Child Seatbelt Use Varies by Race and Ethnicity, Study Determines

   Motor vehicle accidents are the leading cause of death among children.

To address a paucity of data regarding racial/ethnic differences in injury severity score (ISS), use of restraints, and outcomes in the crashes, Rebecca Stark, MD, and colleagues at the departments of Surgery and Emergency Medicine at Harbor-UCLA Medical Center in Torrance, California, collected and analyzed the data.

   In a study, "Are There Racial/Ethnic Disparities in the Use of Restraints and Outcomes in Children Following Motor Vehicle Crashes?" presented at the American Academy of Pediatrics National Conference and Exhibition in Boston, they reviewed 2002-2006 data from the National Trauma Database on car accidents involving nearly 40,000 children under age 16. Specifically, Dr. Stark and her colleagues looked at the race/ethnicity of the children; whether they wore a seat belt; and the severity of their injury as determined by the need for emergency surgery, the length of their hospital stay, and morbidity/mortality.

   Overall, 47.5% of patients were restrained, with the lowest use of seat belts among black, Hispanic, and Native American children and the highest among Asian children. The breakdown for restraint use was Asian, 59.3%; white, 48.8%; black, 39.5%; Hispanic, 39.0%; and Native American, 36.8% (P <0.0001).

  Of the children injured, 12.6% required an emergency operation. Overall morbidity was 6.7% and mortality, 5.8%. While race/ethnicity did not affect mortality or length of hospital stay, the use of restraints was associated with a lower ISS. A higher ISS was associated with an increased need for emergency surgery, morbidity (severe outcome), death, and longer hospital stay.

   On multivariable analysis, blacks, Hispanics, and Native Americans were less likely to need an emergency operation and Asians were more likely to have a complication compared with whites.

   "After adjusting for the use of restraints, we found no differences in mortality among different ethnic groups," Dr. Stark said. "The major determinant of both morbidity and mortality is the severity of the injury as quantified by the initial injury severity score."