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The Role of Restraint and Seat Position in Pediatric Facial Fractures

Arbogast, Kristy B. PhD; Durbin, Dennis R. MD, MSCE; Kallan, Michael J. MS; Menon, Rajiv A. PhD; Lincoln, Andrew E. ScD; Winston, Flaura K. MD, PhD

Journal of Trauma and Acute Care Surgery: April 2002 - Volume 52 - Issue 4 - p 693-698
Original Articles

Background  Recently, head and brain injuries were identified as consequences of the inappropriate use of seat belts by children. The proposed mechanism of these injuries might also place a child at risk for facial fracture.

Methods  A probability sample of children under age 16 involved in crashes were enrolled in an ongoing crash surveillance system (1998–2001) that links insurance claims data to telephone survey and crash investigation data (unweighted, n = 12,659; weighted, n = 131,717). Incidence of facial fracture was estimated and a series of cases were examined using in-depth crash investigation to identify the mechanisms of these injuries, specifically, the role of seating position and restraint use in the mechanism of injury.

Results  Ninety-two children suffered a fracture of the facial bones (0.07% of all children in crashes). Among restrained children with facial fractures (n = 68), those inappropriately restrained were at a 1.6-fold higher risk (95% confidence interval, 1.2–2.1;p = 0.001) of significant injury than those appropriately restrained for their age. The in-depth investigations revealed that excessive head excursion resulting from suboptimal torso restraint caused facial impact, which resulted in the facial injuries described.

Conclusion  The potential for disfigurement associated with these facial injuries may resonate strongly with parents, and prevention of disfigurement may provide additional motivation for proper restraint, in particular, booster seats and rear seat location, for this pediatric population.

From TraumaLink and the Department of Pediatrics (K.B.A., R.A.M., F.K.W.), The Children’s Hospital of Philadelphia, Center for Clinical Epidemiology and Biostatistics (D.R.D., M.J.K.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, and The Johns Hopkins University Bloomberg School of Public Health (A.E.L.), Baltimore, Maryland.

Submitted for publication August 7, 2001.

Accepted for publication November 28, 2001.

Performed as part of the Partners for Child Passenger Safety Study at The Children’s Hospital of Philadelphia funded by State Farm Insurance Companies.

Address for reprints: Kristy Arbogast, PhD, The Children’s Hospital of Philadelphia, 3535 TraumaLink, 10th Floor, 34th and Civic Center Blvd., Philadelphia, PA 19104; email:

© 2002 Lippincott Williams & Wilkins, Inc.