A prospective study of non-fatal childhood road traffic accidents: what can seat restraint achieve?

Abstract

A prospective study of children attending an Accident and Emergency Department was carried out at the Royal Aberdeen Children's Hospital, to determine the association between injury risk and seat restraint usage, and to estimate the likely impact of seat restraint usage at various target levels on the incidence of non-fatal injuries. The subjects were all 91 cases of non-fatal childhood road traffic accidents attending the casualty department between December 1989 and November 1990. The main outcome measures were relative risks of three grades of injury severity and four types of non-fatal injury, population attributable risk fractions and estimated likely reduction in incidence of non-fatal injury at three set target levels of seat restraint usage It was found that 42 (46 per cent) children presenting to the A&E Department were unrestrained; 78 (85.7 per cent) children sustained some injury. The relative risk for children travelling unrestrained in a car for all injuries combined is 1.7 (95 per cent confidence interval (Cl) 1.17–2.45), the relative risk for head injury is 3.13 (1.78–5.51) and for face injury 3.03 (1.44–6.37). The risk of sustaining any moderate or worse injury was 3.25 (1 05–10.07). It is estimated that 24.4 per cent (minimum 5.5 per cent; maximum 45 per cent) of all non-fatal injuries sustained by a child car passenger can be prevented if all children are restrained in a child safety seat or seat restraint; 49.5 per cent of head injuries (minimum 43.4 per cent; maximum 71.19 per cent) and 48.4 per cent of face injuries (minimum 21.9 per cent; maximum 75.3 percent) are preventable. Achieving a target level of seat restraint usage of 90 per cent would prevent 19.1 per cent of all injuries, 38.9 per cent of head injuries and 37.9 per cent of face injuries. It is concluded that seat restraint use appears to be an effective method of reducing moderate to severe injuries caused by road traffic accidents among children. In setting health promotion targets it is essential that valid quantitative information of the marginal health benefits are assessed against the cost of intervention.