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Giovannini E, Santelli S, Pelletti G, Bonasoni MP, Cornacchia A, Pelotti S, Fais P. Pediatric motor vehicle crashes injuries: A systematic review for forensic evaluation. Int J Legal Med 2024; 138:1329-1341. [PMID: 38337078 PMCID: PMC11164731 DOI: 10.1007/s00414-024-03174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Children involved in car crashes can experience either direct trauma or inertial injuries resulting from interactions with external objects, such as other vehicles, or with the restraint system. Furthermore, improper use of restraint systems can lead to additional severe injuries. Recent reports from international institutions underscored the persistent prevalence of inadequate restraint systems utilization and this widespread issue increases children's vulnerability and risk of injuries.The aim of this study is to provide a systematic review of the literature on injuries sustained in children involved in road accidents describing and analyzing elements useful for forensic assessment.The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about traffic accidents involving pediatric passengers. A total of 69 studies satisfied the inclusion criteria and were categorized and analyzed according to the anatomical regions of the body affected (head, neck, thoraco-abdominal, and limb injuries), and the assessment of lesions in reconstruction of the accident was examined and discussed.The review highlights that in motor vehicle accidents involving children, the forensic evaluation of both the cause of death and accident dynamics needs to consider several factors, such as the child's age, the type of restraint system employed, and the specific passenger seat occupied. Considering the complexity of the factors that can be involved in this road accident, it is crucial that there is a comprehensive exchange of information between the judge and the medical expert.
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Affiliation(s)
- Elena Giovannini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Simone Santelli
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Maria Paola Bonasoni
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy.
| | - Angela Cornacchia
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
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Taniguchi H, Nagasawa H, Yanagawa Y. Fatal Head Injury in a 1-Year-Old Child Secured in a Rear-Facing Child Seat by Offset Car-to-Car Collision. J Craniofac Surg 2024:00001665-990000000-01697. [PMID: 38861318 DOI: 10.1097/scs.0000000000010189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 06/13/2024] Open
Abstract
This case study describes a fatal head injury in a 1-year-old child involved in a motor vehicle accident in Japan. The child, secured in a rear-facing child seat, was a passenger in a car driven by their mother when the offset car-to-car collision occurred. The car rotated counterclockwise before coming to a stop. Despite remaining secured in the child seat, the child suffered severe head trauma, leading to cardiac arrest. Autopsy computed tomography revealed a right open depressed fracture, left head contusion, traumatic subarachnoid hemorrhage, intraventricular hemorrhage, and pneumocephalus. The injury mechanism involved the child's head striking the right headrest, followed by a swing to the left, induced by the initial impact and subsequent rotational movement. This case highlights the importance of age-specific data in understanding pediatric injuries in motor vehicle accidents and improving child seat safety measures.
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Affiliation(s)
- Hiroaki Taniguchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
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Nakao S, Katayama Y, Kitamura T, Hirose T, Tachino J, Ishida K, Ojima M, Kiguchi T, Umemura Y, Kiyohara K, Oda J. Trends and characteristics of severe road traffic injuries in children: a nationwide cohort study in Japan. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02372-z. [PMID: 37847398 DOI: 10.1007/s00068-023-02372-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/12/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE The purpose of this study was to evaluate temporal trends of characteristics of severe road traffic injuries in children and identify factors associated with mortality using a nationwide database in Japan. METHODS We performed a retrospective analysis of Japan Trauma Data Bank (JTDB) from 2004 to 2018. We included patients with traffic injuries under the age of 18 who were hospitalized. The primary outcome was in-hospital mortality. We evaluated trends in characteristics and assessed factors associated with in-hospital mortality using a logistic regression analysis. RESULTS A total of 4706 patients were analyzed. The most common mechanism of injury was bicycle crash (34.4%), followed by pedestrian (28.3%), and motorcycle crash (21.3%). The overall in-hospital mortality was 11.2%. We found decreasing trends in motorcycle crash and in-hospital mortality and increasing trends in rear passenger seats in cars over the 15-year period. The following factors were associated with in-hospital mortality: car crash (aOR 1.69, 95%CI 1.18-2.40), pedestrian (aOR 1.50, 95%CI 1.13-1.99), motorcycle crash (aOR 1.42, 95%CI 1.03-1.95) [bicycle crash as a reference]; concomitant injuries to head/neck (aOR 5.06, 95%CI 3.81-6.79), thorax (aOR 2.34, 95%CI 1.92-2.87), abdomen (aOR 1.74, 95%CI 1.29-2.33), pelvis/lower-extremity (aOR 1.57, 95%CI 1.23-2.00), spine (aOR 3.01, 95%CI 2.02-4.43); and 5-year increase in time period (aOR 0.80, 95%CI 0.70-0.91). CONCLUSIONS We found decreasing trends in motorcycle crash and in-hospital mortality, increasing trends in rear passenger seats in cars over the 15-year period, and factors associated with in-hospital mortality such as type of mechanisms and concomitant injuries. Strengthening child road safety measures, particularly for rear passenger seats in vehicles, is imperative to enhance our dedication to injury prevention.
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Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kenichiro Ishida
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masahiro Ojima
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takeyuki Kiguchi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Ishii W, Hitosugi M, Kandori K, Miyaguni M, Iizuka R. Physiological status and anatomical severity factors associated with child versus adult bicyclist fatalities based on a national trauma dataset. Sci Rep 2022; 12:18354. [PMID: 36319680 PMCID: PMC9626561 DOI: 10.1038/s41598-022-21949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022] Open
Abstract
Bicyclists still account for the majority of child deaths in traffic accidents, despite a gradual decrease in incidence. Therefore, we investigated factors associated with child and adult bicyclist fatalities. In this retrospective study, we used data from a national hospital-based database, the Japan Trauma Data Bank. Data from 2004 to 2019 were obtained for child cyclists (5-18 years; n = 4832) and adult cyclists (26-45 years; n = 3449). In each age group, physiological variables, outcomes, and injury severity were compared between fatal and non-fatal cases. Multivariate logistic regression was performed to determine factors associated with fatality. In adults, fatality was associated with lower values for body temperature, Glasgow Coma Scale score, and Abbreviated Injury Scale (AIS) score for the neck and upper extremities, and with higher values for respiratory rate, heart rate, focused assessment with sonography for trauma positivity rate, and AIS scores for the head, chest, and abdomen. In children, fatality was associated with lower values for body temperature and the Glasgow Coma Scale score, and with higher values for the AIS chest score. These findings point to factors associated with bicyclist fatalities and may help in the development of effective strategies to reduce these fatalities.
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Affiliation(s)
- Wataru Ishii
- Critical Care Center, Emergency Medicine, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026 Japan
| | - Masahito Hitosugi
- grid.410827.80000 0000 9747 6806Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192 Japan
| | - Kenji Kandori
- Critical Care Center, Emergency Medicine, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026 Japan
| | - Michitaro Miyaguni
- Critical Care Center, Emergency Medicine, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026 Japan
| | - Ryoji Iizuka
- Critical Care Center, Emergency Medicine, Kyoto Daini Red Cross Hospital, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026 Japan
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Ishii W, Hitosugi M, Baba M, Kandori K, Arai Y. Factors Affecting Death and Severe Injury in Child Motor Vehicle Passengers. Healthcare (Basel) 2021; 9:healthcare9111431. [PMID: 34828478 PMCID: PMC8624717 DOI: 10.3390/healthcare9111431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Saving children from motor vehicle collisions is a high priority because the injury rate among motor vehicle passengers has been increasing in Japan. This study aimed to examine the factors that influence death and serious injury in child motor vehicle passengers to establish effective preventive measures. To identify these factors, we performed a retrospective study using a nationwide medical database. The data of child motor vehicle passengers younger than 15 years (n = 1084) were obtained from the Japanese Trauma Data Bank, registered from 2004 to 2019. Physiological variables, outcomes, and injury severity were compared between fatal and non-fatal patients and between those with and without severe injuries. Multivariate logistic regression analysis was performed to determine factors affecting fatality and severe injury. The Glasgow Coma Scale score (odds ratio (OR): 1.964), body temperature (OR: 2.578), and the Abbreviated Injury Scale score of the head (OR: 0.287) were identified as independent predictors of a non-fatal outcome. Systolic blood pressure (OR: 1.012), the Glasgow Coma Scale score (OR: 0.705), and Focused Assessment with Sonography for Trauma positivity (OR: 3.236) were identified as independent predictors of having severe injury. Decreasing the severity of head injury is the highest priority for child motor vehicle passengers to prevent fatality and severe injury.
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Affiliation(s)
- Wataru Ishii
- Kyoto Daini Red Cross Hospital, Critical Care Center, Emergency of Medicine, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan; (K.K.); (Y.A.)
- Correspondence: ; Tel.: +81-75-231-5171
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan;
| | - Mineko Baba
- Center for Integrated Medical Research, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Kenji Kandori
- Kyoto Daini Red Cross Hospital, Critical Care Center, Emergency of Medicine, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan; (K.K.); (Y.A.)
| | - Yusuke Arai
- Kyoto Daini Red Cross Hospital, Critical Care Center, Emergency of Medicine, Haruobi, Kamazamarutamachi, Kamigyo, Kyoto 602-8026, Japan; (K.K.); (Y.A.)
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