Effect of appropriate restraint use on pediatric injury outcomes in motor vehicle crashes from US Trauma Quality Program data.

OBJECTIVE: Use of appropriate child restraint systems (CRS) based on a child's age and size is important to reduce the risk of injury in motor vehicle crashes (MVCs). The aim of this work was to assess the influence of appropriate versus inappropriate restraint use on pediatric injury outcomes in MVCs using the US Trauma Quality Programs Participant Use File (TQP PUF). METHODS: Trauma registry data were obtained for TQP PUF admission years 2018-2022, and individuals 1-13 years involved in MVCs were identified using ICD-10 external cause of injury codes. Use of an appropriate versus inappropriate restraint was defined using the child's age, height, and weight in addition to the Child Restraint and Protective Devices variables. Ranges of appropriate child age, height, and weight for each restraint type (rear-facing CRS, forward-facing CRS, booster, seat belt only, or unrestrained) were defined using current best-practice recommendations from the American Academy of Pediatrics and typical CRS product allowable age, height, and weight ranges. Abbreviated Injury Scale (AIS) outcomes were used to identify maximum AIS (MAIS) 3+ (serious to maximal) versus 1-2 (minor to moderate) outcomes for the whole body and individual body regions. Logistic regression was used to evaluate relationships between age and use of appropriate restraints, and odds ratios were used to compare injury outcomes between use of appropriate versus inappropriate restraints. RESULTS: 39,993 occupants admitted to trauma centers between 1 and 13 yr were evaluated. Overall, 39.10% of children were unrestrained and an additional 18.73% utilized an inappropriate restraint type, and this varied by age. For children 1-7 yr, the odds of utilizing an inappropriate versus appropriate restraint type increased by 1.46 times with each 1-year increase in age, increasing from 6.29% at 1 yr to 39.36% at 7 yr. 40.5% of occupants sustained MAIS 3+ injuries, and unrestrained children had 1.56 (95% CI [1.49, 1.64]) times increased odds to sustain MAIS 3+ versus MAIS 1-2 injuries compared to use of appropriate restraints. Head injuries were the most frequently injured body region (46.0% of all discrete injuries); however, the relative proportion of head injuries compared to other body regions decreased with age. Odds of sustaining a MAIS 3+ versus MAIS 1-2 injury were higher when unrestrained compared to appropriate restraint use when considering injuries to the head (OR = 1.33, 95% CI [1.25, 1.42]), thorax (OR = 1.71, 95% CI [1.56,1.86]), abdomen (OR = 1.52, 95% CI [1.37, 1.68]), spine (OR = 1.54, 95% CI [1.25, 1.90]), and extremities (OR = 1.87, 95% CI [1.73, 2.01]). CONCLUSIONS: The odds ratios for sustaining a MAIS 3+ versus 1-2 injury when unrestrained compared to appropriate restraints confirm the importance of utilizing appropriate restraint types based on a child's age and size. Continued efforts to increase appropriate restraint use for children, especially between 4-10 yr, would be beneficial.