Traffic environment and demographic factors affecting impaired driving and crashes

IntroductionData availability has forced researchers to examine separately the role of alcohol among drivers who crashed and drivers who did not crash. Such a separation fails to account fully for the transition from impaired driving to an alcohol-related crash.MethodIn this study, we analyzed recent data to investigate how traffic-related environments, conditions, and drivers’ demographics shape the likelihood of a driver being either involved in a crash (alcohol impaired or not) or not involved in a crash (alcohol impaired or not). Our data, from a recent case–control study, included a comprehensive sampling of the drivers in nonfatal crashes and a matched set of comparison drivers in two U.S. locations. Multinomial logistic regression was applied to investigate the likelihood that a driver would crash or would not crash, either with a blood alcohol concentration (BAC) = .00 or with a BAC ≥ .05.ConclusionsTo our knowledge, this study is the first to examine how different driver characteristics and environmental factors simultaneously contribute to alcohol use by crash-involved and non-crash-involved drivers. This effort calls attention to the need for research on the simultaneous roles played by all the factors that may contribute to motor vehicle crashes.     

Examining teen driver crashes and the prevalence of distraction: Recent trends, 2007–2015

IntroductionTeen drivers crash at a much higher rate than adult drivers, with distractions found as a factor in nearly 6 out of 10 moderate-to-severe teen crashes. As the driving environment continues to rapidly evolve, it is important to examine the effect these changes may be having on our youngest and most vulnerable drivers.MethodThe purpose of this study was to identify types of vehicle crashes teens are most frequently involved in, as well as the distracting activities being engaged in leading up to these crashes, with a focus on identifying changes or trends over time. We examined 2,229 naturalistic driving videos involving drivers ages 16–19. These videos captured crashes occurring between 2007 and 2015. The data of interest for this study included crash type, behaviors drivers engaged in leading up to the collision, total duration of time the driver's eyes were off the forward roadway, and duration of the longest glance away from forward.ResultsRear-end crashes increased significantly (annual % change = 3.23 [2.40–4.05]), corresponding with national data trends. Among cell phone related crashes, a significant shift occurred, from talking/listening to operating/looking (annual % change = 4.22 [1.15–7.29]). Among rear-end crashes, there was an increase in the time drivers' eyes were off the road (β = 0.1527, P = 0.0004) and durations of longest glances away (β = 0.1020, P = 0.0014).ConclusionsFindings suggest that shifts in the way cell phones are being used, from talking/listening to operating/looking, may be a cause of the increasing number of rear-end crashes for teen drivers.Practical applicationsUnderstanding the role that cell phone use plays in teen driver crashes is extremely important. Knowing how and when teens are engaging in this behavior is the only way effective technologies can be developed for mitigating these crashes.     

Investigating the different characteristics of weekday and weekend crashes

IntroductionThis study provides a systematic approach to investigate the different characteristics of weekday and weekend crashes.MethodWeekend crashes were defined as crashes occurring between Friday 9 p.m. and Sunday 9 p.m., while the other crashes were labeled as weekday crashes. In order to reveal the various features for weekday and weekend crashes, multi-level traffic safety analyses have been conducted. For the aggregate analysis, crash frequency models have been developed through Bayesian inference technique; correlation effects of weekday and weekend crash frequencies have been accounted. A multivariate Poisson model and correlated random effects Poisson model were estimated; model goodness-of-fits have been compared through DIC values. In addition to the safety performance functions, a disaggregate crash time propensity model was calibrated with Bayesian logistic regression model. Moreover, in order to account for the cross-section unobserved heterogeneity, random effects Bayesian logistic regression model was employed.ResultsIt was concluded that weekday crashes are more probable to happen during congested sections, while the weekend crashes mostly occur under free flow conditions. Finally, for the purpose of confirming the aforementioned conclusions, real-time crash prediction models have been developed. Random effects Bayesian logistic regression models incorporating the microscopic traffic data were developed. Results of the real-time crash prediction models are consistent with the crash time propensity analysis. Furthermore, results from these models would shed some lights on future geometric improvements and traffic management strategies to improve traffic safety.Impact on IndustryUtilizing safety performance to identify potential geometric improvements to reduce crash occurrence and monitoring real-time crash risks to pro-actively improve traffic safety.     

Efficacy of roll stability control and lane departure warning systems using carrier-collected data

IntroductionLarge truck crashes have significantly declined over the last 10 years, likely due, in part, to the increased use of onboard safety systems (OSS). Unfortunately, historically there is a paucity of data on the real-world efficacy of these devices in large trucks. The purpose of this study was to evaluate the two OSSs, lane departure warning (LDW) and roll stability control (RSC), using data collected from motor carriers.MethodA retrospective cohort approach was used to assess the safety benefits of these OSSs installed on Class 7 and 8 trucks as they operated during normal revenue-producing deliveries. Data were collected from 14 carriers representing small, medium, and large carriers hauling a variety of commodities. The data consisted of a total of 88,112 crash records and 151,624 truck-years that traveled 13 billion miles over the observation period.ResultsThe non-LDW cohort had an LDW-related crash rate that was 1.917 times higher than the LDW cohort (p = 0.001), and the non-RSC cohort had an RSC-related crash rate that was 1.555 times higher than the RSC cohort (p < 0.001).ConclusionsThe results across analyses indicated a strong, positive safety benefit for LDW and RSC under real-world conditions.Practical applicationsThe results support the use of LDW and RSC in reducing the crash types associated with each OSS.     

Tracking progress in teenage driver crash risk in the United States since the advent of graduated driver licensing programs

IntroductionThis study examined U.S. teenagers' crash rates since 1996, when the first graduated driver licensing (GDL) program in the United State was implemented.MethodsPassenger vehicle driver crash involvement rates for 16–19 and 30–59 (middle-aged) year-olds were examined, using data from the Fatality Analysis Reporting System, National Automotive Sampling System General Estimates System, Census Bureau, and National Household Travel Surveys.ResultsPer capita fatal and police-reported crash rates in 2012 were lower for 16 year-olds than for middle-aged drivers but older teenagers' rates were higher. Mileage-based fatal and police-reported crash rates in 2008 were higher for teenagers than for middle-aged drivers and higher for 16–17 year-olds than for older teenagers. In 1996–2012, teenagers' per capita fatal and police-reported crash rates declined sharply, especially for 16–17 year-olds, and more so than for middle-aged drivers. Substantial declines also occurred in teenagers' mileage-based fatal and police-reported crash rates from 1995–96 to 2008, generally more so than for middle-aged drivers. Regarding factors in fatal crashes in 1996 and 2012, proportions of young teenagers' crashes occurring at night and with multiple teenage passengers declined, more so than among older teenagers and middle-aged drivers. The proportion of fatally injured drivers who had been drinking declined for teenagers but changed little for middle-aged drivers. Improvements were not apparent in rates of driver errors or speeding among teenage drivers in fatal crashes.ConclusionsTeenage drivers' crash risk dropped during the period of implementation of GDL laws, especially fatal crash types targeted by GDL. However, teenagers' crash risk remains high, and important crash factors remain unaddressed by GDL.Practical applicationsAlthough this study was not designed to examine the role of GDL, the results are consistent with the increased presence of such laws. More gains are achievable if states strengthen their laws.     

Factors associated with motorcycle traffic crash fatalities among active duty U.S. Army personnel

Objective: Research on factors associated with motorcycle fatalities among active duty U.S. Army personnel is limited. This analysis describes motorcycle crash–related injuries from 1995 through 2014 and assesses the effect of alcohol use and helmet use on the risk of fatal injury among active duty U.S. Army motorcycle operators involved in a traffic crash, controlling for other factors shown to be potentially associated with fatality in this population.

Methods: Demographics, crash information, and injury data were obtained from safety reports maintained in the Army Safety Management Information System. Traffic crashes were defined as crashes occurring on a paved public or private roadway or parking area, including those on a U.S. Army installation. Analysis was limited to motorcycle operators. Odds ratios (ORs) and 95% confidence intervals (95% CIs) from a multivariable analysis estimated the effect of alcohol use and helmet use on the risk of a fatal injury given a crash occurred, controlling for operator and crash characteristics.

Results: Of the 2,852 motorcycle traffic crashes, most involved men (97%), operators aged 20–29 years of age (60%), and operators who wore helmets (95%) and did not use alcohol (92%). Two thirds of reported crashes resulted in injuries requiring a lost workday; 17% resulted in fatality. Controlling for operator and crash characteristics, motorcycle traffic crashes involving operators who had used alcohol had a 3.1 times higher odds of fatality than those who did not use alcohol (OR =3.14; 95% CI, 2.17–4.53). Operators who did not wear a helmet had 1.9 times higher odds of fatality than those who did wear a helmet (OR =1.89; 95% CI, 1.24–2.89).

Conclusions: Among U.S. Army motorcycle operators, alcohol use and not wearing a helmet increased the odds of fatality, given that a crash occurred, and additional modifiable risk factors were identified. Results will help inform U.S. Army motorcycle policies and training.     

An examination of the increases in pedestrian motor-vehicle crash fatalities during 2009–2016

IntroductionPedestrian fatalities increased 46% in the United States during 2009–2016. This study identified circumstances under which the largest increases in deaths occurred during this period.MethodAnnual counts of U.S. pedestrian fatalities and crash involvements were extracted from the Fatality Analysis Reporting System and General Estimates System. Poisson regression examined if pedestrian fatalities by various roadway, environmental, personal, and vehicle factors changed significantly during 2009–2016. Linear regression examined changes over the study period in pedestrian deaths per 100 crash involvements and in horsepower per 1000 pounds of weight among passenger vehicles involved in fatal single-vehicle pedestrian crashesResultsPedestrian deaths per 100 crash involvements increased 29% from 2010, when they reached their lowest point, to 2015, the most recent year for which crash involvement data were available. The largest increases in pedestrian deaths during 2009–2016 occurred in urban areas (54% increase from 2009 to 2016), on arterials (67% increase), at nonintersections (50% increase), and in dark conditions (56% increase). The rise in the number of SUVs involved in fatal single-vehicle pedestrian crashes (82% increase) was larger than the increases in the number of cars, vans, pickups, or medium/heavy trucks involved in these crashes. The power of passenger vehicles involved in fatal single-vehicle pedestrian crashes increased over the study period, with larger increases in vehicle power among more powerful vehicles.ConclusionsEfforts to turn back the recent increase in pedestrian fatalities should focus on the conditions where the rise has been the greatest.Practical applicationsTransportation agencies can improve urban arterials by investing in proven countermeasures, such as road diets, median crossing islands, pedestrian hybrid beacons, and automated speed enforcement. Better road lighting and vehicle headlights could improve pedestrian visibility at night.     

Fatal and serious injuries related to vulnerable road users in Canada

IntroductionThe goals of this study were to analyze possible trends of fatal and serious injuries related to vulnerable road users in Canada (pedestrians, cyclists and motorcyclists) from 1990 to 2012 and the role of alcohol and drugs in these cases. Drugs have rarely been documented with respect to vulnerable road users.MethodThe Traffic Injury Research Foundation's National Fatality and Serious Injury Databases and the Public Health Agency of Canada's Canadian Hospitals Injury Reporting and Prevention Program databases were used. Numbers and rates of fatalities and serious injuries among vulnerable road users were analyzed and regression models were used to assess changes over time.ResultsThe analyses show that while the absolute number of fatalities and the rate per 100,000 population among vulnerable road users may be decreasing, no such trends are apparent when looking at the proportions of these road user fatalities out of all motor-vehicle fatalities. The trend for the proportion of motorcyclist fatalities is significantly increasing (coef. = 0.16, p < 0.001). The elderly (76 years or older) are overrepresented among pedestrian fatalities, and serious injuries (they represent 18.5% of all pedestrian fatalities but only 5.8% of the population), while those 15 years or younger are overrepresented among cyclists (they represent 23.3% of cyclist fatalities but 19.5% of the population), and those 16 to 25 years old are overrepresented among motorcyclists (27.2% of motorcyclists fatalities and 13.6% of population). Alcohol and drug use among fatally injured vulnerable road users were significant problems, especially among pedestrians. Among fatally injured pedestrians tested for alcohol and drugs, 39.7% and 43.4% tested positive, respectively.ConclusionsWith the promotion of walking and cycling as forms of exercise and the popularity of motorcycling, the safety of vulnerable road users is an important issue. The results corroborate previous research and extend our understanding about the influence of alcohol and drugs in vulnerable road user injuries.Practical applicationsThese findings can help better inform prevention and mitigation initiatives for vulnerable road users.     

Fatally injured pedestrians and bicyclists in the United States with high blood alcohol concentrations

IntroductionLittle research has focused on the problem of alcohol impairment among pedestrians and bicyclists in the United States. The aim of the current study was to investigate the prevalence, trends, and characteristics of alcohol-impaired fatally injured pedestrians and bicyclists.MethodData from the Fatality Analysis Reporting System (FARS) were analyzed for fatally injured passenger vehicle drivers, pedestrians, and bicyclists 16 and older during 1982–2014. Logistic regression models examined whether personal, roadway, and crash characteristics were associated with high blood alcohol concentrations (BACs) among fatally injured pedestrians and bicyclists.ResultsFrom 1982 to 2014, the percentage of fatally injured pedestrians with high BACs (≥ 0.08 g/dL) declined from 45% to 35%, and the percentage of fatally injured bicyclists with high BACs declined from 28% to 21%. By comparison, the percentage of fatally injured passenger vehicle drivers with high BACs declined from 51% in 1982 to 32% in 2014. The largest reductions in alcohol impairment among fatally injured pedestrians and bicyclists were found among ages 16–20. During 2010–2014, fatally injured pedestrians and bicyclists ages 40–49 had the highest odds of having a high BAC, compared with other age groups.ConclusionsA substantial proportion of fatally injured pedestrians and bicyclists have high BACs, and this proportion has declined less dramatically than for fatally injured passenger vehicle drivers during the past three decades. Most countermeasures used to address alcohol-impaired driving may have only limited effectiveness in reducing fatalities among alcohol-impaired pedestrians and bicyclists.Practical applicationsEfforts should increase public awareness of the risk of walking or bicycling when impaired. Results suggest the primary target audience for educational campaigns directed at pedestrians and bicyclists is middle-age males. Further research should evaluate the effectiveness of potential countermeasures, such as lowering speeds or improving lighting in urban areas.     

Safety effects of automated section speed control on the Italian motorway network

Introduction: Automated Section Speed Control (ASSC) has been identified as an effective countermeasure to reduce speeds and improve speed limit compliance. Method: An Empirical Bayes (EB) before-and-after study was performed in this research in order to evaluate the impact of the ASSC system on the expected crash frequency. The study was carried out on a sample of 125 ASSC sites of the Italian motorway network covering 1252 km, where a total of 21,721 crashes were recorded during a 10-year analysis period from 2004 to 2013. Results: Overall, the EB analysis estimated a significant 22% reduction in the expected crash frequency due to the implementation of the ASSC system. The analysis indicated that the effect is slightly larger on property damage only (PDO) crashes (− 23%) than on fatal injury (FI) crashes (− 18%) and that the highest reductions in crash frequency are expected for multi-vehicle FI crashes (− 25%) and multi-vehicle PDO crashes (− 31%). Furthermore, the results indicated that the ASSC system is more effective in reducing crash rates when traffic volume increases and it is therefore strongly recommended as a countermeasure to improve safety on high-traffic-volume motorway sections.     

Marijuana-, alcohol-, and drug-impaired driving among emerging adults: Changes from high school to one-year post-high school

IntroductionDriving while impaired (DWI) increases the risk of a motor vehicle crash by impairing performance. Few studies have examined the prevalence and predictors of marijuana, alcohol, and drug-specific DWI among emerging adults.MethodsThe data from wave 3 (W3, high school seniors, 2012, N = 2407) and wave 4 (W4, one year after high school, N = 2178) of the NEXT Generation Health Study with a nationally representative cohort. W4 DWI (≥ 1 day of past 30 days) was specified for alcohol-specific, marijuana-specific, alcohol/marijuana-combined, illicit drug-related DWI. Multinomial logistic regression models estimated the association of W4 DWI with W3 covariates (perceived peer/parent influence, drinking/binge drinking, marijuana/illicit drug use), and W4 environmental status variables (work/school/residence) adjusting for W3 overall DWI, demographic, and complex survey variables.ResultsOverall DWI prevalence from W3 to W4 changed slightly (14% to 15%). W4 DWI consisted of 4.34% drinking-specific, 5.02% marijuana-specific, 2.41% drinking/marijuana combined, and 3.37% illicit drug-related DWI. W3 DWI was significantly associated with W4 alcohol-related and alcohol/marijuana-combined DWI, but not other DWI. W3 marijuana use, binge drinking, and illicit drug use were positively associated with W4 marijuana-specific, alcohol/marijuana-combined, and illicit drug-related DWI, respectively. W3 friend drunkenness and marijuana use were positively associated with W4 alcohol-specific and marijuana-related DWI, respectively. W3 peer marijuana use was negatively associated with W4 alcohol-specific DWI.ConclusionsDriving under the influence of alcohol, marijuana, and illicit drugs is a persistent, threatening public health concern among emerging U.S. adults. High school seniors' binge drinking as well as regular alcohol drinking and marijuana/illicit drug use were independently associated with respective DWI one year after high school. Peer drunkenness and marijuana use in high school may be related to subsequent DWI of emerging adults.Practical applicationsThe results support the use of injunctive peer norms about getting drunk and smoking marijuana in guiding the development of prevention programs to reduce youth DWI.     

Access to trauma centers for road crashes in the United States

Introduction: Existing research indicates that around 90% of all U.S. residents have access to at least one level I or II trauma center within 60 min. However, a limitation of these estimates lies in that they are based on where people live and not where people are injured, which may overestimate the access to trauma centers for seriously injured patients in fatal crashes. Method: In this study, the Fatality Analysis Reporting System (FARS) data between 2013 and 2014 were collected and analyzed to quantify the access of injured patients to trauma centers for fatal crashes across states. Two types of distance, linear distance and route distance, were calculated using ArcGIS. The estimated transport time to the nearest level I/II trauma center was also calculated and compared to the recorded on-scene and transport time. Results and Conclusions: The Northeast region had the nearest average linear and route distance between fatal crash and trauma center (25.3 km and 31.7 km, respectively), followed by the Midwest (44.4 km and 54.1 km), the South (47.3 km and 57.0 km), and the West (50.9 km and 67.5 km). The comparison between the estimated and actual transport time revealed that the different states adopted different trauma triage protocols, resulting in different utilization rates of the level I/II trauma center among states. A linear regression analysis demonstrated that the longer the average route distance, the less the seriously injured patients in fatal crashes were taken to level I/II trauma center directly. Practical applications: These findings may help to identify the access to trauma centers for road crashes and the variation of delivery ratio to trauma center among the states, therefore a better utilization of trauma centers for road crashes can be achieved for the emergency medical services (EMS) systems.     

Validation of the principles of injury risk zones for motorcycle protective clothing

IntroductionThe distributions of motorcycle crash impacts and injuries were compared to the four impact risk zones and protective performance specified in the European Standard for motorcycle clothing (EN 13595).MethodsCrashed motorcyclists' (n = 117) injuries and clothing damage were categorized by body area into the four risk zones. Three levels of protection were defined: protective clothing with impact protection, protective clothing only and non-protective clothing.ResultsThe distribution of impact/injury sites corresponded to the predictions of EN 13595, with the proportion of all injuries decreasing from 43.9% in Zone 1, to 18.0%, 16.7%, and 11.5% in Zones 2 to 4, respectively. Protective clothing modified the distribution of injuries with substantially more injuries (OR = 2.69, 95% CL: 20.1–3.59) at unprotected impact sites.Practical applicationThese findings support an appropriate framework for determining performance specifications for the manufacture of motorcycle clothing that will effectively reduce the risk of injury in crashes.     

Driver speed selection and crash risk: Insights from the naturalistic driving study

IntroductionThis study investigates how speed limits affect driver speed selection, as well as the related crash risk, while controlling for various confounding factors such as traffic volumes and roadway geometry. Data from a naturalistic driving study are used to examine how driver speed selection varies among freeways with different posted speed limits, as well as how the likelihood of crash/near-crash events change with respect to mean speed and standard deviation.MethodRegression models are estimated to assess three measures of interest: the average speed of vehicles during the time preceding crash/near-crash and baseline (i.e., normal) driving events; the variation in travel speeds leading up to each event as quantified by the standard deviation in speeds over this period; and the probability of a specific event resulting in a crash/near-crash based on speed selection and other factors.ResultsSpeeds were relatively stable across levels-of-service A and B, within a range of 1.5 mph on average. Speeds were marginally lower (3.3 mph) on freeways posted at 65 mph versus 70 mph. In comparison, speeds were approximately 10.2 to 13.4 mph lower on facilities posted at 55 mph or 60 mph. Speeds were shown to be 2.5 mph lower in rainy weather and 11 mph lower under snow or sleet.ConclusionsSignificant correlation was observed with respect to speed selection behavior among the same individuals. Mean speeds are shown to increase with speed limits. However, these increases are less pronounced at higher speed limits. Drivers tend to reduce their travel speeds in presence of junctions and work zones, under adverse weather conditions, and particularly under heavy congestion. Crash risk increased with the standard deviation in speed, as well as on vertical curves and ramp junctions, and among the youngest and oldest age groups of drivers.     

Improving the safety effect of speed camera programs through innovations: Evidence from the French experience

Problem: This study investigates the effect of the French Automated Speed Enforcement Program (ASEP) on casualties involving different types of road users. Method: Interrupted time-series analyses were conducted to estimate the effect of the ASEP. Results: Overall, the ASEP was associated with a decrease of 19.7% in traffic fatalities and crashes with injuries. Significant diminutions were observed for passenger vehicles/light SUVs (− 25.4%), motorcyclists (− 39.0%), and trucks (− 15.7%). Adding red light cameras and devices taking pictures of both ends of the vehicle produced, in some cases, additional gains among specific categories of road users. Conclusion: Traffic fatalities, crashes with injuries and the severity of crashes significantly declined following the introduction of the ASEP in November 2003. Practical applications: ASEPs are an effective strategy to prevent traffic casualties. Innovations such as red light cameras and devices taking pictures of both ends of the vehicle can improve an ASEP.     

Older drivers’ involvement in fatal RTCs. Do crashes fatal to them differ from crashes involving them but fatal to others?

In several countries, older drivers are disproportionately involved in fatal road traffic crashes (RTCs) for various reasons. This study maps the circumstances of occurrence of crashes involving older drivers that are fatal to either them or other road users and highlights differences between them. Sweden’s national in-depth studies of fatal RTCs archive was used and focus was placed on crashes in which a driver aged 65 years or older was involved between 2002 and 2004 (n = 197). Thirteen driver and crash characteristics were analyzed simultaneously and typical crash patterns (classes) were highlighted. For each pattern, the proportions of crashes fatal to the older driver vs. to someone else were compared. Four patterns were identified: (1) crashes on low-speed stretches, involving left turn and intersections; (2) crashes involving very old drivers and older vehicles, (3) rear-end collisions on high-speed stretches; and (4) head-on and single-vehicle crashes in rural areas. Older drivers dying in the crash were over-represented in classes 2 and 4. The study shows that when older drivers are involved in fatal RTCs, they are often the ones who die (60%). Typical circumstances surrounding their involvement include manoeuvring difficulties, fast-moving traffic, and colliding in an old vehicle. Preventing fatal RTCs involving older drivers requires not only age-specific but also general measures.     

Heavy trucks, conspicuity treatment, and the decline of collision risk in darkness

IntroductionThe influence of amendments to Federal Motor Vehicle Safety Standard (FMVSS) 108, requiring conspicuity treatments on heavy tractors and trailers, was determined in analyses of the odds of fatal collisions in darkness.MethodComparisons were made between crashes in which conspicuity treatment was likely relevant, and those in which it was likely irrelevant.ResultsOver 23 years, the odds that a fatal collision involving a heavy truck occurred in darkness declined by 58% among relevant crashes, while little decline was observed for irrelevant crashes. Disaggregation into crash types revealed the largest declines occurred in fatal rear-end and angle collisions. A parallel analysis of light vehicles also found declines but no differences among crash type. Similar trends were also observed for nonfatal rear end collisions.ConclusionThe results suggest that detection failure may have contributed to the risk of striking a tractor-semitrailer in darkness, and that conspicuity treatments have reduced this risk.Impact on IndustryConspicuity treatments appear to reduce risk of collision into heavy trucks in darkness. It is likely that this benefit would also extend to other vehicles that are not included in the FMVSS 108 regulation (e.g., buses, single unit trucks, recreational vehicles), although many are so equipped, regardless of the regulation.     

Factors contributing to serious and fatal injuries in belted rear seat occupants in frontal crashes

Abstract

Objectives: Earlier research has shown that the rear row is safer for occupants in crashes than the front row, but there is evidence that improvements in front seat occupant protection in more recent vehicle model years have reduced the safety advantage of the rear seat versus the front seat. The study objective was to identify factors that contribute to serious and fatal injuries in belted rear seat occupants in frontal crashes in newer model year vehicles.

Methods: A case series review of belted rear seat occupants who were seriously injured or killed in frontal crashes was conducted. Occupants in frontal crashes were eligible for inclusion if they were 6 years old or older and belted in the rear of a 2000 or newer model year passenger vehicle within 10 model years of the crash year. Crashes were identified using the 2004–2015 National Automotive Sampling System Crashworthiness Data System (NASS-CDS) and included all eligible occupants with at least one Abbreviated Injury Scale (AIS) 3 or greater injury. Using these same inclusion criteria but split into younger (6 to 12 years) and older (55+ years) cohorts, fatal crashes were identified in the 2014–2015 Fatality Analysis Reporting System (FARS) and then local police jurisdictions were contacted for complete crash records.

Results: Detailed case series review was completed for 117 rear seat occupants: 36 with Maximum Abbreviated Injury Scale (MAIS) 3+ injuries in NASS-CDS and 81 fatalities identified in FARS. More than half of the injured and killed rear occupants were more severely injured than front seat occupants in the same crash. Serious chest injury, primarily caused by seat belt loading, was present in 22 of the injured occupants and 17 of the 37 fatalities with documented injuries. Nine injured occupants and 18 fatalities sustained serious head injury, primarily from contact with the vehicle interior or severe intrusion. For fatal cases, 12 crashes were considered unsurvivable due to a complete loss of occupant space. For cases considered survivable, intrusion was not a large contributor to fatality.

Discussion: Rear seat occupants sustained serious and fatal injuries due to belt loading in crashes in which front seat occupants survived, suggesting a discrepancy in restraint performance between the front and rear rows. Restraint strategies that reduce loading to the chest should be considered, but there may be potential tradeoffs with increased head excursion, particularly in the absence of rear seat airbags. Any new restraint designs should consider the unique needs of the rear seat environment.