Analysis of booster seat and seat belt use: how many Wisconsin childhood deaths and hospitalizations could have been prevented in 1998--2002?

BACKGROUND: Motor vehicle collisions (MVC) remain the leading cause of childhood death and injury in Wisconsin and throughout the nation. The objective of this study is to estimate the potential benefits of increased use of belt-positioning booster (BPB) seats for children ages 4-7, and increased seat belt use for children ages 8-18.5 years. The outcomes measured were the reduction in MVC-associated childhood deaths and hospitalizations as a result of increased use of BPB seats or seat belts.
METHOD: Childhood MVC-associated deaths and hospitalizations from 1998 to 2002 were obtained from the Wisconsin Interactive Statistics on Health (WISH) data query system. Three separate age groups were analyzed: children ages 4-7, 8-15, and 16-18.5 years. Ages for the groups were designed to match current "best practice" recommendations for the use of BPB seats, published age-range specific baseline restraint use data, and age specific mortality/injury relative risk (RR) values as closely as possible for a pediatric population. Population attributable risk (PAR) was calculated to predict preventable deaths and injuries (hospitalizations) over the years studied.
RESULTS: From 1998 to 2002, MVCs accounted for 440 childhood deaths and 2639 injuries requiring hospital admission. Using the calculated PAR population statistic for each age group studied, the predicted reduction in childhood MVC deaths and hospitalizations were calculated for various increases in restraint use above current baseline compliance. At the 100% use level, the model predicted 16 fewer deaths and 84 fewer hospitalizations for children 4-7 years old (BPB seat use); 45 fewer deaths and 206 fewer hospitalizations for children 8-15 years old (seat belt use); and 119 fewer deaths and 669 fewer hospitalizations for children 16-18.5 years old (seat belt use). The total potentially avoided deaths and hospitalizations across all age groups studied was 180 childhood deaths and 959 hospitalizations during this 5-year study period.
CONCLUSION: Communities should devote resources to public education programs directed at increasing the use of belt-positioning booster seats for children 4-7 years old and seat belts for older children. Evidence-based child passenger safety laws should be improved and enforced in Wisconsin in an effort to support families in their attempts to safeguard their children. With a multi-component child passenger restraint safety campaign, unnecessary MVC-associated childhood deaths and injuries can be avoided in the future.