Are there racial disparities in the use of restraints and outcomes in children after motor vehicle crashes?

BACKGROUND This study determines whether racial/ethnic disparities exist with respect to restraint use and outcomes in pediatric motor vehicle crash passengers. METHODS A review of passengers (<16 years old) involved in motor vehicle crashes from the National Trauma Database from 2002 to 2006 was performed. Outcome measures were emergency surgery, morbidity, mortality, and length of stay (LOS). RESULTS A total of 37,375 patients were identified (mean age, 9.3 years; 95% confidence interval, 9.2-9.4 years; 59% male). Of the patients, 45.7% were restrained with the lowest use among African Americans, Hispanics, and Native Americans; 12.6% required emergency surgery; morbidity was 6.7%, and mortality, 5.8%. On multivariable analysis, race/ethnicity did not affect mortality or LOS. Higher Injury Severity Score (ISS) was associated with increased need for emergency operation, higher morbidity and mortality, and longer LOS. The use of restraints was associated with a lower ISS and a decreased risk for emergency surgery. The interaction between restraint use and ISS increased the need for emergency surgery, morbidity, and LOS. CONCLUSIONS Less than half of pediatric passengers in this study were restrained. The use of restraints was associated with a lower ISS, whereas a higher ISS was associated with increased need for emergency surgery, morbidity, mortality, and LOS. These data emphasize the need for increased education in preventive measures to minimize the risk of death and injury.