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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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Herren C, Jarvers JS, Jung MK, Blume C, Meinig H, Ruf M, Weiß T, Rüther H, Welk T, Badke A, Gonschorek O, Heyde CE, Kandziora F, Knop C, Kobbe P, Scholz M, Siekmann H, Spiegl U, Strohm P, Strüwind C, Matschke S, Disch AC, Kreinest M. Paediatric spine injuries in the thoracic and lumbar spine-results of the German multicentre CHILDSPINE study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1574-1584. [PMID: 37466720 DOI: 10.1007/s00586-023-07822-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Paediatric thoracolumbar spine injuries are rare, and meaningful epidemiological data are lacking. OBJECTIVES The aim of this study was to provide epidemiological data for paediatric patients with thoracolumbar spinal trauma in Germany with a view to enhancing future decision-making in relation to the diagnostics and treatment of these patients. MATERIALS AND METHODS A retrospective multicentre study includes patients up to 16 years of age who were suffering from thoracolumbar spine injuries who had been treated in six German spine centres between 01/2010 and 12/2016. The clinical database was analysed for patient-specific data, trauma mechanisms, level of injury, and any accompanying injuries. Diagnostic imaging and subsequent treatment were investigated. Patients were divided into three age groups for further evaluation: age group I (0-6 years), age group II (7-9 years) and age group III (10-16 years). RESULTS A total of 153 children with 345 thoracolumbar spine injuries met the inclusion criteria. The mean age at the time of hospitalization due to the injury was 12.9 (± 3.1) years. Boys were likelier to be affected (1:1.3). In all age groups, falls and traffic accidents were the most common causes of thoracolumbar spine injuries. A total of 95 patients (62.1%) were treated conservatively, while 58 (37.9%) of the children underwent surgical treatment. Minimally invasive procedures were the most chosen procedures. Older children and adolescents were likelier to suffer from higher-grade injuries according to the AOSpine classification. The thoracolumbar junction (T11 to L2) was the most affected level along the thoracolumbar spine (n = 90). Neurological deficits were rarely seen in all age groups. Besides extremity injuries (n = 52, 30.2%), head injuries represented the most common accompanying injuries (n = 53, 30.8%). Regarding spinal injuries, most of the patients showed no evidence of complications during their hospital stay (96.7%). CONCLUSIONS The thoracolumbar junction was more frequently affected in older children and adolescents. The majority of thoracolumbar spinal column injuries were treated conservatively. Nevertheless, 37.9% of hospitalized children had to be treated surgically, and there was an acceptable complication rate for the surgeries that were performed.
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Affiliation(s)
- Christian Herren
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Jan-Sven Jarvers
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Matthias K Jung
- BG Klinik Ludwigshafen, Zentrum für Wirbelsäulenchirurgie, Ludwigshafen Am Rhein, Germany
| | - Christian Blume
- Uniklinik RWTH Aachen, Klinik für Neurochirurgie, Aachen, Germany
| | - Holger Meinig
- SRH Klinikum Karlsbad-Langensteinbach, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, Karlsbad, Germany
| | - Michael Ruf
- SRH Klinikum Karlsbad-Langensteinbach, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, Karlsbad, Germany
| | - Thomas Weiß
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Hauke Rüther
- Universitätsmedizin Göttingen, Zentrum für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Göttingen, Germany
| | - Thomas Welk
- SRH Klinikum Karlsbad-Langensteinbach, Abteilung für Radiologie und Neuroradiologie, Karlsbad, Germany
| | - Andreas Badke
- BG Klinik Tübingen, Abteilung für Wirbelsäulenchirurgie, Tübingen, Germany
| | - Oliver Gonschorek
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Christoph E Heyde
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Frank Kandziora
- BG Unfallklinik Frankfurt, Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt Am Main, Germany
| | - Christian Knop
- Klinikum Stuttgart, Klinik für Unfallchirurgie und Orthopädie, Stuttgart, Germany
| | - Philipp Kobbe
- Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Matti Scholz
- BG Unfallklinik Frankfurt, Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Frankfurt Am Main, Germany
| | - Holger Siekmann
- Ameos Klinik Halberstadt, Klinik für Unfall, Hand- und Wiederherstellungschirurgie, Halberstadt, Germany
| | - Ulrich Spiegl
- Universitätsklinikum Leipzig, Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Leipzig, Germany
| | - Peter Strohm
- Klinikum Bamberg, Klinik für Orthopädie und Unfallchirurgie, Bamberg, Germany
| | - Christoph Strüwind
- BG Unfallklinik Murnau, Abteilung Wirbelsäulenchirurgie, Staffelsee, Germany
| | - Stefan Matschke
- ATOS Klinik Heidelberg, Praxis für Wirbelsäulenchirurgie, Heidelberg, Germany
| | - Alexander C Disch
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, UniversitätsWirbelsäulenzentrum (UCSC), UniversitätsCentrum für Orthopädie, Unfall- and Plastische Chirurgie, Dresden, Germany
| | - Michael Kreinest
- BG Klinik Ludwigshafen, Zentrum für Wirbelsäulenchirurgie, Ludwigshafen Am Rhein, Germany
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Haouas MY, Makhchoune M, Faham I, Jihri A, Lakhdar A. Pediatric CHANCE fracture treated by lumbar lacing technique: a case report. Ann Med Surg (Lond) 2023; 85:5629-5633. [PMID: 37915642 PMCID: PMC10617918 DOI: 10.1097/ms9.0000000000000565] [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: 01/06/2023] [Accepted: 03/18/2023] [Indexed: 11/03/2023] Open
Abstract
This paper presents the case of an 7-year-old girl victim of a road accident. The neurological examination revealed a conscious patient without any sensory or motor deficit and she had intense lumbar pain. The lumbar computed tomography scan found a chance fracture at the level of L3. the patient was operated under general anaesthesia with a sublaminar lacing fixation of L2-L3 similar to the lacing of C1C2 in upper cervical trauma. The follow-up was good The control X-ray was satisfied with a complete reduction and restoration of the lumbar lordosis and the patient was discharged from the hospital on the fifth day following the intervention. this article shows that sublaminar lacing can be as effective as pedicle screw fixation, thus preserving bone growth.
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Affiliation(s)
| | - Marouane Makhchoune
- Neurosurgery Department, University Hospital Center IBN ROCHD, Casablanca, Morocco
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Mukhi S, Laffin-Thibodeau M, Beattie T. Innovative technology and established partnerships-a recipe for rapid adaptability under emerging pandemic conditions. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2023; 49:190-196. [PMID: 38410253 PMCID: PMC10896618 DOI: 10.14745/ccdr.v49i05a04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background Aided by a collaborative partnership dating back to 2011, the Canadian Network for Public Health Intelligence (CNPHI) and the Canadian Paediatric Surveillance Program (CPSP) quickly undertook substantial enhancements to the CPSP's data collection instruments on the CNPHI platform to characterize the impacts of the coronavirus disease 2019 (COVID-19) on children and youth in Canada. Faced with an emerging public health threat with impacts yet unknown, the objective of the intervention was to rapidly complete enhancements to existing data collection and analytical tools to enable the CPSP's ability to characterize the impacts of COVID-19 in Canadian children and youth. Intervention Reporting frequency from CPSP's network of paediatric practitioners was increased from monthly to weekly, and the flexibility of detailed case data collection was substantially enhanced using complex survey instruments, interactively designed using CNPHI's Web Data technology. To ensure their data collection proceeded along all required lines of surveillance, CPSP's data collection tools were enhanced to collect demographic, epidemiological, microbiological and clinical data including comorbidities of cases identified. Outcomes Less than a month after the World Health Organization declared the COVID-19 pandemic, CPSP was able to start collecting detailed weekly case data on emerging cases of COVID-19 among Canadian children and youth. By May 2020, CPSP was able to launch a detailed study, supporting research into potential risk factors for severe COVID-19-related illness in children and youth. Conclusion In response to a novel public health threat, CNPHI and CPSP were able to implement rapid adaptations and enhancements to existing data collection instruments while fortifying their preparedness to do the same in the future, when needed. With innovative and agile technologies at the ready, this experience helps to emphasize the importance of established collaborative partnerships across public health disciplines as a factor contributing to preparedness and agility to respond to the unforeseen. Canadian Network for Public Health Intelligence's Web Data technology showed agile adaptability and a capacity for complex and detailed data collection, supporting timely surveillance and response.
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Affiliation(s)
- Shamir Mukhi
- Canadian Network for Public Health Intelligence, National Microbiology Laboratory, Public Health Agency of Canada
| | | | - Tim Beattie
- Canadian Network for Public Health Intelligence, National Microbiology Laboratory, Public Health Agency of Canada
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Alexiades NG, Parisi F, Anderson RCE. Pediatric Spine Trauma: A Brief Review. Neurosurgery 2020; 87:E1-E9. [PMID: 32374883 DOI: 10.1093/neuros/nyaa119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Pediatric spinal trauma is a broad topic with nuances specific to each anatomic region of the spinal column. The purpose of this report is to provide a brief review highlighting the most important and common clinical issues regarding the diagnosis and management of pediatric spine trauma. Detailed descriptions of imaging findings along with specific operative and nonoperative management of each fracture and dislocation type are beyond the scope of this review.
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Affiliation(s)
- Nikita G Alexiades
- Department of Neurological Surgery, Columbia University, New York, New York
| | - Frank Parisi
- Department of Neurological Surgery, Columbia University, New York, New York
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Park MS, Kang SH, Cho YJ, Yang JS. Rapid Healing and Remodeling Process of Pediatric Seat-Belt Fracture without Surgical Treatment. Korean J Neurotrauma 2018; 14:169-172. [PMID: 30402440 PMCID: PMC6218343 DOI: 10.13004/kjnt.2018.14.2.169] [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: 07/12/2018] [Revised: 09/07/2018] [Accepted: 09/27/2018] [Indexed: 11/22/2022] Open
Abstract
Pediatric seat-belt fracture is a rare condition, and its management has not been well defined. The authors report a case of pediatric Chance fracture that was managed conservatively and that demonstrated rapid bone healing. A 7-year-old boy presented with back pain after a motor vehicle accident. Plain lumbar spine radiography, three-dimensional computed tomography (CT), and magnetic resonance imaging revealed a seat-belt fracture type C (classified by Rumball and Jarvis), and the patient's condition was managed conservatively. The patient started to ambulate with a brace 2 weeks after the injury. Spine CT performed 100 days after the injury revealed a remodeled fracture, and dynamic radiography did not show any evidence of instability or kyphotic deformity. We suggest that if there are no neurological deficits or severe deformities, then a pediatric seat-belt fracture should be managed conservatively, because the bone healing process is far more rapid in children than it is in adults and because of possible growth problems after surgery.
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Affiliation(s)
- Mu-Seung Park
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Suk Hyung Kang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong Jun Cho
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Seo Yang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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Smith E, Finn S, Fitzpatrick P. Epidemiology of Pediatric Traumatic and Acquired Nontraumatic Spinal Cord Injury in Ireland. Top Spinal Cord Inj Rehabil 2017; 23:279-284. [PMID: 29339904 DOI: 10.1310/sci16-00029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To examine the epidemiology of pediatric traumatic (TSCI) and acquired nontraumatic spinal cord injury (NTSCI) in Ireland. There are few studies reporting pediatric TSCI incidence and fewer of pediatric NTSCI incidence, although there are several case reports. As there is a single specialist rehabilitation facility for these children, complete population-level data can be obtained. Method: Retrospective review of prospectively gathered data in the Patient Administration System of the National Rehabilitation Hospital of patients age 15 years or younger at the time of SCI onset. Information was retrieved on gender, age, etiology, level of injury/AIS. Population denominator was census results from 1996, 2002, 2006, and 2011, rolled forward. Results: Since 2000, 22 children have sustained TSCI and 26 have sustained NTSCI. Median (IQR) age at TSCI onset was 6.3 (4.4) years, and at NTSCI onset it was 7.3 (8.1) years. Most common TSCI etiology was transportation (n = 10; 45.5%), followed by surgical complications (n = 8; 36.4%); most common injury type was complete paraplegia (n = 12; 54.5%) followed by incomplete paraplegia (n = 5; 22.7%). Most common NTSCI etiology was transverse myelitis (n = 11; 42.3%) followed by vascular (n = 5; 20%); most common injury type was incomplete paraplegia (n = 17; 65.4%) followed by incomplete tetraplegia (n = 6; 24%). Incidence of TSCI ranged from 0 to 3.1 per million per year; incidence of NTSCI ranged from 0 to 6.5 per million per year. Conclusion: Incidence of SCI in Ireland seems similar to or slightly lower than other developed countries. Injury patterns are also similar, considering variations in reporting methods.
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Affiliation(s)
- Eimear Smith
- National Rehabilitation Hospital, Dublin.,Mater Misericordiae University Hospital, Dublin
| | - Susan Finn
- National Rehabilitation Hospital, Dublin.,Our Lady's Children's Hospital Crumlin, Dublin
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9
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Abstract
The seatbelt syndrome represents an injury pattern seen after motor vehicle accidents. It is secondary to either the misplacement of seatbelts over the abdomen or the misuse of the restraint systems. This syndrome is infrequent in the pediatric population and occurs mostly in school-aged children because recommended lap-shoulder belts and booster seats are often not used in this age group, so that the seatbelt lies over the abdomen. Sudden deceleration bends the child around the lap belt causing injuries to the viscera, head, and spine (Chance fracture), often associated with paraplegia. Because not all patients have an abdominal seatbelt sign, this syndrome can easily not be recognized with potentially life-threatening consequences.We report on 3 patients with the seatbelt syndrome and review the literature regarding prevalence, diagnosis, treatment, and prognosis of the different injuries and discuss the diagnostic challenges of intestinal lesions and their management.Following this accident pattern, in hemodynamically stable patients with a normal abdominal computed tomography scan, close surveillance is warranted to rule out intestinal lesions manifesting with progressive peritoneal irritation. In hemodynamically unstable patients, or if there is evidence of free air on the computed tomography scan, emergency abdominal exploration is required.
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The use of an institutional pediatric abdominal trauma protocol improves resource use. J Trauma Acute Care Surg 2016; 80:57-63. [DOI: 10.1097/ta.0000000000000712] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Occupant and Crash Characteristics of Elderly Subjects With Thoracic and Lumbar Spine Injuries After Motor Vehicle Collisions. Spine (Phila Pa 1976) 2016; 41:32-8. [PMID: 26230541 DOI: 10.1097/brs.0000000000001079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of a prospectively gathered database. OBJECTIVE To investigate the incidence and pattern of thoracic and lumbar (T and L) spine injuries among elderly subjects involved in motor vehicle collision (MVC). SUMMARY OF BACKGROUND DATA Adults age 65 and older currently constitute more than 16% of all licensed drivers. Despite driving less than the young, older drivers are involved in a higher proportion of crashes. Notwithstanding the safety features in modern vehicles, 15.8% to 51% of all T and L spine injuries result from MVCs. METHODS Crash Injury Research and Engineering Network database is a prospectively maintained, multicentered database that enrolls MVC occupants with moderate-to-severe injuries. It was queried for T and L spine injuries in subjects 65 and older. 142 Crash Injury Research and Engineering Network files for all elderly individuals were reviewed for demographic, injury, and crash data. Each occupant's T and L injury was categorized using a modified Denis classification. RESULTS Of 661 elderly subjects, 142 (21.48%) sustained T and L spine injuries. Of the 102 major injuries, there were 63 compression, 20 burst and 12 extension fractures. Seatbelt use predisposed elderly subjects to compression and burst fractures, whereas seatbelt and airbag use predisposed to burst fractures. Deployment of airbags without seatbelt use appeared to predispose elderly subjects to neurological injury, higher Injury Severity Score, and higher mortality. Occupants using 3-point belts who had airbags deployed during the collision had the lowest rates of fatality and neurological injury. CONCLUSION T and L spine injuries in the elderly are not uncommon despite restraint use. Whereas seatbelts used alone and in conjunction with airbag deployment reduced fatalities and neurological injuries in the elderly, deployment of airbags in occupants without seatbelts predisposed to more severe injury.
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Singla AA, Singla AA. Seatbelt syndrome with superior mesenteric artery syndrome: leave nothing to chance! J Surg Case Rep 2015; 2015:rjv148. [PMID: 26564612 PMCID: PMC4642231 DOI: 10.1093/jscr/rjv148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The introduction of seatbelts to legislation has dramatically reduced mortality and morbidity from motor vehicle accidents. However, overtime evidence has emerged of ‘seatbelt syndrome’ (SBS), particularly in the paediatric population. The report describes the diagnosis and management of this rare injury in a 12-year-old boy who sustained a chance lumbar fracture and mesenteric tear resulting in small bowel obstruction. His stay was subsequently complicated by superior mesenteric artery (SMA) syndrome. This is the first documented case of SBS with SMA syndrome. High index of suspicion and continuity of care, particularly in the setting of a ‘seatbelt sign’, is paramount to timely diagnosis and management.
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Affiliation(s)
- Animesh A Singla
- University of New South Wales, Kensington 2033, Australia Department of Surgery, Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Apresh A Singla
- University of New South Wales, Kensington 2033, Australia Department of Surgery, Bankstown Hospital, Sydney 2200, Australia
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Nugmanova ZS, Ussatayeva G, McNutt LA. Seatbelt and child-restraint use in Kazakhstan: attitudes and behaviours of medical university students. Inj Prev 2014; 21:e109-12. [PMID: 24966211 DOI: 10.1136/injuryprev-2014-041198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Traffic fatalities in Kazakhstan increased from 15 to more than 30 per 100 000 between 2001 and 2006. Mortality remains high compared with developed nations. Safety-restraint laws have been enacted, but little data exist regarding usage of seatbelts, particularly among children and passengers. This cross-sectional study surveyed medical university students about attitudes and behaviours regarding seatbelt and child safety-restraint usage. Seatbelts are widely used in the front seat (81%) but not in the back seat (79% 'never' or 'rarely' use a seatbelt in the back seat). Fewer than half reported 'always' or 'almost always' providing restraint for children under 7 years and 24% reported children secure the seatbelts themselves. Safety in the back seat merits attention. Adults generally do not buckle in the back seat despite a law requiring seatbelt use. Promotion of child safety restraints should be prioritised in prevention education for physicians and the community.
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Affiliation(s)
| | | | - Louise-Anne McNutt
- Institute for Health and the Environment, University at Albany, State University of New York, Rensselaer, New York, USA
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Knox JB, Wimberly RL, Riccio AI. Pediatric lateral distraction injury of the lumbar spine: a case report. Spine J 2013; 13:e45-8. [PMID: 23773432 DOI: 10.1016/j.spinee.2013.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 02/22/2013] [Accepted: 05/04/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lateral distraction injuries represent a very rare pattern of injury with only five cases reported in the literature. Such injuries are a result of high-energy trauma and have a high association with severe concomitant injuries. All previous reports of this injury are in skeletally mature individuals, and this has not been previously described in young children. PURPOSE To report a case of a lateral distraction injury in a young child secondary to improper seat belt use. STUDY DESIGN Case report and review of the literature. PATIENT SAMPLE Case report of an 8-year-old girl involved in a highway speed head-on collision. METHODS We report here on an 8-year-old girl who was lying supine in the backseat of a motor vehicle while wearing a lap belt when the vehicle was involved in a high-speed motor vehicle crash. She presented with focal back pain, abdominal pain, and a seat belt sign. Imaging demonstrated focal coronal plane deformity with unilateral ligamentous disruption. The patient was diagnosed with a ligamentous lateral distraction injury of the lumbar spine. This injury was treated with open reduction and posterior spinal fusion with pedicle screw fixation. RESULTS The patient tolerated the procedure well and had an uneventful postoperative course. CONCLUSIONS In this case, we describe a lateral distraction injury in a young child secondary to improper seat belt use. This represents the first description of such an injury in this age group, and this case highlights the spectrum of injury caused by improper seat belt use in the pediatric population.
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Affiliation(s)
- Jeffrey B Knox
- Department of Orthopaedic Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI 96859, USA.
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Ugnat AM, Grenier D, Thibodeau ML, Davis MA. The Canadian Paediatric Surveillance Program: Celebrating 15 years of successful paediatric surveillance. Paediatr Child Health 2012; 16:203-5. [PMID: 22468119 DOI: 10.1093/pch/16.4.203] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2011] [Indexed: 11/13/2022] Open
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Abstract
Intra-abdominal vascular injury due to blunt trauma is unusual in children. Due to its rarity, detailed reports dealing with its management are scarce in paediatric literature. Diagnosis of these injuries is challenging, and a high degree of awareness is necessary for rapid identification and treatment of these injuries. We report the case of a child with seatbelt sign and mesenteric vein injury due to blunt trauma to the abdomen during a motor vehicle accident where the seatbelt was incorrectly placed. She also sustained cervical vertebral injury. The pattern of injuries in children in these situations may differ from that found in adults. While seatbelts have undoubtedly saved many lives, awareness about correct placement of these restraints is extremely necessary.
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Rémond C, Henaine R, Teyssedre S, Gouton M, Javouhey E. [Cardiac tamponade by right atrial laceration due to blunt chest trauma in a 3-year-old child]. ACTA ACUST UNITED AC 2010; 29:916-9. [PMID: 21112735 DOI: 10.1016/j.annfar.2010.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 08/23/2010] [Indexed: 10/18/2022]
Abstract
The case of 3-year-old girl severely injured, as restrained car passenger in a road crash, is reported. She presented with isolated circulatory failure, without specific clinical signs except skin contusions corresponding to seat belt. Because of mediastinum enlargement on systematic chest X-ray, a pericardial effusion was suspected, which was confirmed by echography, rapidly complicated by an acute tamponade without visible cause on CT-scan. The radiological assessment showed a moderate peritoneal haemorrhage related to a splenic injury. A persistent haemodynamic instability required a pericardial puncture, after rapid sequence tracheal intubation of the child, but without clinical improvement, despite fluid bolus, red-blood cell transfusion and epinephrine infusion. The child was rapidly transferred to the cardiac operating room for sternotomy, which showed a right atrial laceration. The injury was repaired, allowing the child to survive without disability. Tamponade due to traumatic cardiac injury is extremely rare in children. The clinical diagnosis is particularly difficult to establish in the context of polytrauma. The classical symptoms of cardiac tamponade are rarely complete. The association of chest injury, isolated circulatory failure and enlargement of mediastinum at chest X-ray should alert the physician. As the severity of these injuries is high, a rapid and multidisciplinary management is required, as well as specific anaesthetics precautions.
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Affiliation(s)
- C Rémond
- Service d'anesthésie pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France.
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Paris C, Brindamour M, Ouimet A, St-Vil D. Predictive indicators for bowel injury in pediatric patients who present with a positive seat belt sign after motor vehicle collision. J Pediatr Surg 2010; 45:921-4. [PMID: 20438927 DOI: 10.1016/j.jpedsurg.2010.02.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 02/02/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Abdominal wall bruising (AWB) is a frequent finding in children wearing seat belts involved in motor vehicle collision (MVC) and is highly suspicious but not indicative of intestinal injury. The aim of this study was to find objective clinical and radiologic predictors for the need of an abdominal exploration in these children. MATERIALS AND METHODS A retrospective chart review of children admitted from 1998 and 2008 with AWB after MVC was conducted. Demographics, vital signs, physical examinations, radiologic investigations, associated injuries, management, and outcome were extracted. Univariate and multivariate statistical analyses were done. RESULTS Fifty-three children with a median age of 9 years (range, 3-16 years) were included. Forty-four patients (83%) had abdominal pain on arrival, and 25 (47%) had free intraabdominal fluid on ultrasound/scan. Intraabdominal injuries were noted in 29 patients (55%), and the most common were mesenteric or bowel injuries (25%), splenic injuries (13%), and hepatic injuries (8%). Ten patients (19%) needed therapeutic laparotomy, and all were victims from collision involving 2 moving vehicles, had abdominal pain, free intraabdominal fluid, and tachycardia. Five patients (50%) operated on had lumbar fracture compared to only 4 patients (9%) in the nonoperative group. Pulse rate higher than 120 (P = .048), lumbar fracture (P = .008), and free intraabdominal fluid (P <or= .001) were significant predictors for intestinal perforation. Overall survival was 98% with 1 death because of head trauma. CONCLUSION Intraabdominal injuries in children with AWB after MVC are frequent. Associated lumbar fracture, the presence of free intraabdominal fluid, and pulse rate higher than 120 are significant predictors of intestinal injuries. An abdominal exploration should be considered in these patients.
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Affiliation(s)
- Catherine Paris
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada, H3T 1C5
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Yanchar NL. When treating is not enough: The roles of health care providers in prevention and control of childhood motor vehicle crash injuries. Paediatr Child Health 2008; 13:277-278. [PMID: 19337592 PMCID: PMC2529447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2008] [Indexed: 05/27/2023] Open
Affiliation(s)
- Natalie L Yanchar
- Correspondence: Dr Natalie L Yanchar, Division of Paediatric General Surgery, IWK Health Centre, 5850 University Avenue, Halifax, Nova Scotia B3J 3G9. Telephone 902-470-8114, fax 902-470-7260, e-mail
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