Purpose Motor vehicle crashes (MVCs) are the leading cause of morbidity and mortality in children. Studies have shown that use of proper safety restraints can improve the rate of death and injuries. Since 1998, Alabama has made significant improvements in MV legislation, educational services, and established car seat-fitting programs. Consequently, significant increases in car seat use have occurred. This study analyzes MVC trauma patient visits at a local pediatric trauma center from 1998 through 2005. The primary study question is do recent improvements in MV safety in Alabama lead to discernible changes in pediatric MVC visits at a hospital trauma center?
Methods A trauma database is maintained by the trauma service coordinator at the Children's Hospital of Alabama. All patients who are activated as trauma patients are entered into the database. MVC data include basic demographic information, type of trauma, if restraints were used, and, if so, what kind. Injury severity scores and disposition information were also noted. After institutional review board approval, the database was accessed for MVA trauma code information. Data were analyzed using Epi Info®.
Results Since 1998, the total number of trauma codes has averaged 446 per year. The proportion of MVC codes has decreased from 52.6% of total codes in 1998 to 46.4% in 2005 (z = 1.78, p = 08). The average age of the MVC patient in 1998 was 8.2 years compared with 9.0 years in 2005. The percentage of MVC trauma patients discharged from the hospital has not changed (95.3% in 1998 compared with 95.9% in 2005). The number of MVC trauma patients using some form of restraint increased from 37.6% in 1998 to 51.3% in 2005 (z = 4.05, p < .001), with a peak of 62.1% in 2001, which was 1 year after the enactment of the state primary seat belt law. The percentage of patients using no restraint decreased overall from 62.4% in 1998 to 45% in 2005 (z = 5.14, p < .001), with the largest decline in 2001 to 35.9%.
Conclusions Statewide MV laws, educational interventions, and car seat-fitting services working in tandem can lead to significant increases in car seat use with corresponding decreases in MVC injury. This research demonstrates that such decreases can be detected at local levels using trauma code patient data sets. These data sets are a useful surveillance method that can help evaluate the effectiveness of statewide interventions.
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