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Passenger Compartment Intrusion as a Predictor of Significant Injury for Children in Motor Vehicle Crashes

Evans, Susan L. MD; Nance, Michael L. MD; Arbogast, Kristy B. PhD; Elliott, Michael R. PhD; Winston, Flaura K. MD, PhD

The Journal of Trauma: Injury, Infection, and Critical Care: February 2009 - Volume 66 - Issue 2 - p 504-507
doi: 10.1097/TA.0b013e318166d295
Original Articles

Background: Passenger compartment intrusion, loss of integrity of the vehicle occupant compartment due to a motor vehicle crash, has frequently been used as a triage criterion. Data to support intrusion as a proxy for injury severity in child occupants are lacking. The purpose of this study was to examine the association between intrusion and injury to children in motor vehicle crashes.

Methods: Crash investigation data were reviewed from the partners for child passenger safety database, a large, child-focused crash surveillance system. Data included: intrusion (centimeters), direction of impact, age of occupant, and Abbreviated Injury Scale (AIS) score. Analyses examined the relationship between the amount of intrusion and the risk of any AIS ≥ 2, or ≥3 injury.

Results: Data were available on 880 children, age 0 year to 15 years. AIS ≥2 and ≥3 injuries occurred in 40.3% and 12.6% of child occupants, respectively. Intrusion was strongly and positively associated with the odds of both an AIS ≥ 2 and ≥3 injury (p < 0.0001). The odds of at least one AIS ≥ 2, or ≥3 injury increased on average by 2.9% (95% CI = 1.9–3.8%), or 4.0% (95% CI = 2.7–5.2%), respectively, for each additional centimeter of intrusion, adjusting for age, restraint use, seating row, and direction of impact.

Conclusion: The association between passenger compartment intrusion and injury in children supports its application in triage, and usefulness in injury predictive models. Future studies should determine methods for providing valid field information on intrusion to the trauma team.

From the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Submitted for publication May 10, 2007.

Accepted for publication December 31, 2007.

Address for reprints: Michael Nance, MD, 34th and Civic Center Boulevard, Philadelphia, PA 19104; email:

© 2009 Lippincott Williams & Wilkins, Inc.