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Rear-facing versus forward-facing child restraints: an updated assessment
Timothy L McMurry1, Kristy B Arbogast2, Christopher P Sherwood3
1Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA.
Child safety seats in rear-facing child restraint systems (RFCRS) are recommended for young children. While US data is limited, non-US evidence supports keeping children in RFCRS longer to reduce injuries.
Area of Science:
- Pediatric safety
- Transportation safety
- Biomechanical engineering
Background:
- Current recommendations for rear-facing child restraint systems (RFCRS) are based on lab tests and non-US data.
- Concerns about the strength of US field evidence prompted a re-evaluation.
Purpose of the Study:
- To re-evaluate US field evidence supporting RFCRS recommendations using the NASS-CDS database.
- To analyze injury rates for infants in RFCRS versus forward-facing child restraint systems (FFCRS).
Main Methods:
- Utilized the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) database (1988-2015).
- Compared injury rates for children aged 0-23 months in RFCRS and FFCRS using weighted chi-squared tests.
Main Results:
- Analysis included 1107 children; 47 sustained significant injuries (ISS ≥ 9).
- Both 0- and 1-year-olds in RFCRS showed lower injury rates than those in FFCRS.
- Sample size was insufficient for robust statistical power or covariate-controlled regression.
Conclusions:
- Non-US field data and lab tests support extended RFCRS use.
- US NASS-CDS data, while indicating lower injury rates in RFCRS, is too limited to strongly support current recommendations.
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