396 - Evaluating the Associated Injuries in Pediatric Motor Vehicle Versus Pedestrian Collisions

Poster Number: 396
Publication Number: 396.3307

Background: Pediatric motor vehicle versus pedestrian collisions (MPCs) are a frequent presentation of blunt trauma in the emergency department and require prompt evaluation. Numerous factors such as velocity, vehicle structure, and patient size will alter the impact and subsequent injuries. “Waddell’s Triad” is an injury pattern described as vehicle impact causing lower extremity injury, ipsilateral injury to the trunk from the hood, and contralateral head injury from hitting the ground. This injury pattern has been extrapolated to pediatrics despite having a small sample size and not including pediatric aged patients.

Objective: The purpose of this study is to identify whether a true injury pattern exists in children involved in MPCs. The study will also evaluate factors leading to multi-system injuries, severity, and mortality.

Design/Methods: This is a descriptive, retrospective study with data obtained from the institutional trauma registry and reviewed in the electronic health records. Patients 18 or under presenting between 2010-2022 who sustained a front-end impact MPC were included. Patients with active musculoskeletal injuries at time of injury or history of inherent bone disorders were excluded.

Results: Data from 737 pedestrians involved in MPCs was analyzed. A true Waddell injury pattern was identified in 33 pedestrians (4.5%). Conversely, 37 pedestrians (5.0%) had the same three injuries, all on the ipsilateral side. Our study indicates that 292 pedestrians (39.6%) had zero injuries and an additional 238 pedestrians (32.3%) only had one injury. Of the injuries recorded, the most frequent injuries were noted to be of the lower extremities with total of 290 injuries and the head or neck with a total of 280 injuries. Patients involved in an accident at a speed of 0-19 miles per hour (mph) were shown to have a GCS of 14.4 (SD 2.2) and ISS of 7.0 (SD 8.4) while those injured at 40+ mph had a GCS of 10.9 (SD 5.3) and ISS of 19.4 (SD 16.6).

Conclusion(s): MPCs present in great variations due to abundant patient and vehicle factors. This study shows that a true injury pattern such as Waddell’s triad does not exist. Instead, components of the incident should be evaluated along with a careful physical examination to formulate a diagnostic plan. Our study demonstrates that a higher speed, >40 mph, is the factor most likely to cause an increased number of injuries, decreased GCS, and increased ISS at initial presentation. With improved understanding of the mechanism behind these injuries, emergency physicians can improve their assessments, diagnostics and therapeutic plans for children involved in MPCs.