Pediatric Emergency Medicine Fellow University of Texas Southwestern Medical School Farmers Branch, Texas, United States
Background: In November 2018, the American Academy of Pediatrics recommendations for child car seat positioning changed from all children less than 2 years of age be in rear-acing car seats to children being rear-facing per the height and weight limitations of the car seat manufacturer. This recommendation change can potentially keep children rear-facing for up to 60 months. Very little data exists regarding observed extremity injuries after this latest change in recommendations. Objective: Describe the epidemiology of pediatric long bone fractures in motor vehicle collision (MVC) in a North Texas level 1 trauma center in children less than 60 months of age before and after the change in recommendations. Supplement knowledge regarding areas for injury prevention. Design/Methods: Children 0-60 months of age who had been involved in MVC and evaluated in our emergency department (ED) from 2015-2021 were identified in our trauma registry. Medical records were reviewed retrospectively. Data points were cross-referenced through chart reviews. A descriptive analysis was conducted on the data and stratified by periods prior to and after the change in recommendations and by age (0-24 months, 25-48 months, 49-60 months). Demographic data, collision information, orthopedic intervention, restraint information, and injury severity scores (ISS) were also collected. A chi-square or Fisher’s exact test was conducted to determine associations. Results: A total of 550 patients met study criteria. The mean age of patients was 31 months. Of the 550 patients, 20% (N=111) were unrestrained and 16% (N=88) were improperly restrained in a seatbelt. In all patients, there were 157 fractures identified in 117 patients (21%). The most commonly fractured bone was the femur (33% of fractures). Children aged 48-60 months were more likely to have their radius (p=0.0033) and ulna (p=0.0215) fractured compared to younger children. No change in individual long bone fracture incidence was observed. While the incidence of tibia fractures almost doubled after November 2018, it was not statistically significant (p=0.3319). The mean ISS in these patients was significantly higher before the change in recommendations compared to after 9.0503 vs 6.3939 (p=0.0036).
Conclusion(s): A large portion of our patient population was improperly restrained. The most commonly fractured bone was the femur. Fewer femur fractures were observed in the 0-24 month age group after the change in recommendations. No other change in long bone fracture was identified. The mean ISS significantly decreased after November 2018, perhaps in relation to the change in recommendations.
