Howard Andrew, Rothman Linda, McKeag Alexandra Moses, Pazmino-Canizares Janneth, Monk Brian, Comeau Jean Louis, Mills Dan, Blazeski Steve, Hale Ian, German Alan
Hospital for Sick Children, Toronto, Canada.
J Trauma. 2004 Jun;56(6):1276-85. doi: 10.1097/01.ta.0000078883.74947.eb.
This study aimed to describe the injury mechanisms of children involved in side-impact car crashes, particularly as these relate to seating position, and to estimate the danger of the near-side seating position.
A prospective two-center study of children involved in severe car crashes in Canada was conducted as well as a retrospective cohort study of children involved in crashes reported in the Fatality Analysis Reporting System (FARS) and the National Automotive Sampling System: Crashworthiness Data System (NASS CDS).
Children sitting at the side the car was struck (near-side position) sustained severe head, trunk, and limb injuries. Many of these injuries were attributable to direct intrusion, but some occurred without direct damage to the occupant compartment. Center-seat and far-side occupants had severe injuries only when unrestrained. Injury severity scores were higher for children seated on the near side, and this was statistically significant (p = 0.024) The analysis of Fatality Analysis Reporting System data showed that the risk of fatality was higher for children seated in the near-side position than for those in the center-seat position. The fatality risk ratio was 2.53 (95% confidence interval [CI], 2.08-3.07) for restrained children and 1.84 (95% CI, 1.57-2.17) for unrestrained children. Analysis of the NASS-CDS data showed that for restrained children, severe injury (ISS > or = 16) was more common among those on the near side (7 per 1,000 children) than among those in the center seat (2 per 1,000) or on the far-side seat (1 per 1,000) (p < 0.001).
Severe injuries to near-side occupants occurred in both the presence and absence of compartment intrusion. A typical pattern of head, chest, and extremity injury similar to that seen among child pedestrians was observed among near-side child occupants in side-impact crashes. The center seat was statistically safer than the near-side seat, particularly for restrained child occupants. Scene information may be useful to trauma teams for the prediction of injury type and location. Avoiding intrusion and preventing the occupant from striking the vehicle wall are both important to side-impact protection for children. Improvement of the vehicle safety cage may protect against intrusion injuries. Seating two child occupants in inboard seating positions may provide additional protection against intrusion injuries, and also may protect against nonintrusion injuries.
本研究旨在描述儿童在侧面碰撞汽车事故中的受伤机制，特别是与座位位置相关的机制，并评估近侧座位位置的危险性。
对加拿大严重汽车事故中的儿童进行了一项前瞻性双中心研究，并对死亡分析报告系统（FARS）和国家汽车抽样系统：碰撞worthiness数据系统（NASS CDS）中报告的事故中的儿童进行了回顾性队列研究。
坐在汽车被撞击一侧（近侧位置）的儿童遭受了严重的头部、躯干和肢体损伤。其中许多损伤可归因于直接侵入，但有些损伤发生时乘员舱没有直接损坏。中间座位和远侧座位的乘员只有在未系安全带时才会受到重伤。坐在近侧的儿童损伤严重程度评分更高，且具有统计学意义（p = 0.024）。对死亡分析报告系统数据的分析表明，坐在近侧位置的儿童比坐在中间座位的儿童死亡风险更高。对于系安全带的儿童，死亡风险比为2.53（95%置信区间[CI]，2.08 - 3.07），对于未系安全带的儿童，死亡风险比为1.84（95%CI，1.57 - 2.17）。对NASS - CDS数据的分析表明，对于系安全带的儿童，重伤（损伤严重度评分[ISS]≥16）在近侧座位儿童中（每1000名儿童中有7例）比在中间座位儿童中（每1000名中有2例）或远侧座位儿童中（每1000名中有1例）更常见（p <0.001）。
无论乘员舱是否侵入，近侧座位的乘员都会受到严重伤害。在侧面碰撞事故中近侧座位的儿童乘员中观察到一种典型的头部、胸部和四肢损伤模式，类似于儿童行人中所见的模式。从统计学角度看，中间座位比近侧座位更安全，特别是对于系安全带的儿童乘员。现场信息可能对创伤团队预测损伤类型和位置有用。避免侵入并防止乘员撞击车辆壁对儿童侧面碰撞保护都很重要。改进车辆安全笼可能预防侵入性损伤。将两名儿童乘员安排在内侧座位位置可能提供额外的预防侵入性损伤的保护，也可能预防非侵入性损伤。
