Trauma scores, accident deformity codes, and car restraints in children

Abstract

The importance and effectiveness of the appropriate use of automobile restraints by young children has been emphasized in several studies. Once the child has entered the emergency care system, however, restraint use may not be the best predictor of injury severity. This study was undertaken to investigate the relationship of restraint status to morbidity and mortality in children examined in a hospital emergency facility following involvment in a motor vehicle crash (MVC). The emergency room charts of 101 children under 18 years of age, who were victims of MVCs, were reviewed and the following trauma scores were calculated: Glascow Coma Scale, Pediatric Trauma Score, Revised Trauma Score, Injury Severity Score, and Maximum Abbreviated Injury Score. In addition, the Traffic Accident Damage (TAD) score, an estimate of crash severity determined by the police at the accident scene, was recorded. The patients were age stratified as follows: 0 to 4 years (n = 24), 5 to 11 years (n = 29), and 12 to 17 years (n = 48). Fifty patients were appropriately restrained at the time of the crash. There was a significant correlation between mean trauma scores and mean TAD codes ( P < .05). There were no significant differences in mean trauma scores between improperly restrained (n = 11) and unrestrained (n = 40) children ( P > .05) across all age groups, and these children were grouped together as “unrestrained” in further analyses. In the 0 to 4 age group, there were no significant differences in mean trauma scores between restrained and improperly restrained or unrestrained children in contrast to the 5 to 11 and the 12 to 17 age groups. There were no significant difference between the distribution of restrained and unrestrained victims with regard to mean TAD scores ( P = .5224) in the 0 to 4 age group. This study demonstrates a close correlation between mean trauma scores and vehicle deformity in all age groups, and shows that mean trauma scores appear to be independent of restraint use for the 0 to 4-year-old age subset. Therefore, a police-assigned crash severity score, such as the TAD, may be useful in the initial traige of pediatric trauma victims to an appropriate hospital or trauma center.