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Alex Hulvalchick, 630-626-6282, ahulvalchick@aap.org
DENVER —A 2018 federal mandate to equip all new vehicles with a backup camera was associated with a significant decrease in severe injuries and death in small children according to research presented during the American Academy of Pediatrics 2025 National Conference & Exhibition.
The abstract, “The Impact of a Federally Mandated Car Safety Feature on Rate and Severity of Pediatric Backover Trauma,” will be presented during the conference at the Colorado Convention Center Sept. 26-30. Backover trauma refers to injury sustained when a pedestrian is struck by a motorized vehicle in reverse. These incidents disproportionately affect small children.
The authors conducted a retrospective cohort study of patients less than 5 years of age with backover trauma between January 2011 and November 2024. Two sets of data were compared: trauma registry data of 71 patients treated at a level one pediatric trauma center, and a case list curated by Kids and Car Safety of 28 children from publicly available injury records of the surrounding metropolitan counties.
They found similar trends among both sets of data, with rates of events per year reduced to approximately a third. The proportion of injuries classified as “severe” decreased by nearly half, and the absolute number of publicly reported fatal cases decreased by 78%.
“Our study demonstrates an important association between the federal mandate in 2018 requiring all new vehicles be equipped with a backup camera, and the reduction in both rate and severity of pediatric backover trauma,” said Natalie A. Drucker, MD, MS, an assistant professor of pediatric surgery at UTHealth Houston.
“While this is exciting, necessary progress toward injury prevention in a vulnerable population, these events continue to occur and thus demand attention and continued advocacy efforts to promote the safety of our children.”
Many older vehicles may still lack the safety feature. The authors suggest that backup cameras should be prioritized and subsidized for all vehicles manufactured prior to the 2018 federal mandate.
The research was funded solely by the Pediatric Surgery Department at UTHealth Houston.
Study author Dr. Jeannette M. Joly is scheduled to present her research, which is below, on Sunday, Sept. 28, 2025, from 10:35-10:38AM during the Section on Surgery in the Colorado Convention Center, Mile High Ballroom 2B-3B.
In addition, Dr. Natalie A. Drucker will be among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference from noon-1:30 p.m. Saturday, Sept. 27, in the National Conference Press Room, CCC 705/707. During the meeting, you may reach AAP media relations staff at 303-228-8338.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
Program Name: 2025 Call for Abstracts
Submission Type: Section on Surgery
Abstract Title: The Impact of a Federally Mandated Car Safety Feature on Rate and Severity of Pediatric Backover Trauma
Jeannette Joly
Houston, TX, United States
Pedestrian collision with a motor vehicle-in-reverse is referred to as backover trauma. Resulting injuries carry significant morbidity and mortality, and they disproportionally occur in small children due to challenging visualization. For prevention, a federal mandate was passed on May 1, 2018 requiring all new vehicles to be equipped with a backup camera; however, older vehicles may still lack this safety feature. This study aims to evaluate the rate and severity of pediatric backover trauma before and after enactment of the federal mandate to characterize its impact.
A retrospective cohort study was conducted of patients less than 5 years of age with backover trauma between January 2011 and November 2024. Two sets of data were compared, electronic medical records of patients treated at a level one pediatric trauma center as identified by the institutional trauma registry (IRB#: HSC-MS-24-1247) and data curated by Kids and Car Safety from publicly available injury records of the surrounding metropolitan county, in order to externally validate institutional trends. Trauma registry abstraction included demographics, injury severity score (ISS), hospital course, and disposition. Severe injury in pediatric trauma was defined as ISS >25. Backover trauma rates and severity were compared pre-mandate (01/2011-04/2018) versus post-mandate (05/2018-11/2024). Descriptive statistics, univariate analyses, and Poisson rate tests were utilized.
From trauma center data, 71 patients were identified: 53 (75%) pre-mandate, 18 (25%) post-mandate. Patients were a median age of 2 years (IQR: 1.6-2.8), 61% male, and 68% with governmental insurance. Overall ISS was 10 (IQR: 5-19): no difference between groups (p=0.83) (Figure1). There were 10 cases of severe trauma pre-mandate (19%) versus 2 cases post-mandate (11%) (p=0.72), with one pre-mandate, in-hospital death. The trauma rate pre-mandate was significantly higher at approximately 7.2 backovers/year compared to 2.7 backovers/year post-mandate: a rate ratio of 0.38 (95% CI: 0.21-0.66; p< 0.01) (Figure2). Similar trends were demonstrated in public injury records, from which 19 victims were identified: 13 (68%) pre-mandate, 6 (32%) post-mandate. Injuries were reported fatal on scene or shortly after emergency medical service transport in 10 pre-mandate cases (77%) and 4 post-mandate cases (67%) (p>0.99). Again, the trauma rate pre-mandate was higher at approximately 1.8 backovers/year compared to 0.9 backovers/year post-mandate: a rate ratio of 0.51 (95% CI: 0.16-1.45; p=0.25) (Figure2).
A significant decrease in the rate of backover trauma was observed following the 2018 federal mandate requiring backup cameras in all new vehicles. Severe injuries decreased by half, and the absolute number of publicly reported fatal cases decreased by 60%. Reduction in rate and severity of backover trauma justify public health-driven regulatory requirements. Installation of backup cameras should be prioritized and subsidized for all vehicles manufactured prior to the 2018 federal mandate.
Figure 1. Distribution of Injury Severity Scores by Group
Subject of Research
Not applicable
Article Title
The Impact of a Federally Mandated Car Safety Feature on Rate and Severity of Pediatric Backover Trauma
Article Publication Date
26-Sep-2025