Scheidler M G, Shultz B L, Schall L, Ford H R
Department of Surgery, University of Pittsburgh, Pennsylvania, USA.
J Trauma. 2000 Nov;49(5):864-8. doi: 10.1097/00005373-200011000-00012.
Mortality after ejection from a motor vehicle crash (MVC) has been studied extensively in adults. The magnitude of this problem in children is relatively unknown. We retrospectively examined fatalities resulting from ejection after MVC in the state of Pennsylvania to define risk factors and predictors of mortality in children.
The records for all patients 0 to 16 years of age involved in an MVC and entered in the Pennsylvania Trauma Outcome Study between 1993 and 1997 were reviewed. We examined mortality, length of hospitalization, major injuries sustained, and impact of safety restraint devices. Significant differences were determined using chi2 test.
There were 2,298 children involved in MVCs during this period; 189 were ejected. A total of 77% of the ejected passengers were greater than 10 years of age, 16% were 0 to 4 years of age, and 7% were 5 to 9 years of age. Overall, 88% of the ejected occupants were unrestrained. Ejection nearly tripled the overall mortality rate and significantly increased the Injury Severity Score for each age group. Infants and children 0 to 4 years of age had the highest fatality rate despite having a lower Injury Severity Score than all other age groups. Head injuries accounted for the majority of deaths in all age groups. Children older than 10 years of age had a higher incidence of associated chest, abdominal, and pelvic injuries.
Our data show that most children ejected from MVCs were either unrestrained or improperly restrained. Head injuries were the most common cause of death in all age groups. Greater public awareness through educational programs targeting parents and children at risk may reduce this serious problem.
机动车碰撞事故（MVC）中成年人被抛出车外后的死亡率已得到广泛研究。儿童中这一问题的严重程度相对未知。我们回顾性研究了宾夕法尼亚州机动车碰撞事故中被抛出车外导致的死亡情况，以确定儿童死亡的风险因素和预测指标。
回顾了1993年至1997年间参与机动车碰撞事故并录入宾夕法尼亚创伤结局研究的所有0至16岁患者的记录。我们研究了死亡率、住院时间、遭受的主要损伤以及安全约束装置的影响。使用卡方检验确定显著差异。
在此期间，有2298名儿童参与机动车碰撞事故；189人被抛出车外。被抛出车外的乘客中，77%年龄大于10岁，16%年龄在0至4岁，7%年龄在5至9岁。总体而言，88%被抛出车外的乘客未系安全带。被抛出车外使总体死亡率几乎增加两倍，并显著提高了各年龄组的损伤严重度评分。0至4岁的婴幼儿和儿童尽管损伤严重度评分低于所有其他年龄组，但死亡率最高。所有年龄组中，头部损伤占死亡原因的大多数。10岁以上儿童胸部、腹部和骨盆联合损伤的发生率更高。
我们的数据表明，大多数从机动车碰撞事故中被抛出车外的儿童要么未系安全带，要么安全带使用不当。头部损伤是所有年龄组最常见的死亡原因。通过针对父母和高危儿童的教育项目提高公众意识，可能会减少这一严重问题。
