Suboptimal restraint affects the pattern of abdominal injuries in children involved in motor vehicle crashes

Department of Pediatric General and Thoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
Journal of Pediatric Surgery (Impact Factor: 1.39). 06/2003; 38(6):919-23. DOI: 10.1016/S0022-3468(03)00124-6
Source: PubMed


Both solid and hollow visceral abdominal injuries have been associated with the use of seat belts in children involved in motor vehicle crashes. The relationship between the types of restraint used and the pattern of abdominal injury is unknown.
A probability sample of restrained children involved in crashes was enrolled in an ongoing crash surveillance system (1998 through 2002) linking insurance claims data to telephone survey and crash investigation data. Significant abdominal injuries were considered when the Abbreviated Injury Scale (AIS) score was > or =2 and were defined as hollow visceral (HV; intestine, bladder), or solid visceral (liver, spleen, pancreas, kidney). Restraint type was categorized as optimal restraint (OR) or suboptimal restraint (S-OR) based on the child's age and size.
For the 33 months of review, interviews were obtained for 13,558 restrained children aged 0 to 15 years, of which, 56% were OR (n = 7,591) and 44% were S-OR (n = 5,967). A significant abdominal injury was recorded in 78 children. A hollow visceral injury was recorded in 38 (9 OR and 29 S-OR), and a solid visceral injury in 32 (18 OR and 14 S-OR). Both hollow and solid visceral injuries were present in 8 children (2 OR and 6 S-OR). Suboptimally restrained children had a higher risk for hollow visceral injury when compared with optimally restrained children (Odds Ratio, 4.14 [95% Confidence Interval 1.33 to 13.22, P <.01]).
Among restrained children with intraabdominal injuries, those who were suboptimally restrained were 4 times more likely to have a hollow visceral than a solid visceral injury when compared with those who were optimally restrained. This suggests that the mechanism of injury for hollow viscus may be directly related to the improper positioning of the restraint.

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    • "For rear seat occupants, the seat belt is the common source of these injuries (Parenteau and Viano 2003a). Abdominal injuries in the rear seat have been attributed to submarining (Durbin et al. 2001) in children prematurely graduating to adult seat belts (Lutz et al. 2003; Nance et al. 2004). Our previous work (Beck et al. 2011) has demonstrated increases in measures of abdominal injury with poor pre-impact posture, such as slouching, which occurs when children's thighs are too short for the vehicle rear seat (Klinich et al. 1994; Reed, Ebert- Hamilton, and Manary 2005). "
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    ABSTRACT: Objective: Investigate the combined effects of belt geometry, seat substructure, and seat belt pretensioners and load limiters on rear seat occupant injury risk. Methods: An instrumented Hybrid III 5th percentile adult female dummy was subjected to simulated frontal impacts (Δv = 45.8 km/h, peak acceleration = 27.1 g). Testing was conducted on a rear seat of a typical family sedan with modifications allowing for adjustment in upper anchorage position, mounting of an antisubmarining seat pan, and the use of seat belt pretensioners with load limiters. Results: Dummy seated posture had the strongest effect on submarining. Seat belt pretensioners with load limiters reduced head and femur excursion and decreased chest injury measurements but did not prevent submarining. The antisubmarining seat pan, on the other hand, prevented submarining in one case but could not prevent submarining with the dummy in a slouched posture. Upper anchorage position resulting in poor belt geometry was shown to increase both chest injury measures and submarining. Conclusions: The results from this study demonstrate the importance of an upright seated posture and the potential benefits of including adjustable upper anchorages to allow good sash belt fit, antisubmarining seat pans, belt buckles positioned near the seat bight, and seat belts with pretensioners and load limiters for rear seat occupants. These data can be used to inform the design of a system of restraints to reduce injuries to rear seat occupants.
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    • "Abdominal injury risk among child occupants increases with premature graduation to adult seat belts (Lutz et al. 2003; Nance et al. 2004). This is related, at least in part, to an increased risk of submarining (Durbin et al. 2001). "
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    ABSTRACT: This study aims to investigate the effects of seating posture and seat cushion properties on submarining risk for rear seated children. An instrumented 6-year-old Hybrid III dummy restrained by an inertial-reel 3-point seat belt was subjected to simulated frontal impacts (Δv=28.8 km/h, peak acceleration=16 g). Dummy motion was captured using high-speed digital video. Head acceleration, neck loads, chest deflection, pelvic rotation, and femur displacement were used to assess submarining. Factors investigated included pre-impact seating posture, seat cushion length, stiffness of the seat cushion foam, and the inclination of the seat cushion. The most severe submarining was observed when the dummy was seated in a slouched posture where pelvic rotation was over 3 times greater than in the upright seating posture. Though the standard seat cushion with the dummy seated in the upright posture recorded the lowest values of pelvic rotation and femur displacement, it is unlikely that a child will sit in such a posture. The shortened seat cushion increased femur displacement by 19 percent compared to the standard test seat, but it offers good pre-impact belt position. Submarining occurred in cases where the front edge of the seat collapsed during interactions with the dummy's buttocks. These data suggest that shortening the rear seat cushion alone will not necessarily prevent submarining, but this does allow improved seated posture of the occupant, thus reducing submarining risk. This study has also shown that the collapse of the front edge of the seat cushion is a critical factor in submarining risk.
    Full-text · Article · Feb 2011 · Traffic Injury Prevention
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