Protection of children restrained in child safety seats in side impact crashes

J Trauma. 2010 Oct;69(4):913-23. doi: 10.1097/TA.0b013e3181e883f9.


Background: The performance of child restraint systems (CRS) in side impact motor vehicle crashes has been under study due to the injury and fatality burden of these events. Although previous research has quantified injury risk or described injured body regions, safety advances require an understanding of injury causation. Therefore, the objective was to delineate injury causation scenarios for CRS-restrained children in side impacts and document probable contact points in the vehicle interior.

Methods: Two in-depth crash investigation databases, the Crash Injury Research and Engineering Network and the Partners for Child Passenger Safety Study, were queried for rear-seated, CRS-restrained children in side impact crashes who sustained Abbreviated Injury Scale 2+ injury. These cases were reviewed by a multidisciplinary team of physicians and engineers to describe injury patterns, injury causation, and vehicle components that contributed to the injuries.

Results: Forty-one occupants (average age, 2.6 years) met the inclusion criteria. Twenty-four were near side to the crash, 7 were far side, and 10 were center seated. The most common injuries were to the skull and brain with an increasing proportion of skull fracture as age increased. Head and spine injuries without evidence of head contact were rare but present. All thoracic injuries were lung contusions and no rib fractures occurred. Near-side head and face contacts points were along the rear vertical plane of the window and the horizontal plane of the window sill. Head and face contact points for center- and far-side occupants were along the edges of the front seat back and front seat head restraint.

Conclusions: Head injuries are the target for injury prevention for children in CRS in side impact crashes. Most of these injuries are due to the contact; for near-side occupants, contact with the CRS structure and the door interior, for far- or center-seated occupants, contact with the front seat back. These data are useful in developing both educational and technological interventions to reduce the burden of injury to these children.

MeSH terms

  • Abbreviated Injury Scale
  • Accidents, Traffic*
  • Age Factors
  • Biomechanical Phenomena
  • Causality
  • Child
  • Child Restraint Systems / standards*
  • Child, Preschool
  • Databases, Factual
  • Facial Injuries / epidemiology
  • Facial Injuries / physiopathology
  • Facial Injuries / prevention & control
  • Female
  • Head Injuries, Closed / epidemiology
  • Head Injuries, Closed / physiopathology
  • Head Injuries, Closed / prevention & control
  • Humans
  • Infant
  • Male
  • Quality Indicators, Health Care
  • Safety*
  • Skull Fractures / epidemiology
  • Skull Fractures / physiopathology
  • Skull Fractures / prevention & control
  • Wounds and Injuries / epidemiology
  • Wounds and Injuries / physiopathology
  • Wounds and Injuries / prevention & control*