Childhood crash injury patterns associated with restraint misuse: implications for field triage.

INTRODUCTION Restraint misuse is a common problem leading to increased morbidity and mortality for children involved in motor vehicle crashes. The purpose of this project was to describe the injury patterns associated with restraint misuse in the pediatric population, with particular focus on clues to significant injury that can be identified by the prehospital provider that may impact subsequent triage decisions. METHODS This is a case series presentation that illustrates the injury patterns associated with various types of restraint misuse in infants (ages 0-1 years), toddlers (age 1-4 years), young children (ages 4-8 years), and pre-teens (ages 8-14 years). Cases were identified from the Crash Injury Research and Engineering Network (CIREN) database. RESULTS Six cases are presented that illustrate the injury patterns associated with misuse of rear-facing infant car seats (0-1 years), forward-facing child seats (1-4 years), booster seats (4-8 years), and shoulder belts (8-14 years). Prehospital assessment of appropriate restraint use is described. CONCLUSIONS Restraint misuse in children is a common problem. Emergency medical services providers need to be aware of these issues when assessing children and determining appropriate triage to a trauma center. Ongoing educational efforts also are vital to inform parents regarding the risks of inappropriate restraint use and can encourage legislators to better define appropriate restraint use for older children.