Injuries to children in automobiles in relation to seating location and restraint use

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Abstract

Findings in this study are based on 26,971 passengers less than 15 years of age in reported crashes in 1967 and later model year automobiles in North Carolina during calendar years 1973 and 1974. (1) Children least likely to be injured in crashes are restrained and in the back seat; those most likely to be injured are unrestrained and are in the front seat. Unrestrained children in the front right seat have the highest injury rate. (2) More than 90% of the children in the surveyed crashes were found unprotected by restraints—paralleling earlier findings for those in cars in general. (3) Back seat location reduced the injury rate by 28% among unrestrained children and 18% among restrained children. Use of restraints reduced the injury rate by 39% in the front seat and 31% in back. (4) Among unrestrained children, back seat location is advantageous for both males and females, for both younger and older children, and in automobiles of various sizes. The advantage of back seat location is most pronounced in frontal impacts.

Laws in several European countries regarding belt use and seating location, by in effect forbidding restraint use by some children, may increase the likelihood that those children will be injured in crashes. It is recommended that in automobiles presently on the road without automatic restraints such as air cushions, children be restrained, preferably in the back seat, and that they never travel unrestrained in the front seat.

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      The 44% reduction in the risk of death for restrained rear-seated passengers in our study is identical to that previously reported in a study based on the double pair method that assessed the effectiveness of back seat outboard lap/shoulder belts (Morgan, 1999). Although many previous studies detected a decreased risk of death or severe injury for rear-seated passengers in comparison to front-seated ones (Evans and Frick, 1988; Huelke and Compton, 1995; Smith and Cummings, 2004), particularly in the case of children (Automotive Coalition for Traffic Safety, 2003; Berg et al., 2000; Braver et al., 1998; Durbin et al., 2005; Glass et al., 2000; Petridou et al., 1998; Williams and Zador, 1977), few studies have examined the differences between specific rear-seat positions (Braver et al., 1998; Evans and Frick, 1988; Lund, 2005). Although the present study is not directly comparable with them, our results are in partial agreement with studies that detected a lower risk for the central rear position in comparison to either of the outboard positions (Braver et al., 1998; Evans and Frick, 1988) and also with the higher risk related with the left-rear seating position described by O’Donnell and Connor (1996).

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      Existing literature also suggests that seating position has an effect on the injury and fatality rate of motor vehicle passengers. Several studies have shown that occupants in rear seating positions have a reduced risk of fatality and injury when compared to front seated occupants (Williams and Zador, 1977; Glass et al., 2000; Evans and Frick, 1988). Most recently, Smith and Cummings (2004) estimated that a rear seating position reduces the risk of death by about 39% and the risk of death or serious injury by 33%.

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      Baker et al. (1998) found that the death rate per billion vehicle-miles traveled was 60% higher for Hispanic children aged 5–12 compared to non-Hispanic white children. Seating children in the back seat of motor vehicles has been shown to reduce the risk of injury or fatality in a crash (Williams and Zador, 1977; Huelke and Lawson, 1978; Evans and Frick, 1988; Berg et al., 2000; Glass et al., 2000; Durbin et al., 2001; Winston et al., 2001). Braver et al. (1998) found that the fatality risk was 36% lower for children aged 12 and under seated in back compared to those seated in front (95% CI for RR 1.49–1.64).

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    The data reported in this study were obtained from the University of North Carolina Highway Safety Research Center in the form of cross-tabulations. We are indebted to B.J. Campbell and Eric Rodgman for their cooperation and assistance in providing these data. This report does not necessarily reflect the views of the University of North Carolina Highway Safety Research Center.

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