on patterns of pediatric facial trauma inmotor vehicle collisions

In the Commonwealth of Pennsylvania, it is required that all children under the age of 4 years be restrained by an infant seat or car seat appropriate for their age and weight. Furthermore, ail individuals riding in the front seat must be restrained by a seatbelt. This study examined the relationshi p between patterns of facial injuries and the use of restraining devices in the pediatric population. A retrospective analysis was performed on motor vehicle collision data submitted to the Pennsylvania Trauma Outcome Study d atabase from 1990 through 1995. Criteria for submission included trauma pat ients who were admitted to the Intensive Care Unit, those who died during h ospitalization, those who were hospitalized for more than 72 hours, or thos e who were transferred in or out of the receiving hospital. A subset of 412 pediatric patients, 15 veers of age or younger, was analyzed for patterns of facial Injury and the presence or absence of restraining devices. Restra ining devices were categorized as a car seat or a seatbelt. Statistical ana lysis was performed using chi-square and Fisher's exact tests. Of the 412 p ediatric patients, only 17 children were restrained with a car seat and 121 were wearing a seatbelt. A total of 30 children sustained facial fractures , and 50 children suffered facial lacerations. There tvas a statistically s ignificant increase in the incidence of facial fractures with increasing ag e of the child (p < 0.001). Of children with facial fractures, 70 percent o f those 5 to 12 years old and 90 percent of those 13 to 15 years old were u nrestrained (P = 0.166), In conclusion, despite legislation mandating the u se of restraints, a large proportion of children involved in motor vehicle collisions were unrestrained. Furthermore, there seems to he a direct relat ionship between the age of a child and the incidence of facial fractures su stained in motor vehicle collisions.