what would be the best restraint to use on an infant during care for a head wound?

• Journal Listing
• Annu Proc Assoc Adv Automot Med
• v.42; 1998
• PMC3400190

Annu Proc Assoc Adv Automot Med. 1998; 42: 29–43.

Injuries to Children Restrained in two- and 3- Signal Belts

Abstract

Injury risks to children restrained in 2-betoken belts accept been well described. "Seat chugalug syndrome," associated with the utilize of 2-bespeak belts, includes contusion of the intestinal wall, fracture of the lumbar spine, and intra-abdominal injury. Using crash reconstruction methodologies and prospectively collected clinical data, we compared injury patterns by restraint type amongst a sample of 98 belted children. At that place were no pregnant differences in injury severity or hospital charges past belt type. There was no departure in the gamble of AIS ≥ 2 injury to the head, neck, chest, abdominal contents or extremities by belt type. Children restrained in 3-point belts showroom a similar pattern of injury to those in ii-bespeak belts, however 3-point belts announced to be protective for lumbar fracture.

THE EFFICACY OF Prophylactic BELTS in lowering fatality rates and reducing the adventure of serious injury to children in motor vehicle crashes is well documented [Niemcryk 1997, Chipman 1996, Johnson 1994, Centers for Affliction Control 1991, Kraft 1990, Partyka 1988, Decker 1984, Morris 1983]. Correct use of safety belts can forbid ejection and minimize occupant contact with the vehicle interior during a standoff [Rex 1995, Martinez 1994]. In addition, safety belts are designed to disperse the crash forces over a longer period of time both through the stretching of the belt webbing and, by anchoring the occupant to the vehicle, maximizing the total ride-downward altitude as the vehicle deforms during a crash [Loma 1993].

The employ of safety belts by US children has increased markedly over the final 20 years. While notable reductions in bloodshed associated with increased restraint usage accept occurred in the general population, mortality rates for children betwixt the ages of 5 and fifteen have not fallen equally speedily as they have for other segments of the population [Graham 1998]. According to the National Highway Traffic Safety Administration (1996), the fatality rate for adolescents xvi–20 years has declined approximately 25% between 1975 and 1996, while mortality for children aged 5–nine and 10–15 years has declined only 14% and 11% respectively. Even more than striking are changes in injury rates. From 1988–1996, the injury charge per unit per 100,000 children aged ten–xv remained essentially unchanged; for children aged 5–9 years, in that location was a xx% increase in the injury rate.

Safe belts are designed primarily for adult occupants, nevertheless most U.s.a. country laws allow children to be legally restrained in safety belts once they weigh at least 40 pounds, far less than the 103-pound, 5% female person specified in functioning criteria. There are several reasons to believe that prophylactic belts may exist less effective protecting children than adults. Children, with their smaller body mass, may not load the belts sufficiently to induce stretching of the belt webbing and thus may decelerate more abruptly. Additionally, anatomic differences make it much more difficult to ensure proper belt fit in children. The anterior superior iliac crest, which anchors the lab belt in an developed, does not fully develop until adolescence, this results in the chugalug'south riding cephalad over the intestinal viscera. This, coupled with children's more kyphotic spine, may increase the likelihood of "submarining" under the lap belt in the event of a crash. Finally, the child'southward more compliant rib cage may allow greater transfer of crash forces to the underlying thoracic organs. Evidence of the reduced efficacy of 3-bespeak belts in restraining young children is suggested by Agran, et al., (1992) who compared mean Injury Severity Scores for restrained and unrestrained children. For children anile 4 to 9 years, they found no difference in mean Injury Severity Score between unrestrained children in the right forepart seat and those restrained in 3-point belts, nonetheless a pregnant difference was seen for older children aged 10 to 14 years.

SEAT Belt SYNDROME

Injuries associated with loading past the lap belt were first described in 1956 by Kulowski and Rost. The term "seat chugalug syndrome" was coined in 1963 past Garrett and Braunstein to describe the distinctive pattern of injury including contusion or abrasion of the intestinal wall, fracture of the lumbar spine, and injury to the abdominal viscera occurring to occupants restrained by ii-indicate belts. Many authors have noted the frequency with which these injuries occur in children [Shoemaker 1997, Lane 1994, Stylianos 1990, Newman 1990], several have detailed problems with diagnosis and handling of injury to the abdominal organs [Lynch 1996, Tso 1993, Sivit 1990, Stylianos 1990] and fracture of the lumbar spine [Voss 1996, Greenwald 1994, Glassman 1992, Johnson 1990] specific to pediatric populations. Greater use of three-point restraints is oftentimes cited as a preventive measure for seat belt syndrome in children [Shoemaker 1997, Lane 1994, Stylianos 1990, Johnson 1990].

While there has been no comprehensive review of restraint-related injuries to children from 3-bespeak belts, several authors have published reports of cervical injury to children associated with 3-betoken chugalug use [Lynch 1996, Givens 1996, Huelke 1993, Agran 1990]. Tso (1993) described 4 cases of abdominal injury, although no cervical injuries, amid 9 children restrained in iii-point belts who were admitted to a pediatric trauma center with crash-related injuries. This study compares the risk of belt-related injury amidst 98 children restrained in 2- or 3-indicate belts who were injured in motor vehicle crashes.

METHODS

All belted children anile 0 to 15 years who were consecutively admitted to Children's National Medical Center, a regional pediatric trauma center in Washington, DC, between Dec 1991 and December 1997 were eligible for inclusion. Excluded from the sample were children who were restrained merely by shoulder belts, right forepart seat passengers who experienced air bag deployments, children in vehicles more than vi years quondam at the time of admission, and cases in which the vehicle could not be located; no exclusions were made by principle management of force.

Later parental consent was obtained, all injuries were documented and photographed, and the heights and weights of the children were recorded. Information concerning injury diagnosis, injury severity, medical treatment and result were collected prospectively during the child's acute handling and follow-up. Injury severity was measured using the Abbreviated Injury Calibration, the Injury Severity Score, the Revised Trauma Score and the TRISS probability of survival.

Crash reconstructionists were notified of the fourth dimension and location of the crash immediately subsequently informed consent was secured; notification typically occurred within 36 hours of the crash. The reconstructionists visited the scene of the crash, examined the damaged vehicles, reviewed police accident reports, and interviewed family members and pre-hospital providers in social club to reconstruct the factors leading to the crash and the movements of the vehicles and their occupants immediately following impact. Measurements of mail-crash vehicle dimensions for overall length, width, wheelbase, maximum crush, and front end and rear overhang were compared to manufacturers' specifications. Vehicle deformity measurements were used to judge the total, longitudinal, and lateral velocity changes (Delta Five) experienced by the vehicle. Restraint use was determined by the presence of belt marks on the child'southward torso, concrete signs of belt wear such as evidence of stretched webbing or deformed anchor ridges, and interviews with providers of pre-hospital medical services, vehicle occupants, and the children themselves. Monthly case review meetings were held amid pediatric surgeons, orthopedists, radiologists, nurses, crash reconstructionists, engineers, and traffic rubber advocates to determine the most likely mechanisms responsible for each injury the kid sustained and to found the correctness of restraint use.

Patterns of chugalug-related injury for children in 2- and 3-point belt systems were compared. Children who had placed the shoulder belt behind their backs were grouped with those in 2-indicate belts; children who placed the shoulder belt under their arms were classified with those wearing iii-bespeak restraints. Mean values of injury severity measures past restraint type were compared using Student'south t exam. Odds ratios and 95% confidence intervals were computed by restraint utilise for belt-related injuries to the chest and abdomen and for whatever injury to the head, neck, or extremities. The cumulative probabilities of intra-intestinal injury by height, weight, and Delta 5 were platted by restraint type.

RESULTS

A full of 98 belted children were included in the report. The hateful historic period of the children in the sample was 7.3 years (± 2.five). Half of the children were anile half-dozen years or younger; 72% were between the ages of five and 9 years. The mean height was 121.7 cm (± 17.8), the hateful weight was 27.9 kg (± eleven.5). Nearly threescore% of the children were girls (due north = 57).

The children were as distributed by restraint type, with 49 children in 2-point belts and 49 in 3-betoken belts. Restraint type was evenly distributed by age, as shown in Figure 1. The children were evenly divided by seating position, with half (northward = 49) in the right front seat, and one-half in rear seating positions. Two-thirds (n = 66) of the children were injured in frontal crashes, 21% (n = 21) in lateral crashes, 7% in rollover (n = seven) and iv% (due north = 4) in rear collisions.

Distribution of belt blazon past age of kid.

TYPES OF INJURY

The types of belt-related injuries past restraint type are listed in Table 1. External abrasions and contusions to the chest and abdomen (AIS = ane) were the about mutual. The likelihood of external abrasion increased directly both with the weight of the child and the computed Delta Five.

Table 1

Frequencies and types of belt-related injury by restraint type.

Injury	ii-point belt	3-point belt
Thoracic Injuries
External abrasions/contusions	0	seven
Rib/Sternal fractures	0	0
Clavicle fracture	0	1
T-spine fracture	0	1
Pneumothorax	ane	ane
Lung contusion	0	ane
Abdominal Injuries
Abrasions/Contusions	9	7
L-spine fracture	ix	0
Stomach, perforation/tear	2	0
Modest intestine, hematoma	2	2
Pocket-sized intestine, perforation/tear	3	3
Small intestine, rupture/transection	0	2
Colon, hematoma	two	0
Colon, laceration	3	3
Mesentery, hematoma	0	3
Mesentery, laceration	0	ane
Float, rupture	i	0
Liver, laceration	0	2
Spleen, hematoma	1	2
Spleen, laceration	1	2
Pancreas, hematoma	2	0
Peritoneal hematoma	i	1
Kidney, hematoma	0	1
Kidney, laceration	0	1
Adrenal hematoma	0	1
Retroperitoneal hematoma	1	two

In that location were no fractures of the sternum or ribs attributed to belt loading experienced past the children in this sample, however there was 1 clavicular fracture. There were no chugalug-related injuries to the heart or great vessels. Three of the 4 belt-related injuries involving the thoracic cavity were to children in 3-point belts.

Lumbar fractures were the most common belt-related intestinal injury, all nine of which were sustained past children in 2-indicate belts. I child, who was restrained in a 3-point belt in the left rear seat in a correct offset frontal crash, sustained a compression fracture at T-12/50-i. At that place were a total of 45 chugalug-related intra-intestinal injuries, over half of which (n = 23) were to the hollow viscera. The 10 children with solid organ injuries were about evenly distributed between children in two- and iii-point restraints (4 versus six, respectively). V of the six retroperitoneal injuries were sustained by children in 3-signal restraints.

At that place was one cervical injury > AIS 1. A kid restrained in a iii-point belt sustained a subarachnoid hematoma at the C-one level as the result of a rollover; the injury resulted in hemiparalysis that resolved over ix months.

INJURY SEVERITY

The mean Injury Severity Score was 9.6 (±12.0). The children arrived at the trauma center in relatively stable physiologic condition as indicated by a mean Revised Trauma Score of vii.17 (±1.37); the mean TRISS probability of survival was 0.921 (± 0.219). I child, who was seated on the struck side of a lateral crash died of injuries unrelated to belt use; there were no fatalities from chugalug-related injuries.

There were no differences among any of the injury severity measured studied by belt type (See Tabular array 2.). The somewhat higher, but not statistically significant, hospital charges for children in 2-indicate belts are due largely to the statistical leverage exerted by a single accuse of more than than $270,000.

Tabular array 2

Mean values for indicators of injury severity by restraint utilise.

Injury Descriptors	two-point Belts mean (S.D.)	3-point Belts mean (Due south.D.)	p value
Injury Severity Score	ix.three	10.0	0.76
Revised Trauma Score	7.23 (1.xx	seven.12 (1.54)	0.72
TRISS P(s)	0.919 (0.22)	0.922 (0.23)	0.95
Glasgow Blackout Calibration	fourteen.1 (3.i)	thirteen.eight (iii.2)	0.63
Maximum AIS	two.i (ane.vi)	2.iii (i.9)	0.49
Length of Stay (d)	5.9 (eight.8)	4.1 (5.4)	0.23
Hospital Charges ($US)	25,611 (47,118)	14,682 (19,648)	0.15

BODY REGION INJURED

Children restrained in iii-indicate belts experienced no difference in risk of injury (AIS ≥ 2) to the head, face, chest, abdomen, or extremities, equally shown in Table 3. The odds of lumbar spine fracture were nine times higher for children restrained past the lap belt only compared with those in 3-bespeak belts (95% C.I. 1.2, 68.4).

Tabular array 3

Relative odds of injury by body region for children in 3-point versus two-point belt systems.

Body Region Injured (AIS ≥ 2)	Relative Odds	95% Conviction Interval
Head	1.l	0.81	2.77
Confront	0.25	0.03	ii.16
Chest†	ane.00	0.31	three.24
Abdomen†	0.92	0.47	i.82
Lumbar Spine† *	0.11	0.01	0.84
Extremities	one.57	0.66	3.72

OCCUPANT CHARACTERISTICS

In that location were no gender-related differences in restraint system usage or injury rate; 35% of the girls (northward = 20) and 24% of the boys (n = 10) sustained belt related injuries (p = 0.26).

The kid's pinnacle was not associated with take chances of chugalug-related intra-intestinal injury (AIS ≥ ii). An association between the risk of injury to abdominal organs and weight is suggested by a nearly linear inverse relationship, although this was not statistically meaning (See Tabular array iv.). The empirical cumulative probability plots of belt-related AIS ≥ two abdominal injury (including lumbar fracture) by belt type are well-nigh identical for body height and weight (See Figures 2 and ​ iii.).

Cumulative probability of belt-related abdominal injury by elevation of child and restraint utilize.

Cumulative probability of belt-related abdominal injury by weight of kid and restraint apply.

Table 4

Rate of belt-related abdominal injury (AIS ≥ two) past weight.

Weight (kg)	n	AIS ≥ 2 (due north)	%
< xx	22	8	36.4
twenty–24	25	7	28.0
25–29	19	5	26.3
thirty–34	13	2	15.four
35–44	9	2	22.2
≥ 45	ten	1	10.0

RESTRAINT MISUSE

Incorrect apply of the belt systems was common. Of the children classified as having 2-point restraints, 47% (n = 23) were restrained in 3-point belts with the shoulder belt routed behind their backs. Seven (fourteen%) of the children in 3-signal belts had the shoulder belt routed under their arm to keep the belt away from the child's face. Two pairs of children were "doubled upward," restrained in a single lap belt. Because of the limitations of retrospective restraint use reconstruction, information technology was not possible to uniformly determine whether safe belts were worn too loosely.

Amidst belted children, incorrect restraint use was not associated with increased risk of belt-related injury. For children restrained by the lap belt merely, there was no significant difference in injury risk between those in ii-betoken belts (27% of whom sustained belt-related injury) and those who wore the shoulder portion of their 3-point restraint behind their backs (35% of whom sustained chugalug-related injury).

One of the 7 children who had the shoulder belt routed nether the arm sustained belt-related injuries (liver contusion and intestinal rent). There was no difference in the risk of belt-related injury for children wearing their shoulder belts in the " under-the-arm" configuration versus those wearing the belts across the upper torso. The minor number of children exhibiting this belt misuse design does non support a more detailed assay.

SEATING POSITION

In that location was no difference in risk of injury to the chest or belly past front end versus rear seating position. While children in the rear seating positions appeared to be at greater risk of injury to the lumbar spine (16.3% vs. 4.one%; p < 0.05), this difference disappeared after adjusting for the increased employ of 2-point restraints by rear seat occupants.

CRASH SEVERITY AND Blazon

Children in 2- and iii-bespeak belts experienced crashes of like type and severity, as indicated by the lack of pregnant difference either in mean Delta V (32.vi km/h vs. 33.9 km/h; p = 0.67) or in the distribution of front end, lateral, rear, and coil-over crashes between the two groups. There was no difference in risk of chugalug-related injury past crash type.

The risk of belt-related injury increased with increasing Delta V, for children in both belt systems, equally shown in Tabular array 5. Likewise, the cumulative probability plots for chugalug-related intestinal injury by Delta V indicates no articulate departure in risk of chugalug-related injury by restraint type. However, the information suggest that for crashes with a Delta V greater than 35 km/h the take chances of abdominal injury may exist greater for children in 2-point belts (See Figure four.).

Cumulative probability of chugalug-related abdominal injury by crash severity and restraint use.

Tabular array v

Belt-related injury by crash severity and belt type.

	2-signal Belts		3-bespeak Belts
Delta Five (km/h)	northward	% injured	n	% injured	p value
< xx	21	19.0	23	xiii.0	0.59
20–24.ix	14	35.7	13	38.five	0.88
≥ 25	12	50	10	50	ane.00

Give-and-take

A distinctive pattern of injury to children restrained in 3-point belts is emerging. Contusions to the abdominal wall and intra-intestinal injuries are common and seem to occur with the same frequency as are found in children restrained past lap belts only. While the apply of 3-point belts greatly reduces the risk of fracture to the lumbar spine, use of the restraints may increase the risk of injury to the kidney, liver, and spleen, as 8 of 10 children sustaining these solid organ injuries were so restrained. Tso (1993) also reported a higher percentage of solid organ injuries for children in three-point versus 2-point belts. There may also be increased adventure of injury to the thoracic viscera, however larger databases will be required to fully appraise the run a risk of these less common injuries. In contrast with studies of chugalug related injuries in adults [Hill 1994, Martinez 1992], there were no cases of rib or sternal fractures resulting from belt loading in this serial, although in that location was one clavicular fracture. Differences in thoracic injury patterns betwixt children and adults may be attributed to the kid's more than compliant rib cage.

Givens (1996) has suggested that children in 3-point belts are at increased risk of injury to the cervical spine, withal Huelke (1993) states that these injuries are extremely rare. Agran, et al., (1987) reported that 21% of all children restrained by 3-point belts during motor vehicle crashes suffer cervical strains. Cervical injuries take also been reported for children in 2-point restraints [Lynch 1996, Tso 1993, Williams 1993]. At this time there is insufficient data to comment on the risk of cervical injury relative to chugalug type.

Comparisons of risks of intra-abdominal injury for adults wearing 2- and three-point belts indicate a marked decrease in injury risks for those restrained in 3-signal belts [Huelke 1993, Anderson 1991], in contrast to our findings in children. The reasons for children'south higher risk may stem from a combination of poor fit of the shoulder belt and anatomic differences. The three principle injury mechanisms postulated for belt-related hollow viscus injury are pinch of the viscera between the belt and the spine, shearing due to deceleration of organs with fixed points of zipper, and transient changes in interlumenary pressure [Hill 1993, Asburn 1990, Williams 1963]. The pocket-size antero-posterior diameter of children and their relatively thinner abdominal wall [Newman 1990] put them at greater risk of abdominal injury which may non be mediated by restraint of the upper body provided by shoulder belts. In addition, information technology is difficult to obtain proper fit of the shoulder belt on a small child, often resulting in the shoulder belt'south plumbing fixtures loosely, particularly in vehicles with door-mounted upper anchorages. When the shoulder belt is loose or does non fit properly, the child may load predominately on the lap belt, resulting in an injury pattern similar to that when no shoulder belt is present.

This sample includes children who accept misused their prophylactic belts either by placing the shoulder chugalug behind their backs or by placing the shoulder belt under their arm. Although such belt misuse may dethrone belt performance, we take chosen to include these children in our sample in club to provide a broader flick of belt-related injuries as they occur in " real earth" crashes. Similarly, we accept chosen to include children injured in all crash configurations, not only those in frontal crashes, every bit we plant the take a chance of belt-related injury to be independent of crash blazon, given that an injury was sustained. In trying to develop a clearer agreement of how children are injured in crashes, we believe it is important to investigate all belt-related injuries regardless of restraint misuse or crash type. Nosotros believe that the drawbacks of this focus are minimized in this sample past the lack of significant departure in the adventure of belt-related injury establish either by belt misuse or by crash blazon.

While the data presented here indicate that 3-point belts may pose a greater injury take chances to children than previously believed, circumspection must be exercised in interpreting the results. The sample, while considerably larger than previously published reports on injuries to children related to the apply of 3-point belts, nonetheless is relatively small, and does not support detailed analysis for most specific types of injury. Additionally, by excluding from the sample belted children who were uninjured in motor vehicle crashes, information technology is incommunicable to meaningfully compare the relative efficacy of the two restraint systems. Further research using larger databases is needed to better empathise the contribution of iii-betoken restraints to chugalug related injuries in children.

Although infants, toddlers, and adults typically use restraint systems specifically designed to meet their anatomical needs, children who accept outgrown rubber seats practise not. Belt systems designed for adults exercise not afford effective for the school aged child as much protection as safety seats practice for the preschool child. While employ of condom seats has been found to reduce injuries by 60% for children aged 0 to 4 years, iii-betoken belts have been shown to reduce injuries by only 38% or children aged five to 14 years [Johnson 1994].

The American Academy of Pediatrics and the National SAFE KIDS Campaign recommend that a booster seat be used when a child has outgrown a convertible safety seat, just is too small to fit in a vehicle safety chugalug. Booster seats are bachelor, only they are not yet widely used in the US, and no land or territory mandates their apply. Furthermore, because of express market demand and a lack of appropriate safety standards and testing dummies, very few booster seats are canonical for use by children weighing more than lx pounds, despite the recent recommendation of the NHTSA that children remain in booster seats until they are at least eighty pounds. This report supports the need for continued educational efforts promoting the utilise of booster seats for children who have outgrown traditional safe seats and further supports the need for evolution of booster seats and safety standards to provide meliorate protection for children weighing more than threescore lbs.

ACKNOWLEDGEMENTS

This research was supported past the National Highway Traffic Safety Assistants, Cooperative Agreement DTNH22-91-Y-07350. The authors wish to admit the contributions to the of J. Rene Morrissey, Research Assistant.

REFERENCES

• Agran PF, Dunkle DE, et al. Effects of legislation on motor vehicle injuries to children. Am J Dis Child. 1987;141:959–964. [PubMed] [Google Scholar]
• Agran PF, Castillo DN, Winn D. Comparing of motor vehicle occupant injuries in restrained and unrestrained four- to 14-year-olds. Accid Anal & Prev. 1992;24(four):349–355. [PubMed] [Google Scholar]
• Anderson PA, Rivara FP, Maier RV, Drake C. The epidemiology of seat belt-associated injuries. J Trauma. 1991;31:60–67. [PubMed] [Google Scholar]
• Centers for Illness Control and Prevention. Kid rider restraint utilise and motor vehicle related fatalities among children -- United States, 1982–1990. MMWR. 1991;40(34):600–602. [PubMed] [Google Scholar]
• Chipman ML, Li J, Hu X. The effectiveness of rubber belts in preventing fatalities and major injuries among school-anile children. Proceedings of the 39th Annual AAAM Briefing; Chicago. 1995. pp. 133–145. 111. [Google Scholar]
• Decker MD, Dewey MJ, Hutcheson RH, Schaffner W. The use and efficacy of child restraint devices. JAMA. 1984;252:2571–2571. [PubMed] [Google Scholar]
• Garrett JW, Braunstein PW. The seat chugalug syndrome. J Trauma. 1962;two:220. [PubMed] [Google Scholar]
• Givens TG, Polley KA, Smith GF, et al. Pediatric cervical spine injury: A three-yr experience. J Trauma. 1996;412:310. [PubMed] [Google Scholar]
• Glassman SD, Johnson JR, Holt RT. Seatbelt injuries in children. J Trauma. 33(6):882–886. [PubMed] [Google Scholar]
• Greenwald TA, Mann DC. Pediatric seatbelt injuries: diagnosis and handling of lumbar flexion-distraction injuries. Paraplegia. 1994;32:743–751. [PubMed] [Google Scholar]
• Graham J. New Finding's from Evaluation Enquiry. Auburn House; Boston, USA: 1998. Preventing Car Injury. [Google Scholar]
• Hill JR, MacKay GM, Morris AP. Breast and abdominal injuries caused by seat chugalug loading. Accid Anal & Prev. 1994;261:11. [PubMed] [Google Scholar]
• Huelke DF, MacKay GM, Morris A. Frontal impact protection: seat belts and air bags. Warrendale, PA: Society of Automotive Engineers; 1993. Intra-abdominal injuries associated with lap-shoulder belt usage. ASI SP-747. [Google Scholar]
• Huelke DF, MacKay GM, Morris A, Bradford Yard. A review of cervical fractures and fracture/dislocations without head impacts sustained past restrained occupants. Accid Anal & Prev. 1993;25(6):731–743. [PubMed] [Google Scholar]
• Johnston C, Rivara FP, Soderberg R. Children in machine crashes: analysis of information for injury and employ of restraints. Pediatr. 1994;936:960. [PubMed] [Google Scholar]
• Johnson DL, Falci Southward. The diagnosis and handling of pediatric lumbar spine injuries caused past rear seat lap belts. Neurosurg. 1990;26(3):434–441. [PubMed] [Google Scholar]
• Rex Al, Yang KH. Research in biomechanics of occupant protection. J Trauma. 1995;3(84):v–70. [PubMed] [Google Scholar]
• Kraft M, Nygren C, Tingvall C. Rear seat occupant protection. A study of children and adults in the rear seats of cars in relation to restraint utilize and char characteristics. J Traffic Med. 1990;xviii(ii):51–53. [Google Scholar]
• Kulowski K, Rost WB. Intra-abdominal injury from prophylactic belt in auto accidents. Arch Surg. 1956;73:970–971. [PubMed] [Google Scholar]
• Lane JC. The seat belt syndrome in children. Accid Anal & Prev. 1994;26(half dozen):813–820. [PubMed] [Google Scholar]
• Lynch JM, Meza MP, Pollack IF, et al. Straight injury to the cervical spine of a child by a lap/shoulder belt resulting in quadriplegia: Example study. J Trauma. 1996;414:747. [PubMed] [Google Scholar]
• Martinez R, Sharieff G, Hooper J. Three-point restraints as a risk factor for chest injury in the elderly. J Trauma. 1994;376:980. [PubMed] [Google Scholar]
• Morris JB. Protection of v–12 twelvemonth old children. SAE Paper 831654. SAE Child injury and restraint briefing Proceedings, P-135; 1983. pp. 89–100. [Google Scholar]
• National Highway Traffic Prophylactic Administration. Traffic Safety Facts 1996. Washington, DC: U.S. Department of Transportation; 1996. [Google Scholar]
• Newman KD, Bowman LM, Eichelberger MR, Gotschall CS, Taylor GA, Johnson DL, Thomas Chiliad. The lap belt complex: Intestinal and lumbar spine injury in children. J Trauma. 1990;30(9):1133–1140. [PubMed] [Google Scholar]
• Niemcryk SJ, Kaufmann CR, Brawley Grand, Yount SI. Motor vehicle crashes, restraint utilise, and severity of injury in children in Nevada. Am J Prev Med. 1997;13(2):109–113. [PubMed] [Google Scholar]
• Partyka S. Lives saved past kid restraints from 1982 through 1987. Washington, DC: NHTSA, Department of Transportation; 1988. Technical report HS 807 371. [Google Scholar]
• Reid AB, Letts RM, Black GB. Pediatric Chance fractures: Association with intra-abdominal injuries and seatbelt use. J Trauma. xxx(four):384–391. [PubMed] [Google Scholar]
• Shoemaker BL, Ose 1000. Pediatric lap belt injuries: Care and prevention. Ortho Nursing. 1997;16(5):15–24. [PubMed] [Google Scholar]
• Sivit CJ, Taylor GA, Newman DK, Bulas DI, Gotschall CS, Wright CJ, Eichelberger MR. Safety-chugalug injuries in children with lap-belt ecchymosis: CT findings in 61 patients. Am J Roent. 1991;157:111–114. [PubMed] [Google Scholar]
• Smith Physician, Camp E, James H, et al. Pediatric seat belt injuries. Amer Surg. 1997;633:294. [PubMed] [Google Scholar]
• Stylianos S, Harris BH. Seatbelt utilise and patterns of central nervous organisation injury in children. Ped Emerg Intendance. 1990;61:4. [PubMed] [Google Scholar]
• Tso EL, Beaver BL, Haller JA., Jr Abdominal injuries in restrained pediatric passengers. J Pediatr Surg. 1993;287:915. [PubMed] [Google Scholar]
• Voss L, Cole PA, D'Amato C. Pediatric Chance fractures from lap belts: Unique example written report of three in one accident. J Ortho Trauma. 1996;10(6):421–428. [PubMed] [Google Scholar]
• Williams North, Rose GK, Goodman AM. Lap-style seat belt associated with loftier cervical cord injury in a child. Injury. 1993;24(iii):209–210. [PubMed] [Google Scholar]
• Williams RD, Sargent FT. The mechanism of intestinal injury in trauma. J Trauma. 1963;iii:288–294. [PubMed] [Google Scholar]

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400190/

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