Unintentional injury is the leading cause of pediatric death in the U.S. and motor vehicle crashes (MVCs) are the most common cause of injury. A new paper published in the Journal of Pediatrics by researchers at Center for Surgery and Public Health (CSPH) at Brigham and Women’s Hospital (BWH) and UT Southwestern Medical Center in Dallas, is the first to examine state-level factors contributing to variation in pediatric mortality in motor vehicle crashes and to identify trends across states.

On average across all states, researchers found that 20 percent of children involved in a fatal crash were unrestrained or inappropriately restrained at the time of the crash. Thirteen percent were inappropriately seated in the front seat, and nearly 9% of drivers transporting a child passenger were under the influence of alcohol. The study’s authors estimate that a 10% absolute improvement in child restraint use–decreasing the average number of unrestrained or inappropriately restrained children from 20% to 10% nationally–would avert approximately 232 pediatric deaths per year, or more than 1,100 over five years. These findings highlight the importance of child restraint use and reinforce guidelines on child restraints published by the American Academy of Pediatrics (AAP) in 2011.


“In order to prevent children from being killed in motor vehicle crashes, we must understand the effects of state-level regulations, their implementation and enforcement,” said Lindsey Wolf, MD, MPH, general surgery resident at BWH, research fellow at CSPH and lead author of the study. “Since laws governing child traffic safety are made at the state level, we formulated a study design that would produce state-by-state geographic results, which could easily be utilized by policy makers aiming to reduce pediatric mortality and save children’s lives in their states.”

Crashes were most likely to occur on state highways (35%) and on roads classified as rural by the Federal Highway Authority (62%). Characteristics of the crashes also varied: the percentage of those that occurred on a rural road varied from 17 percent in Massachusetts and Rhode Island to 100 percent in Maine and Vermont; the percentage of those that occurred on state highways varied from 11% in Iowa to 84% in Hawaii; and the percentage of those that occurred on a road with a speed limit 65 to 80 miles per hour varied from 0% in Hawaii, Maine, and Rhode Island to 80% in Wyoming.

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