Seatbelt Use in Females of Childbearing Age at an Urban Safety-Net Level 1 Trauma Center

Background: Safety restraint system (SRS) use is known to improve maternal and fetal outcomes in pregnant women. Factors associated with seatbelt use in females of child-bearing age are largely unstudied despite global public health endeavors to increase use. We sought to define its use and uncover risk factors for not using a restraint system in this vulnerable patient cohort. Materials and methods: A retrospective chart review of all female patients aged 15-35 y presenting from 2007 to 2017 was performed using our institutional level 1 trauma database. Age, pregnancy, insurance status (commercial or private, Medicaid plan, and uninsured), race, and Injury Severity Score (ISS) were examined in unmatched data. A matched cohort was created to evaluate the impact of pregnancy on SRS use based on ISS, age, race, and insurance status with blinding to belt use during matching (two nonpregnant to one pregnant). Differences in restraint use were then examined using Manne-Whitney U and Chi-square tests. Results: A total of 779 patients met inclusion criteria, of which 140 were pregnant. In unmatched data, there was no difference in belt use with regard to age, race, or insurance type. Overall belt use was 59%. Twenty-five percent of patients were uninsured, and 39% used a Medicaid plan. Pregnant patients were statistically more likely to wear belts (71% versus 57%, P = 0.003). In ISS-matched data, this difference was not upheld (63% pregnant belt use versus 58%, P = 0.615). Conclusions: Pregnancy did not induce improved safety behavior in our population. More study is needed to confirm our findings. Overall SRS use in our urban population is very poor, lags behind the national average, and requires additional public health attention. (C) 2019 Elsevier Inc. All rights reserved.