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Young children involved in car crashes may have a greater chance of survival if secured in a child restraint system, such as a safety seat than if buckled only in a seat belt.
Policy for child car safety relies on evaluating the risks of not using safety seats versus the benefits of their use in protecting children in crashes. These safety evaluations are often conducted using the U.S. Department of Transportation Fatality Analysis Reporting System (FARS), a census of car crashes in which one or more persons died. Using only FARS data for these evaluations, however, can be problematic, because these data assume that surviving children in fatal crashes were secured similarly to those of children in other, non-fatal crashes.
Researchers from the University of Michigan, Ann Arbor, who examined vehicle crash data to compare the benefit of using child restraint systems (such as safety seats) to wearing seat belts alone in children two to six years old. Their study sample comprised 7,813 children in fatal crashes from the FARS database and 1,433 children in nonfatal crashes from the National Automotive Sampling System Crashworthiness Data System (NASS CDS), all of whom were involved in crashes in which at least one car was left undriveable between 1998 and 2003.
Overall, approximately one in 1,000 children in a two-way crash died, with less than half (45 percent) of all children in restraint seats.
One of six children (15.7 percent) were in the front seat, two thirds (67.6 percent) were in passenger cars, one of six (15.6 percent) were in pre-1990 model year vehicles and 4 percent of cars were driven by teenage drivers.
Compared with seat belts alone, child safety seats were associated with a 21 percent reduction in risk of death. When excluding cases of serious misuse of safety seats or belts, the reduced risk of death was 28 percent.
The researchers say that child restraint systems offer improved fit of restraints for children who are too small for the adult-sized seat belt, thereby affording a mechanical protection advantage over seat belts. If restraint systems are seriously misused, however, their safety performance would be expected to be diminished.
Based on past and these current findings, the authors state that efforts should continue to promote child restraint use through improved laws and educational programs.
Important new data, were produced by research concerning seat belt injuries indicating that they could signal more serious trauma in children.
Ill-fitting seatbelts raise the risk of serious injury to children involved in car accidents.
And seat belt injuries should alert physicians to look for signs of more serious consequences, particularly spinal cord injury, which is not always immediately apparent.
Unless physicians are diligent, spinal-cord injuries are hard to diagnose in children. In the event of a car accident, seat belt injuries such as bruising and tenderness should warrant a search for other injuries, including spinal-cord injury, vertebral fractures and intra-abdominal injuries.
If spinal-cord injury is missed or not diagnosed early, the consequences can be devastating.
Surgeons at Temple University School of Medicine and Hospital, reviewed 10 years' worth of medical literature on motor vehicle accidents and children. They found that children involved in car accidents who were inappropriately seatbelted were at higher risk for "seat-belt syndrome," a complex of injuries to the spine and abdomen. Consequently, when healthcare professionals see bruising or seat belt marks in pediatric car accident victims, they should have a high degree of suspicion about more serious injury.
Car accidents, the most common cause of injury and death in children, are also the most common cause of spinal cord injury in children and adolescents. Boys are more affected than girls, and the incidence increases with age. Children who are 4 to 8 years old are most likely to be using ill-fitting seatbelts or restraints.
The surgeons recommend that an evaluation of a child or adolescent car-accident victim include a complete work-up for vertebral, spinal cord and intra-abdominal injuries. In addition to bruises or marks from the seat belt, clues of more serious injury include abdominal and/or spine tenderness, and neurological deficits.
Ideal treatment of possible spinal-cord injury starts at the scene of the accident with proper stabilization and transportation of the victims. If a child with a spinal fracture has not been stabilized properly, movement can injure more tissue.
In general, seat belts and safety restraints should be adjusted according to age and weight.
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