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A Matched Cohort Study

Wei Du, MPH; Andrew Hayen, PhD; Lynne Bilston, PhD; Julie Hatfield, PhD; Caroline Finch, PhD; Julie Brown, PhD

Arch Pediatr Adolesc Med. 2008;162(11):1085-1089.

Objective  To investigate the association between restraint use and death in rear-seated child passengers and to examine whether the estimated association varies by restraint type and age.

Design  Matched cohort study.

Setting  All reported crashed passenger vehicles with at least 2 rear-seated child passengers of whom at least 1 died from the US Fatality Analysis Reporting System for 1998 to 2006.

Participants  Rear-seated child passengers aged 2 to 6 years.

Interventions  Three models of restraint use: (1) no restraint use, any restraint use; (2) no restraint use, recorded improper restraint use (including improper use of seat belts or child restraints, use of shoulder-only seat belts, and use of an unknown type of restraint), any other restraint use; and (3) no restraint use, improper restraint use, seat belts, and child restraints.

Main Outcome Measure  Death within 30 days of a crash.

Results  Compared with no restraint use, being restrained reduced the risk of death in rear-seated child passengers (relative risk [RR], 0.33; 95% confidence interval [CI], 0.22-0.49). Compared with improper restraint use, any other restraint use reduced the risk of death (RR, 0.46; 95% CI, 0.20-0.63). The RR of death for using child restraints compared with seat belts was 0.91 (95% CI, 0.57-1.14). Child restraints performed slightly better in fatality risk reduction in children aged 2 to 3 years (RR, 0.24; 95% CI, 0.09-0.33) than in children aged 4 to 6 years (RR, 0.32; 95% CI, 0.11-0.44) compared with traveling unrestrained.

Conclusions  This study demonstrates the protective effects of restraints for child passengers and highlights the importance of using restraints correctly.

Author Affiliations: New South Wales Injury Risk Management Research Centre (Mr Du and Drs Hayen and Hatfield) and Prince of Wales Medical Research Institute (Drs Bilston and Brown), The University of New South Wales, Sydney, New South Wales; Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, New South Wales (Dr Hayen); and School of Human Movement and Sport Sciences, University of Ballarat, Ballarat, Victoria (Dr Finch), Australia.

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