Partners for child passenger safety: a unique child-specific crash surveillance system
Introduction
Motor vehicle crashes, the leading cause of death for children after the first year of life, remain an important public health problem facing children in the US (DHHS, 1999, Winston et al., 1999). During the last 20 years, the National Highway Traffic Safety Administration (NHTSA) and others have dedicated extensive resources to reducing the number of children who are killed and injured in motor vehicle crashes. As a result of these efforts, the fatality rate for motor vehicle occupants less than 19 years of age fell 24% from 1978 to 1991 (NHTSA, 1998). More recently, however, child occupant fatality rates have remained largely unchanged, particularly among children 5–9 years of age. This is likely the result of both increased travel of children in automobiles over time, as well as the limits of current vehicle and restraint system designs to protect children in a variety of crashes.
In order to further reduce the number of children injured in automobile crashes, more comprehensive data are required to address the modern issues in child passenger safety. These issues include improving side and rear impact protection, reducing the risk of injury from interactions with air bags, and reducing the misuse of child safety seats. The two most widely used population-based automobile crash surveillance systems, the National Automotive Sampling System (NASS) and the Fatality Analysis Reporting System (FARS), both maintained by the NHTSA, are derived from police reports or fatal crashes. Because children are present in only 10% of all police reported crashes (Edwards and Sullivan, 1997), these data sources have proved to be of limited value in exploring modern issues in child passenger safety, due to the relatively small number of children they include, as well as the lack of child-specific data collected.
Automobile insurance claims data identify a more complete sample of crashes than police reports (Tingvall, 1987). Because of their potential to identify large numbers of children involved in automobile crashes, insurance claims data are ideally suited for the development of a child-specific crash surveillance system. Partners for Child Passenger Safety (PCPS), a research partnership between The Children's Hospital of Philadelphia and State Farm Insurance Companies, was created to overcome many of the deficiencies in current sources of child occupant injury data. The overall objectives of PCPS are similar to those that resulted in the development of both NASS and FARS (NHTSA, 1998): to provide an estimate of the number of children exposed to automobile crashes, to help identify specific safety problems for child passengers, to suggest solutions to those problems, and to provide an objective basis on which to evaluate the real world effectiveness of several motor vehicle and restraint system characteristics for children. The objective of this paper is to provide a detailed description of the methods employed to develop the first large-scale, child-specific crash surveillance system in the US.
Section snippets
Methods
State Farm Automobile Insurance Company is the largest insurer of automobiles in the US, with over 38 million vehicles covered. State Farm's electronic insurance claims database was used as the mechanism to identify subjects for inclusion in the surveillance system. This database is updated continuously at the time of the initial report of a crash to a State Farm claims representative. Claims qualifying for inclusion in the surveillance system were those reporting a crash including at least one
Results
The surveillance system began operations on June 3, 1998. As of May 31, 1999, a total of 43 306 eligible claims were identified, representing 63 729 child occupants, an average of 1225 children involved in qualifying crashes per week. Using state-specific data regarding the proportion of the State Farm fleet that is older than the 1990 model year, the market share of State Farm, and the number of registered motor vehicles yields an estimate of approximately 1.3 million children involved in
Discussion
A unique and large scale, population based, child-specific crash surveillance system has been created by linking an electronic insurance claims database to telephone survey and crash investigation data. The insurance claims data function as the source of cases, with the telephone survey and crash investigations serving as the primary sources of data with coordination of all entities by an academic research institution. Reliance on electronic transfers of data and automated quality assurance and
Acknowledgements
Partners for Child Passenger Safety is a research partnership between The Children's Hospital of Philadelphia and State Farm Mutual Automobile Insurance Company, and is funded by a grant from State Farm. The authors wish to acknowledge the hard work and cooperation of the many corporate and regional State Farm employees that have made this project possible.
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2008, Ambulatory PediatricsCitation Excerpt :All vehicles with at least 1 child who screened positive for injury, and a 10% random sample of vehicles in which all child occupants who were reported to receive medical treatment but screened negative for injury, were selected for a full interview; a 2.5% sample of crashes where no medical treatment was received was also selected. Nonmortality health outcomes were derived from the PCPS crash surveillance database,26 with 11 761 children weighted to represent the 181 988 children involved in crashes to derive outcome probabilities based on restraint type and age. Probability estimates were averaged over the entire 5 years of data collection (1999 to 2003).