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Purpose: Road traffic injuries are the leading cause of death under 30 years, causing over a million deaths every year. Helmets, seat-belts and child-restraints have an important role in death and injury prevention. Our purpose was to analyze how safety measures relate to pediatric polytrauma severity in road traffic injury. Methods: A retrospective observational study was conducted, including polytraumatized pediatric patients, hospitalized after road traffic accidents, from January 2011 to December 2015. Comparison groups were classified according to protective equipment use. Logistic regression and generalized liner models describe the probability of safety equipment use, head trauma, higher injury severity score and permanent sequelae. Results: Of a total of 149 inpatients, 63.8% were male with a median age of 11 years. Absence of personal protective equipment was predictive for head trauma (p-value=0.014) and diffuse axonal injury associated with neurologic sequelae and death (p-value<0.01). Multivariate analysis confirmed a higher risk of protective equipment misuse in unsupervised children and in two-wheel accidents (p-value<0.05). Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) were inversely proportional (p-value<0.001). Sequelae were more frequent with lower GCS (p<0.001) and diffuse axonal lesion (p<0.001). Conclusions: Despite increasing alertness, helmet use in road accidents remains limited, reflecting on head trauma severity and subsequent neurological impairment. Absence of protective equipment on car collisions provoked more severe injury scores and prolonged hospital stay. In the "Decade of Action for Road Safety" we still find important handicaps in road safety measures, demanding more effective laws and alerting campaigns.

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In children, the most common cause of an elevated anion gap (AG) with ketonemia, ketonuria, hyperglycemia, and glycosuria is diabetic ketoacidosis. However, when the clinical history is not clear, other causes must be considered. A 9-month-old girl was transferred to our pediatric intensive care unit (PICU) because of severe metabolic acidosis. On admission, she presented with Kussmaul breathing, tachycardia, irritability, and fever. Blood gasses revealed metabolic acidosis with superimposed respiratory alkalosis and elevated AG. Fluid replacement and bicarbonate for urine alkalinization were started. Ketonemia, acidic urine with glycosuria, ketonuria, and high blood glucose prompted an insulin infusion. Measurement of plasma salicylate confirmed toxic levels. When confronted, the parents admitted to accidentally preparing the child’s bottle with water containing salicylic acid 1000 mg. Although the incidence of salicylate intoxication has declined, it remains an important cause of pediatric morbidity and mortality.