Lower incidence of blunt cerebrovascular injury among young, properly restrained children: An ATOMAC multicenter study.

BACKGROUND: Motor vehicle collision (MVC) remains a leading cause of injury and death among children, but the proper use of child safety seats and restraints has lowered the risks associated with motor vehicle travel. Blunt cerebrovascular injury (BCVI) is rare but significant among children involved in MVC. This study reviewed the incidence of BCVI after MVC causing blunt injury to the head, face, or neck, comparing those that were properly restrained with those that were not.

METHODS: A prospective, multi-institutional observational study of children less than 15 years old who sustained blunt trauma to the head, face, or neck (AIS > 0) and presented at one of six level I pediatric trauma centers from 2017 to 2020 was conducted. Diagnosis of BCVI was made either by imaging or neurological symptoms at two-week follow up. Restraint status among those involved in MVC was compared for each age group.

RESULTS: A total of 2,284 patients were enrolled at the six trauma centers. Of these, 521 (22.8%) were involved in an MVC. In this cohort, after excluding patients with missing data, 10/371 (2.7%) were diagnosed with a BCVI. For children less than 12 years of age, none that were properly restrained suffered a BCVI (0/75) while 7 of 221 (3.2%) improperly restrained children suffered a BCVI. For children between 12 and 15 years of age, the incidence of BCVI was 2/36 (5.5%) for children in seat belts compared to 1/36 (2.8%) for unrestrained children.

CONCLUSION: In this large multicenter prospectively screened pediatric cohort, the incidence of BCVI among properly restrained children under 12 after MVC was infrequent, while the incidence was 3.2% among those without proper restraint. This effect was not seen among children older than 12 years of age. Restraint status in young children may be an important factor in BCVI screening.

LEVEL OF EVIDENCE: Level IV (prognostic/epidemiological).