Motor Vehicle Occupant Injuries Research Articles

In-Person and Telehealth Behavioral Skills Training to Reduce Child Restraint System Misuse

ABSTRACT One of the leading causes of hospitalizations and fatalities for children in the United States is motor vehicle occupant injury. Risks are reduced when child restraint systems are properly used. However, child restraint system misuse is a continuing public health problem. A longitudinal quasi-experimental within-subjects group design was used across two experiments that recruited 2,448 paired participants to educate proper use of their child restraint system. Experiment one participants were randomly assigned to a behavior skills training or traditional training group. Results demonstrated that behavioral skills training participants reduced misuse more effectively than traditional training. Experiment two participants were assigned to a behavioral skills training in-person or virtual telehealth group. Results confirmed both groups were equally as effective in reducing misuse. A 9-month evaluation validated long-term maintenance of behavioral skills training to reduce misuse. This study demonstrates a method to improve certified child passenger safety training programs to reduce misuse.

Risk Factors and Inequities in Transportation Injury and Mortality in the Canadian Census Health and Environment Cohorts (CanCHECs).

Road traffic injury contributes substantially to morbidity and mortality. Canada stands out among developed countries in not conducting a national household travel survey, leading to a dearth of national transportation mode data and risk calculations that have appropriate denominators. Since traffic injuries are specific to the mode of travel used, these risk calculations should consider travel mode. Census data on mode of commute is one of the few sources of these data for persons aged 15 and over. This study leveraged a national data linkage cohort, the Canadian Census Health and Environment Cohorts, that connects census sociodemographic and commute mode data with records of deaths and hospitalizations, enabling assessment of road traffic injury associations by indicators of mode of travel (commuter mode). We examined longitudinal (1996-2019) bicyclist, pedestrian, and motor vehicle occupant injury and fatality risk in the Canadian Census Health and Environment Cohorts by commuter mode and sociodemographic characteristics using Cox proportional hazards models within the working adult population. We estimated positive associations between commute mode and same mode injury and fatality, particularly for bicycle commuters (hazard ratios for bicycling injury was 9.1 and for bicycling fatality was 11). Low-income populations and Indigenous people had increased injury risk across all modes. This study shows inequities in transportation injury risk in Canada and underscores the importance of adjusting for mode of travel when examining differences between population groups.

Pooling data from fatality analysis reporting system (FARS) and generalized estimates system (GES) to explore the continuum of injury severity spectrum

Fatality Analysis Reporting System (FARS) and Generalized Estimates System (GES) data are most commonly used datasets to examine motor vehicle occupant injury severity in the United States (US). The FARS dataset focuses exclusively on fatal crashes, but provides detailed information on the continuum of fatality (a spectrum ranging from a death occurring within thirty days of the crash up to instantaneous death). While such data is beneficial for understanding fatal crashes, it inherently excludes crashes without fatalities. Hence, the exogenous factors identified as critical in contributing (or reducing) to fatality in the FARS data might possibly offer different effects on non-fatal crash severity levels when a truly random sample of crashes is considered. The GES data fills this gap by compiling data on a sample of roadway crashes involving all possible severity consequences providing a more representative sample of traffic crashes in the US. FARS data provides a continuous timeline of the fatal occurrences from the time to crash – as opposed to considering all fatalities to be the same. This allows an analysis of the survival time of victims before their death. The GES, on the other hand, does not offer such detailed information except identifying who died in the crash. The challenge in obtaining representative estimates for the crash population is the lack of readily available “appropriate” data that contains information available in both GES and FARS datasets. One way to address this issue is to replace the fatal crashes in the GES data with fatal crashes from FARS data thus augmenting the GES data sample with a very refined categorization of fatal crashes. The sample thus formed, if statistically valid, will provide us with a reasonable representation of the crash population.This paper focuses on developing a framework for pooling of data from FARS and GES data. The validation of the pooled sample against the original GES sample (unpooled sample) is carried out through two methods: (1) univariate sample comparison and (2) econometric model parameter estimate comparison. The validation exercise indicates that parameter estimates obtained using the pooled data model closely resemble the parameter estimates obtained using the unpooled data. After we confirm that the differences in model estimates obtained using the pooled and unpooled data are within an acceptable margin, we also simultaneously examine the whole spectrum of injury severity on an eleven point ordinal severity scale – no injury, minor injury, severe injury, incapacitating injury, and 7 refined categories of fatalities ranging from fatality after 30 days to instant death – using a nationally representative pooled dataset. The model estimates are augmented by conducting elasticity analysis to illustrate the applicability of the proposed framework.

Effects of Increasing Child Restraint Use in Reducing Occupant Injuries Among Children Aged 0–5 Years in Japan

Objectives: In Japan, child restraint use among preschool children started to increase before compulsory child restraint use for children aged 0–5 years was introduced by legislation in April 2000. This study determined the effects of increased child restraint use in reducing motor vehicle occupant injuries among children aged 0–5 years.Methods: We obtained monthly police data of child vehicle occupant injuries from 1990 to 2009. We calculated monthly ratios of morbidity rates per population of children aged 0–5 years to those of children aged 6–9 years. Time trends of the morbidity rate ratios were analyzed using a joinpoint regression model to determine whether there were trend changes in child occupant injuries and when they occurred if there were trend changes.Results: The morbidity rate ratios showed a slightly increasing trend of 0.03% per month (95% confidence interval [CI], −0.02% to 0.09%) until the change-point in December 1997 (95% CI, July 1996 to January 1999), which then changed to a decreasing trend of −0.14% per month (95% CI, −0.16 to −0.11), with an overall trend change of −0.17% (95% CI, −0.23 to −0.11). No change-point was identified in or around April 2000 when compulsory restraint use was introduced.Conclusions: The present study used comparative indicators relative to age groups that were not covered by the legislation and showed that a decreasing trend of occupant morbidity among children aged 0–5 years started before the introduction of compulsory restraint use. This change probably reflects the prelegislative voluntary increase in child restraint use.

Causes and Trends in Traumatic Brain Injury for United States Adolescents

Traumatic brain injury (TBI) is a leading cause of death and disability among United States adolescents. The authors sought to determine causes and trends for TBI-related hospitalizations in the United States adolescent population (10-19 years). The authors identified common causes and trends of adolescent TBI, overall and within 2-year age categories, using hospitalization data from 2005 to 2009 in the Nationwide Inpatient Sample. The leading cause of adolescent TBI overall was motor vehicle occupant accidents (35%), which are also the leading cause in the 14-15, 16-17, and 18-19 year age groups. Falls were the cause of most TBI in the 10-11 year (23%) and 12-13 year (20%) age groups. For both unintentional and intentional mechanisms of injury, there was evidence of increasing hospitalizations with increasing age. From 2005 to 2009, the overall annual incidence of adolescent TBI hospitalizations decreased 21% from an estimated 75.5-59.3 per 100,000 (p<0.001). These rates declined for mild, moderate, and severe TBI, and decreased for 2-year age groups, except for the 18-19 year-old group. For TBI attributable to motor vehicle occupants, rates declined 27% from 27.6 to 20.2 per 100,000 (p<0.001). Motor vehicle occupant injuries account for 42% of in-hospital mortality from adolescent TBI; however, firearms are the most lethal mechanism with 46% proportional mortality among victims of firearm-related TBI. Rates of adolescent TBI-related hospitalizations have decreased overall. Motor vehicle accidents and firearms were identified as leading causes of injury and mortality for adolescent TBI, and represent potential targets for intervention.

Wishful thinking

Motor vehicle occupant injury is a significant source of morbidity and mortality among children. Correctly used child safety seats (CSSs) substantially reduce injury morbidity and mortality. The objective of this study was to describe how parents learn to use and install CSS at newborn discharge. We prospectively enrolled maternal/newborn infant dyads at discharge from a large urban teaching hospital. Survey data included maternal demographics and parental knowledge on CSS installation. After survey completion, a certified child passenger safety technician observed and recorded CSS information, infant placement in CSS, and CSS placement in vehicle. Nine specific misuse categories were recorded. A total of 101 mothers were enrolled, with mean age 29.4 years (15-45 years); 52% were white, 18% were black, and 27% were Hispanic; 50% had college degree or higher; and 41% were privately insured. We observed 254 CSS errors (range, 0-7; mean, 2.5). There were 52% infant placement in CSS misuse errors (range 0-4; mean, 1.3), and 48% CSS placement in vehicle misuse errors (range, 0-4; mean, 1.2). The CSS placement misuse included 29% CSS not attached to vehicle. More frequent misuse occurred among non-white, non-college-educated mothers (p < 0.01).There was no difference in misuse related to how, when, and where mothers learned about CSS installation. Despite national, state, and hospital policies that require newborns to be transported in a CSS, we found a significant number of concerning CSS misuse in our study population. These results highlight the need for improved CSS education starting with the first ride home. Therapeutic study, level III.

Injury-related hospital admissions of military dependents compared with similarly aged nonmilitary insured infants, children, and adolescents

Military deployment of one or both parents is associated with declines in school performance, behavioral difficulties, and increases in reported mental health conditions, but less is known regarding injury risks in pediatric military dependents. Kid Health Care Cost and Utilization Project 2006 (KID) was used to identify military dependents aged 0.1 year to 17 years through expected insurance payer being CHAMPUS, Tricare, or CHAMPVA (n = 12,310) and similarly aged privately insured nonmilitary in CHAMPUS, Tricare, or CHAMPVA states (n = 730,065). Mental health diagnoses per 1,000 hospitalizations and mechanisms of injury per 1,000 injury-related hospitalizations are reported. Unweighted univariate analyses used Fisher's exact, χ(2), and analysis of variance tests for significance. Odds ratios are age and sex adjusted with 95% confidence intervals. Injury-related admissions were higher in military than in nonmilitary dependents (15.5% vs. 13.2%, p < 0.0001). Age- and sex-adjusted motor vehicle occupant and pedestrian injuries were significantly lower in all-age military dependents but not in age-stratified categories. Very young military dependents had higher all-cause injury admissions (p < 0.0001), drowning/near drowning (p < 0.0001), and intracranial injury (p < 0.0001) and showed a tendency toward higher suffocation (p = 0.055) and crushing injury (p = 0.065). Military adolescents and teenagers had higher suicide/suicide attempts (p = 0.0001) and poisonings from medicinal substances (p = 0.0001). Mental health diagnoses were significantly higher in every age category of military dependents. All-cause in-hospital mortality tended to be greater in military than in nonmilitary dependents (p = 0.052). This study suggests that military dependents are a vulnerable population with special needs and provides clues to areas where injury prevention professionals might begin to address their needs. Prognostic/epidemiologic study, level II.

Neighborhood Social Inequalities in Road Traffic Injuries: The Influence of Traffic Volume and Road Design

We examined the extent to which differential traffic volume and road geometry can explain social inequalities in pedestrian, cyclist, and motor vehicle occupant injuries across wealthy and poor urban areas. We performed a multilevel observational study of all road users injured over 5 years (n=19,568) at intersections (n=17,498) in a large urban area (Island of Montreal, Canada). We considered intersection-level (traffic estimates, major roads, number of legs) and area-level (population density, commuting travel modes, household income) characteristics in multilevel Poisson regressions that nested intersections in 506 census tracts. There were significantly more injured pedestrians, cyclists, and motor vehicle occupants at intersections in the poorest than in the richest areas. Controlling for traffic volume, intersection geometry, and pedestrian and cyclist volumes greatly attenuated the event rate ratios between intersections in the poorest and richest areas for injured pedestrians (-70%), cyclists (-44%), and motor vehicle occupants (-44%). Roadway environment can explain a substantial portion of the excess rate of road traffic injuries in the poorest urban areas.

Neighborhood-level built environment and social characteristics associated with serious childhood motor vehicle occupant injuries

The effect of residential neighborhood characteristics on a child's risk of serious motor vehicle traffic occupant injuries was evaluated in New York State, USA, for the years 1993–2003, with particular focus on the effect of neighborhood walkability. Risk increased significantly ( p<0.0001) with decreasing street connectivity and as more workers commuted more than 30 min using means other than public transportation, along with more single-parent households and less college attainment in the neighborhood, regardless of whether New York City was in the study. After adjusting for age, gender and socio-economic community factors, the apparent loss of walkability in a child's neighborhood increases their risk of serious injury as an occupant of a motor vehicle.

The introduction of booster seat legislation in Canada: is it working?

BackgroundBooster seat legislation may decrease the burden of motor vehicle occupant injury in children 4–9 years old.MethodsWe examined rates of hospitalisations for motor vehicle (MV) occupant-related injuries, seatbelt-related injuries and...

Recent increases in fatal and non-fatal injury among people aged 65 years and over in the USA

ObjectiveTo identify recent increases in mortality and morbidity rates from injuries among Americans aged 65 years and over.DesignA longitudinal analysis of mortality and morbidity data on injuries in the elderly,...

Motor Vehicle Occupant Injury and Related Hospital Expenditures in Children Aged 3 Years to 8 Years Covered Versus Uncovered by Booster Seat Legislation

Although most states have infant restraint laws, booster seat legislation for older children has not been implemented universally despite evidence of effectiveness. We examined injury and expenditures for motor vehicle traffic (MV) occupant injury among 3 year to 8 year olds covered versus uncovered by booster seat legislation. Age, state of residence/hospitalization, and month of injury were used to examine injury, deaths, and expenditures due to MV occupant injury in children covered versus uncovered by booster seat legislation. Data sources included Kids Inpatient Database 2003 and Web-based Injury Statistics Query and Reporting System. Statistical analyses used chi, Fisher's exact, and analysis of variance. Odds ratios were calculated with 95% confidence intervals (CI). Children covered by booster seat legislation were less likely to be hospitalized for MV occupant injury than uncovered children (odds ratio, 0.78; 95% CI, 0.69-0.88). MV occupant injury constituted a smaller proportion of total injury expenditures in children covered (4.9%) versus uncovered (6.9%) by booster seat legislation. Covered children residing in areas with zip code incomes above the median had 26% lower MV occupant/total injury (p = 0.001) compared with 13% lower MV occupant/total injury for those below the median income (p = 0.0712). The proportion of injury dollars spent for MV occupant injury was higher in self-pay children for covered (7.8%) and uncovered (8.9%) children. This study suggests that booster seat laws are associated with a lower proportion of injury expenditures for MV occupant injuries in booster seat-aged children. Observed income disparities raise questions regarding whether access to booster seats, quality of affordable seats, and proper use and/or enforcement strategies impede legislative effectiveness.

Factors Influencing Booster Seat Use in a Multiethnic Community: Lessons for Program Implementation

Based on the local incidence and severity of motor vehicle occupant injuries, the authors' community and hospital injury prevention partnership identified child passenger safety for 4-to-8-year-old children as a priority. They designed a booster seat promotion campaign using an integrated social cognition model of health behavior. A series of focus groups were held with low-income African American, Somali, and Vietnamese parents to understand determinants of booster seat use in these communities. Deficits in understanding about the purpose of booster seats were seen in all groups, and concerns about cost and self-efficacy varied in important ways. Although legislation is an important tool in motivating child passenger restraint, most families saw safety as the prime reason to use booster seats with their children. These results illustrate the use of qualitative data to adapt a theory-based intervention to the needs of specific communities.

Severe injury mechanisms in two paediatric trauma centres: Determination of prevention priorities

To meet community needs, injury prevention programs for children should be targeted to trends in objective data on mechanisms of injury. The aim of the present study was to identify the most important severe injury mechanisms. The present study retrospectively reviewed severe paediatric trauma patients in two regional trauma centres. Injury prevention priority scores were computed using different severity measures - injury severity score (ISS), revised trauma score, trauma-related injury severity score, Glasgow Coma Scale (GCS) and mortality - to identify prevention priorities. A total of 3732 children with severe injury were identified; mean age (+/-SD) was 9.0+/-5.2 years and 2469 (66.2%) were boys. The GCS was 7 or lower in 209 patients (5.6%) and the median ISS was 9. Overall, there were 77 deaths (2.1%). 'Fall from height' was the most frequent mechanism of injury, and 'motor vehicle traffic injury' resulted in the most severe injury. The most significant mechanisms of injury, using ISS, were 'fall from height', 'motor vehicle traffic injury', 'pedestrian struck by motor vehicle', 'bicycle injuries' and 'child abuse'. Different priorities were identified depending on the severity measures used - 'fall from height' would be the priority with ISS, revised trauma score and trauma-related injury severity score; 'motor vehicle traffic injury' with mortality and 'drowning/submersion' with GCS. 'Fall from height' was the highest ranked mechanism of injury in one centre compared with 'motor vehicle traffic injury' in the other. Younger children tended to have injuries as a result of falls, while adolescents had more motor vehicle occupant injuries. Failure to use safety devices, such as helmets and seat belts, was a common finding among severely injured children. The present study shows that the severe injury prevention priorities identified vary depending on the severity measures used. The variations seen across age groups and between the two centres are also important factors that must be taken into account when developing prevention programs or considering research initiatives.

The epidemiology of pregnancy-associated emergency department injury visits and their impact on birth outcomes

Objective Describe the demographics, injury types, mechanisms, and intents of emergency department (ED) injury visits by pregnant women and to quantify their risk of adverse birth outcomes. Methods Through a retrospective cohort study design, Utah ED, birth, and fetal death records were probabilistically linked to identify women seen in an ED with an injury during pregnancy among births and fetal deaths from 1999 to 2002. Logistic regression was used to assess the effect of having an injury-related ED visit on various adverse pregnancy outcomes. Results 7350 (3.9%) women experienced an injury-related ED visit during pregnancy. Motor vehicle occupant injuries were the leading mechanism of ED injury visits (22.4%). Controlling for known risks, pregnant women with an injury-related ED visit were more likely than non-injured pregnant women to experience preterm labor (OR = 1.22, 95% CI = 1.12–1.34), placental abruption (OR = 1.33, 95% CI = 1.08–1.65), and cesarean delivery (OR = 1.27, 95% CI = 1.19–1.36). Infants born to women who were injured during pregnancy were more likely to be born preterm (OR = 1.23, 95% CI = 1.12–1.34) and have low birth weight (OR = 1.22, 95% CI = 1.1–1.35). Conclusions Most injured pregnant women are treated and released from the ED; however, significant increased risks remain for several maternal complications and birth outcomes.

Risk of Injury and Fatality in Single Vehicle Rollover Crashes: Danger for the Front Seat Occupant in the “Outside Arc”

Rollover crashes are responsible for a large portion of motor vehicle occupant injuries and fatalities. To examine if there is an increased risk of injury or death for either front seat occupant depending on the direction the vehicle rolled over. Between 1992 and 2002, crash data were collected and analyzed from the National Accident Sampling System Crashworthiness Data System (NASS/CDS) database of police reported tow-away crashes in the United States. These data were limited to information concerning single vehicle crashes with right or left initial rollover, in which both driver and front seat passenger were present and secured with lap-shoulder belts. The "outside arc" occupant was defined as the occupant who underwent the greatest degree of initial rotational torque during the rollover. Crashes involving sport utility vehicles (SUVs) were further evaluated for risks of injury or death based on the direction of the initial rollover. The location of roof crush and the types of injuries were also analyzed for these rollovers. This weighted database allows for the calculation of mortality and injury prevalence in the population. There was a significantly higher fatality rate for outside arc occupants than inside arc occupants in rollover crashes. The weighted percentage fatality for the occupant on the outside arc for all classes of light passenger vehicles was 0.38%, while the percentage fatality for the occupant on the inside arc was 0.23% (odds ratio [OR], 1.64; p = 0.04). As a subgroup, the SUV class showed a weighted outside arc fatality percentage of 0.23%, while the inside arc fatality percentage was 0.02% (OR, 10.69; p = 0.06). Additionally, in SUVs, the weighted percentage having an Injury Severity Score of 9-75 was 0.99% for the outside arc passengers but only 0.19% for the inside arc passengers (OR, 5.42; p = 0.04). Roof crush was located more commonly on the outside arc of the rollovers than on the inside arc (42% vs. 26.3%; p < 0.01). There was a trend toward increased head and neck injuries in the fatal rollover crashes when compared with fatalities in the entire NASS/CDS database (91% vs. 58%; p = 0.06). The risk of death for outside arc occupants was higher than for inside arc occupants in rollovers. In addition, outside arc occupants in SUV rollover crashes were more likely to incur moderate or severe traumatic injuries. Roof crush occurs more commonly on the outside arc, and head and neck injuries were more prevalent in rollover crashes.

Counseling about Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use while Driving: U.S. Preventive Services Task Force Recommendation Statement

An assessment of the independent effectiveness of primary care interventions to increase the proper use of child safety seats, booster seats, and lap-and-shoulder belts to prevent motor vehicle occupant injuries (MVOIs) and to prevent alcohol-related MVOIs in adolescents and adults. The U.S. Preventive Services Task Force reviewed evidence on the effectiveness of counseling in primary care about the proper use of child restraints in motor vehicles to prevent injury, as well as evidence on the impact of primary care counseling to prevent alcohol-related MVOIs in adolescents and adults. This included information gathered in the process of making their 1996 recommendation, as well as the accompanying systematic review of English-language articles published through 2005. Current evidence is insufficient to assess the incremental benefits, beyond the efficacy of legislation and community-based interventions, of counseling in the primary care setting to improve rates of proper use of motor vehicle occupant restraints. (I statement) Current evidence is insufficient to assess the balance of benefits and harms of routine counseling of all patients in the primary care setting to reduce driving while under the influence of alcohol or riding with drivers who are alcohol-impaired. (I statement).

The Effect of Unrestrained Rear-Seat Passengers on Driver Mortality

It is well documented that seat belt usage effectively reduces the severity of motor vehicle occupant injuries and fatalities in roadway crashes. This research examines how the presence of an unrestrained rear-seat passenger seated directly behind an airbag and/or belt-restrained driver affects the driver's risk of injury in two different idealized crash scenarios. Empirical data used in the study was obtained from four sled tests conducted with various size Hybrid III crash test dummies. Three tests simulated a frontal (head-on) impact between two vehicles. The first established the baseline condition: a driver dummy restrained by a belt and an airbag system, with an identical belt-restrained dummy seated directly behind. The other two frontal-mode tests involved different size driver dummies restrained in the same manner, with different size unrestrained dummies behind them. A fourth test featured an angled driver-side impact crash with a restrained driver and unrestrained rear seat passenger. In both of the latter cases the driver incurred a high likelihood of severe head and chest injuries relative to that inferred in the baseline exposure. The last test featured two identical dummies in a simulated lateral (driver-side) inter-vehicular impact using a belt-restrained (only) driver and an unrestrained rear-seat passenger. Driver mortality was not significantly affected in this configuration. Unrestrained rear-seat passengers place themselves as well as their driver at great risk of serious injury when involved in a head-on crash.

Community-based programs to promote car seat restraints in children 0–16 years – a systematic review

Study Objective: Community-based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing injury due to inadequate car seat restraint use in children 0–16 years of age. Methods: A comprehensive search of the literature was performed using the following study selection criteria: community-based intervention study; target population was children aged 0–16 years of age; outcome measure was either injury rates due to motor vehicle crashes or observed changes in child restraint use; and use of community control or historical control in the study design. Quality assessment and data abstraction was guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. Results: This review found eight studies, that met all the inclusion criteria. In the studies that measured injury outcomes, significant reductions in risk of motor vehicle occupant injury (33–55%) were reported in the study communities. For those studies reporting observed car seat restraint use the community-based programs were successful in increasing toddler restraint use in 1–5 year aged children by up to 11%; child booster seat use in 4–8 year aged children by up to 13%; rear restraint use in children aged 0–15 years by 8%; a 50% increase in restraint use in pre-school aged children in a high-risk community; and a 44% increase in children aged 5–11 years. Conclusion: While this review highlights that there is some evidence to support the effectiveness of community-based programs to promote car restraint use and/or motor vehicle occupant injury, limitations in the evaluation methodologies of the studies requires the results to be interpreted with caution. There is clearly a need for further high quality program evaluation research to develop an evidence base.

Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age.

Rates of pediatric injuries by 3-month intervals for children 0 to 3 years of age.