Preventing Pediatric Mortality from Motor Vehicle Crashes

Motor vehicle crashes are the most common cause of unintentional injury in children. As pediatric health care providers, it is crucial to determine if there are particular factors we can address to decrease the mortality involved in these events. Many studies exist examining known risk factors, such as not using restraints, younger drivers, higher speed, and rural roads. As several of these elements are controlled at a state level, Wolf and colleagues performed a retrospective analysis to examine passenger, driver, vehicle, crash, and state policy characteristics to identify predictors of mortality and to assess if there are geographic variations in these factors.

This study employed the Fatality Analysis Reporting System (FARS), a nationwide census of publicly available data about fatalities associated with motor vehicle crashes (MVCs). Primary outcomes were age-adjusted MVC-related mortality rates per 100,000 children and percentage of children who had died in those MVCs per state. Statistical analysis was completed using multivariable linear regression.

In this study, there were 18,116 children involved in fatal MVCs, and 15.9% had died. When examined per state, a wide variation of mortality rates was discovered—the MVC-related mortality rate was 0.25 in Massachusetts as compared with 3.23 in Mississippi, with a mean national rate of 0.94. The majority of children involved in a fatal crash were from the Southern United States (52%), followed by the West (21%), the Midwest (19%), and the Northeast (7.5%).

Across all states, 20% of children involved in fatal crashes were inappropriately restrained or unrestrained, 13% were unsuitably seated in the front seat, and 8.9% of drivers were under the influence of alcohol. There was a state-specific variation noted at this level as well—in New Hampshire, the percentage of children involved in a fatal crash who were unrestrained or inappropriately restrained was 2%, compared with 38% in Mississippi. Crashes were most likely to occur on a rural road.

In addition, for each 1% increase in the percentage of children who were unrestrained or inappropriately restrained, the mortality rate increased by 0.038. Predictors of greater rates of age-adjusted MVC-related mortality per 100,000 children includes states where there was a greater percentage of children who were unrestrained or inappropriately restrained, a larger percentage of crashes on rural roads, and a lack of red light camera legislation.

Where variation is noted, possibilities for improvement exist in MVC-related pediatric mortality rates. This study particularly notes that with a potential 10% improvement in child restraint use, the national age-adjusted MVC-related mortality rate would decrease from 0.94 to 0.56 per 100,000 children. Extrapolating this estimation to the current national population of 61 million children, improving child restraint use would prevent approximately 232 deaths per year and at least 1,100 over a period of 5 years. Pediatric health care providers can continue to stress the importance of safe driving practices, especially proper restraint usage.

Reference:

Wolf LL, Chowdhury R, Tweed J, et al. Factors associated with pediatric mortality with motor vehicle crashes in the United States: a state-based analysis. J Pediatr. In Press. https://doi.org/10.1016/j.jpeds.2017.04.044.