Child restraint use and parental perceptions of comfort

Objective: Suboptimal child restraint use includes incorrect and/or inappropriate restraint use and increases the risk of injury. Comfort has been suggested as an important factor impacting on optimal use of restraints by children. This article aims to examine the relationships between parent reported comfort and restraint misuse and age-appropriate restraint choice.

Methods: This is an analysis of data from a cross sectional observation study of child restraint use in New South Wales. Logistic regression was used to model the relationship between parent-reported comfort and restraint misuse and age-appropriate restraint choice.

Results: There was no significant relationship between either parent-reported comfort and restraint misuse or parent-reported comfort and age-appropriate restraint choice.

Conclusions: Parent perceptions of comfort of children in child restraints do not appear to be associated with incorrect child restraint use or age appropriate restraint choice. It is possible that the actual comfort of the child may be related to incorrect use but this remains to be tested. Further investigation of the relationship between parent-perceived comfort and the actual comfort of the child, as well as the impact of child comfort on optimal child restraint use is warranted.     

Predictors of restraint use among child occupants

Objectives: The objective of this study was to identify factors that predict restraint use and optimal restraint use among children aged 0 to 13 years.

Methods: The data set is a national sample of police-reported crashes for years 2010–2014 in which type of child restraint is recorded. The data set was supplemented with demographic census data linked by driver ZIP code, as well as a score for the state child restraint law during the year of the crash relative to best practice recommendations for protecting child occupants. Analysis used linear regression techniques.

Results: The main predictor of unrestrained child occupants was the presence of an unrestrained driver. Among restrained children, children had 1.66 (95% confidence interval, 1.27, 2.17) times higher odds of using the recommended type of restraint system if the state law at the time of the crash included requirements based on best practice recommendations.

Conclusions: Children are more likely to ride in the recommended type of child restraint when their state's child restraint law includes wording that follows best practice recommendations for child occupant protection. However, state child restraint law requirements do not influence when caregivers fail to use an occupant restraint for their child passengers.     

Rating child passenger safety laws relative to best practice recommendations for occupant protection

Background: State laws regarding child passenger protection vary substantially.

Objectives: The objective of this study was to develop a scoring system to rate child passenger safety laws relative to best practice recommendations for each age of child.

Methods: State child passenger safety and seat belt laws were retrieved from the LexisNexis database for the years 2002–2015. Text of the laws was reviewed and compared to current best practice recommendations for child occupant protection for each age of child.

Results: A 0–4 scale was developed to rate the strength of the state law relative to current best practice recommendations. A rating of 3 corresponds to a law that requires a restraint that is sufficient to meet best practice, and a rating of 4 is given to a law that specifies several options that would meet best practice. Scores of 0, 1, or 2 are given to laws requiring less than best practice to different degrees. The same scale is used for each age of child despite different restraint recommendations for each age. Legislation that receives a score of 3 requires rear-facing child restraints for children under age 2, forward-facing harnessed child restraints for children aged 2 to 4, booster seats for children 5 to 10, and primary enforcement of seat belt use in all positions for children aged 11–13. Legislation requiring use of a “child restraint system according to instructions” would receive a score of 1 for children under age 2 and a 2 for children aged 2–4 because it would allow premature use of a booster for children weighing more than 13.6 kg (30 lb).

Conclusions: The scoring system developed in this study can be used in mathematical models to predict how child passenger safety legislation affects child restraint practices.     

Undercounting of large trucks in federal and state crash databases: Extent of problem and how to improve accuracy of truck classifications

Objective: Prior research suggested that single-unit trucks are undercounted when using vehicle body codes in the Fatality Analysis Reporting System (FARS). This study explored the extent of the misclassification and undercounting problem for crashes in FARS and state crash databases.

Methods: Truck misclassifications for fatal crashes were explored by comparing the Trucks Involved in Fatal Accidents (TIFA) database with FARS. TIFA used vehicle identification numbers (VINs) and survey information to classify large trucks. This study used VINs to improve the accuracy of large truck classifications in state crash databases from 5 states (Delaware, Maryland, Minnesota, Nebraska, and Utah).

Results: The vehicle body type codes resulted in a 19% undercount of single-unit trucks in FARS and a 23% undercount of single-unit trucks in state databases. Tractor-trailers were misclassified less often. Misclassifications occurred most frequently among single-unit trucks in the weight classes of 10,001–14,000 pounds.

Conclusions: The amount of misclassification of large trucks is large enough to potentially affect federal and state decisions on traffic safety. Using information from VINs results in more complete and accurate counts of large trucks involved in crashes. The National Transportation Safety Board recommended actions to improve federal and state crash data.     

Restraint use in the Eastern Province of the Kingdom of Saudi Arabia

Objectives: This study set out to examine seat belt and child restraint use in the Dammam Municipality of the Kingdom of Saudi Arabia, based on the premise that an increase in seat belt use would significantly reduce personal injury in traffic crashes. It was expected that local data would help identify intervention strategies necessary to improve seat belt use in the region.

Methods: The research involved 2 methodologies. First, 1,389 face-to-face interviews were conducted with male and female adults in regional shopping plazas regarding their own and their children's restraint use in their vehicles and reasons for these attitudes and beliefs. Second, 2 on-road observation studies of adult and child restraint use were conducted by trained observers. Occupants of approximately 5,000 passenger vehicles were observed while stopped at representative signalized traffic intersections.

Results: The findings showed front seat belt use rates of between 43 and 47% for drivers and 26 to 30% for front seat passengers; rear seat belt use rates were lower. While there seemed to be some knowledge about the purpose and reasons for restraining both adults and children in suitable restraints, this failed to be confirmed in the on-road observations.

Conclusions: Reasons for these rates and findings are discussed fully, and recommendations for improving seat belt use in the Dammam Municipality are included.     

Standardized error severity score (ESS) ratings to quantify risk associated with child restraint system (CRS) and booster seat misuse

Objective: Although numerous research studies have reported high levels of error and misuse of child restraint systems (CRS) and booster seats in experimental and real-world scenarios, conclusions are limited because they provide little information regarding which installation issues pose the highest risk and thus should be targeted for change. Beneficial to legislating bodies and researchers alike would be a standardized, globally relevant assessment of the potential injury risk associated with more common forms of CRS and booster seat misuse, which could be applied with observed error frequency—for example, in car seat clinics or during prototype user testing—to better identify and characterize the installation issues of greatest risk to safety.

Methods: A group of 8 leading world experts in CRS and injury biomechanics, who were members of an international child safety project, estimated the potential injury severity associated with common forms of CRS and booster seat misuse. These injury risk error severity score (ESS) ratings were compiled and compared to scores from previous research that had used a similar procedure but with fewer respondents. To illustrate their application, and as part of a larger study examining CRS and booster seat labeling requirements, the new standardized ESS ratings were applied to objective installation performance data from 26 adult participants who installed a convertible (rear- vs. forward-facing) CRS and booster seat in a vehicle, and a child test dummy in the CRS and booster seat, using labels that only just met minimal regulatory requirements. The outcome measure, the risk priority number (RPN), represented the composite scores of injury risk and observed installation error frequency.

Results: Variability within the sample of ESS ratings in the present study was smaller than that generated in previous studies, indicating better agreement among experts on what constituted injury risk. Application of the new standardized ESS ratings to installation performance data revealed several areas of misuse of the CRS/booster seat associated with high potential injury risk.

Conclusions: Collectively, findings indicate that standardized ESS ratings are useful for estimating injury risk potential associated with real-world CRS and booster seat installation errors.     

Compatibility of booster seats and vehicles in the U.S. market

Objective: The objective of this study was to analyze booster and rear vehicle seat dimensions to identify the most frequent compatibility problems.

Methods: Measurements were collected from 40 high-back and backless boosters and 95 left rear and center rear row seating positions in 50 modern vehicles. Dimensions were compared for 3,800 booster/vehicle seat combinations. For validation and estimation of tolerance and correction factors, 72 booster installations were physically completed and compared with measurement-based compatibility predictions. Dimensions were also compared to the International Organization for Standardization (ISO) volumetric envelopes of forward-facing child restraints and boosters.

Results: Seat belt buckles in outboard positions accommodated the width of boosters better than center positions (success rates of 85.4 and 34.7%, respectively). Adequate head restraint clearance occurred in 71.9 to 77.2% of combinations, depending on the booster's head support setting. Booster recline angles aligned properly with vehicle seat cushion angles in 71.5% of combinations. In cases of poor angle alignment, booster angles were more obtuse than the vehicle seat angles 97.7% of the time. Head restraint interference exacerbated angle alignment issues. Data indicate success rates above 90% for boosters being fully supported by the length of the seat cushion and for adequate height clearance with the vehicle roofline. Comparison to ISO envelopes indicates that most boosters on the U.S. market are taller and angled more obtusely than ISO target envelopes.

Conclusions: This study quantifies some of the common interferences between boosters and vehicles that may complicate booster usage. Data are useful for design and to prioritize specific problem areas.     

Teaching infant car seat installation via interactive visual presence: An experimental trial

Objective: A large portion of child restraint systems (car seats) are installed incorrectly, especially when first-time parents install infant car seats. Expert instruction greatly improves the accuracy of car seat installation but is labor intensive and difficult to obtain for many parents. This study was designed to evaluate the efficacy of 3 ways of communicating instructions for proper car seat installation: phone conversation; HelpLightning, a mobile application (app) that offers virtual interactive presence permitting both verbal and interactive (telestration) visual communication; and the manufacturer's user manual.

Methods: A sample of 39 young adults of child-bearing age who had no previous experience installing car seats were recruited and randomly assigned to install an infant car seat using guidance from one of those 3 communication sources.

Results: Both the phone and interactive app were more effective means to facilitate accurate car seat installation compared to the user manual. There was a trend for the app to offer superior communication compared to the phone, but that difference was not significant in most assessments. The phone and app groups also installed the car seat more efficiently and perceived the communication to be more effective and their installation to be more accurate than those in the user manual group.

Conclusions: Interactive communication may help parents install car seats more accurately than using the manufacturer's manual alone. This was an initial study with a modestly sized sample; if results are replicated in future research, there may be reason to consider centralized “call centers” that provide verbal and/or interactive visual instruction from remote locations to parents installing car seats, paralleling the model of centralized Poison Control centers in the United States.     

Fatal and serious collisions involving pedal cyclists and trucks in London between 2007 and 2011

Objective: Increased numbers of people riding pedal cycles have led to a greater focus on pedal cycle safety. The aim of this article is to explore factors that are associated with fatal and a small number of serious-injury pedal cyclist crashes involving trucks that occurred in London between 2007 and 2011.

Methods: Data were collected from police collision files for 53 crashes, 27 of which involved a truck (≥3.5 tonnes) and a pedal cycle. A systematic case review approach was used to identify the infrastructure, vehicle road user, and management factors that contributed to these crashes and injuries and how these factors interacted.

Results: Trucks turning left conflicting with pedal cyclists traveling straight ahead was a common crash scenario. Key contributory factors identified included the pedal cyclists not being visible to the truck drivers, road narrowing, and inappropriate positioning of pedal cyclists.

Conclusions: Crashes involving trucks and pedal cyclists are complex events that are caused by multiple interacting factors; therefore, multiple measures are required to prevent them from occurring.     

An observational study of child safety seat use in an international safe community: Tehran,Iran

Objective: Despite strong evidence of the effectiveness of child safety seats in reducing injuries, the use of these devices in some communities is still rare. The purpose of this study was to determine the prevalence of child safety seat use and the factors influencing its use in the safe community of Tehran.

Methods: This roadside observational study was conducted in 2015 and 2,178 personal cars with a child under 12 years aboard were observed on Tehran's streets in regard to use of child safety seats. Other variables such as the gender of the driver, driver's age group, type of street, region of municipality, time of day, and day of the week were also collected.

Results: Prevalence of child safety seat use was 4.3% and was significantly higher among women drivers, on freeways, and in municipal regions 1, 4, and 7.

Conclusions: The prevalence of child safety seat use in Tehran as a most populous member of the international safe community was very low and most children commuted in insecure situations in the vehicle. Therefore, it is proposed that plans should be made to increase the use of child safety seats in international safe communities.     

Ticketing aggressive cars and trucks (TACT): How does it work on city streets?

Objective: The purpose of this study was to determine the feasibility of modifying the Ticking Aggressive Cars and Trucks (TACT) program, originally designed to work on state highways, within a metropolitan area to reduce unsafe interactions and their related crashes between drivers of large trucks and passenger vehicles.

Methods: Using crash data, the driving behaviors most commonly associated with large truck and passenger vehicle crashes were identified. A public awareness campaign using media messaging and increased law enforcement was created targeting these associated behaviors. The frequency of these behaviors both before and after the public awareness campaign was determined through observation of traffic at 3 specific locations within the city. Each location had a sufficient volume of large truck and passenger traffic to observe frequent interactions. Pre- and postintervention data were compared using negative binomial regression with generalized estimating equations to evaluate whether the campaign was associated with a reduction in the identified driving behaviors.

Results: A comparison between crash data from before, during, and after the campaign and crashes during the same time periods in previous years did not show a significant difference (P =.081). The number of large trucks observed in traffic remained the same during pre- and postintervention periods (P =.625). The rates of negative interactions per 100 large trucks decreased for both large trucks and passenger vehicles after the intervention, with calculated rate ratios of 0.58 (95% confidence interval [CI], 0.48, 0.70) and 0.31 (95% CI, 0.20, 0.47). The greatest reduction was seen in passenger vehicles following too close, with a rate ratio of 0.21 (95% CI, 0.15, 0.30).

Conclusions: Although designed for reducing crashes on highways, the TACT program can be an effective approach for improving driver behaviors on city streets.     

An energy-absorbing sliding seat for reducing neck injury risks in rear impact—analysis for prototype built

Objective: This study investigated overall performance of an energy-absorbing sliding seat concept for whiplash neck injury prevention. The sliding seat allows its seat pan to slide backward for some distance under certain restraint force to absorb crash energy in rear impacts.

Methods: A numerical model that consisted of vehicle interior, seat, seat belt, and BioRID II dummy was built in MADYMO to evaluate whiplash neck injury in rear impact. A parametric study of the effects of sliding seat parameters, including position and cushion stiffness of head restraint, seatback cushion stiffness, recliner characteristics, and especially sliding energy-absorbing (EA) restraint force, on neck injury criteria was conducted in order to compare the effectiveness of the sliding seat concept with that of other existing anti-whiplash mechanisms. Optimal sliding seat design configurations in rear crashes of different severities were obtained. A sliding seat prototype with bending of a steel strip as an EA mechanism was fabricated and tested in a sled test environment to validate the concept. The performance of the sliding seat under frontal and rollover impacts was checked to make sure the sliding mechanism did not result in any negative effects.

Results: The protective effect of the sliding seat with EA restraint force is comparable to that of head restraint–based and recliner stiffness–based anti-whiplash mechanisms. EA restraint force levels of 3 kN in rear impacts of low and medium severities and 6 kN in impacts of high severity were obtained from optimization. In frontal collision and rollover, compared to the nonsliding seat, the sliding seat does not result in any negative effects on occupant protection. The sled test results of the sliding seat prototype have shown the effectiveness of the concept for reducing neck injury risks.

Conclusion: As a countermeasure, the sliding seat with appropriate restraint forces can significantly reduce whiplash neck injury risk in rear impacts of low, medium, and high severities with no negative effects on other crash load cases.     

Parental awareness and perception for correct use of child restraint systems and airbags in Brazil

Objective: The objective of this study was to obtain information about the current knowledge and habits of parents who transport children in cars in Brazil.

Methods: A cross-sectional survey was conducted using specifically designed self-report questionnaires to parents of children attending a private pediatric office in a town in southwest Brazil. Data were collected regarding children's age, gender, height, and weight and possession of an automobile child restraint system (CRS), its type, frequency and adequacy of use, and reasons for not possessing or not using the devices. Parents were asked whether their cars were equipped with airbags and about the use of the restraints in seats with airbags.

Results: We interviewed parents of 293 children transported in cars who met the criteria for use of a CRS. Children were younger than 1 year in 15.3% of the cases, between 1 and 4 years in 38.6%, and older than 4 in 46.1%. Cars were equipped with CRS in 78.5% of the cases, but in only 58% of the cases was the device proper for child's age and adequately installed in the seat. Among owners of the devices, 84.3% reported that they always used it. Reasons for infrequency were forgetting the device at home or in another car (6.4%), the child disliking the device (3.2%), or the false impression that the child was grown enough not to use it (3.2%)l 87.1% did not justify why they did not always use the CRS. Considering type of CRS, correct installation of the seat, and frequency of use, only 44.4% of children under 1 year, 69.9% of those 1 to 4 years, and 52.6% over age 4 were protected. Only 28.6% of the parents knew that children should never be positioned in a seat with active airbags.

Conclusion: Considering appropriateness for age, correctness of installation (in the back seat in the correct orientation), and frequency of use, only 50.85% (149/293) of the children were reported as always protected with a CRS. Children between 1 and 4 years were more likely to always use a CRS in this Brazilian survey. We were also able to identify an important gap in the knowledge about airbags among parents. Further efforts are needed to correct those distortions.     

Evaluation of the effectiveness of toe board energy-absorbing material for foot,ankle, and lower leg injury reduction

Objective: Since 2000, numerous improvements have been made to the National Association for Stock Car Auto Racing, Incorporated (NASCAR®) driver restraint system, resulting in improved crash protection for motorsports drivers. Advancements have included seats, head and neck restraints (HNRs), seat belt restraint systems, driver helmets, and others. These enhancements have increased protection for drivers from severe crash loading. Extending protection to the driver's extremities remains challenging. Though the drivers’ legs are well contained for lateral and vertical crashes, they remain largely unrestrained in frontal and frontal oblique crashes.

Method: Sled testing was conducted for the evaluation of an energy-absorbing (EA) toe board material to be used as a countermeasure for leg and foot injuries. Testing included baseline rigid toe boards, tests with EA material–covered toe boards, and pretest positioning of the 50th percentile male frontal Hybrid III anthropomorphic test device (ATD) lower extremities. ATD leg and foot instrumentation included foot acceleration and tibia forces and moments.

Results: The sled test data were evaluated using established injury criteria for tibial plateau fractures, leg shaft fractures, and calcaneus, talus, ankle, and midfoot fractures.

Conclusion: A polyurethane EA foam was found to be effective in limiting axial tibia force and foot accelerations when subjected to frontal impacts using the NASCAR motorsport restraint system.     

Pelvic restraint cushion sled test evaluation of pelvic forward motion

Objective: This study was designed to evaluate the performance of a pelvic restraint cushion (PRC), a submarining countermeasure that deploys under the thighs when a crash is detected in order to block the forward motion of the pelvis.

Methods: Sled tests approximating low- and high-speed frontal impacts were conducted with 4 female postmortem human subjects (PMHS) restrained by a lap and shoulder belt in the right front passenger seat. The subjects were tested with and without a PRC.

Results: The PRC is effective in reducing forward motion of the PMHS pelvis and reduces the risk of injury due to lap belt loading in a high-speed frontal crash.

Conclusions: Although small sample size limits the utility of the study's findings, the results suggest that the PRC can limit pelvic forward motion and that pelvic injury due to PRC deployment is not likely.     

Study of chest injuries to 3-year-old child occupants seated in impact shield and 5-point harness CRSs

Objective: The objective of this study was to investigate whether the 5-point harness or the impact shield child restraint system (CRS) or both have the potential to cause chest injuries to children. This is determined by examining whether the loading to the chest reaches the internal organ injury threshold for children.

Method: The chest injury risk to a child occupant in a CRS was investigated using Q3 dummy tests, finite element (FE) simulations (Q3 dummy and human models), and animal tests. The investigation was done for 2 types of CRSs (i.e., the impact shield CRS and 5-point harness CRS) based on the UN R44 dynamic test specifications.

Results: The tests using a Q3 dummy indicated that although the chest deflection of the dummy in the impact shield CRS was large, it was less than the injury threshold (40 mm). Computational biomechanics simulations (using finite element FE analysis) showed that the Q3 dummy's chest is loaded by the shield and deforms substantially under this load. To clarify whether chest injuries due to chest compression can occur with an impact shield or with the 5-point harness CRS, 7 experiments were performed using Tibetan miniature pigs with weights ranging from 9.7 to 13 kg. Severe chest and abdominal injuries (lung contusion, coronary artery laceration, liver laceration) were found in the tests using the impact shield CRS. No chest injuries were present when using the 5-point harness CRS.

Conclusion: When using the impact shield CRS, the chest deformed substantially in dummy tests and FE simulations, and chest and abdominal injuries were observed in pig tests. It is possible that these chest injuries could also occur to child occupants sitting in the impact shield CRS.     

A parametric model of child body shape in seated postures

Objective: The shape of the current physical and computational surrogates of children used for restraint system assessments is based largely on standard anthropometric dimensions. These scalar dimensions provide valuable information on the overall size of the individual but do not provide good guidance on shape or posture. This study introduced the development of a parametric model that statistically predicts individual child body shapes in seated postures with a few given parameters.

Methods: Surface geometry data from a laser scanner of children ages 3 to 11 (n = 135) were standardized by a 2-level fitting method using intermediate templates. The standardized data were analyzed by principal component analysis (PCA) to efficiently describe the body shape variance. Parameters such as stature, body mass index, erect sitting height, and 2 posture variables related to torso recline and lumbar spine flexion were associated with the PCA model using regression.

Results: When the original scan data were compared with the predictions of the model using the given subject dimensions, the average root mean square error for the torso was 9.5 mm, and the 95th percentile error was 17.35 mm.

Conclusions: For the first time, a statistical model of child body shapes in seated postures is available. This parametric model allows the generation of an infinite number of virtual children spanning a wide range of body sizes and postures. The results have broad applicability in product design and safety analysis. Future work is needed to improve the representation of hands and feet and to extend the age range of the model. The model presented in this article is publicly available online through HumanShape.org.