title: Severe-to-fatal injury risks in crashes with two front-seat occupants by seat belt use.
abstract: OBJECTIVE
  This study investigates the risk of severe-to-fatal injury (Maximum Abbreviated Injury Score, MAIS 4+F) in crashes with two front-seat occupants. It determines the relative risk of injury in the same crash by belt use and seating position.
  
  
  METHODS
  1993-2008 NASS-CDS was analyzed for crashes with occupants in both front-outboard seats. The effect of belt use was investigated for the driver and passenger. Light vehicles were included with model year 1990+. Injury severity was subdivided into MAIS 0-2 and 4+F in NASS-CDS to compare no-to-moderate injury with severe-to-fatal injury. Standard errors were calculated in SAS and the z-test was used to determine the significance of differences in risk. Relative risks were determined by seat belt use and seating position; odds ratios were determined for one or both occupants being severely injured.
  
  
  RESULTS
  In 76.7 percent of the MAIS 4+F crashes, either the driver (32.4%) or passenger (44.3%) was severely injured, rather than both occupants (23.3%). When both were belted, one occupant was severely injured in 86.5 percent of crashes. When both were unbelted, both occupants were severely injured in 68.9 percent of the crashes. Both occupants were belted in 74.7 percent of the cases and unbelted in 18.6 percent. In 6.7 percent of crashes, either the driver (4.4%) or passenger (2.3%) was unbelted when the other was belted. The highest risk occurred with an unbelted driver and belted passenger (4.98 +/- 0.73% vs. 1.97 +/- 0.38%, z = 3.65, p < .05). When both occupants were belted, the driver and passenger injury risk was similar (0.459 +/- 0.098% vs. 0.449 +/- 0.047%, z = 0.10, ns).
  
  
  CONCLUSIONS
  In crashes with two front occupants, typically one occupant was severely injured, not both. Overall, the odds ratio was 3.28 for one compared to two occupants being severely injured; and, risks vary by seat belt use and seating position. The highest relative risk for unbelted versus belted occupants was 9.22 when both occupants were severely injured in the same crash.
authors.affiliation: ProBiomechanics LLC, Bloomfield Hills, Michigan, USA. dviano@comcast.net
authors.forename: David C
authors.initials: DC
authors.lastname: Viano
authors.forename: Chantal S
authors.initials: CS
authors.lastname: Parenteau
mesh_terms: D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles / Q000145:classification; D016017:Odds Ratio; D011446:Prospective Studies; D012306:Risk; D012622:Seat Belts / Q000706:statistics & numerical data*; D014481:United States; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology*; D055815:Young Adult