BACKGROUND: Motor vehicle crashes accounted for more than 190,000 injuries to children under 15 years of age in 2006 and were one of the leading causes of injury-related hospital admissions in children. Moreover, motor vehicle crashes accounted for 23% of all pediatric facial fractures and are an ongoing source of pediatric emergency room visits and maxillofacial and plastic surgery referrals. The authors utilize a national, representative database to evaluate factors that contribute to crash-related facial fractures in children.
METHODS:The data analyzed for this study was collected as part of Partners for Child Passenger Safety (PCPS), an on-going child-focused crash surveillance system created by the Children's Hospital of Philadelphia (CHOP) and State Farm® Insurance Companies (Bloomington, IL) in which children under age 16 involved in crashes were enrolled. Insurance claims data from 15 states and the District of Columbia were linked to telephone survey and crash investigation data, and incidence and facial fracture characteristics were estimated. Data was analyzed to identify crash-related characteristics and mechanisms of these injuries.
RESULTS: Between 12/1/98 and 11/30/07, the PCPS database included 526,651 children 15 years or younger involved in crashes. During this period, 406 children sustained 453 facial fractures for a facial fracture rate of 0.08 percent. Of the 453 facial fractures, 53.6 percent were nasal fractures, 13.9 percent orbital fractures, 11.3 percent mandibular fractures, 8.3 percent zygomatico-maxillary fractures and the remaining percentage classified as other. Facial fractures in children of all age groups were highly correlated with the degree of crash severity. A severe crash increased the odds of facial fractures by greater than 40 fold over non-severe crashes (odds ratio, 44.59; 95% confidence interval, 21.28 to 93.46) and an intermediate severity crash increased odds by greater than 17 fold (odds ratio, 17.45; 95% confidence interval 8.42 to 36.19). Facial fractures were also associated with lack of restraint use (odds ratio, 4.02; 95% confidence interval, 2.77 to 5.84) and, in children 4-8 years old, front row seating (odds ratio, 2.24; 95% confidence interval 1.27 to 3.93). In addition, younger passenger age (4-8 and 9-12 years) and younger driver age increased the likelihood of pediatric facial fractures.
CONCLUSIONS:Crash-related facial fractures are a significant cause of pediatric morbidity and pose unique challenges to the reconstructive surgeon. This analysis provides the first generalizable data on the epidemiology of pediatric facial fractures associated with motor vehicle crashes and illustrates the relationship between age, seating position and restraint status on facial fractures in children.