Driveway motor vehicle injuries in children Andrew J A Holland, Rhea W Y Liang, Shailinder J Singh, David N Schell, Frank I Ross and Daniel T Cass MJA 2000; 173: 192-195 Abstract Objectives: To describe the frequency, nature and outcome of driveway injuries in children. Design: Retrospective case series of driveway-related injuries in children under 16 years of age admitted to the New Children's Hospital (NCH), New South Wales, from November 1995 to February 2000, and deaths reported to the New South Wales Paediatric Trauma Death (NPTD) Registry from January 1988 to December 1999. Main outcome measures: Circumstances of injury; type and number of injuries identified. Results: 42 children were admitted to our institution with driveway-related injuries over four years and four months. These represent 12% of all children admitted with pedestrian motor vehicle injuries. Fourteen deaths (including one of the children admitted to NCH) were reported to the NPTD Registry over 12 years, accounting for 8% of all paediatric pedestrian motor vehicle deaths reported to the registry. Typically, the injury involved a parent or relative reversing a motor vehicle in the home driveway over a toddler or preschool-age child in the late afternoon or early evening. Four-wheel-drive or light commercial vehicles were involved in 42% of all injuries, although they accounted for just 30.4% of registered vehicles in NSW. These vehicles were associated with a 2.5- times increased risk of fatality. In 13 of the 14 deaths, the cause was a severe head injury not amenable to medical intervention. Conclusions: Driveway injuries in children account for a significant proportion of paediatric pedestrian motor vehicle injuries and deaths in NSW. Prevention represents the only effective approach to reducing deaths from this cause. Trauma is the leading cause of death and disability in children after the first year of life. 1 In children with major injuries (defined as an Injury Severity Score 2 greater than 15), motor vehicle accidents have consistently been the most common cause of injury. 3-6 Within this group, children as pedestrians frequently suffer the most severe injuries as a consequence of their small size in relation to motor vehicles. 3,4,7 As paediatric pedestrian motor vehicle injuries predominantly involve young school-age children, 8,9 conventional prevention campaigns have been directed toward these age groups. 3,9,10 A recognised clinical scenario in children is traumatic asphyxia with associated visceral injuries resulting from low-velocity compression of the torso. 11,12 Typically, a motor vehicle reverses over a toddler or older pre-school child in a driveway or car park. 7,13 In these cases, the pliability of a child's skeleton and soft tissues, together with the ability of the applied force to be distributed over the short time of the impact, often allows a good outcome. 7,12,13 This clinical scenario has been variously termed the driveway, back over, crush, non-traffic or low-