Seat Belt Use and Brachial Plexus Injury: A National Trauma Databank Analysis

Abstract

Introduction: High-speed motor vehicle accidents (MVAs) are an important cause of brachial plexus injury (BPI). Some case reports have demonstrated seat belt use resulting in traction injuries to the brachial plexus. We aimed to utilize a national trauma registry to understand the association between seat belt use and brachial plexus injury in MVAs. Methods: The authors queried the National Trauma Databank for patients with motor vehicle accidents between 2016 and 2017. 1:2 Case-control matching based on age and sex with subsequent multivariable conditional logistic regression adjusting for BMI, alcohol use, drug use was performed to the adjusted association between protective devices and BPI. Results: A total of 526,007 cases of MVAs were identified, of which 704 sustained a BPI. The incidence of BPI in patients without any protective device, with airbag deployment alone, seat belt use alone and with combined airbag deployment and seat belt use were the following: 0.16%, 0.08%, 0.08% and 0.07%. Following 1:2 case-control matching by age and sex and multivariable conditional logistic regression, seat belt use (OR 0.55 (0.42-0.71), p<0.001) and airbag deployment (OR 0.52 (0.33-0.82), p=0.004) were found to be associated with decreased odds for BPI, with the least odds with combined seat belt use and airbag deployment (OR 0.49 (0.33-0.74), p=0.001). Conclusion: Both seat belt use and airbag deployment are associated with lower likelihood of sustaining BPIs in MVAs, with the highest protective effect observed with combined use. Future studies adjusting for other potential confounders may help further definitively characterize this association.