Background Motor vehicle collisions (MVCs) are a leading cause of death for paediatric patients. Safety restraints are associated with improved outcomes. Prior work within our community identified decreased restraint use in patients treated in the city’s urban core trauma centre. The present study expands prior work to include an additional paediatric trauma centre within our county. Methods A retrospective cohort study was performed where the trauma registries of two level 1 trauma centres were queried for patients aged 0–18 from October 2013 to September 2023. Demographic and clinical outcomes were recorded. Appropriate restraint use was defined using the 2018 American Academy of Pediatrics restraint use guidelines. Results 1028 paediatric MVCs were identified, averaging 112 MVC events annually. Overall, 54.6% of patients were inappropriately restrained, with the highest proportion in booster-sized patients (78% vs 50% seatbelt vs 57% car seat), p<0.001. Those inappropriately restrained had higher Injury Severity Scores (ISSs) (17.6% vs 11.6% ≥15 ISS) and severe abbreviated injury scale scores for head, face, thorax and extremity. Inappropriate restraint use was associated with the need for surgical procedures (29.4% vs 18.4%), post-trauma complications (12.1% vs 4.5%) and mortality (3% vs 0.6%), all p<0.01. Patients living in lower percentile Child Opportunity Index zip codes had higher odds of being inappropriately restrained. Conclusions Appropriate restraint use remains low among paediatric patients in this metropolitan city. Inappropriate restraint use is most prominent in booster seat and seatbelt-aged populations with notable racial disparities. Interventions include hospital screenings, legislative advocacy and organisational partnerships.
Alligood et al. (Thu,) studied this question.