The risk of whiplash injury in the rear seat compared to the front seat in rear impacts

One hundred ninety-five rear impacts with both front- and rear-seat occupants in the struck car, where at least one occupant sustained permanent disability, were selected for study. There was a significantly higher disability risk for the female rear-seat occupant compared with the male driver. Furthermore, a higher risk was found for female rear-seat occupants compared with female front-seat passengers. The disability risk for occupants of the driver's seat was three times higher for females than for males, and four times higher for females in the rear seat. In the future, test methods should consider the risk of whiplash injury in both the front and the rear seat.     

Investigating traffic fatality trends and restraint use among rear-seat passengers in the United States, 2000–2016

Introduction: Motor-vehicle crash is one of the leading causes of unintentional injury death in the United States. Previous studies focused on fatalities among drivers and front-seat passengers, with a limited number of studies examining rear-seat passenger fatalities. The objectives of this study were to assess trends in rear-seat passenger motor-vehicle fatalities in the United States from 2000 to 2016 and to identify demographic factors associated with being unrestrained among fatally injured rear-seat passengers. Methods: Rear-seat passenger fatality data were obtained from the Fatality Analysis Reporting System (FARS) database. The fatality rate ratios for overall rear-seat passengers and for different age and sex groups were determined by comparing fatality rates in 2000 and 2016 using random effects models. Risk ratios of being unrestrained for age and sex groups were obtained using general estimating equations. Results: Compared to 2000, the overall rear-seat passenger fatality rate in 2016 decreased by 44% (95% confidence interval [CI]: 39–49%). In particular, the fatality rate among rear-seat passengers decreased more in males than females, and passengers aged 14–19 years experienced a larger decline than all other age groups. Fatally injured male rear-seat passengers had a higher risk of being unrestrained (adjusted risk ratio: 1.06, 95% CI: 1.04–1.07) than their female counterparts, and both youngest (≤13 years) and oldest (65–85 years) passengers were less likely to be unrestrained than those aged 20–64 years. Conclusions: Overall, fatality rates among rear-seat passengers have declined, with differential degrees of improvement by age and sex. Practical Applications: Continued restraint use enforcement campaigns targeted at teenagers and males would further preserve them from fatal injuries and improve traffic safety for the overall population.     

The safety implications of vehicle seat adjustments

INTRODUCTION: The goal of this study was to gather information on the preferred front seat position of vehicle occupants and to determine the impact of variation in seat position on safety during crashes. METHOD: The study evaluated the relationship between seat position and occupant size using the chi-square test and compared the risk of severe injury for small females and large males with regard to forward and rearward seat position using logistic regression. RESULTS: While smaller drivers sat closer to the steering wheel than larger drivers, front passengers of all sizes used similar seat positions. Additionally, the risk of injury was higher for small, unbelted females in rearward seat positions and large males (belted and unbelted) in forward seat positions. CONCLUSIONS: Occupants who adjust their seats to positions that are not consistent with required federal tests are at a greater risk for severe injury in a crash.     

Responsibility of drivers, by age and gender, for motor-vehicle crash deaths

Problem: Motor-vehicle crash rate comparisons by age and gender usually are based on the extent to which drivers in a particular age/gender category are themselves injured or involved in crashes (e.g., the number of 20-year-old females in crashes). Basing comparisons instead on the extent to which drivers in various age/gender groups are responsible for deaths (including themselves) in their crashes is more revealing of their overall contribution to the problem. Methods: Data from the Fatality Analysis Reporting System (FARS, 1996–2000) were used in the analysis, which was based on crashes that involved one or two vehicles only. Drivers in fatal single-vehicle crashes were assumed to have responsibility for the crash. In fatal two-vehicle crashes, driver operator errors reported by police were used to assign crash responsibility. Results: When all crashes were considered, both the youngest and oldest drivers were most likely to be responsible for deaths in their crashes. In two-vehicle crashes, the oldest drivers were more likely than young drivers to be responsible. Young males were more likely than young females to be responsible for crash deaths, whereas females in their 50s and older were more likely than same-age males to be responsible. In terms of responsibility for deaths per licensed driver, young drivers, especially males, had the highest rates because of their high involvement rates and high responsibility rates. The majority of deaths for which young drivers were responsible occurred to people other than themselves, especially passengers in their vehicles, whereas the bulk of the deaths for which older drivers were responsible were their own. Discussion: The results highlight the contribution of young drivers to the motor-vehicle crash problem, the need for measures such as passenger restrictions in graduated licensing systems, and the need for vehicle modifications to better protect older occupants.     

Teenage drivers: patterns of risk

PROBLEM: To determine patterns of risk among teenage drivers. METHOD: Review and synthesis of the literature. RESULTS: On most measures, crash rates during the teenage years are higher than at any other age, for both males and females. Risk among teenagers varies greatly by driving situation; it is particularly low in some situations (e.g., the learner period) and particularly high in others (e.g., right after licensure, late at night, with passengers present). In some of these high-risk driving situations, risk is elevated for drivers of all ages (e.g., late night driving), in others risk is elevated more for teens than adults (e.g., driving after consuming alcohol), and in others the risk is unique to teen drivers (e.g., having passengers). IMPACT ON RESEARCH, PRACTICE, AND POLICY: These varying patterns of risk form the basis for graduated licensing systems, which are designed to promote low-risk and discourage high-risk driving.     

Impact of primary safety belt laws on alcohol-related front-seat occupant fatalities: five case studies

OBJECTIVE: Impaired drivers and other high-risk road users are less likely to use their safety belts, thus increasing the risk of fatal injury in the event of a crash. Although safety belt laws have been shown to increase wearing rates for daytime non-crash-involved drivers and their front-seat passengers, little evidence is available on the effect these laws have on belt usage by crash-involved drinking drivers and their passengers. METHODS: This study evaluated the influence of primary safety belt law upgrades from secondary laws on front-seat occupants of passenger cars driven by drinking drivers in fatal crashes in five states: California, Illinois, Maryland, Michigan, and Washington. The outcome measures used to evaluate these law upgrades were (1) the change in safety belt usage rates of front-seat occupants in passenger cars driven by drinking drivers in fatal crashes and (2) the change in alcohol-related front-seat occupant fatalities in passenger cars driven by drinking drivers. RESULTS: Four of the five states demonstrated increases in safety belt use by front-seat occupants of passenger cars of drinking drivers in fatal crashes following the upgrade to primary safety belt laws. Three states (California, Michigan, and Washington) experienced significant reductions in the number of front-seat occupant fatalities in vehicles driven by drinking drivers. CONCLUSIONS: The adoption of primary law upgrades was associated with significant increases in safety belt use (four of five states) and significant reductions in fatalities among high-risk occupants (i.e., front-seat occupants involved in fatal crashes in vehicles driven by drinking drivers) in three of the five states studied.     

Alcohol-related deaths among young passengers: An analysis of national alcohol-related fatal crashes

Introduction: There is consensus that riding with an impaired driver (RWI) constitutes a major threat to public health. The aim of this study was to characterize the factors contributing to the motor-vehicle deaths of 15–20 year-old (y/o) passengers that RWI with a peer. Method: Secondary analyses of the 2010–2018 Fatality Analysis Reporting System. 5,673 passengers aged 15–20 y/o killed while riding in passenger cars with a driver aged 21 or older, 3,542 of these drivers also aged 15–20 y/o. Analyses were conducted between October 2019 and December 2020. Results: Sixty-three percent of the young passengers were killed while riding with a driver 15–20 y/o. Of these drivers, 26.8% had a blood alcohol concentration (BAC) >0.00 g/dL and 77.1% had a BAC ≥0.08 g/dL. Compared with those occurring during the day on weekdays, fatalities of young passengers who RWI with a peer driver with a BAC ≥ 0.08 g/dL often occurred on weekend nights (OR = 8.2) and weekday nights (OR = 5.2), and when the passenger and driver were both male (OR = 1.8). Race/ethnicity was not a significant contributor to RWI fatalities. Conclusions: Most 15–20 y/o RWI fatalities occurred on weekends, at night, when the driver was a young peer with a high BAC, and the passenger and driver were male. The high prevalence of fatalities in these high-risk situations suggests that young driver-passenger dynamics may contribute to alcohol-related fatalities. Practical Applications: To curb RWI fatalities among underage passengers, countermeasures should focus not only on underage drinking drivers and riders, but also on drinking drivers of all ages. Prevention should increase focus on situations in which both the young passenger and young driver are males.     

Effect of vehicle and crash factors on older occupants

PROBLEM: The expected substantial increase in people aged 65 or older is important for those concerned about transportation injuries. However, much of the previous research concentrates on older drivers and overlooks the fact that vehicle and crash factors may provide significant explanations of older occupant injury rates. METHOD: Differences across age groups are explored using two nationwide travel surveys, crash involvement, fatalities, and injuries from crash databases and an ordered probit model of injury severity. RESULTS AND DISCUSSION: Two noticeable differences that help explain injury risk are that older people are more likely to travel in passenger cars than younger people who frequently use light trucks, and that seriously injured older occupants are more likely to be involved in side-impact crashes than their younger counterparts. IMPACT: Increased attention to vehicle engagement in side-impact crashes and to vehicle technologies that can help drivers avoid side collisions would be particularly helpful for older occupants.     

Sex differences in job attribute preferences

This study investigated the job attribute preferences of male and female MBA candidates. Participants were drawn from 27 different MBA programmes in the United States. Factor analysis of the job attributes questionnaire revealed three primary job attribute dimensions: (1) professional growth; (2) work environment; and (3) salary. Contrary to most previous research, females were found to place a greater emphasis on the professional growth dimension than did males. Males, on the other hand, placed greater emphasis on salary considerations. No sex difference was found in participants' ratings of the work environment job attribute dimension. Consistent with earlier research, women were found to place more importance on the calibre of colleagues than did males. In general, both males and females rated job attributes concerning job content as more important than job attributes concerning job context. These results are discussed with respect to earlier research findings. Finally, the generalizability of these findings to other occupational groups is discussed and managerial implications presented.     

Trends in aggressivity and driver risk for cars,SUVs, and pickups: Vehicle incompatibility from 1989 to 2016

Abstract

Objective: When 2 vehicles of different sizes collide, the occupants of the smaller vehicle are more likely to be injured than the occupants of the larger vehicle. The larger vehicle is both more protective of its own occupants and more aggressive toward occupants of the other vehicle. However, larger, heavier vehicles tend to be designed in ways that amplify their incompatibility with smaller, lighter vehicles (by having a higher ride height, for example). A 2012 study by the Insurance Institute for Highway Safety (IIHS) concluded that fatalities caused by design incompatibility have decreased in recent years. The current study was conducted to update the 2012 IIHS analysis and to explore trends in vehicle incompatibility over time.

Methods: Analyses examined deaths in crashes involving 1- to 4-year-old passenger vehicles from 1989 to 2016 collected from the Fatality Analysis Reporting System (FARS). Trends in driver risk were examined by comparing driver death rates per million registered vehicle years across vehicle type and size. Trends in aggressivity were examined by comparing partner driver death rates across vehicle type and size.

Results: Cars and SUVs have continued their trend toward reduced incompatibility. In 1989–1992, SUVs were 132% more likely to kill the driver in a partner car compared with when a car crashed with another car. By 2013–2016, this value had dropped to 28%. Pickups and cars remain just as incompatible in 2013–2016 as they were in 1989–1992, however (159% vs. 158%). Remaining pickup incompatibility may be largely due to excess curb weight rather than to shape or design features, because light pickups were just 23% more likely to kill the driver in a partner car compared with when a car crashed with another car.

Conclusions: The trend toward reduced fleet incompatibility has continued in the latest crash data, particularly for cars and SUVs. Although pickup–car incompatibility has also decreased over time, pickups remain disproportionately aggressive toward other vehicles, possibly due to their greater average curb weight. Reducing the weight of some of the heaviest vehicles and making crash avoidance technology fitment more widespread may be promising means to reduce remaining fleet incompatibility. Identifying the source of remaining incompatibility will be important for safety improvements going forward.     

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.     

Association Between NCAP Ratings and Real-World Rear Seat Occupant Risk of Injury

Objective: Several studies have evaluated the correlation between U.S. or Euro New Car Assessment Program (NCAP) ratings and injury risk to front seat occupants, in particular driver injuries. Conversely, little is known about whether NCAP 5-star ratings predict real-world risk of injury to restrained rear seat occupants. The NHTSA has identified rear seat occupant protection as a specific area under consideration for improvements to its NCAP. In order to inform NHTSA's efforts, we examined how NCAP's current 5-star rating system predicts risk of moderate or greater injury among restrained rear seat occupants in real-world crashes.

Methods: We identified crash-involved vehicles, model year 2004–2013, in NASS-CDS (2003–2012) with known make and model and nonmissing occupant information. We manually matched these vehicles to their NCAP star ratings using data on make, model, model year, body type, and other identifying information. The resultant linked NASS-CDS and NCAP database was analyzed to examine associations between vehicle ratings and rear seat occupant injury risk; risk to front seat occupants was also estimated for comparison. Data were limited to restrained occupants and occupant injuries were defined as any injury with a maximum Abbreviated Injury Scale (AIS) score of 2 or greater.

Results: We linked 95% of vehicles in NASS-CDS to a specific vehicle in NCAP. The 18,218 vehicles represented an estimated 6 million vehicles with over 9 million occupants. Rear seat passengers accounted for 12.4% of restrained occupants. The risk of injury in all crashes for restrained rear seat occupants was lower in vehicles with a 5-star driver rating in frontal impact tests (1.4%) than with 4 or fewer stars (2.6%, P =.015); results were similar for the frontal impact passenger rating (1.3% vs. 2.4%, P =.024). Conversely, side impact driver and passenger crash tests were not associated with rear seat occupant injury risk (driver test: 1.7% for 5-star vs. 1.8% for 1–4 stars; passenger test: 1.6% for 5 stars vs 1.8% for 1–4 stars).

Conclusions: Current frontal impact test procedures provide some degree of discrimination in real-world rear seat injury risk among vehicles with 5 compared to fewer than 5 stars. However, there is no evidence that vehicles with a 5-star side impact passenger rating, which is the only crash test procedure to include an anthropomorphic test dummy (ATD) in the rear, demonstrate lower risks of injury in the rear than vehicles with fewer than 5 stars. These results support prioritizing modifications to the NCAP program that specifically evaluate rear seat injury risk to restrained occupants of all ages.     

Association between driver and child passenger restraint: Analysis of community-based observational survey data from 2005 to 2019

Introduction: Crash data suggest an association between driver seatbelt use and child passenger restraint. However, community-based restraint use is largely unknown. We examined the association between driver seatbelt use and child restraint using data from a state-wide observational study. Methods: Data from Iowa Child Passenger Restraint Survey, a representative state-wide survey of adult seat belt use and child passenger safety, were analyzed. A total of 44,996 child passengers age 0–17 years were observed from 2005 to 2019. Information about driver seatbelt use and child restraint was directly observed by surveyors and driver age was reported. Logistic regression was used to examine the association between driver seatbelt use and child restraint adjusting for vehicle type, community size, child seating position, child passenger age, and year. Results: Over the 15-year study period, 4,114 (9.1%) drivers were unbelted, 3,692 (8.2%) children were completely unrestrained, and another 1,601 (3.6%) children were improperly restrained (analyzed as unrestrained). About half of unbelted drivers had their child passengers unrestrained (51.8%), while nearly all belted drivers had their child passengers properly restrained (92.3%). Compared with belted drivers, unbelted drivers had an 11-fold increased odds of driving an unrestrained child passenger (OR = 11.19, 95%CI = 10.36, 12.09). The association between driver seatbelt use and child restraint was much stronger among teenage drivers. Unbelted teenage drivers were 33-fold more likely (OR = 33.34, 95%CI = 21.11, 52.64) to have an unrestrained child passenger. Conclusion: These data suggest that efforts to increase driver seatbelt use may also have the added benefit of increasing child restraint use. Practical applications: Enforcement of child passenger laws and existing education programs for new drivers could be leveraged to increase awareness of the benefits of seatbelt use for both drivers themselves and their occupants. Interventions aimed at rural parents could emphasize the importance of child safety restraints.     

Characteristics of teens-with-teens fatal crashes in the United States, 2005–2010

BackgroundMore than 40% of fatal crashes of 16- and 17-year-old drivers occur when transporting teenagers. Characteristics of this predominant crash type and prevention possibilities are described, based on data from fatal crashes in the United States during 2005–2010.ResultsFifty-seven percent of 16- and 17-year old drivers in fatal crashes had at least one passenger. Most commonly, all passengers were ages 13–19 (42% of all drivers and 73% of those with passengers). Of fatal crashinvolved drivers with teenage passengers and no passengers of other ages, 56% had one passenger, 24% had two, and 20% had three or more. Most frequently, passengers were the same sex and within one year of the driver. Risk factors involving speeding, alcohol use, late-night driving, lack of a valid license, seat belt non-use, and crash responsibility were more prevalent with teenage passengers than when driving alone, and the prevalence of these factors increased with the number of teenage passengers. Many risk factors were most prevalent with passengers ages 20–29, although few crashes had this occupant configuration. Risk factors were least prevalent with a passenger 30 or older.DiscussionFatal crashes of 16- and 17-year-old drivers with teen passengers are a common crash scenario, despite passenger restrictions in 42 states and the District of Columbia during some or all of the study period. The proportion of these fatal crashes decreased slightly from 46% in 1995 (pre-GDL) to 43% in 2010 and showed no signs of decreasing during the six-year study period (range 41% to 43%).Practical applicationsExisting passenger restrictions are relatively weak and could be strengthened. Fatal crashes involving teen passengers, especially multiple passengers, are more likely to involve alcohol, late-night driving, driver error, and invalid licensure, so stepped-up enforcement of existing laws involving these behaviors might reduce the prevalence of such crashes.     

Underutilization of occupant restraint systems in motor vehicle injury crashes: A quantitative analysis from Qatar

Introduction: Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar.

Methods: A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive.

Results: Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49–2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31–7.38, P = .001) was significantly greater among unrestrained passengers.

Conclusion: The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar.     

Occurrence of Serious Injury in Real-World Side Impacts of Vehicles with Good Side-Impact Protection Ratings

Objective: The Insurance Institute for Highway Safety (IIHS) introduced its side impact consumer information test program in 2003. Since that time, side airbags and structural improvements have been implemented across the fleet and the proportion of good ratings has increased to 93% of 2012–2014 model year vehicles. Research has shown that drivers of good-rated vehicles are 70% less likely to die in a left-side crash than drivers of poor-rated vehicles. Despite these improvements, side impact fatalities accounted for about one quarter of passenger vehicle occupant fatalities in 2012. This study is a detailed analysis of real-world cases with serious injury resulting from side crashes of vehicles with good ratings in the IIHS side impact test.

Methods: NASS-CDS and Crash Injury Research and Engineering Network (CIREN) were queried for occupants of good-rated vehicles who sustained an Abbreviated Injury Scale (AIS) ≥ 3 injury in a side-impact crash. The resulting 110 cases were categorized by impact configuration and other factors that contributed to injury. Patterns of impact configuration, restraint performance, and occupant injury were identified and discussed in the context of potential upgrades to the current IIHS side impact test.

Results: Three quarters of the injured occupants were involved in near-side impacts. For these occupants, the most common factors contributing to injury were crash severities greater than the IIHS test, inadequate side-airbag performance, and lack of side-airbag coverage for the injured body region. In the cases where an airbag was present but did not prevent the injury, occupants were often exposed to loading centered farther forward on the vehicle than in the IIHS test. Around 40% of the far-side occupants were injured from contact with the struck-side interior structure, and almost all of these cases were more severe than the IIHS test. The remaining far-side occupants were mostly elderly and sustained injury from the center console, instrument panel, or seat belt. In addition, many far-side occupants were likely out of position due to events preceding the side impact and/or being unbelted.

Conclusion: Individual changes to the IIHS side impact test have the potential to reduce the number of serious injuries in real-world crashes. These include impacting the vehicle farther forward (relevant to 28% of all cases studied), greater test severity (17%), the inclusion of far-side occupants (9%), and more restrictive injury criteria (9%). Combinations of these changes could be more effective.     

Analysis of deaths caused by pat-pat accidents in Turkey

This study deals with deaths during the period 2004 to 2009 that occurred during the use of a vehicle known as pat-pat, which is an unusual vehicle, similar to a tractor-trailer used in agricultural production and transportation The records of crime scene investigation and autopsies of 28 cases of death due to pat-pat-related crushes were evaluated. Of all cases, 60.7 percent were drivers and the remaining 39.3% were passengers. The most common cause of death (in 39.3% of cases) was brain-spinal cord injury due to blunt trauma of the head and neck. Implementing legislation regarding safety measures or limitation of the use for transportation should be performed for pat-pats, of which thousands are currently in use.