CLINICAL STUDY

Effect of Restraining Devices on Eye Injury in Motor Vehicle Collisions Kun Hwang, MD, PhD and Joo Ho Kim, MD Abstract: The aim of this systematic review is to summarize and critically evaluate the evidence for or against the effectiveness of restraining devices on eye injury in motor vehicle collisions (MVCs). In a PubMed search, the search terms “eye injury and seatbelt,” “eye injury and car belt,” “eye injury and airbag,” and “eye injury and restraining” were used. Among the 30 potentially relevant articles, 5 articles met our inclusion criteria. The odds ratio (OR) and 95% confidence intervals (CIs) from each study were abstracted. The statistical analysis was performed with Review Manager (The Nordic Cochrane Centre). Three studies were subgrouped, and a meta-analysis of these data suggested no significant effects of an airbag on increasing eye injury in MVCs (n = 10,123,954; OR, 1.10; 95% CI, 0.77–1.56). Two studies were subgrouped, and a meta-analysis of these data suggested that there are beneficial effects of seat belts on decreasing eye injury in MVCs (n = 43,057,271; OR, 0.50; 95% CI, 0.50–0.51). Seat belts were effective to decrease eye injuries in MVCs. However, airbags had no significant effect on an increase to eye injuries. When using airbags, seat belts should be used together.

MATERIALS AND METHODS

In a PubMed search, the search terms “eye injury and seatbelt,” “eye injury and car belt,” “eye injury and airbag,” and “eye injury and restraining” were used. Studies that did not allow an evaluation of the effectiveness of restraining devices (seat belt, airbag) were excluded. No restrictions on language and publication forms were imposed. However, the searched articles were all in English. All articles were read by 2 independent reviewers who extracted data from the articles. To summarize the effectiveness of restraining devices on eye injury in MVCs, we abstracted the odds ratio (OR) and 95% confidence intervals (CIs) from each study. Weighted mean differences and 95% CIs were also calculated. The statistical analysis was performed with Review Manager (The Nordic Cochrane Centre).

RESULTS We found 30 potentially relevant articles (Fig. 1), of which 5 articles met our inclusion criteria (Table 1).2–6

Key Words: Meta-analysis, motor vehicles, eye, seat belts, airbags (J Craniofac Surg 2014;26: 00–00)

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irbags have reduced motor vehicle accident fatalities by 31% to 32%, which is approaching the 45% of reduction achieved with the use of seat belts. Motor vehicle collisions (MVCs) are a serious global health problem, and the most common mechanism of injury produces maxillofacial injuries.1 Conversely, airbags have been associated with ocular injuries, with an estimated incidence of 5%.2 The prevention of MVC-related eye injuries will require the identification of characteristics associated with their occurrence.3 To date, however, no systematic review of this subject is available. The aim of this systematic review is to summarize and critically evaluate the evidence for or against the effectiveness of restraining devices on eye injury MVCs.

From the Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea Received June 3, 2014. Accepted for publication July 31, 2014. Address correspondence and reprint requests to Dr. Kun Hwang, Department of Plastic Surgery, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon 400-711, Korea; E-mail: [email protected] Supported by grant from the Inha University (Inha Research Grant). The authors report no conflicts of interest. Copyright © 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001261

FIGURE 1. Flow chart of the selection process.

The Journal of Craniofacial Surgery • Volume 26, Number 1, January 2014

Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.

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The Journal of Craniofacial Surgery • Volume 26, Number 1, January 2014

Hwang and Kim

TABLE 1. Summary of Retrospective Database Studies Included Eye Injury Author Airbag

Without Eye Injury

Year Total Group Size, n Intervention Group, n Control Group, n Intervention Group, n Control Group, n Results, OR (CI)

Pearlman et al4 Duma et al5 Anderson et al2 Seat belt McGwin and Owsley3 Rao et al6

2001 2002 2002 2005 2008

8,831,678 1,291,519 757 43,057,224 47

187,437 60,112 6 574,812 24

4,369,629 178,151 81 625,319 21

167,038 188,681 113 42,482,412 2

4,107,574 864,575 557 23,258,878 0

1.05 1.55 0.37 0.50 0.23

(1.05–1.06) (1.53–1.56) (0.16–0.86) (0.50–0.51) (0.01–5.01)

FIGURE 2. Meta-analysis of the restraining devices for decreasing facial fractures in MVCs. A, Airbag. B, Seat belt.

1. Effectiveness of an airbag on eye injury

Three studies were subgrouped, and a meta-analysis of these data suggested no significant effects of an airbag on increasing eye injury in MVCs (n = 10,123,954; OR, 1.10; 95% CI, 0.77–1.56; Z = 0.51; P = 0.61; heterogeneity, τ2 = 0.07, P < 0.00001, I2 = 100%) (Fig. 2A).

seat belts as additional protection to prevent head and upper body injuries that result from an occupant striking the vehicle's interior. The results of our systematic review correspond well with the above 2 studies. In conclusion, seat belts were effective to decrease eye injuries in MVCs (OR, 0.50). However, airbags had no significant effect (OR, 1.10) to increase eye injuries. In using airbags, seat belts should be used together.

2. Effectiveness of a seat belt on eye injury

Two studies were subgrouped, and a meta-analysis of these data suggested that there are beneficial effects of seat belts on decreasing eye injury in MVCs (n = 43,057,271; OR, 0.50; 95% CI, 0.50–0.51; Z = 372.08; P < 0.00001; heterogeneity, Chi-squared = 0.25, P = 0.62, I2 = 0%) (Fig. 2B).

DISCUSSION All the studies analyzed were retrospective database studies because no randomized controlled study was available for the safety devices. We used a random effect model because heterogeneities were high in the subgroups of airbag and eye injury (Higgins I2 was >100%). Our meta-analysis implied no significant effects of an airbag on increasing eye injury by using a seat belt alone (OR, 0.10). However, the results yielded beneficial effects of seat belts on decreasing eye injuries (OR, 0.50). It has been suggested that the use of seat belts may prevent premature contact with the airbag during deployment, leading to a decreased risk for ocular injury.4 Sutyak et al7 wrote that airbags have not been proven to be as effective in preventing injury when used alone. He insisted that airbags should be used with supplemental

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REFERENCES 1. Braver ER, Ferguson SA, Greene MA, et al. Reductions in deaths in frontal crashes among right front passengers in vehicles equipped with passenger air bags. JAMA 1997;278:1437–1439 2. Anderson SK, Desai UR, Raman SV. Incidence of ocular injuries in motor vehicle crash victims with concomitant air bag deployment. Ophthalmology 2002;109:2356–2358 3. McGwin G, Owsley C. Risk factors for motor vehicle collision-related eye injuries. Arch Ophthalmol 2005;123:89–95 4. Pearlman JA, Au Eong KG, Kuhn F, et al. Airbags and eye injuries: epidemiology, spectrum of injury, and analysis of risk factors. Surv Ophthalmol 2001;46:234–242 5. Duma SM, Jernigan MV, Stitzel JD, et al. The effect of frontal air bags on eye injury patterns in automobile crashes. Arch Ophthalmol 2002;120:1517–1522 6. Rao SK, Greenberg PB, Filippopoulos T, et al. Potential impact of seatbelt use on the spectrum of ocular injuries and visual acuity outcomes after motor vehicle accidents with airbag deployment. Ophthalmology 2008;115:573–576 7. Sutyak JP, Passi V, Hammond JS. Air bags alone compared with the combination of mechanical restraints and air bags: implications for the emergency evaluation of crash victims. South Med J 1997;90:915–919

© 2014 Mutaz B. Habal, MD

Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.

Effect of restraining devices on eye injury in motor vehicle collisions.

The aim of this systematic review is to summarize and critically evaluate the evidence for or against the effectiveness of restraining devices on eye ...
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