Influence of age-related stature on the frequency of body region injury and overall injury severity in child pedestrian casualties

OBJECTIVE: The current study aims to evaluate the influence of age-related stature on the frequency of body region injury and overall injury severity in children involved in pedestrian versus motor vehicle collisions (PMVCs). METHODS: A trauma registry including the coded injuries sustained by 1,590 1- to 15-year-old pedestrian casualties treated at a level-one trauma center was categorized by stature-related age (1-3, 4-6, 7-9, 10-12, and 13-15 years) and body region (head and face, neck, thorax, abdomen and pelvic content, thoracic and lumbar spine, upper extremities, pelvis, and lower extremities). The lower extremity category was further divided into three sub-structures (thigh, leg, and knee). For each age group and body region/sub-structure the proportion of casualties with at least one injury was then determined at given Abbreviated Injury Scale (AIS) severity levels. In addition, the average and distribution of the Maximum Abbreviated Injury Score (MAIS) and the average Injury Severity Score (ISS) were determined for each age group. The calculated proportions, averages, and distributions were then compared between age groups using appropriate significance tests. RESULTS: The overall outcome showed relatively minor variation between age groups, with the average +/- SD MAIS and ISS ranging from 2.3 +/- 0.9 to 2.5 +/- 1.0 and 8.2 +/- 7.2 to 9.4 +/- 8.9, respectively. The subjects in the 1- to 3-year-old age group were more likely to sustain injury to the head, face, and torso regions than the older subjects. The frequency of AIS 2+ lower extremity injury was approximately 20% in the 1- to 3-year-old group, but was twice as high in the 4- to 12-years age range and 2.5 times as high in the oldest age group. The frequency of femur fracture increased from 10% in the youngest group to 26% in the 4- to 6-year-old group and then declined to 14% in the 10- to 15-years age range. The frequency of tibia/fibula fracture increased monotonically with group age from 8% in the 1- to 3-year-old group to 31% in the 13- to 15-year-old group. CONCLUSIONS: While the overall outcome of child pedestrian casualties appears to be relatively constant across the pediatric stature range considered ( approximately 74-170 cm), subject height seems to affect the frequency of injury to individual body regions, including the thorax and lower extremities. This suggests that vehicle safety designers need not only account for the difference in injury patterns between adult and pediatric pedestrian casualties, but also for the variation within the pediatric group.