Seatbelts Save Lives, and Spines, in Motor Vehicle Accidents: A Review of the National Trauma Data Bank in the Pediatric Population.

Abstract

STUDY DESIGN\nDatabase Study.\n\n\nOBJECTIVE\nThe purpose of this study was to use a large, nationwide database to determine prevalence of pediatric spine fractures in the US, associated injuries, mechanisms of injury, use of safety devices and mortality rates.\n\n\nSUMMARY OF BACKGROUND DATA\nSpinal fractures account for 1- 2% of pediatric injuries. However, they are associated with significant co-morbidities and complications. Motor vehicle accidents (MVA) are most responsible for increased incidence observed.\n\n\nMETHODS\nRetrospective review of NTDB between 2009-2014 (analysis in 2019), for all vertebral fractures in patients under 18\u200ayears of age. Sub-analysis included those in MVAs where protective device use data was available. Patient demographics, mechanism (MOI), geographical and anatomical region of injury, concomitant musculoskeletal/organ injury, protective device usage, hospital length of stay, surgical procedures and mortality were all analyzed.\n\n\nRESULTS\n34,563 patients with 45,430 fractured vertebrae included. Median age was 15\u200ayears. Most fractures (63.1%) occurred in patients aged 15-17, most frequent MOI was MVA (66.8%), most common geographic location was the South (38%). Males sustained more spine fractures than females, overall (58.4%vs41.6%;p\u200a<\u200a0.001) and in MVAs (54.4%vs45.6%;p\u200a<\u200a0.001). Those in MVAs wearing seatbelts had lower odds of cranial (29.6%vs70.4%;OR\u200a=\u200a0.85,95%CI:0.82-0.89;p\u200a<\u200a0.001) and thoracic (30.1%vs69.9%;OR\u200a=\u200a0.88,95%CI:0.84-0.91;p\u200a<\u200a0.001) organ injury, multi-vertebral (30%vs70%;OR\u200a=\u200a0.78,95%CI:0.73-0.83;p\u200a<\u200a0.001) and concomitant non-vertebral fractures (30.9%vs69.1%;OR\u200a=\u200a0.89,95%CI:0.73-0.83;p\u200a<\u200a0.001), and 21% lower odds of mortality (29.3%vs70.7%;OR\u200a=\u200a0.79,95%CI:0.66-0.94;p\u200a=\u200a0.009). Over 70% of drivers were not restrained during MVA, with majority of seatbelt violations incurred by males, ages 15-17, in the South.\n\n\nCONCLUSION\nOver 60% of pediatric spinal fractures occur in children ages 15-17, coinciding with the beginning of legal driving. MVA is most common cause and has significant association with morbidity/mortality. Nearly 2/3 pediatric spinal fractures sustained in MVAs occurred without seatbelts. Absence of seatbelts associated with more than 20% greater odds of mortality. Ensuring new drivers wear protective devices can greatly reduce morbidity/ mortality associated with MVA.Level of Evidence: 3.