title: Association between different restraint use and rear-seated child passenger fatalities: a matched cohort study.
abstract: 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.
  
  
  METHODS
  Matched cohort study.
  
  
  METHODS
  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.
  
  
  METHODS
  Rear-seated child passengers aged 2 to 6 years.
  
  
  METHODS
  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.
authors.affiliation: New South Wales Injury Risk Management Research Centre, The University of New South Wales, Sydney, NSW, Australia. w.du@unsw.edu.au
authors.forename: Wei
authors.initials: W
authors.lastname: Du
authors.forename: Andrew
authors.initials: A
authors.lastname: Hayen
authors.forename: Lynne
authors.initials: L
authors.lastname: Bilston
authors.forename: Julie
authors.initials: J
authors.lastname: Hatfield
authors.forename: Caroline
authors.initials: C
authors.lastname: Finch
authors.forename: Julie
authors.initials: J
authors.lastname: Brown
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000517:prevention & control; D001334:Automobile Driving / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D014677:Pharmaceutical Vehicles; D012149:Restraint, Physical / Q000592:standards*; D014481:United States / Q000453:epidemiology
chemical_list: D014677:Pharmaceutical Vehicles