Racial Differences in the Identification of Seat Belt Signs Among Pediatric Motor Vehicle Crash Occupants

Objective: To determine if there are racial differences in the identification of seat belt signs (SBS) among children with motor vehicle crash (MVC)-related blunt torso trauma. Methods: This was a secondary analysis of a de-identified, public-use data set from a Pediatric Emergency Care Applied Research Network (PECARN) prospective cohort study of children with blunt torso trauma between May 2007 and January 2010. Children <18 years in MVCs were included. Patient demographics, documentation of an abdominal SBS presence, MVC crash speed, and restraint status were analyzed. Descriptive statistics, χ 2 analyses, and the Cochran-Armitage test for trend were performed. Results: There were 3832 children in MVCs. The mean age was 10.6 years (SD: 5.5), 52.6% of patients were White, 31.1% Black, 16.3% other/unknown, and 2.3% Asian. Restraint status differed significantly by race ( P <0.001), with 74.1% of White children (95% CI: 72.2%-76.0%), 64.5% of Black children (95% CI: 61.7%-67.2%), 83.0% of Asian children (95% CI: 75.1%-90.8%), and 68.3% of other/unknown race children (95% CI: 64.4%-72.3%) reported as restrained. There was a significant difference in the proportion of restrained Black children with SBS (7.2% [95% CI: 5.3%-9.0%]) compared with White children (27.0% [95% CI: 24.7%-29.2%]) ( P <0.001) and Asian children (26.0% [95% Cl: 16.0%-36.1%]). When adjusting for age, MVC speed, and restraint status, Black patients were 74% less likely than White patients to have SBS observed (OR: 0.26, 95% CI: 0.18-0.36). Conclusions: There were significant differences in SBS identification among Black children compared with other race children after MVCs. Prospective studies accounting for skin tone are necessary to further investigate these findings.