Reclining in Moving Car Ups Injury Risk: Report
By Charnicia E. Huggins

NEW YORK (Reuters Health) - It is already known that incorrect usage of combination lap and shoulder seat belts can lead to injuries of the spine, neck and pelvis. Now, evidence from three case reports suggests that individuals who ride in a reclined position while wearing these safety belts may place themselves at additional risk of injury.

``There is no question that the three-point shoulder harness lap belt restraint system...saves lives,'' according to study authors Drs. Christina G. Rehm and Robert K. Goldman, of Oregon Health & Science University in Portland. ``Unfortunately, while they save lives, seat belts do also have limitations.''

``In order to get the maximum benefit and be secured in a seat belt the way it was intended, the car seat must be in an upright position,'' Rehm told Reuters Health.

For their study, Rehm and Goldman analyzed three instances in which individuals sustained injuries in car collisions while using their lap and shoulder belts as they rode in a fully reclined position in the front passenger seat. Their findings were published in the December issue of The Journal of Trauma: Injury, Infection, and Critical Care.

The first case involved a 17-year-old female who was sleeping when the car crashed head-on into a pole after the driver also fell asleep. The passenger suffered multiple injuries, including massive swelling of the neck, a deep strangulation mark across her neck, severe breathing problems caused by injuries to her trachea and esophagus, and injuries to her spinal cord.

The second case involved an intoxicated 22-year-old male who was sleeping when the car was involved in a rollover crash. He was partially ejected through the back car window, and suffered a concussion and severe bruises to his face.

Lastly, a 25-year-old female was also sleeping when the vehicle she was in was involved in a head-on collision at about 60 miles per hour. She suffered injuries to the neck and chest, as well as a deep seat belt mark across the upper part of her neck.

All of the patients eventually recovered, the researchers note.

``The seat belt in modern cars is not designed to protect with the seat in a reclining position, (because) there is no fixed relationship between the seat belt and the car seat,'' Rehm explained. The seat belt is attached to the car frame, and therefore does not provide adequate protection unless the individual is sitting upright.

``The current three-point lap shoulder harness restraint provides the maximum level of protection with minimal additional risk of seat belt-associated injury for adults when the car seat is kept in the full upright position at all times,'' Rehm and Goldman conclude.

SOURCE: The Journal of Trauma: Injury, Infection, and Critical Care