Seatbelts Save Lives, and Spines, in Motor Vehicle Accidents: A Review of the National Trauma Data Bank in the Pediatric Population.

STUDY DESIGN Database Study. OBJECTIVE The purpose of this study was to use a large, nationwide database to determine prevalence of pediatric spine fractures in the US, associated injuries, mechanisms of injury, use of safety devices and mortality rates. SUMMARY OF BACKGROUND DATA Spinal fractures account for 1- 2% of pediatric injuries. However, they are associated with significant co-morbidities and complications. Motor vehicle accidents (MVA) are most responsible for increased incidence observed. METHODS Retrospective review of NTDB between 2009-2014 (analysis in 2019), for all vertebral fractures in patients under 18 years of age. Sub-analysis included those in MVAs where protective device use data was available. Patient demographics, mechanism (MOI), geographical and anatomical region of injury, concomitant musculoskeletal/organ injury, protective device usage, hospital length of stay, surgical procedures and mortality were all analyzed. RESULTS 34,563 patients with 45,430 fractured vertebrae included. Median age was 15 years. Most fractures (63.1%) occurred in patients aged 15-17, most frequent MOI was MVA (66.8%), most common geographic location was the South (38%). Males sustained more spine fractures than females, overall (58.4%vs41.6%;p < 0.001) and in MVAs (54.4%vs45.6%;p < 0.001). Those in MVAs wearing seatbelts had lower odds of cranial (29.6%vs70.4%;OR = 0.85,95%CI:0.82-0.89;p < 0.001) and thoracic (30.1%vs69.9%;OR = 0.88,95%CI:0.84-0.91;p < 0.001) organ injury, multi-vertebral (30%vs70%;OR = 0.78,95%CI:0.73-0.83;p < 0.001) and concomitant non-vertebral fractures (30.9%vs69.1%;OR = 0.89,95%CI:0.73-0.83;p < 0.001), and 21% lower odds of mortality (29.3%vs70.7%;OR = 0.79,95%CI:0.66-0.94;p = 0.009). Over 70% of drivers were not restrained during MVA, with majority of seatbelt violations incurred by males, ages 15-17, in the South. CONCLUSION Over 60% of pediatric spinal fractures occur in children ages 15-17, coinciding with the beginning of legal driving. MVA is most common cause and has significant association with morbidity/mortality. Nearly 2/3 pediatric spinal fractures sustained in MVAs occurred without seatbelts. Absence of seatbelts associated with more than 20% greater odds of mortality. Ensuring new drivers wear protective devices can greatly reduce morbidity/ mortality associated with MVA.Level of Evidence: 3.