Object. Injury to the brain as a result of motor vehicle accidents (MVAs) represents a frequent cause of pediatric disability. The authors analyze the correlation between the relative risk of pediatric brain injury and the use of child safety seats (CSSs). Methods. A national database of MVAs was examined to provide data for the analysis of four age categories (infant, toddler, young child and adolescent) and four restraint categories (unrestrained, properly restrained, improperly restrained, and other). The Abbreviated Injury Scale (AIS) was used to assess the severity of head injury; children with no injuries and children with moderate-to-maximum head injuries were evaluated. The data confirm that proper use of a CSS substantially increases the likelihood of not sustaining head injury in an MVA. The data are most dramatic for infants (the likelihood of sustaining no head injury was 15.2% for unrestrained infants compared with 92.8% for properly restrained infants) but the protective effect is seen in all age categories, with the least difference observed in the adolescent category. For children who sustain a moderate-to-maximum head injury, proper use of a CSS reduces the incidence of injury, again most dramatically for the infant category (unrestrained infants had a 7% risk of moderate-to-maximum head injury compared with only 0.5% for properly restrained infants). Conclusions. Improvements in CSSs have reduced the risk of moderate-to-maximum head injuries in children of all age categories. Overall, a CSS is most protective for the infant and toddler categories. The improperly restrained child still has substantial protection, although the properly restrained child has more. Detailed parental education regarding appropriate restraint system installation and use should be required.
