Association between different restraint use and rear-seated child passenger fatalities: a matched cohort study.

OBJECTIVE To investigate the association between restraint use and death in rear-seated child passengers and to examine whether the estimated association varies by restraint type and age. DESIGN Matched cohort study. SETTING All reported crashed passenger vehicles with at least 2 rear-seated child passengers of whom at least 1 died from the US Fatality Analysis Reporting System for 1998 to 2006. PARTICIPANTS Rear-seated child passengers aged 2 to 6 years. INTERVENTIONS Three models of restraint use: (1) no restraint use, any restraint use; (2) no restraint use, recorded improper restraint use (including improper use of seat belts or child restraints, use of shoulder-only seat belts, and use of an unknown type of restraint), any other restraint use; and (3) no restraint use, improper restraint use, seat belts, and child restraints. Main Outcome Measure Death within 30 days of a crash. RESULTS Compared with no restraint use, being restrained reduced the risk of death in rear-seated child passengers (relative risk [RR], 0.33; 95% confidence interval [CI], 0.22-0.49). Compared with improper restraint use, any other restraint use reduced the risk of death (RR, 0.46; 95% CI, 0.20-0.63). The RR of death for using child restraints compared with seat belts was 0.91 (95% CI, 0.57-1.14). Child restraints performed slightly better in fatality risk reduction in children aged 2 to 3 years (RR, 0.24; 95% CI, 0.09-0.33) than in children aged 4 to 6 years (RR, 0.32; 95% CI, 0.11-0.44) compared with traveling unrestrained. CONCLUSIONS This study demonstrates the protective effects of restraints for child passengers and highlights the importance of using restraints correctly.