01664978

Component

Background: Restraint use reduces injury in infants with rear facing restraints showing a greater impact than forward facing. This report examines trends and predictors of restraint non-use and of compliance pre- and post- American Academy of Pediatrics (AAP) recommendations for rear-facing restraints. Methods: Data from the Fatality Analysis Reporting System (FARS) from 2008 to 2015 were used to examine the restraint status and injury of infants and toddlers aged 0 to less than 2 years old who were rear-seated motor vehicle occupants of vehicles involved in a fatal collision (N=4,966). Subpopulation analysis was conducted on 1,557 children with recorded facing directions. Multivariable logistic regression was used to generate odds ratios with 95% confidence intervals (CI). Results: Approximately 6.7% of 4,996 infants and toddlers were unrestrained and mortality was approximately triple for unrestrained versus restrained (40.0% vs 13.7%, P<0.0001). In the subpopulation analysis of children with direction of child restraint recorded, children in a rear-facing restraint system were less likely to be injured or to die compared to passengers in a forward-facing restraint system (57.5% vs. 42.5%, χ2 = 10.4, p = 0.01). In multivariable adjusted models, predictors of an infant being unrestrained included younger drivers (2.43, 1.56–3.79), unrestrained driver (3.22, 2.40–4.32), alcohol (2.05, 1.29–3.27), center-seated infant (1.52, 1.15-2.01) and weekday crashes (1.52, 1.12-2.05). Rear-facing car seat compliance among infants and toddlers aged 0-2 years increased from 5.0% to 23.2% (P<0.0001), but only 40.6% had restraint direction recorded. The odds of rear-facing restraint increased post-AAP guideline among infants aged 0-1 year (2.70, 1.46, 4.97) while compliance for ages 1-2 remained unchanged. Conclusion: Trends in rear facing restraint use improved over the timeframe of this study, but remain unacceptably low despite introduction of the AAP guideline and recent changes in state child restraint laws.

This paper was sponsored by TRB committee ANB00 Section - Safety. Alternate title: Infant and Toddler Motor Vehicle Occupant Injury and Restraint Patterns Pre- and Post-American Academy of Pediatrics Rear-Facing Restraint Recommendations

18-01249

English

15p

2018

Transportation Research Board 97th Annual Meeting

Digital/other

Figures; References; Tables

Child restraint systems; Fatalities; Infants; Injuries; Rear facing restraint systems; Traffic crashes

Highways; Safety and Human Factors

Transportation Research Board Annual Meeting 2018 Paper #18-01249

TRIS, TRB, ATRI

Jan 8 2018 10:19AM