Driver seat belt use indicates decreased risk for child passengers in a motor vehicle crash

Study objective

We examined the association between driver restraint use and child emergency department (ED) evaluation following a motor vehicle crash (MVC).

Methods

This cohort study included child passengers aged 0-12 years riding with an adult driver aged 21 years or older involved in a MVC in Utah from 1999 to 2004. The 6 years of Utah MVC records were probabilistically linked to statewide Utah ED records. We estimated the relative risk of ED evaluation following a MVC for children riding with restrained versus unrestrained drivers. Generalized estimating equations were used to calculate relative risks adjusted for child, driver, and crash characteristics.

Results

Six percent (6%) of children riding with restrained adult drivers were evaluated in the ED compared to twenty-two percent (22%) of children riding with unrestrained adult drivers following a MVC (relative risk 0.29, 95% confidence interval 0.26-0.32). After adjusting for child, vehicle, and crash characteristics, the relative risk of child ED evaluation associated with driver restraint remained significant (relative risk 0.82, 95% confidence interval 0.72-0.94). Driver restraint use was associated with child restraint use, less alcohol/drug involvement, and lower relative risk of severe collision types (head-on, rollover).

Conclusions

Driver seat belt use is associated with decreased risk of ED evaluation for child passengers in the event of a MVC.     

Deaths of teenagers as passengers in motor vehicles

Teenagers far exceed all other ages in fatalities per capita both as drivers and as passengers in motor vehicles. Most studies of vehicle crashes involving teenagers focus on teenage drivers, despite the fact that the numbers of teenage deaths as passengers and as drivers are about equal. In 1978, 63% of all fatally injured teenage passengers sustained their injuries in vehicles driven by teenage drivers: 72% of the passengers fatally injured in vehicles driven by teenage drivers were teenagers. Half of the teenage passenger deaths occurred in nighttime crashes. Possible ways to reduce the crash deaths of teenagers are discussed. These include restricting the driving of teenagers; prohibiting teenage drivers from transporting teenage passengers; greater implementation of crash packaging technologies; cleaning up highway and roadside hazards, and laws requiring seat belt use by teenagers.     

Restraint use and seating position among child car passengers: an observational study in Shanghai

Child passenger restraint practices in China are poorly characterized and few direct observational studies have been performed. This study aims to describe child passenger restraint use and to investigate factors influencing the restraint practices. A cross-sectional observational study was conducted at toll-gates in Shanghai during an 11-day period in June in 2009. A pro-forma observation checklist was used to collect data related to restraint use by child passengers aged ≤12 years, restraint use by drivers, and the number of child passengers traveling in passenger cars registered in Shanghai. Adjusted risk ratios (RR) comparing those children who were properly rear seated with those in other positions (front seat, on adult's lap) and any restraint use with no restraint use were evaluated using multivariate binomial regression with robust variance estimation. Among 967 children observed, 44.1% of children were in suboptimal seating positions (i.e., 12.2% in the front seat and 31.9% in adult laps) and 93.9% were unrestrained. Children aged ≤4 years (RR: 0.35, 95% Confidence Interval: 0.28–0.44), and those who were the only child in a car (RR: 0.84, 95% confidence interval: 0.74–0.96) had a lower likelihood of being properly rear seated. Children traveling with unrestrained drivers (RR: 0.09, 95% confidence interval: 0.01–0.60) were less likely to be restrained. This study demonstrates low restraint use and common suboptimal seating positions for child passengers in China and relates these to driver restraint use. These findings support the need for targeted programs to improve child restraint practices in China.     

Restraint use patterns for older child passengers in Michigan

The purpose of the present study was to conduct the first statewide direct observation survey of restraint use designed specifically for older child passengers (4-15 years of age). We also sought to determine the factors that were related to belt use by older child passengers in Michigan so that effective programs could be developed to promote use of restraint devices in this age group. The study found that older child restraint use was about 58% statewide. Restraint use was highest in regions where overall belt use was higher, when the driver was using a safety belt, in sport utility vehicles and vans/minivans, and in the front-right seating position. No difference in restraint use was found for the day of week, the sex of the child, or the type of site where data was collected. The study provides the largest scale analysis to date on older child occupant restraint use patterns. The data provide some much needed empirical data on the restraint use patterns of older child passengers for development of theory to better understand and predict lack of restraint use in this age group.     

Factors influencing premature graduation from the use of child restraints in Japan

This study examined the association of child passenger restraint use by younger and older children taking into account situational factors and driver/child passenger characteristics. The Japanese national traffic accident data pertaining to children injured in rear-end collisions where the drivers were not-at-fault was analyzed, while applying the quasi-induced exposure method. Multivariate logistic regression analyses were conducted to examine the adjusted effects of predictors for proper restraint use by 0-5, 6-9, and 10-12-year-old children. Unbelted drivers, child's seating position, the number of total occupants, and the child's age were significantly associated with restraint use by both younger and older children. Riding in the rear seats was strongly associated with older SB-age children not being properly restrained, suggesting a link between the lack of booster seat-use requirements and the generally low restraint use rate in rear seats as well as the premature graduation from CRS use in general. The results were discussed in light of other international findings in this field.     

The influence of driver distraction on the severity of injuries sustained by teenage drivers and their passengers

Studies show that teenage drivers are at a higher risk for crashes. Opportunities to engage in technology and non-technology based distractions appear to be a particular concern among this age group. An ordered logit model was developed to predict the likelihood of a severe injury for these drivers and their passenger using a national crash database (the 2003, U.S. DOT-General Estimate System [GES]). As one would expect, speeding substantially increases the likelihood of severe injuries for teenage drivers and their passengers. The results of the analysis also reveal that teenage drivers have an increased likelihood of more severe injuries if distracted by a cell phone or by passengers than if the source of distraction was related to in-vehicle devices or if the driver was inattentive. Additionally, passengers of teenage drivers are more likely to sustain severe injuries when their driver is distracted by devices or passengers than with a non-distracted or inattentive driver. This supports the previous literature on teenage drivers and extends our understanding of injuries for this age group related to distraction-related crashes.     

The effects of seat belts on injury severity of front and rear seat occupants in the same frontal crash

Data on passenger cars in frontal crashes were reviewed using NASS 1980–1991. Only crashes with one or more rear seat passengers were included. Combinations (pairs) were made based on restraint use: lap-shoulder belts in the front seat (or no belts worn) and lap belts, (or belts worn) in the rear seat. Passive belts or child restrained occupants were not included. The AIS was used for injury severity. The data indicate the rear seat to be a safer environment. Lap belted rear seat occupants always fared better than their front seat counterparts.     

Increased risk of driver fatality due to unrestrained rear-seat passengers in severe frontal crashes

While belt usage among rear-seat passengers is disproportionately lower than their front-seat counterpart, this may have serious consequences in the event of a crash not only for the unbelted rear-seat passenger but also for the front-seat passengers as well. To quantify that effect, the objective of the study is to evaluate the increased likelihood of driver fatality in the presence of unrestrained rear-seat passengers in a severe frontal collision. U.S.-based census data from 2001 to 2009 fatal motor vehicle crashes was used to enroll frontal crashes which involved 1998 or later year vehicle models with belted drivers and at least one adult passenger in the rear left seat behind the driver. Results using multivariate logistic regression analysis indicated that the odds of a belt restrained driver sustaining a fatal injury was 137% (95% CI = 95%, 189%) higher when the passenger behind the driver was unbelted in comparison to a belted case while the effects of driver age, sex, speed limit, vehicle body type, airbag deployment and driver ejection were controlled in the model. The likelihood of driver fatality due to an unrestrained rear left passenger increased further (119–197%) in the presence of additional unrestrained rear seat passengers in the rear middle or right seats. The results from the study highlight the fact that future advances to front row passive safety systems (e.g. multi-stage airbag deployment) must be adapted to take into account the effect of unrestrained rear-seat passengers.     

Short-term physical limitations in children following motor vehicle crashes

This study describes frequency of injury and short-term physical limitation among child occupants ≤15 years in motor vehicle crashes and examines the association between age, restraint use, seating position, and type of crash on the presence of physical limitations. Conducted from 1/1/2005–11/30/2007, as part of a child-specific crash surveillance system in 15 U.S. states; data were collected using claims records and parent/driver telephone surveys. Respondents were asked whether children sustained physical limitations from the crash and the duration limitations persisted. Overall, 3.3% had ≥1 physical limitations. Limitations increased with age, from 0.7% for children ≤3 years to 7.6% for adolescents 13–15 years (p < 0.001). Among children with AIS ≥2 injuries, the proportion with physical limitations ranged from 58% to 91% depending on injury diagnosis. Among children with whiplash, 47% resulted in physical limitations. Suboptimally restrained children were nearly twice as likely to have a limitation compared to optimally restrained children. After adjusting for driver characteristics and vehicle type, child's age, restraint use, and type of initial impact were independently associated with the presence of physical limitations. Our results show the importance of assessing children for physical limitations following motor vehicle crashes. We also observed that children with whiplash were at risk for physical limitations.     

The effect of distractions on the crash types of teenage drivers

Teenage drivers are overrepresented in crashes when compared to middle-aged drivers. Driver distraction is becoming a greater concern among this group as in-vehicle devices, opportunities for distractions, and teenage drivers' willingness to engage in these activities increase. The objective of this study was to determine how different distraction factors impact the crash types that are common among teenage drivers. A multinomial logit model was developed to predict the likelihood that a driver will be involved in one of three common crash types: an angular collision with a moving vehicle, a rear-end collision with a moving lead vehicle, and a collision with a fixed object. These crashes were evaluated in terms of four driver distraction categories: cognitive, cell phone related, in-vehicle, and passenger-related distractions. Different driver distractions have varying effects on teenage drivers' crash involvement. Teenage drivers that were distracted at an intersection by passengers or cognitively were more likely to be involved in rear-end and angular collisions when compared to fixed-object collisions. In-vehicle distractions resulted in a greater likelihood of a collision with a fixed object when compared to angular collisions. Cell phone distractions resulted in a higher likelihood of rear-end collision. The results from this study need to be evaluated with caution due to the limited number of distraction related cases available in the U.S. GES crash database. Implications for identifying and improving the reporting of driver distraction related factors are therefore discussed.