Policy for child car safety relies on evaluating the risks of not using safety seats versus the benefits of their use in protecting children in crashes, according to background information in the article. These safety evaluations are often conducted using the U.S. Department of Transportation Fatality Analysis Reporting System (FARS), a census of car crashes in which one or more persons died. Using only FARS data for these evaluations, however, can be problematic, because these data assume that surviving children in fatal crashes were secured similarly to those of children in other, non-fatal crashes.
Michael R. Elliott, Ph.D., University of Michigan, Ann Arbor, and colleagues examined vehicle crash data to compare the benefit of using child restraint systems (such as safety seats) to wearing seat belts alone in children two to six years old. The study sample comprised 7,813 children in fatal crashes from the FARS database and 1,433 children in nonfatal crashes from the National Automotive Sampling System Crashworthiness Data System (NASS CDS), all of whom were involved in crashes in which at least one car was left undriveable between 1998 and 2003.
Overall, approximately one in 1,000 children in a two-way crash died, with less than half (45 percent) of all children in restraint seats. One of six children (15.7 percent) were in the front seat, two thirds (67.6 percent) were in passenger cars, one of six (15.6 percent) were in pre-1990 model year vehicles and 4 percent of cars were driven by teenage drivers. Compared with seat belts alone, child safety seats were associated with a 21 percent reduction in risk of death. When excluding cases of serious misuse of safety seats or belts, the reduced risk of death was 28 percent.
"Child restraint systems offer improved fit of restraints for children who are too small for the adult-sized seat belt, thereby affording a mechanical protection advantage over seat belts," the researchers write. "If restraint systems are seriously misused, however, their safety performance would be expected to be diminished." Based on past and these current findings, the authors state that efforts should continue to promote child restraint use through improved laws and educational programs.
(Arch Pediatr Adolesc Med. 2006; 160: 617 - 621. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: The authors acknowledge the support of State Farm Mutual Automobile Insurance Company for the conduct of this research study.
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