Impact of adult restraint use on child injuries in motor vehicle crashes

Background/Purpose: Previous work has established an association between driver and child restraint use and associations between restraint non-use and injury. This study examines the association between adult restraint use and child injury after adjusting for child safety factors and crash severity. Methods: Six years (1999-2005) of Utah crash records were probabilistically linked to Emergency Department (ED) records. Children under 13 years old involved in a motor vehicle crash (MVC) with one adult were included in the analysis. A hierarchical statistical model was used to estimate the association between adult safety belt use and child treatment in the ED after adjusting for child restraint use, seating position, and age, as well as adult treatment in the ED, alcohol-use, vehicle age, weather conditions, posted speed, nighttime, and collision type. A secondary model was applied to those children who were treated in the ED with treatment for injury vs. non-injury as the outcome. Results/Outcomes: After adjusting for child safety factors and crash severity, the odds of being treated in the ED following a MVC were 1.4 times higher for children riding with an unrestrained adult driver (OR: 1.4, 95% CI: 1.1, 1.7). The unadjusted odds of being treated in the ED were 4.1 times higher for children riding with an unrestrained driver (OR: 4.1, 95% CI: 3.6, 4.7). There was no association between adult restraint use and the odds of being treated for injury versus non-injury. Conclusions: Children riding with unrestrained drivers are at increased risk of injury in an MVC.