Seat Belt Usage in Injured Car Occupants: Injury Patterns, Severity and Outcome After Two Main Car Accident Mechanisms in Kashan, Iran, 2012

BACKGROUND: Road traffic accidents (RTAs) are the main public health problems in Iran. The seat belts, which are vehicle safety devices, are imperative to reduce the risk of severe injuries and mortality. OBJECTIVES: The aim of the study was to evaluate injury patterns, severity and outcome among belted and unbelted car occupants who were injured in car accidents. PATIENTS AND METHODS: This cross-sectional prospective study was performed on all car occupants injured in RTAs (n = 822) who were transported to hospital and hospitalized for more than 24 hours from March 2012 to March 2013. Demographic profile of the patients, including age, gender, position in the vehicle, the use of seat belts, type of car crashes, injured body regions, revised trauma score (RTS), Glasgow coma score (GCS), duration of hospital stay and mortality rate were analyzed by descriptive analysis, chi-square and independent t-test. P < 0.05 was considered significant. RESULTS: A total of 560 patients used seat belts (68.1%). The unbelted occupants were younger (28 years vs. 38 years) and had more frequently sustained head, abdomen and multiple injuries (P = 0.01, P = 0.01 and P = 0.009, respectively). Also, these patients had significantly lower GCS and elongated hospitalization and higher death rate (P = 0.001, P = 0.001 and P = 0.05, respectively). Tendency of severe head trauma and low RTS and death were increased in unbelted occupants in car rollover accident mechanisms (P = 0.001, P = 0.01 and P = 0.008, respectively). CONCLUSIONS: During car crashes, especially car rollover, unbelted occupants are more likely to sustain multiple severe injuries and death. Law enforcement of the seat belt usage for all occupants (front and rear seat) is obligatory to reduce severe injuries sustained as a result of car accidents, especially in vehicles with low safety.