Although previous research has linked poor seat belt fit to abdominal organ injury for children, few have studied the pattern of pediatric abdominal injuries and its relationship to key characteristics beyond this primary association. In this study, data were obtained from a probability sample of 19,125 children, representing 243,540 children, under age 16 years who were enrolled in an on-going crash surveillance system which links insurance claims data to validated telephone survey and crash investigation data. The risk of AIS2+ abdominal injury was estimated for various crash, restraint, vehicle and child correlates and multivariate logistic regression was used to identify the relative importance of these predictors.

Children 4-8 years of age were at the highest risk of abdominal injury:​ they were 24.5 times and 2.6 times more likely to sustain an AIS2+ abdominal injury than those 0-3 years and 9-15 years, respectively. The injury risk for children 4-8 years of age was 6 and 10 times higher in passenger cars and SUVs, respectively, compared to minivans. No reduction in abdominal injury risk was seen with rear seating. The role of direction of impact on injury risk varied by child age indicating diverse injury sources influenced by developmental differences and changes in restraint practices among the age groups. The data suggested a trade-off between head/face injury and abdominal injury:​ for those restrained in vehicle seat belts in rear seats, those with an AIS2+ head/face injury were nearly 90% less likely to sustain an abdominal injury than those without a head/face injury. These findings suggest mechanistic hypotheses to be tested with additional in-depth data.