Arbogast KB, Jermakian JS, Kallan MJ, Durbin DR. Effectiveness of belt positioning booster seats: an updated assessment

Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
PEDIATRICS (Impact Factor: 5.47). 10/2009; 124(5):1281-6. DOI: 10.1542/peds.2009-0908
Source: PubMed


The objective of this study was to provide an updated estimate of the effectiveness of belt-positioning booster (BPB) seats compared with seat belts alone in reducing the risk for injury for children aged 4 to 8 years.
Data were collected from a longitudinal study of children who were involved in crashes in 16 states and the District of Columbia from December 1, 1998, to November 30, 2007, with data collected via insurance claims records and a validated telephone survey. The study sample included children who were aged 4 to 8 years, seated in the rear rows of the vehicle, and restrained by either a seat belt or a BPB seat. Multivariable logistic regression was used to determine the odds of injury for those in BPB seats versus those in seat belts. Effects of crash direction and booster seat type were also explored.
Complete interview data were obtained on 7151 children in 6591 crashes representing an estimated 120646 children in 116503 crashes in the study population. The adjusted relative risk for injury to children in BPB seats compared with those in seat belts was 0.55.
This study reconfirms previous reports that BPB seats reduce the risk for injury in children aged 4 through 8 years. On the basis of these analyses, parents, pediatricians, and health educators should continue to recommend as best practice the use of BPB seats once a child outgrows a harness-based child restraint until he or she is at least 8 years of age.

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    • "Proper fit of a safety restraint is essential for maximum protection. It has been established that the primary reasons for injuries to children who are restrained at the time of motor vehicle crashes relate to premature graduation from child safety seats to booster seats, premature graduation from booster seats to adult safety belts, prematurely turning a child forward, misuse of safety restraints and children seated in the front seat of the vehicle " (Arbogast et al, 2009, p. 1284). "
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    ABSTRACT: Objective The study surveyed child safety restraints use among drivers transporting children to school in Dansoman, Accra. Method Employing a naturalistic observational method, the following were observed: sex of the driver, vehicle model, child characteristics, child location in the vehicle, whether child was restrained and how they were restrained, whether the driver was belted and the presence of other vehicle occupants. In total 126 vehicles were observed. Results The study revealed low child restraints use among the observed drivers; children in new vehicles were more likely to be restrained; children seated in the back seat were more likely to be unrestrained; and child occupants were more likely to be unrestrained where there were other vehicle occupants. Conclusion The study maintained that a collaborated effort by road safety stakeholders in terms of education/awareness creation and subsequent strict enforcement of child restraints use laws were required.
    Full-text · Article · Jun 2015
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    • "These directives are based on reports that proper use of infant car safety seats prevent injury, and that rear-facing car safety seats are better at preventing injury compared to forward-facing car safety seats [4] [10] [11]. Unfortunately , non-medical professionals provide the injury assessment in many studies [10] [12] [13]. As a result, some types of head injuries are excluded from evaluation [12]. "
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    ABSTRACT: We observed a high incidence of traumatic brain injuries (TBI) in properly restrained infants involved in higher speed motor vehicle crashes (MVCs). We hypothesized that car safety seats are inadequately protecting infants from TBI. We retrospectively queried scene crash data from our State Department of Transportation (2007-2011) and State Department of Public Health data (2000-2011) regarding infants who presented to a trauma center after MVC. Department of Transportation data revealed 94% of infants in MVCs were properly restrained (782/833) with average speed of 44.6 miles/h when there was concern for injury. Department of Public Health data showed only 67/119 (56.3%) of infants who presented to a trauma center after MVC were properly restrained. Properly restrained infants were 12.7 times less likely to present to a trauma center after an MVC (OR=12.7, CI 95% 5.6-28.8, p<0.001). TBI was diagnosed in 73/119 (61.3%) infants; 42/73 (57.5%) properly restrained, and 31/73 (42.5%) improperly/unrestrained (p=0.34). Average head abbreviated injury scale was similar for properly restrained (3.2±0.2) and improperly/unrestrained infants (3.5±0.2, p=0.37). Car safety seats prevent injuries. However, TBI is similar among properly restrained and improperly/unrestrained infants involved in higher speed MVCs who present to a trauma center.
    Full-text · Article · Jan 2014 · Journal of Pediatric Surgery
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    • "When properly installed, child safety seats have been shown to reduce the risk of childhood injury by 71% to 82% and death by 28% relative to seat belts alone [3] [4] [5] [6]. Within the subset of four-to eightyear olds, booster seats reduced the risk of nonfatal injury by 45% relative to seat belts alone [7]. Nonetheless, about 50% of the 1,500 US children who die in MVCs each year are unrestrained [8]. "
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    ABSTRACT: . Motor vehicle crashes are the leading cause of death among US children aged 4-14 years. In theory, health provider counseling about Child Passenger Safety (CPS) could be a useful deterrent. The data about the effectiveness of CPS dissemination is sparse, but existing results suggest that providers are not well informed. Moreover, there is insufficient evidence to determine whether provider counseling about CPS is effective. . We therefore assessed CPS best practice knowledge among 217 healthcare workers at hospitals in seven cities throughout the USA and evaluated the impact of a brief, lunch and learn educational intervention with a five-item questionnaire. Attendees were comprised of physicians, nurses, social workers, pediatric residents, and pediatric trauma response teams. . Pre-post survey completion was nearly 100% (216 of 217 attendees). Participation was fairly evenly distributed according to age (18-29, 30-44, and 45+ years). More than 80% of attendees were women. Before intervention, only 4% of respondents (9/216) answered all five questions correctly; this rose to 77% (167/216) ( < 0.001, using a Wilcoxon signed-rank test) after intervention. . Future research should consider implementation and controlled testing of comparable educational programs to determine if they improve dissemination of CPS best practice recommendations in the long term.
    Full-text · Article · Feb 2013 · International Journal of Pediatrics
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