Motor Vehicle Collision Injuries Research Articles

Dynamic spatial tuning of cervical muscle reflexes to multidirectional seated perturbations.

Human volunteers were exposed experimentally to multidirectional seated perturbations. To determine the activation patterns, spatial distribution and preferred directions of reflexively activated cervical muscles for human model development and validation. Models of the human head and neck are used to predict occupant kinematics and injuries in motor vehicle collisions. Because of a dearth of relevant experimental data, few models use activation schemes based on in vivo recordings of muscle activation and instead assume uniform activation levels for all muscles within presumed agonist or antagonist groups. Data recorded from individual cervical muscles are needed to validate or refute this assumption. Eight subjects (6 males, 2 females) were exposed to seated perturbations in 8 directions. Electromyography was measured with wire electrodes inserted into the sternocleidomastoid, trapezius, levator scapulae, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles. Surface electrodes were used to measure sternohyoid activity. Muscle activity evoked by the perturbations was normalized with recordings from maximum voluntary contractions. The multidirectional perturbations produced activation patterns that varied with direction within and between muscles. Sternocleidomastoid and sternohyoid activated similarly in forward and forward oblique directions. The semispinalis capitis, semispinalis cervicis, and multifidus exhibited similar spatial patterns and preferred directions, but varied in activation levels. Levator scapulae and trapezius activity generally remained low, and splenius capitis activity varied widely between subjects. All muscles showed muscle- and direction-specific contraction levels. Models should implement muscle- and direction-specific activation schemes during simulations of the head and neck responses to omnidirectional horizontal perturbations where muscle forces influence kinematics, such as during emergency maneuvers and low-severity crashes. N/A.

Effect of restraining devices on eye injury in motor vehicle collisions.

The aim of this systematic review is to summarize and critically evaluate the evidence for or against the effectiveness of restraining devices on eye injury in motor vehicle collisions (MVCs).In a PubMed search, the search terms "eye injury and seatbelt," "eye injury and car belt," "eye injury and airbag," and "eye injury and restraining" were used. Among the 30 potentially relevant articles, 5 articles met our inclusion criteria. The odds ratio (OR) and 95% confidence intervals (CIs) from each study were abstracted. The statistical analysis was performed with Review Manager (The Nordic Cochrane Centre).Three studies were subgrouped, and a meta-analysis of these data suggested no significant effects of an airbag on increasing eye injury in MVCs (n = 10,123,954; OR, 1.10; 95% CI, 0.77-1.56). Two studies were subgrouped, and a meta-analysis of these data suggested that there are beneficial effects of seat belts on decreasing eye injury in MVCs (n = 43,057,271; OR, 0.50; 95% CI, 0.50-0.51).Seat belts were effective to decrease eye injuries in MVCs. However, airbags had no significant effect on an increase to eye injuries. When using airbags, seat belts should be used together.

Analysis of pediatric trauma data from a hospital based trauma registry in Qatar.

Background:Trauma is the leading killer in the young age children, but data about the injury burden on pediatric population are lacking. The aim of this study is to describe the epidemiology and outcome of the traumatic injuries among children in Qatar.Materials and Methods:This is a retrospective analysis of a trauma registry database, which reviewed all cases of serious traumatic injury (ISS ≥ 9) to children aged 0–18 years who were admitted to the national pediatric Level I trauma center at the Hamad General Hospital (HGH), over a period of one year. Data included demographics, day of injuries, location, time, type and mechanism of injuries, co-morbidity, safety equipment use, pre-hospital intubation, mode of pre-hospital transport, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), emergency department (ED) intervention, hospital length of stay and mortality outcome.Results:The incidence of severe pediatric trauma was 163 per 280,000 children who visited the ED of HGH in 2011. Out of them, 83% were male, mean age was 9.6 ± 5.9 years and mortality rate was 1.8%. On presentation to the ED, the mean ISS was 13.9 ± 6.6 and GCS was 13.4 ± 3.8. Over half of the patients needed ICU admission. For the ages 0-4 years, injuries most frequently occurred at home; for 5-9 years (59%) and 15-18 years (68%), the street; and for 10-14 years (50%), sports and recreational sites. The most common mechanisms of injury for the age groups were falls for 0-4 years, motor vehicle collision (MVC) or pedestrian injury for 5-9 years, all-terrain vehicle (ATV)/bicycle injuries for 10-14 years, and MVC injuries for 15-18 years. Head (34%) and long bone (18%) injuries were the most common, with 18% suffering from polytrauma. None of the patients were using safety equipment when injured.Conclusion:Traumatic injuries to children have an age- and mechanism-specific pattern in Qatar. This has important implications for the formulation of focused injury prevention programs for the children of Qatar.

Six Month Recovery Following Musculoskeletal Injuries in Motor Vehicle Collisions

To provide standardized physical examination interim results from an ongoing study on the natural history of recovery from musculoskeletal injuries in motor vehicle accidents. Repeated measures. McMaster University and Toronto Rehabilitation Institute. 24 adult (15 women, 9 men) occupants of motor vehicles. who reported any pain following collisions. Patients were examined by a physical medicine specialist at 2 weeks and 6 weeks following motor vehicle collisions. Changes over time were analyzed by correlated t-tests. 1. Self-reported pain on pain diagrams using 200 equal size regions, 2. Goniometer ranges in all symptomatic joints, 3. Examination tenderness (scaled 0, 1, 2) at all spinous processes, paraspinal muscles and symptomatic limb joint structures, 4. Work Status. In sub-acute assessment, mean body surface in pain was 25% (SD=23%) and mean tenderness was 2.3 (SD = 1.7). Improvement in pain distribution was significant (p < .05) but only averaged 30% of the affected body area. Mean tenderness did not improve. Imaging showed fractures in 4 patients and tendon tears in 2. Among the 18 with normal imaging, 13 had joint range loss compared to published values, creating a subgroup of 19 with measurable impairments. In this group, ranges remained impaired at 6 months in 11 subjects. Of the 23 working at the time of injury, 19 had returned to work by 6 months. Within the clinical range studied, there was only modest clinical improvement in pain and joint movement, but most returned to work.

Obesity and vehicle type as risk factors for injury caused by motor vehicle collision

This study sought to describe variations in the risk of motor vehicle collision (MVC) injury and death by occupant body mass index (BMI) class and vehicle type. We hypothesized that the relationship between BMI and the risk of MVC injury or mortality would be modified by vehicle type. This is a retrospective cohort study of occupants involved in MVCs using data from the Crash Injury Research and Engineering Network and the National Automotive Sampling System Crashworthiness Data System. Occupants were grouped based on vehicle body style (passenger car, sport utility vehicle, or light truck) and vehicle size (compact or normal, corresponding to below- or above-average curb weight). The relationship between occupant BMI class (underweight, normal weight, overweight, or obese) and risk of injury or mortality was examined for each vehicle type. Odds ratios (ORs) adjusted for various occupant and collision characteristics were estimated. Of an estimated 44 million occupants of MVCs sampled from 2000 to 2009, 37.1% sustained an injury. We limited our analysis to injuries achieving an Abbreviated Injury Scale (AIS) score of 2 or more severe, totaling 17 million injuries. Occupants differed substantially in terms of demographic and collision characteristics. After adjustment for confounding factors, we found that obesity was a risk factor for mortality caused by MVC (OR, 1.6; 95% confidence interval [CI], 1.2-2.0). When stratified by vehicle type, we found that obesity was a risk factor for mortality in larger vehicles, including any-sized light trucks (OR, 2.1; 95% CI, 1.3-3.5), normal-sized passenger cars (OR, 1.6; 95% CI, 1.1-2.3), and normal-sized sports utility vehicles or vans (OR, 2.0; 95% CI, 1.0-3.8). Being overweight was a risk factor in any-sized light trucks (OR, 1.5; 95% CI, 1.1-2.1). We identified a significant interaction between occupant BMI class and vehicle type in terms of MVC-related mortality risk. Both factors should be taken into account when considering occupant safety, and additional study is needed to determine underlying causes of the observed relationships. Epidemiologic study, level III.

Causes and patterns of spine trauma in children and adolescents in Saudi Arabia: implications for injury prevention

BACKGROUND AND OBJECTIVESKnowledge regarding traumatic spine injuries (TSIs) is essential for effective prevention strategies, particularly in the developing world, where majority of the population is younger and organized prevention programs are scarce. Therefore, our objective was to describe TSI mechanisms, demographics, patterns, and outcomes in children and adolescents.DESIGN AND SETTINGSRetrospective chart review in a major trauma center from May 2001 to May 2009 in Riyadh, Saudi Arabia.PATIENTS AND METHODSDetailed chart reviews were done for all consecutive TSI patients ≤18 years old. Cases were identified through the trauma database registry that included admitted patients.RESULTSOf the 3796 cases identified, 120 cases (3.2%) sustained 141 TSIs (mean age: 13.5 years; males: 83.8%). TSI was most common among children from 16 to 18 years old. Overall, motor vehicle collision (MVC) was the most common injury mechanism (60.8%). However, younger patients (<12 years) sustained more pedestrian injuries (40.6%). Among MVC cases with known seat belt statuses (43.8%), 90.6% were not wearing seat belts. The cervical spine level was the most commonly affected (55.8%) region, especially in children <12 years old (88%). More than 1 affected spinal level was found in 23.3% cases. Spinal cord injuries were found in 19.2% cases. Overall, mortality was 8.3%, and half of these mortalities were secondary to pedestrian injuries. A total of 22.7% of cases were discharged with neurological deficits.CONCLUSIONThe high frequency and severity of MVC and pedestrian injuries observed in the present study raise significant concerns regarding the safety of children on the roads. Spine involvement was age specific; younger patients tended to have more cervical injuries, and older patients exhibited more thoracic spine involvement.

A comparison of injuries, crashes, and outcomes for pediatric rear occupants in traffic motor vehicle collisions

This study was initiated was initiated to describe pediatric rear-occupant motor vehicle collision (MVC) injuries, including injury patterns and outcomes as well as characteristics associated with severe injury to the head and abdomen. A retrospective cohort of severely injured (Injury Severity Score [ISS] > 12) pediatric (age <18 years) patients involved in a traffic MVC as a rear occupant and treated at one of two Ontario trauma centers (2001-2010) was studied was studied. Demographic, injury, crash and outcome data were obtained from the trauma registries. Data were statistically compared by two pediatric age groups: children (0-8 years; requiring a child or booster seat) versus adolescents (9-17 years; requiring a lap-shoulder belt). There were 36 children (34%) and 70 adolescents (66%) severely injured as rear occupants in MVCs. Despite similar ISS (p = 0.716) and mortality rates (p = 0.680) between age groups, there were significant differences in injury patterns and risk factors. Children were more likely to have severe head injuries (78% vs. 39%, p < 0.001) associated with a lack of an age-appropriate child restraints (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.1-10.8; p = 0.029), middle seating (OR, 6.2; 95% CI, 1.5-26.1; p = 0.013), and side-impact crashes (p = 0.007). Adolescents were more likely to have severe abdominal injuries (23% vs. 6%, p < 0.001) associated with the use of lap-shoulder belts (OR, 3.8; 95% CI, 1.1-13.3; p = 0.034), single-vehicle MVCs (p = 0.007), and vehicle extrications (p = 0.035). While safer than the front seat for children, additional study is needed on the restraint systems and the potential for injury to pediatric rear occupants in an MVC. Our data suggest that pediatric age groups differ in injuries, risk factors, and MVC impacts. Recommendations for improved protection of child occupants and preferred seating positions are required. Epidemiologic study, level III.

Defining and predicting surgeon utilization at forward surgical teams in Afghanistan

BackgroundThe forward surgical team (FST) is the US Army's smallest surgical element. These teams have supported current conflicts since 2001. The purpose of this study was to determine if surgeon utilization varied at two different FSTs and to determine factors that may predict the need for a surgeon. MethodData from two FSTs were reviewed. A t-test was used to compare the military injury severity scores (mISS) and the revised trauma scores (RTS). χ2 analysis was used to compare types and mechanisms of injury and to compare life- or limb-saving surgeries (LLSS) and life-saving interventions among the FSTs. Logistic regression was used to determine if mISS, RTS, physiologic parameters, or laboratory values predicted the need for LLSS or life-saving intervention. ResultsThe 541st FST treated a larger volume of patients than the 772nd FST (n = 761 versus n = 311). The 772nd FST performed a significantly higher percentage of LLSS; however, absolute number of LLSS was 31 at both FSTs. The mISS among operative patients were similar, but RTS were significantly different (772nd FST = 7.28 versus 541st FST = 7.58, P = 0.008). The 772nd FST saw a higher percentage of motor vehicle collision and rocket-propelled grenade injuries and thoracic and neurologic injuries, and the 541st FST saw a higher percentage of blast and gunshot wound injuries and abdominal injuries. Lactate level was the most significant predictor of the need for LLSS. ConclusionAlthough percentage of surgical interventions varied between the two FSTs, the absolute number of needed surgical interventions was the same and was small. Lactate level predicted the need for surgical intervention in our population.

Pedestrian crossing location influences injury severity in urban areas

BackgroundPedestrian incidents represent an increasing proportion of serious injuries resulting from motor vehicle collisions in Canada. However, few studies have examined the effect of pedestrian crossing location in urban areas...

Research and Theory Towards a National Injury Costing System?:Lessons from a Public-Private Injury Costing Pilot Study in South Africa

South Africa has extremely high incidence rates of fatal and non-fatal injuries due to interpersonal violence, pedestrian&ndash;motor vehicle collisions, burns, falls and other unintentional causes. While the actual cost associated with these injuries remains relatively unknown, the estimated direct cost of the medical treatment, rehabilitation and administration of these victims may run into billions of rands. This public&ndash;private injury costing pilot study (hereafter the study) was conducted at a tertiary public health facility in Johannesburg, South Africa (hereafter the public facility). The study attempted to facilitate further costing capacity through skills transfers from personnel at a sentinel private health facility in Johannesburg (hereafter the private hospital) to selected personnel within the identified public facility, and through the determination of the partial baseline direct medical cost of the treatment of gun shot wounds, pedestrian&ndash;motor vehicle collision injuries, falls and burns at the public facility. Both the capacity building component and the actual study were complicated by a number of obstacles, including limited personnel, poor costing and billing capacity, underdeveloped billing documentation and recording procedures, and limited levels of investment in the general practice of injury costing in the public health sector itself. This article examines the practical challenges facing further attempts to describe the cost of injuries in South Africa. It concludes with several critical reflections on concerns associated with an uncritical pursuit of the roll-out of a national injury costing system, which may have a negative impact on service delivery to the very populations that encounter injuries as a public health sector priority.

Examination of the Impact of Airbags on Renal Injury Using a National Database

Little is known about preventative measures to lessen solid organ injury in motor vehicle collisions (MVCs). To evaluate the efficacy of airbags in reducing renal injuries in MVC, we analyzed renal injury rates in vehicles with and without airbags using the Crash Injury Research and Engineering Network (CIREN) database. The CIREN database was queried for MVC and renal injury from 1996 to September 2008. CIREN is weighted toward late model vehicles and selects more severely injured patients. Search fields were primary direction of force (PDOF), presence of airbags, and location of airbags (steering wheel, instrument panel, seat back, door panel, and roof-side curtain). Abdominal Abbreviated Injury Score was converted to AAST renal injury grade. Renal injury rates were compared between vehicles with and without frontal and side airbags. We reviewed 2,864 records and identified 139 renal injuries (28.9% AAST grade III to V). In MVCs with renal injuries, frontal impact was 54.7% of total (n = 76) and side impact was 45.3% of total (n = 63). Most occupants in frontal impact MVCs had exposure to a steering wheel airbag (74.9%); 16.6% had an instrument panel (passenger) airbags. In side impact MVCs, 32.2% of occupants had a side airbag. Compared with the non-airbags cohort, frontal airbags and side airbags were associated with a 45.3% and 52.8% reduction in renal injury, respectively. Passengers in automobiles with frontal and side airbags have a reduced rate of renal injury compared with those without airbags. Our data support further study of the role of airbags in reducing renal injury after MVC.

Towards a National Injury Costing System?:Lessons from a Public-Private Injury Costing Pilot Study in South Africa

South Africa has extremely high incidence rates of fatal and non-fatal injuries due to interpersonal violence, pedestrian–motor vehicle collisions, burns, falls and other unintentional causes. Whilethe actual cost associated with these injuries remains relatively unknown, the estimated direct cost of the medical treatment, rehabilitation and administration of these victims may run into billionsof rands. This public–private injury costing pilot study (hereafter the study) was conducted at a tertiary public health facility in Johannesburg, South Africa (hereafter the public facility). The studyattempted to facilitate further costing capacity through skills transfers from personnel at a sentinel private health facility in Johannesburg (hereafter the private hospital) to selected personnel withinthe identified public facility, and through the determination of the partial baseline direct medical cost of the treatment of gun shot wounds, pedestrian–motor vehicle collision injuries, falls and burns at the public facility. Both the capacity building component and the actual study werecomplicated by a number of obstacles, including limited personnel, poor costing and billing capacity, underdeveloped billing documentation and recording procedures, and limited levels of investment in the general practice of injury costing in the public health sector itself. This articleexamines the practical challenges facing further attempts to describe the cost of injuries in South Africa. It concludes with several critical reflections on concerns associated with an uncritical pursuit of the roll-out of a national injury costing system, which may have a negative impact on service delivery to the very populations that encounter injuries as a public health sector priority.

Self-Reported Motor Vehicle Injury Prevention Strategies, Risky Driving Behaviours, and Subsequent Motor Vehicle Injuries: Analysis of Canadian National Population Health Survey

The purpose of this study was to examine self-reported motor vehicle injury prevention strategies, speeding and impaired driving, and the effects of speeding and impaired driving on subsequent motor vehicle collision injuries, using the Canadian National Population Health Survey (NPHS). Strategies commonly reported were preventing impaired drivers from driving, using designated drivers, and requiring passengers to use seatbelts. Yet a substantial minority, particularly young males, reported engaging in risky driving behaviours such as speeding and impaired driving. Self-reported speeders and impaired drivers had significantly higher odds of reporting injuries from subsequent motor vehicle collisions. Specifically, those who reported sometimes/rarely or never obeying the speed limits were two and a half times more likely to report a subsequent motor vehicle injury, while those who reported impaired driving one or more times in the past 12 months were two times more likely to report a subsequent motor vehicle injury. These findings support the need for continued focus on speeding, drinking and driving, and other risky driving behaviours to reduce collisions in Canada.

Self-Reported Motor Vehicle Injury Prevention Strategies, Risky Driving Behaviours, and Subsequent Motor Vehicle Injuries: Analysis of Canadian National Population Health Survey

The purpose of this study was to examine self-reported motor vehicle injury prevention strategies, speeding and impaired driving, and the effects of speeding and impaired driving on subsequent motor vehicle collision injuries, using the Canadian National Population Health Survey (NPHS). Strategies commonly reported were preventing impaired drivers from driving, using designated drivers, and requiring passengers to use seatbelts. Yet a substantial minority, particularly young males, reported engaging in risky driving behaviours such as speeding and impaired driving. Self-reported speeders and impaired drivers had significantly higher odds of reporting injuries from subsequent motor vehicle collisions. Specifically, those who reported sometimes/rarely or never obeying the speed limits were two and a half times more likely to report a subsequent motor vehicle injury, while those who reported impaired driving one or more times in the past 12 months were two times more likely to report a subsequent motor vehicle injury. These findings support the need for continued focus on speeding, drinking and driving, and other risky driving behaviours to reduce collisions in Canada.

A comparison of booster seat use in Canadian provinces with and without legislation

Background:The use of booster seats continues to be low, despite their effectiveness in reducing injury in motor vehicle collisions. Many jurisdictions have introduced legislation requiring the use of booster seats....

A Chronic Posterolateral Knee and Patella Dislocation: Case Report

Knee dislocations are uncommon as isolated orthopaedic injuries, but their prevalence is increased in the setting of high-energy multiple trauma. In these circumstances, it is important for the orthopaedic clinician to recognize and appropriately treat the knee dislocation in parallel with other significant injuries. We report the case of an 18-year-old woman who was involved in a motor vehicle collision and sustained multiple injuries in addition to a posterolateral knee dislocation. An attempt at reduction was made in the initial trauma setting, and the patient was medically stabilized. She was discharged from the hospital in a splint with orthopaedic follow-up and presented 3 months after injury with an unreduced posterolateral dislocation. A single-stage operation was performed with reduction and stabilization of the knee. Postoperatively, the patient has done well and regained significant range of motion.

Mild Traumatic Brain Injury and Posttraumatic Stress Disorder and Their Associations With Health Symptoms

Vanderploeg RD, Belanger HG, Curtiss G. Mild traumatic brain injury and posttraumatic stress disorder and their associations with health symptoms. Objective To determine the association of various symptoms and psychiatric diagnoses with a remote history of mild traumatic brain injury (MTBI) and a current diagnosis of posttraumatic stress disorder (PTSD). Design Cross-sectional cohort study. Setting Nonclinical. Participants Three groups of randomly selected community dwelling male U.S. Army Vietnam-era veterans: healthy control (n=3218), those injured in a motor vehicle collision (MVC) but without a head injury (MVC injury control; n=548), and those who had an MTBI (n=278). Interventions None. Main Outcome Measures Prevalence of psychiatric diagnoses, physical, cognitive, and emotional symptoms, and course of PTSD across time. Results Logistic regression procedures were used to determine group association with symptoms and psychiatric diagnosis after controlling for demographic variables, combat intensity, medical disorders, and other current psychiatric conditions. MTBI was associated with headaches, memory problems, sleep problems, and fainting even after controlling for current psychiatric problems (including PTSD), as well as demographic variables, combat intensity, and comorbid medical conditions. MTBI also was associated with a current diagnosis of PTSD even controlling for other demographic, psychiatric, and medical covariates. MTBI did not moderate or mediate the relationship between PTSD and current symptomatology. However, MTBI did adversely affect long-term recovery from PTSD (odds ratio=1.59, 95% CI, 1.07–2.37). PTSD also was associated with physical, cognitive, and emotional symptoms, and had a larger effect size than MTBI. Conclusions MTBI, even in the chronic phase years postinjury, is not a benign condition. It is associated with increased rates of headaches, sleep problems, and memory difficulties. Furthermore, it can complicate or prolong recovery from preexisting or comorbid conditions such as PTSD. Similarly, PTSD is a potent cocontributor to physical, cognitive, and emotional symptoms.

Overweight children: Are they at increased risk for severe injury in motor vehicle collisions?

Background Obesity is an epidemic in the United States. The relationship between traumatic injury and obesity in children is not well-studied. We hypothesized that overweight children suffer more severe injuries, different distributions of injuries and improper use of restraints in motor vehicle collisions. Methods We conducted a secondary analysis of the CIREN database of motor vehicle collisions of subjects 2–17 years old. Overweight was defined as a BMI percentile for age >85%. Significant injury was an Injury Severity Score (ISS) >15 or an Abbreviated Injury Scale (AIS) score greater than one. Further analysis looked at injuries classified as head, trunk, or extremities and appropriateness of restraints. Odds ratios compared the overweight to lean groups. Results 335 subjects met inclusion criteria with 35.5% of cases being overweight. For significant injury, overweight cases had an odds ratio of 1.2 [95% CI: 0.8–1.9]. Analysis by AIS for overall significant injury and to specific body regions also did not show any significant associations. Overweight versus lean subjects had an odds ratio of 1.3 [95% CI: 0.8–2.1] for improper use of restraints. Conclusions We found no significant relationship between pediatric injury severity, distribution of injuries, or restraint use and being overweight. Limitations of this study were the small sample size in this database and the large number of unrestrained subjects.

Fatal child cervical spine injuries in motor vehicle collisions: Analysis using unique linked national datasets

Aim To improve insight into fatal child cervical spine injuries (CSI) caused by motor vehicle collisions. Method Two large national mortality datasets were linked at the level of the individual decedent to analyse and compare anatomical injuries and vehicle crash characteristics for fatally injured child occupants. Results Cervical spine injury was identified among 176 of 6065 child (age 0–15 years) motor vehicle occupant fatalities. Presence compared with absence of CSI had significant association with female gender, traumatic brain injury and seat restraint, but not with age, vehicle model, year or type, exposure to airbag, severe vehicle intrusion, collision speed or direction, drivability of the vehicle or seating position. Conclusions Cervical spine injury, which was uncommon in the studied subset of child decedents, was associated with female gender, the use of passenger restraints and the presence of traumatic brain injury.

Comparison of motor vehicle collision and non-motor vehicle collisions related child restraint seat injuries in British Columbia: 1997-2002

In Canada, as in many other countries, the mandatory use of child safety restraints (CSRs) over the past two decades has resulted in a drastic reduction in child mortality attributed to motor vehicle collisions (MVCs) (Snowdon, Polgar, Patrick, & Stamler, 2006). However, the ease of using CSRs outside of a vehicle has led to unexpected deleterious consequences to younger children. In this study, we looked at all injuries sustained by children (0-9 years) which involved a CSR and compared injuries which related to MVCs to those which occurred in other locations. Out of a total of 107 cases, 95 (88.8%) were not motor vehicle collision related (non-MVC) and the majority of these (87/95; 91.6%) occurred among children under 12 months of age. Children injured while in a CSR outside of a vehicle were also more likely to suffer from a head injury than those involved in an MVC (Odds Ratio 23.3). This study highlighted the importance of the continued education of parents to the unexpected hazard of placing children on elevated surfaces while in a CSR. Furthermore, it demonstrated the need to place additional pressure on manufacturers to ensure that design modifications address this consistent pattern of injury. Language: en