Factors Affecting Death and Severe Injury in Child Motor Vehicle Passengers

Ishii, Wataru; Hitosugi, Masahito; Baba, Mineko; Kandori, Kenji; Arai, Yusuke · 2021 · Crossref

DOI: 10.3390/healthcare9111431

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Summary

This study investigates the factors influencing death and severe injury in child motor vehicle passengers (under 15 years old) in Japan, aiming to establish effective preventive measures. The research was motivated by the increasing rate of injuries among child vehicle passengers despite overall improvements in traffic safety and a declining birth rate, which makes saving each child a critical national priority. While previous studies relied on police or crash databases, this research uniquely utilized nationwide medical data to identify clinical predictors of poor outcomes. The researchers conducted a retrospective observational study using data from the Japanese Trauma Data Bank (JTDB), a national registry covering approximately 75% of critical care centers in Japan. The study analyzed records of 1,084 child passengers involved in motor vehicle collisions between 2004 and 2019. Patients were categorized into fatal and non-fatal groups, as well as those with and without severe injuries (defined by an Abbreviated Injury Scale score ≥3). The analysis included physiological variables (vital signs, Glasgow Coma Scale scores), injury severity metrics, and treatment outcomes. Multivariate logistic regression analyses were performed to determine independent predictors of fatality and severe injury. The results indicated that 3.2% of the cohort died, while 60.1% sustained severe injuries. Multivariate analysis identified three independent predictors of a non-fatal outcome: higher Glasgow Coma Scale (GCS) scores (odds ratio [OR]: 1.964), higher body temperature (OR: 2.578), and lower Abbreviated Injury Scale scores for head injuries (OR: 0.287). Conversely, predictors for sustaining severe injuries included higher systolic blood pressure (OR: 1.012), lower GCS scores (OR: 0.705), and positive Focused Assessment with Sonography for Trauma (FAST) results (OR: 3.236). The fatal group exhibited significantly lower vital signs and higher injury severity scores in the head, chest, and spine compared to survivors. The study concludes that decreasing the severity of head injuries is the highest priority for preventing both fatality and severe injury in child motor vehicle passengers. The findings highlight that physiological stability, particularly regarding consciousness and body temperature, alongside the mitigation of head trauma, are critical determinants of survival. These insights provide evidence-based targets for pre-hospital care and trauma management protocols, emphasizing the need for interventions that specifically address head injury prevention and early physiological stabilization in pediatric traffic accident victims.

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• demographic disparities

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• Empirical Findings: crash risk outcomes