Evaluating the "cushion effect" among children in frontal motor vehicle crashes.
BACKGROUND
The "Cushion Effect," the phenomenon in which obesity protects against abdominal injury in adults in motor vehicle accidents, has not been evaluated among pediatric patients. This work evaluates the association between subcutaneous fat cross-sectional area, quantified using analytic morphomic techniques and abdominal injury.


METHODS
This retrospective study includes 119 patients aged 1 to 18years involved in frontal impact motor vehicle accidents (2003-2015) with computed tomography scans. Subcutaneous fat cross-sectional area was measured and converted to age- and gender-adjusted percentiles from population-based normative data. Multivariable analysis determined the risk of the primary outcome, Maximum Abbreviated Injury Scale (MAIS) 2+ abdominal injury, after adjusting for age, weight, seatbelt status, and impact rating.


RESULTS
MAIS 2+ abdominal injuries occurred in 20 (16.8%) of the patients. Subcutaneous fat area percentile was not significantly associated with MAIS 2+ abdominal injury on multivariable logistic regression (adjusted Odds Ratio, 0.86; 95% CI, 0.72-1.03; p=0.10).


DISCUSSION
The "cushion effect" was not apparent among pediatric frontal motor vehicle crash victims in this study. Future work is needed to investigate other analytic morphomic measures. By understanding how body composition relates to injury patterns, there is a unique opportunity to improve vehicle safety design.


LEVEL OF EVIDENCE
Prognosis Study, Level III.
['Harbaugh|Calista M|CM|', 'Zhang|Peng|P|', 'Henderson|Brianna|B|', 'Derstine|Brian A|BA|', 'Holcombe|Sven A|SA|', 'Wang|Stewart C|SC|', 'Kohoyda-Inglis|Carla|C|', 'Ehrlich|Peter F|PF|']
D000007:Abdominal Injuries D000063:Accidents, Traffic D000293:Adolescent D001835:Body Weight D002648:Child D002675:Child, Preschool D005260:Female D006801:Humans D015994:Incidence D015601:Injury Severity Score D008297:Male D009765:Obesity D012189:Retrospective Studies D012622:Seat Belts D015996:Survival Rate D013898:Thoracic Injuries D014057:Tomography, X-Ray Computed D014481:United States
Abdominal injury Analytic morphomics Pediatric surgery Trauma