Pediatric Facial Trauma in Rural Versus Urban Areas: Challenges and Opportunities for Intervention With Safety Device Usage in Motorized Vehicles

Abstract

Study design:

Retrospective chart review.

Objective:

Improper usage of safety devices in motorized vehicles can lead to serious facial injuries in the pediatric population. This study compares pediatric facial trauma patients from rural and urban counties who present to 2 high-volume Level 1 Trauma Centers to investigate factors influencing injury severity and management, and to guide preventative measures to improve patient outcomes.

Methods:

A retrospective chart review of pediatric facial trauma patients (<18 years old) was performed between January 2020 and December 2022 at 2 high-volume Level 1 Trauma Centers. Data on patient demographics, facial injuries, management, and outcomes were collected. Urban and rural county designation was defined according to the Department of Health and Human Services.

Results:

Of 2977 pediatric facial trauma patients evaluated, 206 sustained facial fractures from motorized vehicle accidents (MVA) −176 were from an urban-designated county (UC) and 30 from a rural-designated county (RC) at the time of injury. RC patients were significantly more likely to be transferred from outside institutions (P = .007) and to sustain injuries from an ATV accident (P = .006). Lack of safety device use in UC patients were significantly more likely to sustain injuries from low-energy trauma (P = .01), to have a higher ISS score (P = .02), and to have a longer hospital stay (P = .01). RC patients using appropriate safety devices were significantly more likely to receive specialty follow-up for their facial injuries (P = .04) and to have resolution of their facial trauma injuries within 1 year (P = .004).

Conclusion:

Proper safety device usage is crucial in the prevention of pediatric facial injuries in motorized vehicles. While the type of facial fractures did not differ, patients not using safety devices had more severe injuries with less specialized follow-up care and longer duration of residual symptoms. Further research should focus on improving follow-up care with a focus on rural patients to enhance long-term recovery.