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Flaura Koplin Winston, MD, PhD; Michael J. Kallan, MS; Teresa M. Senserrick, PhD; Michael R. Elliott, PhD

Arch Pediatr Adolesc Med. 2008;162(3):253-260.

Objective  To identify and prioritize risk factors for passenger death.

Design  Retrospective cohort captured in 2 databases: US census of fatal crashes (Fatality Analysis Reporting System) and US-representative sample of police-reported crashes (National Automotive Sampling System Crash Data System).

Setting  Crashes in 50 states and the District of Columbia from January 1, 2000, to December 31, 2005.

Participants  A total of 45 560 passengers aged 8 to 17 years in crashes, representing 2 545 168 passengers (weighted).

Main Exposures  Age and sex of driver, vehicle and road type, restraint use, seating position, day of week, month, time of day, and speed limit.

Outcome Measure  Passenger fatality.

Results  Approximately 424 000 passengers (aged 8-17 years) annually were in tow-away crashes and experienced a fatality rate of 3.9 per 1000. Just more than three-quarters as many passengers (aged 8-17 years) were in crashes with 16- to 19-year-old drivers as with all adult drivers (those aged 25 years), with double the passenger fatality rate. For drivers aged 16 to 17 years, passenger fatalities doubled between passenger ages 11 to 12 years and increased to a peak at a passenger age of 16 years. Of crashes with child passenger fatality, 21.2% involved alcohol. In crashes with drivers younger than 18 years, the greatest risk factors for death for passengers aged 8 to 17 years were drivers younger than 16 years, restraint nonuse, and high-speed roads (55 and 45-54 mph).

Conclusions  While passenger risks because of restraint nonuse require continued attention, interventions must be developed to address risk because of travel on high-speed roads and riding with drivers younger than 16 years. For safety, child passengers and their parents should monitor these characteristics of the drive and the driver. Anticipatory guidance about passenger risks should begin by the age of 11 years.

Author Affiliations: Center for Injury Research and Prevention (formerly TraumaLink), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Drs Winston, Senserrick, and Elliott and Mr Kallan); Division of General Pediatrics, Department of Pediatrics (Dr Winston), Leonard Davis Institute for Health Economics (Dr Winston), and Center for Clinical Epidemiology and Biostatistics, School of Medicine (Mr Kallan), University of Pennsylvania, Philadelphia; and Department of Biostatistics, School of Public Health, and Institute for Social Research, University of Michigan, Ann Arbor (Dr Elliott).

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