Using Crash Outcome Data Evaluation System (CODES) to examine injury in front vs. rear-seated infants and children involved in a motor vehicle crash in New York State

Abstract

Background In New York State (NYS), motor vehicle (MV) injury to child passengers is a leading cause of hospitalization and emergency department (ED) visits in children aged 0–12 years. NYS laws require appropriate child restraints for ages 0–7 years and safety belts for ages 8 and up while traveling in a private passenger vehicle, but do not specify a seating position. Methods Factors associated with injury in front-seated (n = 11,212) compared to rear-seated (n = 93,092) passengers aged 0–12 years were examined by age groups 0–3, 4–7 and 8–12 years using the 2012–2014 NYS Crash Outcome Data Evaluation System (CODES). CODES consists of Department of Motor Vehicle (DMV) crash reports linked to ED visits and hospitalizations. The front seat was row 1 and the rear rows 2–3. Vehicle towed from scene and air bag deployed were proxies for crash severity. Injury was dichotomized based on Maximum Abbreviated Injury Severity (MAIS) scores greater than zero. Multivariable logistic regression (odds ratios (OR) with 95% CI) was used to examine factors predictive of injury for the total population and for each age group. Results Front-seated children had more frequent injury than those rear-seated (8.46% vs. 4.92%, p < 0.0001). Children in child restraints experienced fewer medically-treated injuries compared to seat belted or unrestrained children (3.80, 6.50 and 13.62%, p < 0.0001 respectively). A higher proportion of children traveling with an unrestrained vs. restrained driver experienced injury (14.50% vs 5.26%, p < 0.0001). After controlling for crash severity, multivariable adjusted predictors of injury for children aged 0–12 years included riding in the front seat (1.20, 1.10–1.31), being unrestrained vs. child restraint (2.13, 1.73–2.62), being restrained in a seat belt vs. child restraint (1.20, 1.11–1.31), and traveling in a car vs. other vehicle type (1.21, 1.14–1.28). Similarly, protective factors included traveling with a restrained driver (0.61, 0.50–0.75), a driver aged < 25 years (0.91, 0.82–0.99), being an occupant of a later vehicle model year 2005–2008 (0.68, 0.53–0.89) or 2009–2015 (0.55, 0.42–0.71) compared to older model years (1970–1993). Conclusions Compared to front-seated children, rear-seated children and children in age-appropriate restraints had lower adjusted odds of medically-treated injury.

Motor Vehicle Crash and Hospital Charges in Front- and Rear-Seated Restrained and Unrestrained Adult Motor Vehicle Occupants

“…A strength of this study is the use of the CODES data base which includes nonfatal and fatal occupants, vehicle and crash characteristics merged with hospitalization and emergency department visits, including charge data [ 21 , 22 , 23 ]. Although many of the factors associated with restraint use in front- and rear-seated occupants are similar to earlier findings using the Fatality Analysis Reporting System, the current study using the CODES database includes nonfatal crashes and treatment charge information which is more representative of all injurious motor vehicle crashes [ 21 , 24 ].…”

“…NYS CODES for calendar years 2016–2017 was used to examine characteristics between seating position and restraint status in this study. CODES uses a probabilistic linkage to match motor vehicle crash data from the NYS Department of Motor Vehicles (DMV) to the New York Statewide Planning and Research Cooperative System (SPARCS) which maintains hospitalization and emergency department data in NYS [ 20 , 21 , 22 ]. LinkSolv is the current commercial version of the linkage software originally funded by the National Highway Traffic Safety Administration [ 22 , 23 , 24 ].…”

“…The study population was identified from the original data set of all identified and linked crashes in NYS for 2016–2017. The population for this study was determined first by excluding infants, children and adolescents who have been previously reported [ 20 , 21 ]. Next, persons who were traveling on bicycles, foot, or in buses which may not have seat belts were excluded.…”

“…Many current studies of rear-seated passengers focus on or include children making it difficult to assess the impact on adults and elderly occupants [ 20 , 21 ]. The majority of states have gaps in covered ages for restraint requirements for rear-seated passengers, which is hypothesized to be due, at least in part, to a lack of convincing studies that examine the full social, financial, and health impacts related to restraint use in adult rear-seated passengers.…”

Risk and Protective Factors for Injury in Adult Front- and Rear-Seated Motor Vehicle Occupants in New York State

“…While restraint use has been shown to reduce motor vehicle crash injury and mortality by 50%, many teens and adults continue to travel unrestrained [ 2 , 3 , 4 ]. Restraint laws are stronger and restraint use higher for infants and children than for adults traveling in the rear-seat [ 5 , 6 , 7 ]. At the time of this study, fewer than twenty U.S. states had a primary enforced rear-seat restraint law that covered all ages [ 8 ].…”