Rib fractures (RF) are noted in 4 to 12 per cent of trauma admissions. To define RF risks at a Level 1 trauma center, investigators conducted a 10-year (1995–2004) retrospective analysis of all trauma patients. Blunt chest trauma was seen in 13 per cent (1,475/11,533) of patients and RF in 808 patients (55% blunt chest trauma, 7% blunt trauma). RF were observed in 26 per cent of children (<18 years), 56 per cent of adults (18–64 years), and 65 per cent of elderly patients (≥65 years). RF were caused by motorcycle crashes (16%, 57/347), motor vehicle crashes (12%, 411/3493), pedestrian-auto collisions (8%, 31/404), and falls (5%, 227/5018). Mortality was 12 per cent (97/808; children 17%, 8/46; adults 9%, 46/522; elderly 18%, 43/240) and was linearly associated with a higher number of RF (5% 1–2 RF, 15% 3–5 RF, 34% ≥6 RF). Elderly patients had the highest mortality in each RF category. Patients with an injury severity score ≥15 had 20 per cent mortality versus 2.7 per cent with ISS <15 ( P < 0.0001). Increasing age and number of RF were inversely related to the percentage of patients discharged home. ISS, age, number of RF, and injury mechanism determine patients’ course and outcome. Patients with associated injuries, extremes of age, and ≥3 RF should be admitted for close observation.

These results identify a void in the documentation of pain assessment and implementation of pain-control interventions for injured pediatric patients. Education for prehospital providers is recommended, emphasizing the importance of pain assessment and documentation of pain-control care for pediatric trauma patients.

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Patients with the seat belt sign (SBS) from motor vehicle crashes (MVCs) are prone to specific regional injury patterns. Investigators at a Level 1 trauma center analyzed the incidence, clinical implications, and spectrum of regional injuries in patients injured in MVC over 2 years. SBS was seen in 11.3 per cent of patients injured in MVCs and 20.5 per cent of patients with known restraint use. Restrained patients were less severely injured with lower injury severity scores (7.62 vs 11.33) and mortality (1.1 vs 5.7%). Patients with SBS had lower mortality rates than patients without SBS (1.4 vs 3.7%). Thoraco-abdominal injuries were present in 47 per cent (34 of 72) of patients with SBS. Compared with patients without SBS, patients had a higher incidence of hollow viscous injuries (HVI) and solid organ trauma (8 and 17% vs 1 and 3%, P < 0.05); splenic trauma was 24-fold higher (9.7 vs 0.4%), liver injuries 3.1-fold higher (6 vs 3%), and rib fractures 2.4-fold higher ( P < 0.05). Children had 2.8-fold higher rates of HVI (18 vs 9%, P < 0.05). SBS is associated with underlying regional injuries in nearly half of patients with a higher prevalence of HVI and solid organ trauma.

Pediatricians are a recognized primary resource and advocate for injury prevention. The purpose of this study was to examine pediatricians' knowledge, perceptions, and behaviors regarding car booster seats and their willingness to use resources for parent education. Investigators implemented an anonymous, mailed survey to a national random sample of 1,041 US office-based pediatricians with 464 respondents: 53% female, 63% Caucasian, 52% parents of children under 12 years, and 87% board-certified. Fifty-two percent have counseled at least half of their families about booster seats. Sixty-nine percent rely on American Academy of Pediatrics (AAP) resources for counseling, and 87% agreed that counseling parents improves child outcomes in a motor vehicle crash. Fifty-seven percent said there were no barriers to booster seat counseling; 39% did not counsel parents about booster seats unless it is the reason for the office visit. Forty-seven percent lacked the time to counsel, and 81% were confident they were counseling according to AAP guidelines. Twelve percent were unsure of their state's booster seat laws. Significant relationships were found between responses to knowledge questions and suburban location, gender, race, length of time in pediatric practice. Many pediatricians are not counseling their patients' parents on booster seats but believe counseling is important; many are confident in their counseling but do not rely on AAP-recognized counseling resources. Education about state booster seat laws and AAP guidelines may be useful in increasing the cues to action pediatricians convey to parents regarding booster seat use.