Front versus Rear Seat Injury Risk for Child Passengers: Evaluation of Newer Model Year Vehicles

Abstract

Objective: Design improvements to frontal air bags for vehicles of model year 1998 and newer have reduced the risk of injury to child occupants exposed to their deployment. These changes in conjunction with other improvements in the protection of front seat occupants give impetus for the reconsideration of rear seating recommendations for child occupants. Thus, the objective of this study was to evaluate the association between seating row (front vs. rear) and risk of injury to children in newer model year vehicles. Methods: Data was collected on child occupants from December 1, 1998, to November 30, 2007, via insurance claim records and a validated telephone survey. The study sample included child occupants aged 0 to 15 years seated in the front and rear rows of vehicles model year 1998 or newer, involved in a crash in sixteen states. Children were classified as injured if a parent or driver reported an injury corresponding with Abbreviated Injury Scale scores of ≥2. The age-specific relative risk of injury by seat row was calculated for the whole data set and then further stratified by model year. Results: Complete interview data were obtained on 10,670 crashes involving 16,920 children, representing an estimated 205,408 crashes with 314,968 child passengers in the study population. The adjusted relative risk of injury to children in the rear seat compared to those in the front was 0.36 (0.23–0.57) and 0.69 (0.49–0.98) for 0- to 8-year-olds and 9- to 12-year-olds, respectively. For 13- to 15-year-olds, the reduced injury risk associated with rear row seating narrowly missed statistical significance. When stratified by model year (1998 to 2002 and 2003+), all age group/model year combinations demonstrated a crude rear row injury risk that was lower than that of the front row. Conclusions: This analysis, conducted on a set of vehicles with advanced front seat safety systems including second-generation and newer air bags, strongly confirmed the recommendation that all children 0–12 years should be seated in the rear row(s) of their vehicles. Children in the rear row(s) were one half to two thirds as likely to sustain injury than those in the front after adjusting for potentially confounding crash, vehicle, and child factors.