Concurrent paediatric seat belt injuries of the abdomen and spine

Between 1981 and 1989, 541 children were admitted with abdominal injuries sustained as passengers in motor vehicle accidents. Twenty-nine of them had seat belt injuries of the abdomen. From 1981 to 1984, 1 child was admitted each year with such injuries and 21% of the abdominal injuries were due to seat belts. The number of cases had increased to 8 in 1989 and 78% of abdominal injuries were due to seat belts. These changes coincided with increased compliance with seat belt legislation in the State of Victoria. Restraint of children under 8 years of age in the front seat was legislated in 1976 and in the rear seat in 1981. In 1985, drivers were also held responsible for the restraint of children 8-17 years of age. Most of the children with seat belt injuries of the abdomen used lap belts or poorly fitting lap/sash belts. Twenty of the children had other non-abdominal injuries including 11 head, 7 thoracic, and 12 limb injuries. Eight children had spinal injuries including 7 Chance flexion-distraction fractures of the spine and 1 spinal cord injury without radiological abnormality. Chance fractures were only detected in one-half of the children on admission and in only 1 of the 9 children who had a laparotomy. Seventy-five per cent of children with spinal injuries had a laparotomy; 67% of those with abdominal injuries had spinal injuries, while only 7% of those not undergoing laparotomy had spinal injuries. These findings indicate that all children with seat belt injuries of the abdomen need careful clinical and radiographic assessment of the thoracolumbar spine. Prevention of seat belt injuries of the abdomen and spine requires legislation that ensures that all children use effective restraints that are appropriate for their age, size, and position within the vehicle.