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Giovannini E, Santelli S, Pelletti G, Bonasoni MP, Cornacchia A, Pelotti S, Fais P. Pediatric motor vehicle crashes injuries: A systematic review for forensic evaluation. Int J Legal Med 2024:10.1007/s00414-024-03174-7. [PMID: 38337078 DOI: 10.1007/s00414-024-03174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Children involved in car crashes can experience either direct trauma or inertial injuries resulting from interactions with external objects, such as other vehicles, or with the restraint system. Furthermore, improper use of restraint systems can lead to additional severe injuries. Recent reports from international institutions underscored the persistent prevalence of inadequate restraint systems utilization and this widespread issue increases children's vulnerability and risk of injuries.The aim of this study is to provide a systematic review of the literature on injuries sustained in children involved in road accidents describing and analyzing elements useful for forensic assessment.The literature search was performed using PubMed, Scopus and Web of Science from January 1970 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about traffic accidents involving pediatric passengers. A total of 69 studies satisfied the inclusion criteria and were categorized and analyzed according to the anatomical regions of the body affected (head, neck, thoraco-abdominal, and limb injuries), and the assessment of lesions in reconstruction of the accident was examined and discussed.The review highlights that in motor vehicle accidents involving children, the forensic evaluation of both the cause of death and accident dynamics needs to consider several factors, such as the child's age, the type of restraint system employed, and the specific passenger seat occupied. Considering the complexity of the factors that can be involved in this road accident, it is crucial that there is a comprehensive exchange of information between the judge and the medical expert.
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Affiliation(s)
- Elena Giovannini
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Simone Santelli
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Maria Paola Bonasoni
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy.
| | - Angela Cornacchia
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Susi Pelotti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy
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Jenjitranant P, Beckmann NM, Cai C, Cheekatla SK, West OC. There has to be an easier way: facet fracture characteristics that reliably differentiate AOSpine F1 and F2 injuries. Emerg Radiol 2019; 26:391-399. [DOI: 10.1007/s10140-019-01684-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/08/2019] [Indexed: 11/29/2022]
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Risk Factors for Blunt Cerebrovascular Injury in Children: Do They Mimic Those Seen in Adults? ACTA ACUST UNITED AC 2011; 71:559-64; discussion 564. [DOI: 10.1097/ta.0b013e318226eadd] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Delayed sequelae after pressure on the neck are rare. Awareness of such sequelae as well as a high degree of suspicion is essential for early detection and proper clinical management. Injuries to the common carotid artery and pseudo aneurysm formation leading to fatal hemorrhage are still rare occurrences after attempts of manual strangulation. When such cases are presented to the forensic pathologist, he has to establish the link between the cause and effect, excluding other possible causes for such complications. In addition, he may have to give opinions in possible medical negligence charges.
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Sgarlato A, deRoux SJ. Motor Vehicle Occupants, Neck Injuries, and Seat Belt Utilization: A 5-Year Study of Fatalities in New York City. J Forensic Sci 2010; 55:527-30. [DOI: 10.1111/j.1556-4029.2009.01270.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Levack MM, Pettitt BJ, Winston AD. Carotid artery thrombosis and delayed stroke associated with the use of a shoulder belt in a teenager. J Pediatr Surg 2009; 44:E29-33. [PMID: 19635289 DOI: 10.1016/j.jpedsurg.2009.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 05/18/2009] [Accepted: 05/18/2009] [Indexed: 11/28/2022]
Abstract
Blunt carotid artery injury caused by shoulder belts is rare and requires a high index of suspicion to diagnose before the onset of neurologic sequelae. Neurologic abnormalities may be erroneously attributed to concomitant head trauma, and the onset of neurologic abnormalities may be delayed for hours or days. The case of a young, teenaged driver with a "seatbelt sign" and presentation of signs and symptoms of carotid artery thrombosis 13 days after injury is described. Occult vascular injury should be suspected if neurologic deterioration occurs after a lucid interval and/or computed tomography of the head is inconsistent with neurologic findings. Screening criteria and possible screening modalities are discussed.
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Affiliation(s)
- Melissa M Levack
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA 30303, USA
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Abstract
Seatbelts save lives. However, they may cause injury to adjacent structures and when they malfunction can cause injury to the abdominal viscera, bony skeleton and vascular structures. The motor industry has attempted to reduce these injuries by modification of vehicle design and safety equipment. This paper discusses the patterns of injury caused by seatbelts and the methods by which the motor industry attempts to reduce their incidence.
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Affiliation(s)
- JE Smith
- Emergency Department, Derriford Hospital, Plymouth, UK,
| | - MJ Hall
- Department of Orthopaedic Surgery, Derriford Hospital, Plymouth, UK
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Abstract
A 7-year-old boy travelling in the rear seat of a sedan car was wearing a lap-shoulder seat belt and sitting on a booster seat. Following a collision the boy 'submarined' under the seat belt sustaining trauma to the anterior aspect of his neck, cardiac arrest and subsequent death from hypoxic-ischaemic encephalopathy. This case demonstrates a potential problem with unsecured older-style booster seats. Movement of a seat in a collision may cause a child to slip under a seat belt and sustain significant neck injuries. Seatbelts for children must be correctly fitted, booster seats or capsules must be securely fastened and manufacturer's recommendations for size and weight limits should be followed. Unfortunately older booster seats may not have attached instructions for installation and use, may not fit later model vehicles, may not conform to current safety recommendations and may have worn webbing. For these reasons their use should be discouraged.
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Affiliation(s)
- R W Byard
- Forensic Science Centre, Adelaide, South Australia, Australia.
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Dickey RA, Parker JL, Feld S. Discovery of unsuspected thyroid pathologic conditions after trauma to the anterior neck area attributable to a motor vehicle accident: relationship to use of the shoulder harness. Endocr Pract 2003; 9:5-11. [PMID: 12917086 DOI: 10.4158/ep.9.1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To alert physicians to the possibility of antecedent trauma to the neck in patients presenting with a thyroid nodule or with symptoms and signs related to the thyroid gland. METHODS We present five case reports in which the cause of thyroid nodular disease was suspected to have been trauma to the anterior neck area during an earlier motor vehicle accident in which the shoulder harness impacted the neck. RESULTS In five female patients, shoulder harness trauma from an automobile accident led to the subsequent discovery of a thyroid lesion. Four of the five patients underwent surgical removal of the thyroid nodule. Although traumatic injury of the thyroid may be common, we found only one report in the medical literature regarding the discovery of a thyroid nodule or thyroiditis in the setting of traffic accident-related trauma to the thyroid gland. CONCLUSION In the initial assessment of patients with thyroid nodular disease, we emphasize the importance of obtaining a detailed and comprehensive history, including inquiry about trauma to the neck. Prompt diagnostic accuracy will help avoid unnecessary costs and risks in the workup of such patients.
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Diperna CA, Rowe VL, Terramani TT, Salim A, Hood DB, Velmahos GC, Weaver FA. Clinical Importance of the “Seat Belt Sign” in Blunt Trauma to the Neck. Am Surg 2002. [DOI: 10.1177/000313480206800509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Currently a carotid duplex scan is the initial screening modality routinely used to evaluate occult extracranial carotid artery injuries secondary to blunt neck trauma. The objective of this study was to investigate the role of carotid artery duplex scanning in patients who suffered blunt trauma to the neck with a “seat belt sign.” The medical records of 131 consecutive patients who sustained blunt trauma to the neck from a motor vehicle accident were reviewed. Patients with the cervical seat belt sign underwent a complete physical examination and carotid duplex scan in an accredited vascular laboratory. An intimal flap with severe carotid artery stenosis was found in one of 131 patients (0.76%). This patient has multiple injuries to the face, head, chest, lateralizing neurological signs, and a Glasgow Coma Scale score of 8. In an era of cost containment, resource consumption should target appropriate populations. A cervical seat belt sign should not serve as a sole indicator for evaluation of the carotid artery in the absence of other pertinent signs or symptoms.
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Affiliation(s)
- Costanzo A. Diperna
- Department of Surgery, Division of Vascular Surgery and Trauma Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Vincent L. Rowe
- Department of Surgery, Division of Vascular Surgery and Trauma Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Thomas T. Terramani
- Department of Surgery, Division of Vascular Surgery and Trauma Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Ali Salim
- Department of Surgery, Division of Vascular Surgery and Trauma Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Douglas B. Hood
- Department of Surgery, Division of Vascular Surgery and Trauma Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - George C. Velmahos
- Department of Surgery, Division of Vascular Surgery and Trauma Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Fred A. Weaver
- Department of Surgery, Division of Vascular Surgery and Trauma Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California
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Rozycki GS, Tremblay L, Feliciano DV, Tchorz K, Hattaway A, Fountain J, Pettitt BJ. A prospective study for the detection of vascular injury in adult and pediatric patients with cervicothoracic seat belt signs. THE JOURNAL OF TRAUMA 2002; 52:618-23; discussion 623-4. [PMID: 11956373 DOI: 10.1097/00005373-200204000-00002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A delayed diagnosis of injury to cervicothoracic vessels from blunt trauma may cause significant adverse sequelae. The association of a cervicothoracic seat belt sign with such an injury is unknown. METHODS Algorithms were prospectively studied for the detection of occult vascular injury in patients with cervicothoracic seat belt signs. Patients with neck seat belt signs underwent arteriography or computed tomographic angiography (CTA). Those with thoracic seat belt signs underwent aortography/arteriography if a ruptured thoracic aorta or injury to a great vessel was suspected or a neurovascular abnormality was present. RESULTS During a 17-month period, 797 patients were admitted to the trauma service secondary to motor vehicle crashes. One hundred thirty-one (16.4%) had cervical or thoracic seat belt signs. Four (3%) of the patients had carotid artery injuries, the presence of which was strongly associated with a Glasgow Coma Scale score < 14, an Injury Severity Score > 16 (p < 0.0001), and the presence of a clavicle and/or first rib fracture (p < 0.0037). Of the remaining patients, 17 had thoracic trauma. There were no vascular injuries in the children and only one had thoracic trauma. CONCLUSION The algorithms are safe and accurate for the detection of cervicothoracic vascular injury in adult and pediatric patients with seat belt signs. The cervicothoracic seat belt mark and an abnormal physical examination are an effective combination in screening for cervicothoracic vascular injury.
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Affiliation(s)
- Grace S Rozycki
- Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia 30303, USA
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Riches KJ, James RA, Gilbert JD, Byard RW. Fatal childhood vascular injuries associated with seat belt use. Am J Forensic Med Pathol 2002; 23:45-7. [PMID: 11953493 DOI: 10.1097/00000433-200203000-00009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The deaths of two children who were passengers in motor vehicles involved in accidents were directly attributable to vascular injuries derived from seat belts. In the first case, a 10-year-old boy died as a result of abdominal aortic transection by a lap seat belt, and in the second case a 15-year-old boy died as a result of transection of his common carotid artery by a lap-shoulder seat belt. Although these cases demonstrate rare fatalities associated with seat belt use, there is no doubt that seat belts have significantly reduced mortality and morbidity from traffic accidents. Although it is possible that a fatal outcome might have occurred in each of these cases from other injuries that might have been sustained had seat belts not been worn, appropriate positioning and size of seat belt harnesses might have avoided the lethal injuries.
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Affiliation(s)
- K J Riches
- Forensic Science Centre, Adelaide, South Australia.
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Krüger K, Landwehr P, Kristen F, Gossmann A, Lackner K. Unusual pseudoaneurysm of an axillofemoral bypass caused by seat belt trauma: case report. THE JOURNAL OF TRAUMA 1999; 46:189-91. [PMID: 9932706 DOI: 10.1097/00005373-199901000-00033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- K Krüger
- Department of Diagnostic Radiology, University of Cologne Medical School, Germany.
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