Seat Passengers at
Higher Brain Injury Risk
SAN DIEGO (Reuters Health) - While people riding in the back
seat of a car without a seat belt are less likely to sustain life-threatening
injuries during a crash than unrestrained drivers and front-seat
passengers, they are at greater risk for brain damage, a new study
The results challenge the common belief that rear seat belts
aren't important, said study author Dr. Lewis Kaplan of the MCP/Hahnemann
University Hospital in Philadelphia.
``When people put people in the back seat of their cars, they
have to be just as vigilant about belting them in as they are
for front-seat passengers and children,'' Kaplan told Reuters
But that is often not the case, despite the awareness brought
to the issue when Princess Diana was killed in a car crash in
Paris in 1997. She was in the back seat and was not wearing a
seat belt; neither was the driver or her companion, Dodi Fayed,
also in the back. Only her bodyguard, who was buckled up in the
front passenger seat and had an air bag, survived.
Kaplan said that after Diana's death, he looked through the medical
literature to see if there were studies on the risks to rear passengers,
and found very little information. So he and his colleagues began
collecting data on people treated for crash injuries at his hospital
between November 1998 and November 2000.
Of 152 cases involving both front and rear riders, 79% of rear-seat
passengers and 63% of front-seat drivers or passengers were not
wearing seat belts at the time of the crash, Kaplan reported here
Sunday at a meeting of the Society of Critical Care Medicine.
When the researchers looked at injury patterns, they found--as
expected--that unrestrained front riders were most likely to require
lengthy stays in the intensive care unit: an average of 104 days,
compared with a dozen or fewer for the other study groups.
That's because the crash impact is usually much greater in the
front of the vehicle, and drivers and front-seat passengers often
sustain multiple severe injuries, including internal organ and
spinal cord damage, the researchers explained.
But, surprisingly, the study found that unrestrained rear passengers
were the most likely to sustain brain injuries--65% did, compared
with 61% of unrestrained front-seat riders, 43% of rear restrained
riders and 43% of front restrained riders.
Despite the often-greater impact in the front, air bags can help
protect against brain injury, Kaplan explained. In addition, the
steering column frequently keeps drivers from hitting their heads
on the windshield. But rear passengers, who are typically in tighter
spaces, often hit their heads on the seat in front of them, the
side post or the side window, he said.
Another unexpected finding was that rear passengers wearing seat
belts were most likely to sustain orthopedic injuries, such as
fractures of the arms, ribs and collarbone. In the study, 43%
of rear restrained passengers had orthopedic injuries--more than
twice as many as the other groups studied. A big factor is that
many cars don't come with shoulder restraints in addition to lap
belts in the back, Kaplan said, particularly for the middle passenger
position. As a result, the upper body can be propelled forward
or sideways during an accident.
Still, the risk of fracture is no reason to forgo a seat belt,
Kaplan stressed. ``You recover from orthopedic injuries pretty
readily but brain injuries can cause lasting impairment,'' he
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