Injury Severity In Children Research Articles

Effect of vehicle speed on injury of child passenger in frontal crashes

Speed is major cause of death to vehicle occupants especially children. Studying effect of speed on child injury severity is crucial to establishing safety regulations. This work investigates the effect of vehicle speed on the severity of injury sustained by three-year-old (3YO) children. Restrained 3YO child dummy Finite Element (FE) model was used to conduct crash simulation at impact speed of 40km/h, 46 km/h and 48 km/h in Ford Taurus FE model using LS DYNA code. Vehicle deceleration was found to increase with increase in speed. Head Injury Criteria (HIC36), HIC15, chest acceleration (CA), chest severity index (CSI), chest deflection (CD) and neck moment (NM) were evaluated and compared with National Highway Traffic Safety Administration (NHTSA) threshold. It was found that the injury parameters sustained by 3YO child increased with increase in speed. HIC36 was found to be above threshold for 48km/h and 46km/h. Speed of 40 km/h had all the injury values below the threshold. Chest deflection was lower than the threshold for all the three speeds. Chest acceleration and neck moment were also presented and their values also increase with speed, though, NHTSA doesn’t capture their threshold. The study disseminates information on the effect of speeding on child injuries in frontal crashes for road safety agents and vehicle designers and users. Limiting vehicle speed is therefore crucial to child occupant protection.

Relative Safety Assessment for Positioning Children in Vehicles with Varying Levels of Advanced Safety Technologies

Recent studies suggest that advances in rear seat occupant protection are trailing while frontal crash prevention technologies have disproportionately improved front seat occupant safety. Therefore, the first objective of this study is to identify the safest seat for children by estimating injury severity by seat position using current crash data. The second objective of this study is to demonstrate that Level-2 and above (i.e., L2+) AVs will be significantly different from current vehicles regarding child injury severity, and therefore it is essential to find the safest seat for children in L2+ AVs. This study utilized data from the National Automotive Sampling System (NASS) to estimate crash injury severity by seat position in children. This study used the Injury Severity Score (ISS) as its measure of crash severity. The mean ISS for restrained children sitting in the front passenger seat was 0.494 (for model year > 2000 vehicles). The mean ISSs for second-row left and second-row right seats were 0.374 and 0.322, respectively. The second-row middle seat had 162, 98, and 71% lower mean ISSs than the front passenger, second-row left, and second-row right seats, respectively. Overall, in both restrained and unrestrained scenarios, the safest seat for a child was the second-row middle seat.

Early Thalamic Injury After Resuscitation From Severe Asphyxial Cardiac Arrest in Developing Rats.

Children who survive cardiac arrest often develop debilitating sensorimotor and cognitive deficits. In animal models of cardiac arrest, delayed neuronal death in the hippocampal CA1 region has served as a fruitful paradigm for investigating mechanisms of injury and neuroprotection. Cardiac arrest in humans, however, is more prolonged than in most experimental models. Consequently, neurologic deficits in cardiac arrest survivors arise from injury not solely to CA1 but to multiple vulnerable brain structures. Here, we develop a rat model of prolonged pediatric asphyxial cardiac arrest and resuscitation, which better approximates arrest characteristics and injury severity in children. Using this model, we characterize features of microglial activation and neuronal degeneration in the thalamus 24 h after resuscitation from 11 and 12 min long cardiac arrest. In addition, we test the effect of mild hypothermia to 34°C for 8 h after 12.5 min of arrest. Microglial activation and neuronal degeneration are most prominent in the thalamic Reticular Nucleus (nRT). The severity of injury increases with increasing arrest duration, leading to frank loss of nRT neurons at longer arrest times. Hypothermia does not prevent nRT injury. Interestingly, injury occurs selectively in intermediate and posterior nRT segments while sparing the anterior segment. Since all nRT segments consist exclusively of GABA-ergic neurons, we asked if GABA-ergic neurons in general are more susceptible to hypoxic-ischemic injury. Surprisingly, cortical GABA-ergic neurons, like their counterparts in the anterior nRT segment, do not degenerate in this model. Hence, we propose that GABA-ergic identity alone is not sufficient to explain selective vulnerability of intermediate and posterior nRT neurons to hypoxic-ischemic injury after cardiac arrest and resuscitation. Our current findings align the animal model of pediatric cardiac arrest with human data and suggest novel mechanisms of selective vulnerability to hypoxic-ischemic injury among thalamic GABA-ergic neurons.

Discriminatory Capacity of the Physical Domain Versus the Full-Scale Pediatric Quality of Life Inventory With Traumatic Brain Injury Severity in Children.

A previous study demonstrated that the Pediatric Quality of Life Inventory, a health-related quality-of-life instrument consisting of physical and psychosocial domain scores, reliably differentiates between children with varying severities of traumatic brain injuries (N = 729) 3, 12, and 24 mos after injury. However, the Pediatric Quality of Life Inventory physical domain score alone may simplify evaluation outcomes in physical rehabilitation and clinical research when comparing different trauma interventions. Therefore, we performed a secondary analysis to evaluate and compare the discriminative capacity of traumatic brain injury severity for changes in the overall Pediatric Quality of Life Inventory or the Pediatric Quality of Life Inventory physical domain score alone. We used linear mixed models to assess the change of outcome scores from baseline compared with arm-injury controls. Somers' D was calculated to compare discriminatory capacity with injury severity as a predictor of change in Pediatric Quality of Life Inventory outcome scores. We found that traumatic brain injury severity in children can be differentiated by the Pediatric Quality of Life Inventory physical domain score alone. However, at all follow-up time points, traumatic brain injury severity had higher discriminatory capacity for changes in the overall Pediatric Quality of Life Inventory. Our results suggest that the overall Pediatric Quality of Life Inventory should be used preferentially in children with traumatic brain injuries, although further investigation of the physical domain is warranted in conditions where physical injuries may predominate.

An evaluation of the presentation and severity of Australian football injury in children

Introduction Child participation in sport is important for physical, cognitive and psychosocial wellbeing. Australian rules football has high participation, but also carries a high risk of injury due to the contact nature of the sport. This study aimed to evaluate changes in the presentation and hospital admission of paediatric Australian rules football-related injuries, and to compare the severity of these injuries with those from other team ball sports. Materials and methods At an Australian paediatric major trauma service, ED and hospital trauma registry data relating to Australian rules football injury between 2009 and 2015 were obtained. Data from other common team ball sports with a shared field of play were also identified. Results During the study period, there were 10,003 ED presentations, and 1110 admissions resulting from team ball sports. With 4751 ED presentations and 616 admissions, Australian rules football accounted for almost one-third of all sports-related presentations and admissions, and around half of the team ball sports cohort. Compared to other team ball sports patients, Australian rules football-related patients were 40% more likely to be admitted, and nearly twice as likely to be classified as severe injury. Australian rules football players presented with different injury patterns were compared to other team ball sports players; admitted players were significantly more likely to have sustained head or neck injuries, and were more than twice as likely to sustain truncal injury. Conclusions Australian rules football is a common cause of ED presentations and results in substantial morbidity, both overall and when compared with other team ball sports. Australian rules football should remain a focus for ongoing and active research into strategies which reduce injury risk.

Aquatic Competencies and Drowning Prevention in Children 2–4 Years: A Systematic Review

Aquatic competencies have been proposed as a prevention strategy for children aged 2–4 years who are over-represented in drowning statistics. For this recommendation to be made, exploration of the connection between aquatic competencies and drowning is required. This review critically analyzed studies exploring aquatic competencies and their effect on drowning and/or injury severity in children 2–4 years. English language peer-reviewed literature up to 31 July 2019 was searched and the PRISMA process utilized. Data were extracted from twelve studies that fulfilled the inclusion criteria. Findings from this study included that aquatic competencies were not found to increase risk of drowning and demonstrated children aged 2–4 years are capable of developing age-appropriate aquatic competencies. Age-appropriate aquatic competencies extracted were propulsion/locomotion, flotation/buoyancy, water familiarization, submersion and water exits. The acquisition of these competencies holds benefit for the prevention of drowning. No evidence was found relating to injury severity. There was limited exploration of the relationship between aquatic competencies attainment and age-related developmental readiness. The review highlights the need for consistent measures of exposure, clarity around skills acquisition, better age-specific data (2 years vs. 3 years vs. 4 years), studies with larger sample sizes, further exploration of the dose–response relationship and consistent skill level testing across age groups. Further investigation is required to establish the efficacy of aquatic competencies as a drowning prevention intervention, as well as exploring the relationship between aquatic competencies and age-related developmental readiness. In conclusion, early evidence suggests aquatic competencies can help to reduce drowning.

Preferences for emergency medical service transport after childhood injury: An emergency department-based multi-methods study

BackgroundPre-hospital emergency medical services (EMS) transport can be associated with benefits following pediatric injury. However, many pediatric trauma patients do not use EMS. The objective of this study was to elucidate guardians’ decision factors for pre-hospital transport for children after injury. MethodsThis is a multi-methods study of pediatric trauma patients (≤14 years) and their guardians presenting to the ED of a Level I Pediatric Trauma Center via both EMS and non-EMS modalities. Demographic information and injury characteristics were collected. Semi-structured interviews were conducted, and qualitative codes were identified and assigned into themes. Results(Quantitative): Of the 29 child-guardian pairs, five participants initially presented by EMS, 18 were admitted, and the majority (66%) sustained mild injuries. Guardians’ assessment of their child's injury severity did not correlate with Injury Severity Score (ISS). Neither EMS status (did or did not use EMS to transport to first hospital) nor rurality status of participants’ place of residence were associated with disparate management in any of the three scenarios. (Qualitative)Five themes emerged, which informed guardians’ transport decisions: Factors Related to the Nature of the Patient's Injury, Guardian Attributes and Prior Experiences, Access and Availability of EMS, Perceived Risks and Benefits of EMS and Hospital, and Collaborative Decision-Making. Injury characteristics and contextual factors, like perceived EMS response times and advice from family or medical providers, were considered in choices about EMS utilization and hospital selection. Despite the view that EMS response times were important in determining what to do following injury, both EMS and non-EMS users were largely unfamiliar with the capabilities of EMS in their area. Finally, guardians described cost to be a theoretical risk of EMS use, and a few cited this as a factor contributing to their decision-making. ConclusionsGuardians used a variety of considerations to make transport decisions, including the five themes identified above. Future studies could explore modalities to disseminate information about pre-hospital decision-making for guardians and determine the relationship between EMS utilization and patient outcomes.

Early Right Ventricular Systolic Dysfunction and Pulmonary Hypertension Are Associated With Worse Outcomes in Pediatric Acute Respiratory Distress Syndrome.

The prevalence and importance of early right ventricular dysfunction and pulmonary hypertension in pediatric acute respiratory distress syndrome are unknown. We aimed to describe the prevalence of right ventricular dysfunction and pulmonary hypertension within 24 hours of pediatric acute respiratory distress syndrome diagnosis and their associations with outcomes. Retrospective, single-center cohort study. Tertiary care, university-affiliated PICU. Children who had echocardiograms performed within 24 hours of pediatric acute respiratory distress syndrome diagnosis. None. Between July 1, 2012, and June 30, 2016, 103 children met inclusion criteria. Echocardiograms were analyzed using established indices of right ventricular and left ventricular systolic function and for evidence of pulmonary hypertension. Echocardiographic abnormalities were common: 26% had low right ventricular fractional area change, 65% had low tricuspid annular plane systolic excursion, 30% had low left ventricular fractional shortening, and 21% had evidence of pulmonary hypertension. Abnormal right ventricular global longitudinal strain and abnormal right ventricular free wall strain were present in 35% and 40% of patients, respectively. No echocardiographic variables differed between or across pediatric acute respiratory distress syndrome severity. In multivariable analyses, right ventricular global longitudinal strain was independently associated with PICU mortality (odds ratio, 3.57 [1.33-9.60]; p = 0.01), whereas right ventricular global longitudinal strain, right ventricular free wall strain, and the presence of pulmonary hypertension were independently associated with lower probability of extubation (subdistribution hazard ratio, 0.46 [0.26-0.83], p = 0.01; subdistribution hazard ratio, 0.58 [0.35-0.98], p = 0.04; and subdistribution hazard ratio, 0.49 [0.26-0.92], p = 0.03, respectively). Early ventricular dysfunction and pulmonary hypertension were detectable, prevalent, and independent of lung injury severity in children with pediatric acute respiratory distress syndrome. Right ventricular dysfunction was associated with PICU mortality, whereas right ventricular dysfunction and pulmonary hypertension were associated with lower probability of extubation.

Children after motor vehicle crashes: Restraint utilization and injury severity

BackgroundAlthough injury patterns after motor vehicle crashes (MVCs) are well documented, association between adequate restraint and injury severity is unclear. We aimed to determine if improper restraint affects injury rates and severity. MethodsA retrospective chart review of 477 children hospitalized in Pediatric Trauma Center after MVC was performed. Injuries in various age groups (0–7, 8–12, 13–16, 17–18 years) with different restraint quality measures (proper [PR] and improper/unrestrained [IUR]) as well as injury severity score (ISS: mild [1–9], moderate [10–15], severe [16–25], and profound [>25]) were evaluated and compared. Chi-square and Wilcoxon rank-sum tests were used for statistics. ResultsIn all age groups head/neck injuries were most common (55–63%), while abdominal and pelvic injuries were least likely except group 8–12 years where abdominal injuries ranked third (17.1%). Overall, 64.5% had PR and 35.5% IUR. Interestingly, that greatest proportion of IUR was in the youngest age group (0–7). It decreased with aging and children aged 17–18 years were significantly less likely to be IUR compared to those 0–7 years (OR[odds ratio] = 0.58; 95%CI[confidence interval] 0.35–0.94). We did not find significant differences in rates of various injuries between PR and IUR. However, ISS severity in IUR was significantly greater than in PR (median with interquartile range 6(2–14) and 5(1–9), respectively; P = 0.001). As a result, IUR compared to PR were less likely to have mild ISS (OR = 0.6, 95%CI 0.39–0.90) but more likely to have profound ISS (OR = 3.3, 95%CI 1.48–7.43). ConclusionRestraint quality has significant impact on injury severity in children after MVC. Level of EvidenceLevel III.

Clavicle Fracture Is Not Predictive of the Need for Microsurgery in Brachial Plexus Birth Palsy.

Brachial plexus birth palsy (BPBP) and clavicle fractures occur concurrently as well as in isolation during difficult deliveries. The concept that concurrent clavicle fracture may spare nerve injury has been advocated. Our aim was to compare those children with BPBP presenting to a tertiary care center with and without concurrent clavicle fractures and assess the utility of the presence of a clavicle fracture as a predictor of injury severity in children with BPBP. Records of all patients belonging to a large prospective multicenter cohort study of infants with BPBP (Treatment and Outcomes of Brachial Plexus Injuries study) were analyzed for demographic information and birth information including risk factors, comorbidity, presence of clavicle fracture, and injury severity. The records of 639 children with BPBP were examined. Thirteen patients were excluded for incomplete data. Ninety-six children who sustained concurrent birth fracture and BPBP were identified (15%). Of these, 57 sustained clavicle fractures (9%), 44 sustained humerus fractures, and 4 sustained other fractures. Of the demographic factors analyzed, only the presence of gestational diabetes was found to be significantly higher in those children with fractures versus those without. The presence of a clavicle fracture did not change the rate of microsurgical intervention, nor did clavicle fracture rates differ by Toronto score, suggesting that there was no difference in injury severity between the 2 groups. In a large multicenter prospective study, 9% of children presenting with BPBP also sustained a clavicle fracture at birth. The presence of a clavicle fracture did not correlate with the severity of brachial plexus injury. We suggest that in study populations of children with severe enough BPBP to present to a tertiary care center, compared with studies collected in the obstetric population, the presence of a clavicle fracture is neither protective from nerve injury nor predictive of injury severity. Level 2-prognostic.

Optimization of MRI‐based scoring scales of brain injury severity in children with unilateral cerebral palsy

Optimization of MRI‐based scoring scales of brain injury severity in children with unilateral cerebral palsy

Optimization of MRI‐based scoring scales of brain injury severity in children with unilateral cerebral palsy

Optimization of MRI‐based scoring scales of brain injury severity in children with unilateral cerebral palsy

Predictors of increasing injury severity across suspected recurrent episodes of non-accidental trauma: a retrospective cohort study.

BackgroundLittle is known about how the severity of injury changes with recurrent events of suspected non-accidental trauma (NAT). Our objective was to determine risk factors for escalating severity of injury in children with multiple events of suspected NAT.MethodsThis retrospective longitudinal cohort study included children from a pediatric Medicaid accountable care organization with ≥ 1 non-birth related episode containing an International Classification of Diseases, Ninth Revision, Clinical Modification or Current Procedural Terminology code for NAT or a skeletal survey between 2007 and 2011. Subsequent potential NAT events were defined as independent episodes with codes for either NAT, a skeletal survey, or injuries suspicious for abuse. Severity of injury was calculated using the New Injury Severity Score (NISS). Multivariable Cox proportional hazards regression modeling was used with results expressed as hazard ratios and 95 % confidence intervals.ResultsOf the 914 children with at least one suspected NAT event, 39 % had at least one suspected recurrent NAT event; 12 % had 2 events and 5 % had ≥ 3 events during follow-up. Factors associated with an increased risk for a recurrent episode of suspected NAT with higher NISS were living in a rural area (1.69, 1.02–2.78, p = 0.04) and having an open wound (2.12, 1.24–3.62, p = 0.006), or superficial injury (2.28, 1.31–3.98, p = 0.004). In contrast, a greater number of injuries was associated with a decreased risk for a recurrent episode of suspected NAT with higher NISS (p < 0.0001).ConclusionsThough limited by a lack of follow-up of children placed in out of home care, our results suggest that children with “minor” or less numerous injuries are either not reported to child protective services or not removed from the unsafe environment with either situation leading to subsequent events. The medical and child welfare systems need to better identify these potential victims of recurrent events..

Optimization of MRI-based scoring scales of brain injury severity in children with unilateral cerebral palsy.

Several scoring systems for measuring brain injury severity have been developed to standardize the classification of MRI results, which allows for the prediction of functional outcomes to help plan effective interventions for children with cerebral palsy. The aim of this study is to use statistical techniques to optimize the clinical utility of a recently proposed template-based scoring method by weighting individual anatomical scores of injury, while maintaining its simplicity by retaining only a subset of scored anatomical regions. Seventy-six children with unilateral cerebral palsy were evaluated in terms of upper limb motor function using the Assisting Hand Assessment measure and injuries visible on MRI using a semiquantitative approach. This cohort included 52 children with periventricular white matter injury and 24 with cortical and deep gray matter injuries. A subset of the template-derived cerebral regions was selected using a data-driven region selection algorithm. Linear regression was performed using this subset, with interaction effects excluded. Linear regression improved multiple correlations between MRI-based and Assisting Hand Assessment scores for both periventricular white matter (R squared increased to 0.45 from 0, P < 0.0001) and cortical and deep gray matter (0.84 from 0.44, P < 0.0001) cohorts. In both cohorts, the data-driven approach retained fewer than 8 of the 40 template-derived anatomical regions. The equal or better prediction of the clinically meaningful Assisting Hand Assessment measure using fewer anatomical regions highlights the potential of these developments to enable enhanced quantification of injury and prediction of patient motor outcome, while maintaining the clinical expediency of the scoring approach.

Cerebral Activation During the Test of Spinal Cord Injury Severity in Children: an fMRI Methodological Study

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) are internationally accepted to determine and classify the extent of motor and sensory impairment along with severity (ASIA Impairment Scale [AIS]) following spinal cord injury (SCI). The anorectal examination is a component of the ISNCSCI that determines injury severity. There is a void in the health care literature on the validity of the anorectal examination as an indication of SCI severity. To validate the use of functional magnetic resonance imagining (fMRI) for the purpose of classifying the severity of SCI in children. Seventeen patients, with the average age of 14.3 years, underwent 1 complete ISNCSCI examination. Subjects also underwent the anorectal portion of this exam while fMRI data were collected using a 3.0 Tesla Siemens Verio Scanner. Cortical areas of activation were analyzed for possible differences of cortical involvement between complete (AIS A) and incomplete (AIS B, C, and D) SCI subjects. Anxiety/anticipation of the test was also assessed. This study established an fMRI imaging protocol that captures the cortical locations and intensity of activation during the test of sacral sparing. In addition to developing the data acquisition protocol, we also established the postacquisition preprocessing and statistical analysis parameters using SPM8. Preliminary findings indicate that fMRI is a useful tool in evaluating the validity of the anorectal examination in determining SCI severity. Assessment of which cortical regions are activated during the testing procedure provides an indication of which pathways are transmitting information to the brain.

CHILD SAFETY IN A CAR DURING A FRONTAL COLLISION

Road accidents with participation of the children are of particular nature. According to surveys, the older children at the age of 8-12 years are often transported in cars in a wrong way. They are usually fastened with seat belts designed for adult passengers. In order to make the seat belts safe for a child, they should be used together with a booster cushion or a high back booster seat. This paper presents the test results and analysis of dynamic loads affecting a child in the back seat of a passenger car during a frontal collision. The car body was accelerated to a speed of about 48 km/h and then it was suddenly stopped in a time of about 100 ms. The analysis was carried out on the basis of results of experimental tests performed at the collision station in the Automotive Industry Institute in Warsaw. The attention was paid to the influence of protection device type on the P10 dummy, representing a child at the age of about 10 years. Three child protection options during a collision were considered: the dummy was sitting directly in a car seat, on a booster cushion and on a seat. The dummy was fastened with standard seat belts. Evaluation of the protection device influence on the dummy loads was given in association with the operation of the seat belts. During evaluation, the indexes of biomechanical resistance of a human body to the impact load effects were used. They made the basis for the evaluation of the child injury severity risk.

Serum Sp-D Levels as a Biomarker of Lung Injury in Children Suffering of Bronchopneumonia

The efficacy of SP-D concentration as a useful biomarker of the severity of lung injury in children with bronchopneumonia with or without chronic airway disease was studied. A total of 48 patients (2 to 4 years old) diagnosed bronchopneumonia were admitted to Department of Pediatrics, Al-Dar hospital, Al-Madinah, Saudi Arabia over the year 2009. They were divided into two groups: G1 included patients without any underlying disease and G2 included asthmatic patients. They were assigned to one of three categories. Stage A patients without oxygen dosage, Stage B patients required oxygen dosage, and Stage C patients required ICU admission. We evaluated baseline characteristics, clinical features, and serum SP-D concentration in G1, G2, and G3a (healthy control cross-matched infants). The mean serum SP-D concentrations in G1 and G2 were higher than those in G3 (118.7 +/- 46.2 & 39.7 +/- 18.7 ng/ml, respectively), but also higher in G2 than in G1 (149.9 +/- 52.8 & 109.8 + 36.7 ng/ml, respectively). The mean serum SP-D concentrations were higher in Stage C than in Stages A or B patients, and mean serum SP-D concentrations were higher in Stage B than in Stage A.

Hyperphosphorylated neurofilament NF-H, S100β and NSE as indicators of severity of brain injury in children

The aim of the study was to determine whether serum levels of biomarkers - hyperphosphorylated neurofilament NF-H, S100β protein and NSE - correlate with severity of brain injury and outcome in children with traumatic brain injury (TBI).

Intra-rater agreement of the anorectal exam and classification of injury severity in children with spinal cord injury

Intra-rater reliability study, cross-sectional design. To report on the intra-rater agreement of the anorectal examinations and classification of injury severity in children with spinal cord injury (SCI). Two, non-profit children's hospitals specializing in pediatric SCI. 180 subjects had at least two trials of the anorectal examinations as defined by the International Standards for Neurological Classification of Spinal Cord Injury. Intraclass correlation coefficients (ICC) and 95% confidence intervals (CI) were used to evaluate the agreement. ICC>0.90=high agreement; ICC between 0.75-0.89=moderate agreement; ICC<0.75=poor agreement. When evaluated for the entire sample, agreement was moderate-high for anal sensation and contraction and injury classification. When evaluated as a function of age at examination and type of injury, agreement for anal sensation was poor for subjects with tetraplegia in the 12-15-year age group (ICC=0.56) and 16-21-year age group (ICC=0.70) and for subjects with paraplegia in the 6-11-year age group (ICC=0.69). Agreement for anal contraction was moderate for subjects with tetraplegia in the 16-21-year age group (ICC=0.81) and subjects with paraplegia in the 12-15-year age group (ICC=0.78) and poor for subjects with paraplegia in the 6-11-year age group (ICC=0.67). Agreement for injury classification was poor for subjects with tetraplegia in the 12-15-year group (ICC=0.56) and 16-21-year group (ICC=0.74) and paraplegia in the 6-11-year group (ICC=0.11) and 12-15-year group (ICC=0.63). Anorectal responses had high agreement in subjects with tetraplegia in the 6-11-year group and moderate to high agreement in subjects with paraplegia in the 16-21-year group. The data do not fully support the use of anorectal examination in children. Further work is warranted to establish the validity of anorectal examination.

Using multiple imputation and propensity scores to test the effect of car seats and seat belt usage on injury severity from trauma registry data

BackgroundMissing data and the retrospective, nonrandomized nature of trauma registries can decrease the quality of registry-based research. Therefore, we used multiple imputation and propensity scores to test the effect of car seats and seat belt usage on injury severity in children involved in motor vehicle crashes. MethodsAll children admitted after injury from motor vehicle crashes who had complete data on seat belt or car seat usage from 2003 to 2006 were included in the study. The sample was divided into children younger than 4 years (n = 130) or 5 years or older (n = 575) and analyzed for seat belt usage, car seat usage, injury severity score, revised trauma score, and Glasgow Coma Scale score. Data were analyzed before and after matching on propensity scores after multiple imputation. ResultsThere were no outcome differences between car seat users and non–car seat users. However, there were significant improvements in injury severity score (7.0 vs. 10.1, P = .002) and revised trauma score (7.6 vs 7.3, P = .013 for seat belt users compared to nonusers) even after matching on propensity score. ConclusionMultiple imputation and propensity scores demonstrated the efficacy of seat belts, but not car seat in this preliminary study. This statistical method can strengthen registry-based research.