Adults and children in severe motor vehicle crashes: A matched-pairs study

Study objective: Many articles report seat belt injuries to children. This study examines the effect of child versus adult age and seat belt use on ou tcome in severe motor vehicle crashes. Methods: A population-based data set of all motor vehicle crashes statewide was analyzed by using matched-pairs logistic regression. Subjects were par ticipants in motor vehicle crashes in which at least one occupant was kille d or hospitalized and at least one was a child (age <15 years). Only passen gers in cars, vans, and the front of light trucks were considered. Unique m atched pairs were formed of one adult and one child from the same vehicle. The main outcome measure was death or hospitalization. Covariates were seat belt use and front or back seat position. Results: Overall, 413 pairs were analyzed. Seat belt use in these severe cr ashes was low for children and adults (40% versus 45%). Children more often sat in the back seat (74% versus 31% for adults). Risk of death was simila r (7% for children and 8% for adults), but the percentage killed or hospita lized differed (13% for children and 28% for adults; odds ratio [OR] 2.5; 9 5% confidence interval [CI] 1.8 to 3.7). After controlling for seat belt us e and seat position, adults remained at a similarly increased risk compared with children (OR 2.6; 95% CI 1.6 to 4.2). The back seat was much safer th an the front seat (OR 5.5; 95% CI 3.7 to 8.1). An adult's nonuse of restrai nts was strongly predictive of a child's nonuse. Conclusion: Seat belts were at least as protective for children as for adul ts, but only 40% of the children in these severe crashes were restrained.