John Recicar1, Amanda Barczyk2, Sarah Duzinski2, Karla A Lawson2, Nilda M Garcia2, Robert Letton3, Alexander R Raines3, James W Eubanks4, Nima Azarakhsh4, Sandra Grimes4, David M Notrica5, Pamela Garcia-Fillon5, Adam Alder6, Cynthia Greenwell6, Stephen Megison6, Mallikarjuna Rettiganti7, Chunqiao Luo7, Robert Todd Maxson8. 1. Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR, USA. 2. Trauma Services, Dell Children's Medical Center of Central Texas, Austin TX, USA. 3. Department of Surgery, The Children's Hospital at OU Medical Center, Oklahoma City, OK, USA. 4. Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA. 5. Department of Surgery and Level 1 Pediatric Trauma Center, Phoenix Children's Hospital, Phoenix, AZ, USA. 6. Department of Surgery and Trauma Services, Children's Medical Center Dallas, Dallas, TX, USA. 7. University of Arkansas for Medical Sciences, Department of Pediatrics, Division of Biostatistics, Little Rock, AR, USA. 8. Division of Pediatric Surgery, Department of Surgery, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, AR, USA. Electronic address: rtmaxson@uams.edu.
Abstract
PURPOSE: Restraint status has not been combined with mechanistic criteria for trauma team activation. This study aims to assess the relationship between motor vehicle crash rollover (MVC-R) mechanism with and without proper restraint and need for trauma team activation. METHODS: Patients <16years old involved in an MVC-R between November 2007 and November 2012 at 6 Level 1 pediatric trauma centers were included. Restraint status, the need for transfusion or intervention in the emergency department (ED), hospital and intensive care length of stay and mortality were assessed. RESULTS: Of 690 cases reviewed, 48% were improperly restrained. Improperly restrained children were more likely to require intubation (OR 10.24; 95% CI 2.42 to 91.69), receive blood in the ED (OR 4.06; 95% CI 1.43 to 14.17) and require intensive care (ICU) (OR; 3.11; 95% CI 1.96 to 4.93) than the properly restrained group. The improperly restrained group had a longer hospital length of stay (p<0.001), and a higher mortality (3.4% vs. 0.8%; OR 4.09; 95% CI 1.07 to 23.02) than the properly restrained group. CONCLUSION: Unrestrained children in MVC-R had higher injury severity and were significantly more likely to need urgent interventions compared to properly restrained children. This supports a modification to include restraint status with the rollover criterion for trauma team activation.
PURPOSE: Restraint status has not been combined with mechanistic criteria for trauma team activation. This study aims to assess the relationship between motor vehicle crash rollover (MVC-R) mechanism with and without proper restraint and need for trauma team activation. METHODS:Patients <16years old involved in an MVC-R between November 2007 and November 2012 at 6 Level 1 pediatric trauma centers were included. Restraint status, the need for transfusion or intervention in the emergency department (ED), hospital and intensive care length of stay and mortality were assessed. RESULTS: Of 690 cases reviewed, 48% were improperly restrained. Improperly restrained children were more likely to require intubation (OR 10.24; 95% CI 2.42 to 91.69), receive blood in the ED (OR 4.06; 95% CI 1.43 to 14.17) and require intensive care (ICU) (OR; 3.11; 95% CI 1.96 to 4.93) than the properly restrained group. The improperly restrained group had a longer hospital length of stay (p<0.001), and a higher mortality (3.4% vs. 0.8%; OR 4.09; 95% CI 1.07 to 23.02) than the properly restrained group. CONCLUSION: Unrestrained children in MVC-R had higher injury severity and were significantly more likely to need urgent interventions compared to properly restrained children. This supports a modification to include restraint status with the rollover criterion for trauma team activation.