Two-thirds of all pediatric vertebral fractures, especially in adolescents, occur in motor vehicle accidents (MVAs) that do not use seat belts, reports a study in Spine. The magazine is published by Wolters Kluwer in the Lippincott portfolio.
“More than 60 percent of spinal fractures in children occur in children 15 to 17 years of age, which coincides with the onset of legal driving,” said the new study by Dr. Vishal Sarwahi, MD, of Cohen Children’s Medical Center, New Hyde Park, NY, and colleagues. They emphasize the need for measures to increase seat belt use, especially by younger drivers, and outline the potential trauma that can be avoided through proper seat belt use.
Seat belts save lives … and spines
Motor vehicle accidents are the leading cause of death among teenagers in the United States. Many previous studies have reported an increasing rate of pediatric spinal cord injuries, especially in teens 15 years and older. This new study confirms that MVAs actually cause the most vertebral fractures in children and adolescents, with a high percentage of other injuries. Spinal fractures in young patients are also associated with a three percent mortality rate, with many deaths among uninhibited drivers and passengers.
Using the National Trauma Data Bank at the American College of Surgeons, Dr. Sarwahi and colleagues 34,563 pediatric patients (less than 18 years old) who developed vertebral fractures between 2009 and 2014. Many of the patients had multiple vertebral fractures, with a total of 45,430 fractured vertebrae.
Overall, teens between the ages of 15 and 17 were responsible for about 63 percent of vertebral fractures, two-thirds of which occurred in MVAs. These findings show that around the time teens get their driver’s license, drivers and passengers are most at risk for MVA, resulting in vertebral fractures.
Fifty-eight percent of the injured patients were male. Pediatric vertebral fractures were most common in the South: 38 percent, probably due to a lack of public transport and therefore more vehicles on the road.
The study also shows the impact of seat belt use on these devastating injuries.
Nearly two-thirds of the pediatric vertebral fractures experienced in MVAs occurred in children who were not wearing a seat belt. “
Dr. Vishal Sarwahi, MD, of Cohen Children’s Medical Center, New Hyde Park, NY and co-authors
Without seat belts, the risks of serious or multiple injury and death have increased significantly, with a significantly increased death rate from 29.3 percent to 70.7 percent – more than doubled.
Data on seat belt use was available for nearly 19,000 patients, of which about two-thirds of the patients (65.9 percent) were uninhibited. Nearly half (44.2 percent) of the uninhibited patients in MVAs were teenagers. Despite a higher percentage of MVAs generally occurring in the South, the percentage of vertebral fractures of MVAs for uninhibited drivers and passengers was similar in all regions of the United States; about two-thirds of all teens in all regions – Northeast, Midwest, West, South – who were involved in MVAs were not wearing a seat belt. This demonstrates the universality of teenage risk behavior and identifies risk groups for risk modification strategies.
When seat belts were worn, the number of vertebral fractures was significantly lower for all drivers and passengers. Using seat belts reduced the risk of death by more than 20 percent. In young patients in MVAs, seat belt wear has also been associated with a lower rate of multiple vertebral fractures, other types of fractures in addition to vertebral fractures, and head and brain injuries.
While the percentage of drivers with seat belts has steadily increased over the years, adolescents and young adults remain less likely to use these life-saving devices. Dr. Sarwahi and his colleagues discuss targeted approaches using technology and media awareness campaigns to increase seat belt use among young people, as well as studies demonstrating the importance of societal and cultural norms related to seat belts. The researchers conclude, “By ensuring that our new young drivers wear protective devices, the morbidity / mortality associated with MVA can be significantly reduced and lives and spines can be saved.”
Sarwahi, V., et al. (2021) Seat belts save lives and spine in motor vehicle accidents. An overview of the National Trauma Data Bank in the pediatric population. Vertebral column. doi.org/10.1097/BRS.0000000000004072.