Seatbelt Use and Traumatic Brain Injury Outcomes After Pediatric Motor Vehicle Collisions

Background Seatbelts and age-appropriate restraints reduce crash-related injuries, but associations with specific pediatric traumatic brain injury (TBI) outcomes require further characterization. Objective To examine associations between documented seatbelt use, TBI severity, head computed tomography (CT) findings, and hospital admission after pediatric motor vehicle collisions. Methods This retrospective study reviewed trauma registry and medical record data from a Level I pediatric trauma center. Of 179 collision-related cases identified among 1,095 pediatric trauma records, 138 had documented seatbelt status. Categorical outcomes were compared using chi-square and exact tests. A multivariable logistic regression examined hospital admission in 96 complete cases. Results ED TBI severity was available for 97 patients: 74 mild, 6 moderate, and 17 severe. Seatbelt use was not significantly associated with severity (P = .098). Among 107 patients with available CT results, abnormal findings occurred in 17/56 (30.4%) with seatbelt use and 25/51 (49.0%) without seatbelt use (Pearson P = .048; Fisher exact P = .074). The prehospital Glasgow Coma Scale comparison was not significant (P = .075). Loss of consciousness and transfer status were associated with higher adjusted odds of hospital admission, whereas higher ED Glasgow Coma Scale scores were associated with lower odds. Conclusion Abnormal CT findings were less frequent with seatbelt use, ED TBI severity did not differ significantly. Missing data, limited sample size, and unmeasured crash characteristics constrain causal interpretation.