1. Connecticut Department of Public Health National Highway Traffic Safety Administration (NHTSA) Crash Outcome Data Evaluation System (CODES) Grand Rounds February 9, 2011 Promoting back seat travel for children < 13 years old in Connecticut

2. Connecticut CODES Project The CT CODES Project is located in the CT Department of Public Health’s Health Education, Management and Surveillance Section (HEMS ) CT CODES Project Staff Supervising Epidemiologist for Epidemiology Unit Injury Epidemiologist Unintentional Injury Prevention Coordinator Currently have 1997-2007 linked crash, inpatient and emergency dept data.

3. CT CODES Advisory Board Membership CT Dept of Transportation* Transportation Safety Div Crash Analysis Unit CT Hospital Association* CT Dept of Public Health* Office of Emergency Medical Services CT Dept of Public Safety/ Crimes Analysis Unit CT Dept of Motor Vehicles NHTSA Region 1 Safe Kids Connecticut A regional planning agency Yale School of Medicine Section of Emergency Medicine Researcher on older drivers Yale New Haven Hospital Injury Program Coordinator University of CT Dept of Engineering & Transportation Institute A hospital trauma manager * Data Owners

4. Reason for the study:  Safe Kids Connecticut requested state specific data  To enhance child passenger safety for children < 13 years old  To promote back seat travel for children < 13 years old  Target audiences:  Parents  Care givers  Traffic safety decision makers

5. Reason for the study: CT law (2005) : Children should ride in a car seat or booster until they reach 7 years old and 60 pounds Children who ride in a booster seat must use a lap and shoulder belt Recommendation: Children should ride in the back seat until they are 13 years old

6. Methods:  Data  Linked imputed CT crash, inpatient & ED data (2000 – 2006)  Restraint use of  None  Shoulder belt only  Lap belt only  Shoulder and lap belt  Child safety seat  Vehicle type:  Passenger car  Light truck  Passengers only

7. Methods (continued):  Injury severity score (ISS) i. < 9 = Minor ii. 9 - 15 = Moderate iii. >15 = Severe  Analysis  Severe injury – Front seat vs. back seat  Control for restraint use  Examine 0-6y and 7-12y separately  Odds ratio/relative risk

8. Results

9. Slightly higher one-third of 0-12 year old sat at front seat Majority of other age groups sat at front seat

10. Severe injuries for <13 year old were significantly higher by 2.5 times at the front seat than at back seat No significant risk or protection for other age groups

11. Restraint use by seating position and severe injuries  Restraint use did not change results for 0 – 12 year old (OR=2.56, 95% CL 1.04-6.04) Further analyses:  0 – 6 year old  7 – 12 year old

14. Restraint use by seating position 0 – 6 year age group Severe/moderate injuries For kids who used shoulder & lap belt, those who sat in the front seat were 1.67 times more likely to suffer severe or moderate injuries when compared to those who sat in the back (OR=1.67, 1.02-2.74)

17. Restraint use by seating position 7 – 12 year age group Severe/moderate injuries For kids who used shoulder & lap belt, those who sat in the front seat were three and half times more likely to suffer severe or moderate injuries when compared to those who sat in the back (OR=3.46, 2.19-5.47)

18. Key findings:  Children <13 years of age seated at the front seat are 2.5 times more likely to suffer severe injuries compared to children at the back seat  The risk remained pretty much the same even if they had some type of restrain use  For those restrained with lap & shoulder belt, seated at the front increased the risk of severe/moderate injury by 1.7 times for 0 – 6 years old and by 3.5 times for 7-12 years old

19. Limitations  Due to smaller sample size hard to produce comparable hospital medical charges confidence limits of risk ratio/odds ratios are wide  Our plan is to add three more years of linked data and see if results change.

20. CT CODES Program CT Department of Public Health Injury Prevention Program  Justin Peng : justin.peng@ct.gov  Marian Storch : marian.storch@ct.gov  Mukhtar Mohamed : mukhtar.mohamed@ct.gov