CHILDREN IN CAR CRASHES - ANALYSIS OF DATA FOR INJURY AND USE OF RESTRAINTS

Objective. To determine the effect of car restraints on motor vehicle injury rates for children aged 0 to 14 years. Methods. A probability s ample 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. Resu lts. 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 wa s 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 stron gest 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 i njuries by 606 for 0 to 4 year olds, whereas the lap shoulder harness was only 38% effective for 5 to 14 year olds (P less than or equal to .001) Injury rates of unrestrained 0 to 4 and 5 to 14 year olds were s imilar. Conclusions. Greater involvement in car crashes and less use o f car restraints explains the 64% higher rate of injury for 3 year old s than for infants. It is time to target the toddlers. Restraints desi gned for adults are not as effective for the school age child as car s eats are for the preschool child. A better restraint for the school ag e child should be designed and evaluated. Meanwhile, increased usage o f current restraints must be encouraged, as they substantially reduce injuries.