P0100 - Geo-Demographic Profiling of Inappropriate Restraint Use in Pediatric Motor Vehicle Collisions

Purpose: Motor vehicle collisions (MVC) are a leading cause of devastating injury and unintentional death in children and adolescents. The American Academy of Pediatrics (AAP) recommends (1) rear-facing car seat until age 2 yrs, (2) forward facing car seat with harness until ~65 lbs, (3) booster until age [~8-12 yrs] and height [4’9”] appropriate, (4) children < 13 yrs should be back-seat occupant, and (5) lap belt for all others. Improved outcomes from correct use of restraints is well-known, yet inappropriate adherence to pediatric restraint recommendations hinders their success. This study aims to identify areas deficient in appropriate pediatric restraint use in our catchment area.

Methods: After obtaining IRB approval, we retrospectively queried an urban Level 1 trauma center registry for pediatric (0-18yrs) MVC victims from October 2013 to December 2018. Demographic and clinical variables were included. Data regarding home zip code and inappropriate restraint use by age group, including seatbelt, car seat, booster, and seating position, were examined. We used a geographic information system to map the patient home addresses of MVC incidents and visualize, at the census tract level, the rates of MVC where victims were inappropriately restrained.

Results: 303 cases of pediatric MVC were identified. Demographics were 55% male, 44% Hispanic, 39% African American, 17% Caucasian, and 0.3% Asian. Overall, 52% (158/303) were categorized as inappropriately restrained or unrestrained. Among seatbelt-age children, 45% were unrestrained, with 3% restrained but inappropriately riding in the front seat for their age. Among booster-age children, 57% were inappropriately restrained (no booster seat, no lap belt, or riding in the front seat). Car-seat age children were inappropriately restrained in 60% of cases (unrestrained in car-seat, restrained in car-seat without being secured to car, or no car seat or seatbelt at all). 21% of subjects required surgery, with death occurring in 2%. African American children were more likely to be inappropriately restrained than Caucasian and Hispanic children (62% vs. 41% vs. 47%; p=.012). Home addresses were mapped and then percentage of inappropriately restrained were aggregated by census tract (Figure 1). The census tracts where MVC patients were most likely to be inappropriately restrained were positively correlated with majority Black Non-Hispanic neighborhoods.

Conclusions: Our metropolitan county continues to see a high rate of noncompliance with AAP pediatric motor vehicle safety guidelines with inappropriate restraint use present in greater than half of MVC cases at our hospital. Inappropriate restraint use is common among all racial groups but highest for African Americans from majority Black Non-Hispanic neighborhoods. Targeted educational efforts and needs assessments among vulnerable groups, performed in collaboration with our injury prevention colleagues, are necessary to ensure the safety of our community’s children.