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. 2022 Dec;88(12):2913-2922.
doi: 10.1177/00031348211011106. Epub 2021 Apr 18.

The Effects of Body Mass Index and Seatbelt Use on Pediatric Chest and Abdominal Injuries after Motor Vehicle Collisions

Brad Boserup  1 , Mason Sutherland  1 , Rinald Paloka  1 , Mark McKenney  1   2 , Adel Elkbuli  1
Affiliations

The Effects of Body Mass Index and Seatbelt Use on Pediatric Chest and Abdominal Injuries after Motor Vehicle Collisions

Brad Boserup et al. Am Surg. 2022 Dec.

Expression of concern in

  • Expression of Concern.
    [No authors listed] [No authors listed] Am Surg. 2025 Mar;91(3):464-472. doi: 10.1177/00031348241305412. Epub 2025 Jan 10. Am Surg. 2025. PMID: 39791244 Free PMC article. No abstract available.

Abstract

Background: Motor vehicle collisions (MVCs) are a major cause of pediatric morbidity and mortality. However, the effect of body mass index (BMI) and seatbelt use on thoracic injuries and outcomes in pediatric patients with rib fractures remains unexplored. We aim to assess how seatbelt use and BMI affect thoracic injuries and outcomes in pediatric patients who sustained ≥3 rib fractures following an MVC.

Methods: The Trauma Quality Improvement Program (TQIP) database (2013-2017) was queried for pediatric patients (8-17 years and >4 feet 9 inches tall) admitted secondary to MVCs, with ≥3 rib fractures and all non-thoracic Abbreviated Injury Scale ≤2. Patients were then divided by Injury Severity Score (ISS) into low (<15) and intermediate-severe (≥15) groups, which were further subdivided according to seatbelt use and BMI. Logistic and linear regression was performed to assess the effects of seatbelt use and BMI on outcomes.

Results: Seatbelt compliance varied from 39.6 to 50.7%. Belted patients (intermediate-severe ISS) had a reduced hospital length of stay (HLOS), intensive care unit length of stay(ICU-LOS), and mechanical ventilation time but had increased odds of splenic laceration vs. unbelted patients (aOR = 2.46, 95% CI: 1.03-5.93, P = .044). Obese patients (low ISS) had lower incidences of hemothorax, pneumothorax, pulmonary contusion, splenic laceration, and liver injury compared to normal-weight patients. Overweight patients (intermediate-severe ISS) had a significantly reduced ICU-LOS vs. normal-weight patients (β = -.17, 95% CI: -.33,-.01, = .041).

Conclusions: Seatbelt use may improve outcomes for pediatric MVC patients with ≥3 rib fractures. Higher BMI may be associated with reduced thoracic injury and decreased ICU-LOS. Effective educational initiatives are needed to increase pediatric seatbelt compliance.

Keywords: body mass index; pediatric trauma; rib fractures; seatbelt use; trauma outcomes.

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