Pediatric Trauma Society

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The Prevalence of Pediatric Car Restraint Use and Trauma Outcomes: Are Current Laws Sufficient?
Adel Elkbuli, MD, MPH; Dessy Boneva, MD; Mark McKenney, MD, MBA; Shaikh Hai, MD, FACS
Kendall Regional Medical Center, Miami, FL

Background: All 50 states require pediatric passengers in motor vehicles to travel in booster seats or approved child restraint belts. The National Highway Traffic Safety Administration (NHTSA) estimates from observational studies that only 2% of children are not wearing safety restraints in motor vehicles. This study aimed to evaluate the use of booster seats/pediatric restraints in motor vehicle crashes transported to a pediatric trauma center compared to historical controls.

Study Design and Methods: A four-year review using our Pediatric Level I Trauma Center registry for patients ?15 years old, involved in an MVC. Booster seat/child restraint use was evaluated on arrival from conversation with Emergency Medical Services, Fire Rescue, patient, and family. The attending surgeon on call when the child arrival adjudicated discrepancies. Chi-square was used with significance defined as p<0.05.

Results: There were 672 pediatric patients involved in MVCs that were admitted to our center during the 4-year study. Only 77 (11.5%) pediatric patients were in child restraints or child booster seat at the time of the crash, while 595 (88.5%) pediatric patients were not restrained. Based on the NHTSA historical controls, 658 of 672 (98%) children would have been expected to be using a booster seat/child restraint (11.5% vs. 98%, p<<0.01)

Conclusion: Lack of child restraints in motor vehicles is strongly associated with pediatric injury requiring admission to a Pediatric Trauma Center. Astonishingly low rates of seatbelt use in Pediatric Motor Vehicle injuries indicate the need for better driver education on risks associated with lack of restraint use.


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