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Lower Incidence of Pediatric Blunt Cerebrovascular Injury when Properly Restrained: An ATOMAC Multicenter Study
*Todd A. Nickoles1, *James W. Eubanks, III2, *Ruth A. Lewit2, *Adam C. Alder3, *Jeremy Johnson4, *Robert T. Maxson5, *Jessica A. Naiditch6, *Karla A. Lawson7, M'hamed Temkit1, Benjamin Padilla1, *David M. Notrica1
1Phoenix Children's Hospital, Phoenix, AZ; 2Le Bonheur Children's Hospital, Memphis, TN; 3Children's Health - Plano, Dallas, TX; 4Oklahoma Children's Hospital, OU Health, Oklahoma City, OK; 5Arkansas Children's Hospital, Little Rock, AR; 6Dell Children's Medical Center of Central Texas, Austin, TX; 7Dell Medical School, University of Texas at Austin, Austin, TX

Introduction: Motor vehicle collision (MVC) remains a leading cause of injury and death among children, but the proper use of child safety seats and restraints has lowered the risks associated with motor vehicle travel. Blunt cerebrovascular injury (BCVI) is rare but significant among children involved in MVC. This study reviewed the incidence of BCVI after MVC, comparing those that were properly restrained with those that were not.Methods: A prospective, multi-institutional observational study of children under 15 years old who sustained blunt trauma to the head, face or neck (AIS>0) who presented at one of six level I pediatric trauma centers from 2017 to 2020 was conducted. Restraint status was compared in each age group. Results: A total of 2,284 patients were enrolled at the six trauma centers. Of these, 521 (22.8%) were involved in an MVC. In this cohort, and excluding missing data, 11/388 (2.8%) were diagnosed with a BCVI and accounted for 44.0% of all patients with a BCVI. For children less than 12 years of age, none that were properly restrained suffered a BCVI (0/52) while 8 of 260 (3.1%) improperly restrained children suffered a BCVI. For children between 12 and 15 years of age, the incidence of BCVI was 2/38 (5.3%) for properly restrained compared to 1/38 (2.6%) for unrestrained children (Table 1).Conclusion: In this large multicenter prospectively screened pediatric cohort, the incidence of BCVI among properly restrained children under 12 after MVC was unmeasurably low, while the incidence was 3.2% in those without proper restraint. This protective effect was not seen after 12 years of age. Restraint status in young children may be an important factor in BCVI screening.

Table 1. Incidence of BCVI by age and restraint status among pediatric MVC victims
Age, yearsRestraint StatusNo BCVI N=377BCVI N=11
Age <8No restraint/improper restraint1442
Proper restraint460
Age 8-12No restraint/improper restraint1086
Proper restraint60
Age >12No restraint/improper restraint371
Proper restraint362
BCVI = blunt cerebrovascular injury; MVC = motor vehicle collision

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