Citation

Notrica DM, Sayrs LW, Krishna N. J. Trauma Acute Care Surg. 2018; 85(5): 944-952.

Affiliation

Level 1 Pediatric Trauma Center, Phoenix Children's Hospital, Phoenix, AZ, USA.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001972

PMID

29787526

Abstract

BACKGROUND: Motor vehicle crashes (MVCs) are a leading cause of adolescent death from trauma. A recent study found ACS verified pediatric trauma centers (vPTC) were inversely correlated with pediatric mortality, but the analysis was limited to a single year. This study assesses the contribution of vPTCs, crash characteristics, and state driver laws on 15 to 17 years old MVC mortality for all 50 states from 1999-2015.

METHODS: Prospective data on motor vehicle fatalities, crash characteristics, state driving laws, and ACS verified trauma centers were collected from publically available sources for 50 U.S. states from 1999-2015. A mixed fixed/random effects multivariate regression model was fitted to assess the relative contribution of crash characteristics, state laws and vPTCs while controlling for state variation and time trends.

RESULTS: The final regression model included driver and crash characteristics, verified trauma centers, and state laws. Camera laws ([B=-0.57[P<0.001]) were associated with a 57% decrease in the rate of change in adolescent crude fatalities. The lagged Level 1 vPTC crude rate (B=-0.12[P<.001]) was protective and contributed independently to a 12% decline in the rate of change in teen fatalities over the time period. Seat belt laws (B=-0.15[P<0.001]), GDL passenger restrictions (B=-0.07[P<0.001]), GDL learner permit period (B=-0.04[P<0.002]), non-deployed airbag (B=-0.003[P<0.001]), Hispanic heritage (B=-0.003[P<0.05]), were protective. Increased risk of fatality was associated with mini-van (B=0.01[P<0.001]), speed>90mph (B=0.004[P<0.001]), rural roads (B=0.002[P<0.002], unknown seat belt compliance (B=0.004[P<0.001]) and dry road surface (B=0.005[P<0.001]).

CONCLUSIONS: State camera laws during the study time frame are associated with a 57% decrease in the rate of change in adolescent crude fatalities; vPTCs during the study time period reduced overall rate of change in the crude fatality rate by 12%. State laws, restrictions on teenage passengers and longer learner's permit periods, and seat belt laws are associated with significant decreases the crude teen mortality rate. LEVEL OF EVIDENCE: Level III, Prospective.

Language: en