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Ms Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
Car accidents are the top cause of death in children under age 15, and restraints were either not used or improperly used in nearly half of those fatal crashes, according to a new report.
For children, accidents-or unintentional injuries-are the top cause of death. The most common cause of those injuries is car accidents, and a new report is revealing some of the top factors that contribute to car-related injuries in children aged younger than 15 years.
The study was completed by researchers at Brigham and Women’s Hospital in Boston, Massachusetts, and at the University of Texas Southwestern Medical Center in Dallas using data from the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System and was published in Pediatrics. The American Academy of Pediatrics (AAP) previously published detailed guidance on child vehicle safety, but no state has implemented these guidelines in their entirety. The safety recommendations offer guidance on what types of restraints should be used based on a child’s age and size.
According to the new report, 2885 children died in motor vehicle accidents between 2010 and 2014. That total does not include pedestrians injured by motor vehicles or children injured in motorcycle, trailer, bicycle, or cargo vehicle accidents.
Death rates were greatly impacted by restraint use, but also by geographic location and road type.
Across all states, 20% of children who died in car crashes were unrestrained or inappropriately restrained at the time of the accident; 13% were inappropriately sitting in the front seat; and 9% were riding in cars driven by someone under the influence of alcohol.
There was a wide range by location, which may be impacted by regional laws, with 0.25 deaths per 100,000 children in Massachusetts compared with 3.23 deaths per 100,000 in Mississippi.
Other factors in crashes were also region- and roadway-specific. The percentage of children killed in crashes due to not being restrained or being improperly restrained ranged from 2% in New Hampshire to 38% in Mississippi, and rural crash deaths ranged from 17% in Massachusetts and Rhode Island to 100% in Maine and Vermont, according to the study. Fatal crashes on state highways also ranged widely, with 11% of fatal crashes occurring on highways in Iowa compared to 84% in Hawaii.
In addition to differences by region, the type of roadway also plays a role in crash incidence. Crashes were more likely to occur on state highways (35%) and rural roads (62%). The type of car may also be a factor, with the majority of crashes involving cars that were on average 9 years old while vans/minivans appear to have a somewhat protective factor.
Most of the accidents occurred in the South (52%) compared with 21% in the West; 19% in the Midwest; and 7.5% in the Northeastern parts of the country. Response times of emergency personnel related to geographical location may play a role, particularly in rural areas. Of the 18,116 children killed in motor vehicle crashes during the study period, 2885 died within 30 days of the crash and 1424 died at the scene.
Other laws may also play a role in the incidence of fatal accidents, with the percentage of children who died being on average 3.73% higher in states without legislation regarding red light cameras. Additionally, law regarding restraints could have a huge impact.
Pediatricians have a role in both parent education, as well as advocacy for state laws that regulate restraint use. According to the study, a significant number of deaths could be prevented through small but important changes in restraint use.
“For instance, a potential 10% absolute improvement in child restraint use-decreasing the average number of unrestrained or inappropriately restrained children from 20% to 10% nationally- would decrease the national age-adjusted MVC-related mortality rate from 0.94 to 0.56 per 100 000 children,” according to the report. “For the current national population of 61.0 million children, this would lead to approximately 232 pediatric deaths averted per year. Over 5 years, this translates to more than 1100 pediatric deaths averted, or nearly 40% of the deaths observed over the 2010-2014 period.”
Numerous studies show that despite education efforts, parents continue to misuse car seats, with 95% of new mothers misusing child seats at the time of hospital discharge in a recent report.