Purpose Despite public efforts encouraging use of child safety restraints, our emergency department (ED) continues to evaluate children involved in motor vehicle collisions (MVC) who are unrestrained. To emphasize the need for further educational and legislative measures to convince guardians to use proper safety restraints, we conducted a study to compare injuries, death, and financial cost between unrestrained and restrained pediatric victims of MVC and also to determine the compliance of safety restraint use in this population.
Methods This retrospective chart review compared restrained children (RC) to unrestrained children (URC) (< 14 years old) of MVC who presented to our ED from 1/1/3-12/31/3. Our ED is in an urban, teaching hospital with an annual 68K census, which is racially, ethnically, and socioeconomically diverse. Our level 1 trauma center encompasses a catchment area>40K square miles with a 1.3 million population. Charts were excluded if use or nonuse of safety restraint was not documented. The two groups were compared for age, gender, medical charges, hospital duration, injuries (intraabdominal, intrathoracic, intracranial and fractures), admission, surgery, transfusion of blood products, and intubation. Use of restraint was reported as a percentage. Chi-square was used for analysis of gender and t-test with 95% CIs for age, medical charges, and duration of admission. Odds ratios and 95% CIs were calculated for URC with respect to RC for dichotomous data. All statistical tests were two tailed using a significance level of 0.05.
Results 353 patients were identified. 17 (4.8%) lacked documentation on car restraint use. Of the remaining 336, 255 (76%) were RC and 81 (24%) were URC. The URC group was statistically older (8.86 years, CI: 7.94, 9.78) than the RC (6.95 years, CI: 6.42, 7.48). Length of hospital stay of 1.94 days (CI: 0.75, 3.12) for URC was significantly longer than RC, 0.10 days (CI: 0.02, 0.21). Cost of care for URC ($14,754, CI: $7676, $21,831) was significantly higher than RC ($1996, CI: $1207, $2786). Odds of admission was 14.48 times (CI: 5.91, 38.63) higher in URC than RC. Odds of serious injuries were higher in URC: intraabdominal [OR = 20.16 (CI: 2.36, 930.68)], intrathoracic [OR = 13.09 (CI: 1.26, 647.05)], and fractures [OR = 5.85, CI: 2.13, 16.89]. Nine (11.11%) URC had an intracranial bleed versus no RC. The URC group had higher need for surgery [OR = 13.09 (CI: 3.30, 74.33)] and transfusion [OR = 27.61 (CI: 3.56, 1229.85)]. Ten URC (12.35%) required intubation versus no RC. The only two mortalities were URC.
Conclusion Serious injuries and cost of care were significantly higher in unrestrained than restrained victims of MVC. In this population, there was room for improvement in terms of compliance with child safety restraint.
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