Factors Affecting Child Injury Risk in Motor-Vehicle Crashes
Published March 31, 2020 by The Stapp Association in United States
This content contains downloadable datasetsAnnotation ability available
Current recommendations for restraining child occupants are based on biomechanical testing and data from national and international field studies primarily conducted prior to 2011. We hypothesized that analysis to identify factors associated with pediatric injury in motor-vehicle crashes using a national database of more recent police-reported crashes in the United States involving children under age 13 where type of child restraint system (CRS) is recorded would support previous recommendations. Weighted data were extracted from the National Automotive Sampling System General Estimates System (NASS-GES) for crash years 2010 to 2015. Injury outcomes were grouped as CO (possible and no injury) or KAB (killed, incapacitating injury, non-incapacitating injury). Restraint was characterized as optimal, suboptimal, or unrestrained based on current best practice recommendations. Analysis used survey methods to identify factors associated with injury. Factors with significant effect on pediatric injury risk include restraint type, child age, driver injury, driver alcohol use, seating position, and crash direction. Compared to children using optimal restraint, unrestrained children have 4.9 (13-year-old) to 5.6 (< 1-year-old) times higher odds of injury, while suboptimally restrained children have 1.1 (13-year-old) to 1.9 (< 1-year-old) times higher odds of injury. As indicated by the differences in odds ratios, effects of restraint type attenuate with age. Results support current best practice recommendations to use each stage of child restraint (rear-facing CRS, forward-facing harnessed CRS, belt-positioning booster seat, lap and shoulder belt) as long as possible before switching to the next step.
- Marco Benedetti - University of Michigan Transportation Research Institute
- Kathleen D. Klinich - University of Michigan Transportation Research Institute
- Miriam A. Manary - University of Michigan Transportation Research Institute
- Carol A. C. Flannagan - University of Michigan Transportation Research Institute
CitationBenedetti, M., Klinich, K., Manary, M., and Flannagan, C., "Factors Affecting Child Injury Risk in Motor-Vehicle Crashes," SAE Technical Paper 2019-22-0008, 2020, https://doi.org/10.4271/2019-22-0008.
Data Sets - Support Documents
|[Unnamed Dataset 1]|
|[Unnamed Dataset 2]|
|[Unnamed Dataset 3]|
|[Unnamed Dataset 4]|
|[Unnamed Dataset 5]|
|[Unnamed Dataset 6]|
- Baratta, R., Solomonow, M. (1991) The effect of tendon viscoelastic stiffness on the dynamic performance of isometric muscle. Journal of Biomechanics 24(2): 1647-1652.
- Goldstein, S., Frankenburg, E., and Kuhn, J. (1993) Biomechanics of bone. In Accidental Injury: Biomechanics and Prevention, ed. A.M. Nahum and J.W. Melvin, pp. 198-223. Springer-Verlag, New York.
- Letournel, E., and Judet, R. (1993) Fractures of the acetabulum. Springer-Verlag, New York.
- Reber, J.G. (1978) Lumped parameter model of whiplash. MS Thesis, University of California, Berkeley.
- Shreiber, D.I., Bain, A.C., and Meaney, D.F. (1997) In vivo thresholds for mechanical injury to the blood-brain barrier. Proc. 41st Stapp Car Crash Conference, pp. 277-292. Society of Automotive Engineers, Warrendale, PA.
- Stitzel, J.D., Duma, S.M., Cormier, J.M., and Herring, I.P. (2002) A nonlinear finite element model of the eye with experimental validation for the prediction of globe rupture. Stapp Car Crash Journal 46: 81-102.
- American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention. (2001) Policy Statement: Child passenger safety. Pediatrics 127:788-793.
- Arbogast, K.B., Durbin, D.R., Cornejo, R.A., Kallan, M. F., Winston, F. K. (2004) An evaluation of the effectiveness of forward facing child restraint systems. Accident Analysis and Prevention 36(4):585-589.
- Arbogast, K.B., Jermakian, J.S., Kallan, M.F., Durbin, D.R. (2009) Effectiveness of belt positioning booster seats: an updated assessment. Pediatrics 124:1281-1286.
- Arbogast, K.B., Kallan, M.J., Durbin, D.R. (2005) Effectiveness of high back and backless belt-positioning booster seats in side impact crashes. Association for the Advancement of Automotive Medicine Proceedings 49: 201-213.
- Bae, J.Y., Anderson, E., Silver, D., Macinko, J. (2014) Child passenger safety laws in the United States, 1978-2010: Policy diffusion in the absence of strong federal intervention. Social Science and Medicine 100:30-37.
- Benedetti, M., Klinich, K.D., Manary, M.A., Flannagan, C.A. (2017) Predictors of restraint use among child occupants. Traffic Injury Prevention 1-4. doi:10.1080/15389588.2017.1318209.
- Bondy, N. and Glassbrenner, D. (2001) National Occupant Protection Use Survey - 2000 Controlled Intersection Study. (Report No. DOT HS 809 318) Washington, DC: National Highway Traffic Safety Administration.
- Compton, C.P. (2005) Injury severity codes: a comparison of police injury codes and medical outcomes as determined by NASS CDS investigators. Journal of Safety Research 36(5):483-484.
- Daly, L., Kallan, M.J., Arbogast, K.B., Durbin, D.R. (2006) Risk of injury to child passengers in sport utility vehicles. Pediatrics 117(1):9-14.
- Durbin, D.R., Chen, I., Smith, R., Elliott, M.R., Winston, F.K. (2005) Effects of seating position and appropriate restraint use on the risk of injury to children in motor vehicle crashes. Pediatrics 115(3):e305-e309.
- Durbin, D.R., Jermakian, J.S., Kallan, M.J., McCartt, A.T., Arbogast, K.B., Zonfrillo, M.R., Myers, R.K. (2015) Rear seat safety: variation in protection by occupant, crash and vehicle characteristics. Accident Analysis and Prevention 80:185-192.
- Eichelberger, A.H., Chouniard, A.O., Jermakian, J.S. (2012) Effects of booster seat laws on injury risk among children in crashes. Traffic Injury Prevention 13(6):631-639. doi:10.1080/15389588.2012.660663.
- Elliott, M.R., Kallan, M.J., Durbin, D.R., Winston, F.K. (2006) Effectiveness of child safety seats vs seat belts in reducing risk for death in children in passenger vehicle crashes. Archives of Pediatric and Adolescent Medicine 160(6):617-621.
- Farmer, C.M. (2003) Reliability of police-reported information for determining crash and injury severity Traffic Injury Prevention 4(1): 38-44.
- Farmer, P., Howard, A., Rothman, L., Macpherson, A. (2009) Booster seat laws and child fatalities: a case-control study. Injury Prevention 15(5):348-350. doi:10.1136/ip.2008.021204.
- Flannagan, C.A. (2013) A method for estimating delta-V distributions from injury outcomes in crashes. UMTRI-2013-15. University of Michigan Transportation Research Institute. Ann Arbor, MI.
- Greenland, S. and Thomas, D.C. (1982) On the need for the rare disease assumption in case-control studies. American Journal of Epidemiology 116(3): 547-553.
- Henary, B., Sherwood, C.P., Crandall, J.R., Kent, R. W., Vaca, F.E., Arbogast K.B., Bull, M.J. (2007) Car safety seats for children: rear facing for best protection. Injury Prevention 13:398–402. doi:10.1136/ip.2006.015115.
- Isaksson-Hellman, I., Jakobsson, L., Gustafsson, C., Norin, H. (1997) Trends and effects of child restraint systems based on Volvo’s Swedish accident database. SAE 973299. Child Occupant Protection 2nd Symposium. Society of Automotive Engineers, Warrendale, PA, 43-54.
- Jakobsson, L., Wiberg, H., Isaksson-Hellman, I., Gustafsson, J. (2007) Rear seat safety for the growing child––a new 2-state integrated booster cushion. Proceedings of the Enhanced Safety of Vehicles Conference, Paper Number 07-0322, National Highway Traffic Safety Administration.
- Jones, L.E., Ziebarth, N.R. (2017) U.S. child safety seat laws: are they effective, and who complies? Journal of Policy Analysis and Management 36(3):584-607.
- Kallan, M.J., Arbogast, K.B., Elliott, M.R., Durbin, D.R. (2009) Non-fatal and fatal crash injury risk for children in minivans compared with children in sport utility vehicles. Injury Prevention 15(1):8-12.
- Kelley-Baker, T., Romano, E. (2014) Child passengers killed in reckless and alcohol related motor vehicle crashes. Journal of Safety Research;48:103-110.
- Klinich, K.D., Benedetti, M., Manary, M.A., Flannagan, C.A. (2016) Rating child passenger safety laws relative to best practices for child occupant protection Traffic Injury Prevention, 18(4):406-411. doi:10.1080/15389588.2016.1203427. Epub 2016 Aug 30
- Kononen, D., Flannagan, C.A., Wang, S. (2011) Identification and validation of a logistic regression model for predicting serious injuries associated with motor vehicle crashes. Accident Analysis and Prevention 43(1):112-122.
- Lee, L.K., Monuteaux, M.C., Burghardt, L.C., Fleegler, E.W., Nigrovic, L.E., Meehan, W.P., Schultzman, S.A., Mannix, R. (2015) Motor vehicle crash fatalities in states with primary versus secondary seat belt laws: A time-series analysis. Annals of Internal Medicine 163(3):184-190. doi:10.7326/M14-2368.
- Li, H. R., Pickrell, T. M., and Shova, K.C. (2016) The 2015 National Survey of the Use of Booster Seats (Report No. DOT HS 812 309). Washington, DC: National Highway Traffic Safety Administration.
- Little, R.J.A., Rubin, D.B. (2002) Statistical analysis with missing data. 2. New York: John Wiley & Sons.
- Mannix, R., Fleegler, E., Meehan III, W.P., Schultzman, S.A., Hennelly, K., Nigrovic, L., Lee, L.K. (2012) Booster seat law and fatalities in children 4 to 7 years of age. Pediatrics 130(6):996-1002 doi:10.1542/peds.2012-1058.
- Margolis, L.H., Foss, R.D., Tolbert, W.G. (2000) Alcohol and motor vehicle-related deaths of children as passengers, pedestrians, and bicyclists. Journal of the Ameican Medical Association 283:2245-2248.
- McDonald, G., Davie, G., Langley, J. (2009) Validity of police-reported information on injury severity for those hospitalized from motor vehicle traffic crashes. Traffic Injury Prevention 10(2):184-190. doi:10.1080/15389580802593699
- McMurry, T.L., Arbogast, K.B., Sherwood, C.P., Vaca, F., Bull, M., Crandall, J.R., Kent, R.W. (2018) Rear-facing versus forward-facing child restraints: an updated assessment. Injury Prevention 24:55-59.
- NASS-FARS. People/PeopleAllVictims.aspx, accessed July 25, 2017.
- National Highway Traffic Safety Administration. Car seat recommendations for children. (2011) http://www.safercar.gov/parents/Car-Seat-Safety.htm Publication 10849b-090814-v2.
- National Safety Council. (1996) Manual on the Classification of Motor Vehicle Traffic Accidents Sixth Edition (ANSI D 16.1–1996). Itasca, IL: National Safety Council.
- National Highway Traffic Safety Administration (2015) National Automotive Sampling System (NASS) General Estimates System (GES) analytical user’s manual 1988–2014 (Report No. DOT HS 812 215) Washington, DC. Available at www-nrd.nhtsa.dot.gov/Pubs/812215.pdf
- Pressley, J.C., Trieu, L., Barlow, B., Kendig, T. (2009) Motor vehicle occupant injury and related hospital expenditures in children aged 3 years to 8 years covered versus uncovered by booster seat legislation. Journal of Trauma 67(1 Suppl):S20-S29 doi:10.1097/TA.0b013e3181951a90.
- Quinlan, K.P., Brewer, R.D., Sleet, D.A., Dellinger, A.M. (2000) Characteristics of child passenger deaths and injuries involving drinking drivers. Journal of the American Medical Association 283(17):2249–2252.
- Sauber-Schatz, E.K., West, B.A., Bergen, G.B. (February 7, 2014) Vital signs: restraint use and motor vehicle occupant death rates among children aged 0–12 years - United States, 2002–2011. Morbidity and Mortality Weekly Report 63(05):113-118.
- Sun, K., Bauer, M.J., Hardman, S. (2010) Effects of upgraded child restraint law designed to increase booster seat use in New York. Pediatrics 126(3):484-489. doi:10.1542/peds.2010-0249.
- Watson, A., Watson, B., Vallmuur, K. (2015) Estimating underreporting of road crash injuries to police using multiple linked data collections. Accident Analysis and Prevention 83:18-25. doi:10.106/j.aap.2015.06.011.
- Winston, F.K., Kallan, M.J., Elliott, M.R., Menon, R.A., Durbin, D.R. (2002) Risk of injury to child passengers in compact extended-cab pickup trucks. Journal of the American Medical Association 287(9):1147-1152.
- Wolf, L., Chowdhury, R., Tweed, J., Vinson, L., Losina, E., Haider, A. H., Quereshi, F. G. (2017) Factors associated with pediatric mortality from motor vehicle crashes in the United States: A state-based analysis. Journal of Pediatrics 187:295 - 302.e3. doi:10.1016/j.jpeds.2017.04.044.
- Zaloshnja, E., Miller, T.R., Hendrie, D. (2007) Effectiveness of child safety seats vs safety belts for children aged 2 to 3 years. Archives of Pediatric and Adolescent Medicine 161(1):65-68.