Does restraint status in motor vehicle crash with rollover predict the need for trauma team presence on arrival? An ATOMAC study

John Recicar, Amanda Barczyk, Sarah Duzinski, Karla A. Lawson, Nilda M. Garcia, Robert Letton, Alexander R. Raines, James W. Eubanks, Nima Azarakhsh, Sandra Grimes, David M. Notrica, Pamela Garcia-Fillon, Adam Alder, Cynthia Greenwell, Stephen Megison, Mallikarjuna Rettiganti, Chunqiao Luo, Robert Todd Maxson

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Purpose Restraint status has not been combined with mechanistic criteria for trauma team activation. This study aims to assess the relationship between motor vehicle crash rollover (MVC-R) mechanism with and without proper restraint and need for trauma team activation. Methods Patients < 16 years old involved in an MVC-R between November 2007 and November 2012 at 6 Level 1 pediatric trauma centers were included. Restraint status, the need for transfusion or intervention in the emergency department (ED), hospital and intensive care length of stay and mortality were assessed. Results Of 690 cases reviewed, 48% were improperly restrained. Improperly restrained children were more likely to require intubation (OR 10.24; 95% CI 2.42 to 91.69), receive blood in the ED (OR 4.06; 95% CI 1.43 to 14.17) and require intensive care (ICU) (OR; 3.11; 95% CI 1.96 to 4.93) than the properly restrained group. The improperly restrained group had a longer hospital length of stay (p < 0.001), and a higher mortality (3.4% vs. 0.8%; OR 4.09; 95% CI 1.07 to 23.02) than the properly restrained group. Conclusion Unrestrained children in MVC-R had higher injury severity and were significantly more likely to need urgent interventions compared to properly restrained children. This supports a modification to include restraint status with the rollover criterion for trauma team activation.

Original languageEnglish (US)
Pages (from-to)319-322
Number of pages4
JournalJournal of Pediatric Surgery
Issue number2
StatePublished - Feb 1 2016


  • Mechanistic criteria
  • Pediatric trauma
  • Rollover crash

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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