Children in car crashes: analysis of data for injury and use of restraints

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Johnston, Carden; Rivara, Frederick P.; Soderberg, Robert

Children in car crashes: analysis of data for injury and use of restraints

Pediatrics. June 1994;93(6):960-965

Affiliations

¹Harborview injury Prevention and Research Center and Department of Pediatrics, School of Medicine, University of Alabama at Birmingham
Abstract and keywords

Objective: To determine the effect of car restraints on motor vehicle injury rates for children aged 0 to 14 years.

Methods: A probability sample of all police-reported car crashes in the United States in 1990 and 1991 was analyzed for injury rates of passengers aged less than 15 years in relation to restraint usage, age, and seating position. Results: Optimal restraint usage (defined as car seats for children 0 to 4 years old and lap shoulder belts for children 5 to 14 years old) was 40%. The use of the car seat was 76% for infants (0 to 12 months old) and 41% for toddlers (1 to 4 year olds). The non use of a restraint was highest for 10 to 14 year olds (43%).

The rate of involvement in car crashes for all children was 21.4 (per 1000/yr). The highest rate was the 14 year olds with 29.6 followed by 2 year olds with 26.5.

Injury rates were 4.76 (per 1000/yr) for all children. The lowest rate was 2.91 for infants but increased to 4.78 for 3 year olds. The single strongest risk factor for injury was the non use of a restraint. (Adjusted odds ratio 2.7; 95% CI 2.4 to 3.0.) The risk factor for injury for the front seat was 1.5 (95% CI 1.4 to 1.7).

Use of the car seat reduced injuries by 60% forO to 4 year olds, whereas the lap shoulder harness was only 38% effective for 5 to 14 year olds (P < .001) Injury rates of unrestrained 0 to 4 and 5 to 14 year olds were similar.

Conclusions: Greater involvement in car crashes and less use of car restraints explains the 64% higher rate of injury for 3 year olds than for infants. It is time to target the toddlers.

Restraints designed for adults are not as effective for the school age child as car seats are for the preschool child. A better restraint for the school age child should be designed and evaluated. Meanwhile, increased usage of current restraints must be encouraged, as they substantially reduce injuries.

Keywords: car crashes; injury; children; car seats; seat belts; automobile restraints; motor vehicle crashes
Links

URL: http://pediatrics.aappublications.org/content/93/6/960.abstract

PubMed: 8190584

WoS: A1994NP67800015
History

Received: 1993-11-15

Accepted: 1993-11-19

Cited Works (5)

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1977	Williams A, Zador P. Injuries to children in automobiles in relation to seating location and restraint use. Accid Anal Prev. March 1977;9(1):69-76.

Cited By (21)

Year	Entry
1997	Agran PF, Anderson CL, Winn DG. Restraint use among children in fatal crashes. In: Proceedings of the 2nd Child Occupant Protection Symposium. November 12, 1997; Orlando, FL.55-59. SAE 973300.
1997	Braver ER, Whitfield R, Ferguson SA. Risk of death among child passengers in front and rear seating positions. In: Proceedings of the 2nd Child Occupant Protection Symposium. November 12, 1997; Orlando, FL.25-34. SAE 973298.
2010	Doyle JJ Jr, Levitt SD. Evaluating the effectiveness of child safety seats and seat belts in protecting children from injury. Econ Inq. 2010;48(3):521-536.
2000	Weber K. Crash protection for child passengers: a review of best practice. UMTRI Res Rev. July–September 2000;31(3):1-27.
2002	Weber K. Child passenger protection. In: Nahum AM, Melvin JW, eds. Accidental Injury: Biomechanics and Prevention. 2nd ed. New York, NY: Springer-Verlag; 2002:523-549.
1998	Gotschall CS, Better AI, Bulas D, Eichelberger MR, Bents F, Warner M. Injuries to children restrained in 2- and 3- point belts. In: 42nd Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 5-7, 1998; Charlottesville, VA.29-43.
1998	Gotschall CS, Dougherty DJ, Eichelberger MR, Bents FD. Traffic-related injuries to children: lessons from real world crashes. In: 42nd Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 5-7, 1998; Charlottesville, VA.165-177.
2001	Anderson CL, Agran PF, Winn DG. Exposure-based death rates for child motor vehicle occupants. In: 45th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 24-26, 2001; San Antonio, TX.
1998	Winston FK, Durbin DR, Bents FD, Werner JV, Bhatia E, Menon RA, Arbogast KB. A comprehensive surveillance system to investigate targeted issues in child occupant protection. In: Proceedings of the 16th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 31–June 4, 1998; Windsor, Ontario, Canada.1291-1297.
2013	Boucher LC, Chaudhari AMW, Kang YS, Bolte J IV. Range of motion and stiffness of the pediatric ankle and implications for current ATDs. In: Proceedings of the 2013 International IRCOBI Conference on the Biomechanics of Injury. September 11-13, 2013; Gothenburg, Sweden.195-207.
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1998	Braver ER, Whitfield R, Ferguson SA. Seating positions and children’s risk of dying in motor vehicle crashes. Inj Prev. 1998;4(3):181-187.
2003	Orzechowski KM, Edgerton EA, Bulas DI, McLaughlin PM, Eichelberger MR. Patterns of injury to restrained children in side impact motor vehicle crashes: the side impact syndrome. J Trauma. June 2003;54(6):1094-1101.
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2002	American Academy of Pediatrics, Committee on Injury and Poison Prevention. Selecting and using the most appropriate car safety seats for growing children: guidelines for counseling parents. Pediatrics. March 2002;109(3):550-553.
2005	Durbin DR, Chen I, Smith R, Elliott MR, Winston FK. Effects of seating position and appropriate restraint use on the risk of injury to children in motor vehicle crashes. Pediatrics. March 2005;115(3):e305-e309.
2014	Boucher LC. Lower Extremity Anthropometry, Range of Motion, and Stiffness in Children and the Application for Modification and Validation of the Anthropomorphic Test Device [PhD thesis]. The Ohio State University; 2014.
2014	Icke KJ. Determination of the Compressive Response of the Pediatric Thorax Utilizing System Identification Techniques [PhD thesis]. The Ohio State University; 2014.
2002	Giacomin JA. An Experimental Investigation of the Vibrational Comfort of Child Safety Seats [PhD thesis]. University of Sheffield; December 2002.
2008	Brown J. The Aetiology and Mechanisms of Serious Injury in Restrained Child Occupants [PhD thesis]. University of New South Wales; 2008.