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Three Part Question

In [children involved in motor vehicle collisions] is [airbag deployment] associated with [cervical spine injuries]?

Clinical Scenario

A 5-year-old child with presented to the emergency department following an motor vehicle collision. He was a restrained passenger of a vehicle going approximately 30 mph when the collision occurred. Air bags deployed at the time of impact. His workup in the emergency department was significant for atlantooccipital dissociation and the patient was eventually pronounced dead on arrival. During your review of the case, you wonder whether airbag deployment contributed to his cervical spine injury.

Search Strategy

Medline 1966-07/21 using PubMed, Cochrane Library (2021), and Embase
[(exp cervical cord injuries) AND (exp cervical vertebrae injuries) AND (exp neck injuries)] OR (Air Bags). Limit to children and English language.

[Air Bags/adverse effects]. Limit to children and English language

Search Outcome

233 studies were identified; three answered the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Quiñones-Hinojosa A, et al. Sept 2005 USA	263 patients less than 19 years with injuries caused by airbag deployment.	Retrospective cohort study	Mortality	Of the 263 pediatric injuries caused by airbag deployment, 159 were fatal.	Retrospective; voluntary reporting; selective investigated cases; reliance on physician for information; and small sample size.
			Frequency of spinal injuries	Spinal injuries were present in 38%
			Restraint status	Of all children studied, only six (2.3%) were properly restrained.
Marshall KW, et al. Oct 1998 USA	Pediatric patients who sustained fatal or serious injuries due to air bag deployment	Retrospective cohort study	Injury pattern based on patient age and type of restraint.	Cervical spine injuries ranging from nonfatal fractures to frank decapitation were identified in 30 of the 48 recorded cases	Retrospective; small sample size; non-consecutive sample; patients identified through media
Arbogast KB, et al. April 2005 USA	1781 seatbelt restrained children, 3-15 years exposed to air-bag deployment	Retrospective cohort study	Risk of neck injury in children with first generation airbags versus second generation.	0.4% neck injury with first generation airbags versus 0.3% in second generation.	Retrospective; selection bias leading to misclassification; only involved restrained patients; sample number of patients with neck injuries

Comment(s)

Air bags became mandated in US vehicles in 1991 for both driver and passengers as standard protective equipment. However, air bags were intended to an adult occupant, not the pediatric population. Since these regulations were released, air bag traumatic injuries have also increased. Children are not small adults and their differences in anatomy create different patterns of injury from their adult counterparts. Namely, due to their shorter stature and weight, children are vulnerable to head and neck injuries.

Clinical Bottom Line

In children involved in motor vehicle collisions, airbag deployment is associated with cervical spine injuries. Use of appropriate restraints in the back seat, should be prioritized to avoid disastrous cervical spine injuries in the younger population.

References

1. Quiñones-Hinojosa A, Jun P, Manley GT, Knudson MM, Gupta N. Airbag deployment and improperly restrained children: a lethal combination J Trauma 2005 Sep;59(3):729-733
2. Marshall KW, Koch BL, Egelhoff JC. Air bag-related deaths and serious injuries in children: injury patterns and imaging findings Am J Neuroradiol 1998 Oct;19(9):1599-607
3. Arbogast KB, Durbin DR, Kallan MJ, Elliott MR, Winston FK Injury risk to restrained children exposed to deployed first- and second-generation air bags in frontal crashes. Arch Pediatr Adolesc Med 2005 Apr;159(4):342-346