Trauma is one of the most important causes of mortality and morbidity in children [1]. The injuries associated with the use of motorized machines is extremely common due to the lack of safety norms and their poor implementation [2]. The locally made machines with open conveyer belts are being frequently used in the villages. In recent years, we have been witnessing an emerging mode of trauma in children with extremely high case fatality rate and very high morbidity in children who are surviving. We present our experience of managing children with these injuries.

A retrospective review was conducted of the medical records at a level two trauma center of Northern India between May 2015 to April 2019. Clearance was taken from institutional ethics committee. The study included all the children presenting to our trauma center during the study period with a common mode of injury i.e. trauma due to entrapment in the open belt of motorized machine. All these children had sustained polytrauma. We classified these children into three groups having different spectrum of injury due to entrapment of different body parts: viz, Type I: Children pulled through their torso and had a blow to their head or face from the metallic wheel at the end of the belt; Type II: Children pulled through their torso with torso getting entrapped between the belt wheel; and Type III: Children pulled through their upper or lower limbs.

Injury severity was assessed by a pediatric trauma score (PTS) and Glasgow coma scale (GCS) [3].

Total of six children (4 female) with belt entrapment injuries presented during the study period. The mean (SD) age of the studied patients was 5 (1.51) years. 66.6% of injuries occurred in rural areas. Two (33.33%) patients were shifted to a trauma center in an ambulance and only three got primary treatment at the health center. Others were directly referred to our trauma center with a median distance of 80 km (30-140). All the children were entrapped while playing near the machines. They were caught in the belt by their clothes while their parents were working nearby. All the patients had polytrauma (Table I). The mean pediatric trauma score was 3.2 (1.21) (range 2-5) and mean GCS score was 5.7 (3.54) (range 3-13) at the time of presentation to the trauma center. Two children were dead at the time of arrival at the trauma center. Two of these had extradural hemorrhage with a parenchymal contusion. Four children had thoracic trauma and three children had associated abdominal and vertebral fractures. Two of these children had paraplegia at the time of presentation with mortality in one patient.

TABLE I Description of Pattern and Demography of Children with Conveyor Belt Entrapment Trauma

As a developing country with a large pediatric population, we have a huge burden of trauma [4]. We have witnessed an increasing incidence of trauma in children related to construction sites and use of machines. The assignment of children into three groups according to which body part got entrapped in the belt first, was extremely useful in predicting the pattern of injuries and overall morbidity and mortality.

Type I injury was most fatal as children had severe head and maxillofacial trauma. We propose the use of this classification for identifying the different injuries in these children with polytrauma. These injuries may compromise both airway and breathing which is rapidly fatal apart from the head injury itself. Type II injury were also severe in terms of both mortality and morbidity. All three children with these injuries had associated vertebral injuries with two children having paraplegia at the time of presentation. Type III injuries were least severe but also least common. The GCS and PTS scores were much lower when compared to scores reported in other studies [5,6]. This highlights the severe nature of this trauma and an overall mortality rate of 50% [6]. The use of Roller machines and conveyer belts have become extremely common, and they are a part of numerous manufacturing units. Though there are safety norms, but because of cost cutting their implementation is extremely poor [7,8]. Scarf used around the neck by females in our region has been reported to cause similar injuries [9].

The belt entrapment injuries in children have very high mortality and morbidity. The incidence may be higher because of very high prehospital mortality rate. Legislation for norms and their strict implementation is required for prevention of these injuries.

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