Citation

Durbin DR, Elliott MR, Winston FK. J. Am. Med. Assoc. JAMA 2003; 289(21): 2835-2840.

Affiliation

Department of Pediatrics, Children's Hospital of Philadelphia, and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia 19104, USA. durbind@e-mail.chop.edu

Copyright

(Copyright © 2003, American Medical Association)

DOI

10.1001/jama.289.21.2835

PMID

12783914

Abstract

CONTEXT: Although more than a dozen states have ratified laws that require booster seats for children older than 4 years, most states continue to have child restraint laws that only cover children through age 4 years. Lack of booster seat effectiveness data may be a barrier to passage of stronger child restraint laws. OBJECTIVES: To quantify the association of belt-positioning booster seats compared with seat belts alone and risk of injury among 4- to 7-year-old children and to assess patterns of injury among children in booster seats vs seat belts. DESIGN, SETTING, AND POPULATION: Cross-sectional study of children aged 4 to 7 years in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. A probability sample of 3616 crashes involving 4243 children, weighted to represent 56,593 children in 48,257 crashes was collected between December 1, 1998, and May 31, 2002. MAIN OUTCOME MEASURE: Parent report of clinically significant injuries. RESULTS: Injuries occurred among 1.81% of all 4- to 7-year-olds, including 1.95% of those in seat belts and 0.77% of those in belt-positioning booster seats. The odds of injury, adjusting for child, driver, crash, and vehicle characteristics, were 59% lower for children aged 4 to 7 years in belt-positioning boosters than in seat belts (odds ratio, 0.41; 95% confidence interval, 0.20-0.86). Children in belt-positioning booster seats had no injuries to the abdomen, neck/spine/back, or lower extremities, while children in seat belts alone had injuries to all body regions. CONCLUSION: Belt-positioning booster seats were associated with added safety benefits compared with seat belts to children through age 7 years, including reduction of injuries classically associated with improper seat belt fit in children.