Some aspects of the safety of children as car passengers in road traffic accidents

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Abstract
The purpose of this study was to investigate child safety in cars from different aspects, such as the epidemiology of child injuries and injury assessment, restraint use effectiveness, restraint use limitations and drawbacks, data quality and improper use of child restraints. The materials used for the studies were of different types and sizes. Insurance materials were used for the epidemiological investigation and supplemented with questionnaires, for studies of restraint use effectiveness. Data on injuries reported by the police were used for studies of data quality and of the limitations and drawbacks of restraint use. Observational studies were conducted to detect improper use of child restraints and these were followed-up by dynamic barrier tests to assess possible consequences in frontal collisions. All injuries were classified according to the Abbreviated Injury Scale (AIS) and the risk of death and disability was predicted by RSC (Rating system for Serious Consequences) with modified figures for children. The main conclusions reached were that injury assessing methods derived for adults can be used also for children with some modifications concerning disability risks. Child restraint use was found to be effective in reducing injuries, especially the use of rearward-facing restraints. Injuries occurring in spite of restraint use were often minor in terms of fatality risks, but injuries to the neck and head may cause long-term consequences. The police was found to report only slightly more than half of the injured children reported to the insurance company. Misuse of child restraints was found to exist and may decrease restraint use effectiveness or induce injuries. On the basis of these studies it is recommended that child restraints be incorporated into cars as an in-built system with the same basic design as restraints that are available as extra equipment. Certain considerations should be paid, however, to those injuries occurring among restrained children that entail a risk of medical disability.

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