Children in crashes: mechanisms of injury and restraint systems

Objectives: To explore the levels of protection offered to children involve d in motor vehicle collisions. Design: A joint study by the Children's Hosp ital of Eastern Ontario (CHEO) and Transport Canada, Ottawa, conducted in 2 phases: retrospective from 1990 to 1997 and prospective from 1998 to 2000. Setting: CHEO, a university affiliated tertiary care centre. Patients: Chi ldren admitted to CHEO between 1990 and 2000 with spinal trauma due to moto r vehical crashes (MVCs). Phase I of the study involved analysis, in a seri es of 45 children after MVAs, by location of spinal injury versus belt type . Phase 2 was a prospective study of 22 children injured in 15 MN,As. Inter ventions: A biomechanical assessment of the vehicle and its influence on th e injuries sustained. Main outcome measures: The nature and extent of the i njuries sustained, and the vehicle dynamics and associated occupant kinemat ics. Results: The odds ratio of sustaining a spinal injury while wearing a 2-point belt versus a 3-point belt was 24 (95% confidence interval 2.0-2.45 , p < 0.1), indicating a much higher incidence with a lap belt than a shoul der strap. Conclusions: Proper seat-belt restraint reduces the morbidity in children involved in MVCs. Children under the age of 12 years should not b e front-scat passengers until the sensitivity of air bags has been improved . Three-point pediatric seat belts should be available for family automobil es to reduce childhood trauma in MVCs.