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.     

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.     

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.     

Unintentional non-traffic injury and fatal events: Threats to children in and around vehicles

Objective: There have been substantial reductions in motor vehicle crash–related child fatalities due to advances in legislation, public safety campaigns, and engineering. Less is known about non-traffic injuries and fatalities to children in and around motor vehicles. The objective of this study was to describe the frequency of various non-traffic incidents, injuries, and fatalities to children using a unique surveillance system and database.

Methods: Instances of non-traffic injuries and fatalities in the United States to children 0–14 years were tracked from January 1990 to December 2014 using a compilation of sources including media reports, individual accounts from families of affected children, medical examiner reports, police reports, child death review teams, coroner reports, medical professionals, legal professionals, and other various modes of publication.

Results: Over the 25-year period, there were at least 11,759 events resulting in 3,396 deaths. The median age of the affected child was 3.7 years. The incident types included 3,115 children unattended in hot vehicles resulting in 729 deaths, 2,251 backovers resulting in 1,232 deaths, 1,439 frontovers resulting in 692 deaths, 777 vehicles knocked into motion resulting in 227 deaths, 415 underage drivers resulting in 203 deaths, 172 power window incidents resulting in 61 deaths, 134 falls resulting in 54 deaths, 79 fires resulting in 41 deaths, and 3,377 other incidents resulting in 157 deaths.

Conclusions: Non-traffic injuries and fatalities present an important threat to the safety and lives of very young children. Future efforts should consider complementary surveillance mechanisms to systematically and comprehensively capture all non-traffic incidents. Continued education, engineering modifications, advocacy, and legislation can help continue to prevent these incidents and must be incorporated in overall child vehicle safety initiatives.     

Characteristics and clinical outcomes of head-injured cyclists with and without helmets in urban and rural areas of Taiwan: A 15-year study

Objective: Bicycle riding is increasingly popular in Taiwan, but the number of cyclists injured and cyclists' death rates are both increasing. The aim of this study was to investigate the different characteristics and clinical outcomes of traffic accident–related head injuries among cyclists in urban and rural areas.

Methods: Records of 812 patients (533 urban and 279 rural) admitted to 27 hospitals in Taipei City and Hualien County as the result of a traumatic head injury while bicycling between 1998 and 2013 were retrieved for study. Demographics, details about the accident, protective helmet use, and clinical outcomes were then subjected to analysis.

Results: Urban victims were more likely to be injured during morning and early evening rush hours and rural victims during the day; most urban victims were between 19 and 34 years of age and injured in the slow lane; rural victims tended to be younger or older and were injured in the fast lane (all P ≤.001). Riders who wore a helmet were less likely to suffer loss of consciousness (odds ratio [OR] = 0.31), amnesia (OR = 0.069), neurological disorders (OR = 0.205), or facial fractures (OR = 0.369). Older age, more severe head injuries, and bicycle–motor vehicle collisions influenced the severity of symptoms on admission and the residual effects at discharge.

Conclusions: Differences in the characteristics of injuries in urban and rural areas and the utilization of protective helmets may help government authorities adopt appropriate policies to promote safer and more enjoyable cycling.     

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.     

Transport company safety climate—The impact on truck driver behavior and crash involvement

Objective: The present study investigated the relationships between safety climate and driving behavior and crash involvement.

Methods: A total of 339 company-employed truck drivers completed a questionnaire that measured their perceptions of safety climate, crash record, speed choice, and aberrant driving behaviors (errors, lapses, and violations).

Results: Although there was no direct relationship between the drivers' perceptions of safety climate and crash involvement, safety climate was a significant predictor of engagement in risky driving behaviors, which were in turn predictive of crash involvement.

Conclusions: This research shows that safety climate may offer an important starting point for interventions aimed at reducing risky driving behavior and thus fewer vehicle collisions.     

Modeling the probability of freeway lane-changing collision occurrence considering intervehicle interaction

Objective: To better capture the relationships between lane-changing collisions and explanatory variables, a microscopic model is developed for freeway lane-changing collisions based on the interactions between lane-changing vehicles.

Methods: The model applies an intervehicle interaction structure to account for the occurrence mechanism of lane-changing collisions. The occurrence mechanism can be described as the failure of a vehicle driver of an adjacent lane in avoiding the lane-changing vehicle, which disturbs the smooth movement of the adjacent lane vehicle and requires the driver's brake action to avoid an angle collision. This model is examined using data collected from freeways in Washington State during 2010 to 2011 and validated using lane-changing collision data for the SR 520 freeway.

Results: The findings of this study show that generalized truck percentage has a significant decreasing effect on lane-changing collision risk, whereas average spacing and several roadway characteristics have significant increasing effects. The frequency of slight collisions during peak hours is higher than that during off-peak hours. Young female drivers are more likely to be involved in collisions during lane-changing than young male drivers, but the result for senior drivers is opposite, with older male drivers having a higher probability of lane-changing collisions than female drivers in the same age group.

Conclusion: The process of lane-changing collisions is a complicated maneuver. Truck percentage, average spacing, and good roadway characteristics, such as straight and level segment, in the target lane have a significant effect on the occurrence of lane-changing collisions. Age and gender are also 2 important factors contributing to the relationship between lane-changing collisions and explanatory variables.     

Orthopedic injury in electric bicycle-related collisions

Objective: Although electric bicycle-related injuries have become the most common reason for hospitalization due to a road crash in China, no study has comprehensively investigated electric bicycle collisions and their impact on orthopedic injuries; such a study may provide evidence to support a new road safety policy.

Methods: A retrospective review of orthopedic injuries from electric bicycle collisions was performed in an urban trauma center. We collected variables including age, gender, location of fracture, presence of open or closed fractures, concomitant vascular, and neurologic injuries.

Results: A total of 2,044 cases were involved in electric bicycle collisions. The orthopedic injury victims were predominantly male and middle aged. The most common orthopedic injury was a femur fracture. Open fractures frequently involved the forearm and tibia/fibula. Male patients were more likely to suffer from multiple fractures and associated injuries than female patients. Fewer patients age 60 years old or older wore helmets at the time of the accident compared to those in other age groups.

Conclusions: Orthopedic injuries from electric bicycle-related accidents cause patients substantial suffering that could lead to serious social consequences. Helmet use and protective clothing or similar safety gear, especially for electric bicycle users, should be required to provide greater protection.     

Road accident fatality risks for “vulnerable” versus “protected” road users in northern Ghana

Background: Road traffic injuries (RTIs) are a serious epidemic that claims more than a million lives across the globe each year. The burden of RTIs is particularly pronounced in Africa and other low- and middle-income countries. The unfavorable disparity of the burden of road trauma in the world is largely attributable to unsafe vehicles, lack of appropriate road infrastructure, and the predominance of vulnerable road users (VRUs) in developing countries. However, little research exists in northern Ghana to highlight the scale and risk of death among road users.

Objective: The objective of this research was to establish the relative risk of death among road users in northern Ghana.

Methods: Crash data from police reports between 2007 and 2011 were analyzed for the Upper Regions of Ghana. Conditional probabilities and multivariable logistic regression techniques were used to report proportions and adjusted odds ratios (AORs), respectively.

Results: Generally, crashes in northern Ghana were extremely severe; that is, 35% of all injury related collisions were fatal. The proportion of fatal casualties ranged between 21% among victims of sideswipe collisions and 41% among pedestrians and victims of rear-end collisions. Though males were 6 times more likely to die than females overall, females were more likely to die as pedestrians (90% of all female casualty deaths) and males were more likely to die as riders/drivers (78% of all male casualty deaths). Pedestrians were 3 times more likely to die (odds ratio [OR] = 3.1; 95% confidence interval [CI], 2.4 to 4.1) compared with drivers/riders. Compared with drivers, the odds of death among cyclists was about 4 times higher (AOR = 3.6; 95% CI, 2.3 to 5.6) and about 2 times higher among motorcyclists (AOR = 1.6; 95% CI, 1.2 to 2.2). Compared with casualties aged between 30 and 59 years, children under 10 years and those aged 60 years and above were independently 2 times more likely to die in traffic collisions.

Conclusion: Provision of requisite road infrastructure is vital for the safety of VRUs in northern Ghana. Cycle paths and lanes (for cyclists) as well as sidewalks (for pedestrians) in particular will separate VRUs from motorists and improve their safety. Enforcement of traffic laws particularly regarding helmet use, speeding, and alcohol use will be beneficial. Introduction of the demerit points system in the enforcement of traffic regulations may have significant deterrent effects on road users who have the penchant for violating traffic regulations. Road safety education is also required to create responsible road users.     

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.     

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.     

Personal injury recovery cost of pedestrian–vehicle collisions in New South Wales,Australia

Background: There is a need for routine estimates of injury recovery costs from pedestrian collisions using hospital separation records for economic evaluations.

Objective: To estimate the cost of injury recovery following pedestrian–vehicle collisions using the personal injury recover cost (PIRC) equation using key demographic and injury characteristics.

Method: An estimation of the costs of on-road pedestrian–vehicle collisions involving individuals who were injured and hospitalized in New South Wales (NSW), Australia, from 2002 to 2011 using the PIRC equation. The PIRC estimates individual injury recovery costs and does not include costs associated with property damage, vehicle repair, or rescue services. Individual recovery costs associated with severe traumatic brain injury (TBI) were estimated. The injured individual's mean, median, and total injury recovery costs are described for key demographic, injury, and crash characteristics.

Results: There were 9,781 pedestrians who were injured, costing an estimated total of $2.4 billion in personal injury recovery costs, an annual cost of $243 million. Males had a total injury recovery cost 1.7 times higher than females. The median injury recovery cost decreased with increasing age. TBI ($248,491) and spinal cord and vertebral column injuries ($264,103) had the highest median injury recovery costs for the body region of the most severe injury. TBI accounted for 22.6% of the total injury recovery costs for the most severe injury sustained. Just over one third of pedestrians sustained 4 or more injuries, with a median cost of $243,992, which was 1.6 times higher than the cost for a pedestrian who sustained a single injury ($153,682).

Conclusions: Personal injury recovery costs following pedestrian–vehicle collisions where a pedestrian is injured are substantial in NSW. The PIRC equation enables the economic cost burden of road traffic injury to be calculated using hospital separation data. The PIRC enables comprehensive personal injury recovery costs to be estimated and would aid in economic evaluations of preventive strategies in road safety.     

A new approach to road accident rescue

Objective: This article develops and validates a new methodology and tool for rescue assistance in traffic accidents, with the aim of improving its efficiency and safety in the evacuation of people, reducing the number of victims in road accidents.

Method: Different tests supported by professionals and experts have been designed under different circumstances and with different categories of damaged vehicles coming from real accidents and simulated trapped victims in order to calibrate and refine the proposed methodology and tool.

Results: To validate this new approach, a tool called App_Rescue has been developed. This tool is based on the use of a computer system that allows an efficient access to the technical information of the vehicle and sanitary information of the common passengers. The time spent during rescue using the standard protocol and the proposed method was compared.

Conclusion: This rescue assistance system allows us to make vital information accessible in posttrauma care services, improving the effectiveness of interventions by the emergency services, reducing the rescue time and therefore minimizing the consequences involved and the number of victims. This could often mean saving lives. In the different simulated rescue operations, the rescue time has been reduced an average of 14%.     

Cross-correlation between the controlled collision environment and real-world motor vehicle collisions: Evaluating the protection of the thoracic side airbag

Objective: Thoracic side airbags (tSABs) were integrated into the vehicle fleet to attenuate and distribute forces on the occupant's chest and abdomen, dissipate the impact energy, and move the occupant away from the intruding structure, all of which reduce the risk of injury. This research piece investigates and evaluates the safety performance of the airbag unit by cross-correlating data from a controlled collision environment with field data.

Method: We focus exclusively on vehicle–vehicle lateral impacts from the NHTSA's Vehicle Crash Test Database and NASS-CDS database, which are replicated in the controlled environment by the (crabbed) barrier impact. Similar collisions with and without seat-embedded tSABs are matched to each other and the injury risks are compared.

Results: Results indicated that dummy-based thoracic injury metrics were significantly lower with tSAB exposure (P <.001). Yet, when the controlled collision environment data were cross-correlated with NASS-CDS collisions, deployment of the tSAB indicated no association with thoracic injury (tho. MAIS 2+ unadjusted relative risk [RR] = 1.14; 90% confidence interval [CI], 0.80–1.62; tho. MAIS 3+ unadjusted RR = 1.12; 90% CI, 0.76–1.65).

Conclusion: The data from the controlled collision environment indicated an unequivocal benefit provided by the thoracic side airbag for the crash dummy; however, the real-world collisions demonstrate that no benefit is provided to the occupant. This has resulted from a noncorrelation between the crash test/dummy-based design taking the abstracting process too far to represent the real-world collision scenario.     

Features of fatal injuries in older cyclists in vehicle–bicycle accidents in Japan

Objective: The purpose of this study was to identify and better understand the features of fatal injuries in cyclists aged 75 years and over involved in collisions with either hood- or van-type vehicles.

Methods: This study investigated the fatal injuries of cyclists aged 75 years old and over by analyzing accident data. We focused on the body regions to which the fatal injury occurred using vehicle–bicycle accident data from the Institute for Traffic Accident Research and Data Analysis (ITARDA) in Japan. Using data from 2009 to 2013, we examined the frequency of fatally injured body region by gender, age, and actual vehicle travel speed. We investigated any significant differences in distributions of fatal injuries by body region for cyclists aged 75 years and over using chi-square tests to compare with cyclists in other age groups. We also investigated the cause of fatal head injuries, such as impact with a road surface or vehicle.

Results: The results indicated that head injuries were the most common cause of fatalities among the study group. At low vehicle travel speeds for both hood- and van-type vehicles, fatalities were most likely to be the result of head impacts against the road surface.

The percentage of fatalities following hip injuries was significantly higher for cyclists aged 75 years and over than for those aged 65–74 or 13–59 in impacts with hood-type vehicles. It was also higher for women than men in the over-75 age group in impacts with these vehicles.

Conclusions: For cyclists aged 75 years and over, wearing a helmet may be helpful to prevent head injuries in vehicle-to-cyclist accidents. It may also be helpful to introduce some safety measures to prevent hip injuries, given the higher level of fatalities following hip injury among all cyclists aged 75 and over, particularly women.     

Prevalence of alcohol among nonfatally injured road accident casualties in two level III trauma centers in northern Ghana

Background: Alcohol use is pervasive among motorists on the road in Ghana; however, we do not know the extent to which this behavior is implicated in road accidents in this country.

Objectives: The main objective of this research was to establish the prevalence of alcohol in the blood of nonfatally injured casualties in the emergency departments (EDs) in northern Ghana.

Method: Participants were injured road traffic crash victims, namely, pedestrians, cyclists, motorcyclists, and drivers seeking treatment at an ED. The study sites were 2 level III trauma centers located in Wa and Bolgatanga. Participants were screened for alcohol followed by breath tests for positive participants using breathalyzers.

Results: Two hundred and sixty-two accident victims visited EDs, 58% of whom were in Wa. Among the victims, 41% were hospitalized and 57% experienced slight injuries. The vast majority (76%) of the casualties were motorcyclists, 13% were pedestrians, 8% were cyclists, and 2% were drivers. Casualties who had detectable alcohol in their blood were predominantly vulnerable road users. In all, 34% of participants had detectable blood alcohol concentrations (BACs) and the mean BAC for all casualties who tested positive and could give definitive BACs was 0.2265 (226 mg/dl). The prevalence of alcohol use was 53% among cyclists, 34% among motorcyclists, 21% among pedestrians, and 17% among drivers. Male casualties were more likely to test positive for alcohol than females. In addition, the prevalence of alcohol was significantly higher among injured casualties in Bolgatanga compared to Wa.

Conclusion: There was a high prevalence of alcohol use among nonfatally injured casualties in northern Ghana and injury severity increased with BAC. AUDIT screening in the hospital, alcohol consumption guideline, road safety education with an emphasis on minimizing or eliminating alcohol consumption, and enhanced enforcement of the BAC limit among motorists are recommended.     

Ankle fracture patterns in drivers are associated with femoral fracture,higher BMI,and advanced age

Objective: Despite advances in vehicle safety systems, motor vehicle crashes continue to cause ankle fractures. This study attempts to provide insight into the mechanisms of injury and to identify the at-risk population groups.

Methods: A study was made of ankle fractures patients treated at an urban level 1 trauma center following motor vehicle crashes, with a concurrent analysis of a nationally representative crash data set. The national data set focused on ankle fractures in drivers involved in frontal crashes. Statistical analysis was applied to the national data set to identify factors associated with fracture risk.

Results: Malleolar fractures occurred most frequently in the driver's right foot due to pedal interaction. The majority of complex/open fractures occurred in the left foot due to interaction with the vehicle floor. These fractures occurred in association with a femoral fracture, but their broad injury pattern suggests a range of fracture causation mechanisms. The statistical analysis indicated that the risk of fracture increased with increasing driver body mass index (BMI) and age.

Conclusions: Efforts to reduce the risk of driver ankle injury should focus on right foot and pedal interaction. The range of injury patterns identified here suggest that efforts to minimize driver ankle fracture risk will likely need to consider injury tolerances for flexion, pronation/supination, and axial loading in order to capture the full range of injury mechanisms. In the clinical environment, physicians examining drivers after a frontal crash should consider those who are older or obese or who have severe femoral injury without concurrent head injury as highly suspicious for an ankle injury.