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Belt-Positioning
Booster Seats and Reduction in Risk of Injury Among
Children in Vehicle Crashes
Dennis R. Durbin, MD, MSCE;
Michael R. Elliott, PhD; Flaura K. Winston,
MD, PhD
JAMA. 2003;289:2835-2840.
Context Although more than a dozen
states have ratified laws that require
booster seats for children older than 4 years,
most states continue to have child restraint laws
that only cover children through age 4 years.
Lack of booster seat effectiveness data may
be a barrier to passage of stronger child restraint
laws.
Objectives To quantify the association of
belt-positioning booster seats compared with
seat belts alone and risk of injury among 4-
to 7-year-old children and to assess patterns of injury
among children in booster seats vs seat belts.
Design, Setting, and Population
Cross-sectional study of children aged 4 to 7
years in crashes of insured vehicles in 15
states, with data collected via insurance claims records
and a telephone survey. A probability sample of
3616 crashes involving 4243 children,
weighted to represent 56 593 children in
48 257 crashes was collected between December 1, 1998,
and May 31, 2002.
Main Outcome Measure Parent report of
clinically significant injuries.
Results Injuries occurred among 1.81% of all
4- to 7-year-olds, including 1.95% of those
in seat belts and 0.77% of those in
belt-positioning booster seats. The odds of injury,
adjusting for child, driver, crash, and
vehicle characteristics, were 59% lower for
children aged 4 to 7 years in belt-positioning
boosters than in seat belts (odds ratio, 0.41; 95%
confidence interval, 0.20-0.86). Children in
belt-positioning booster seats had no
injuries to the abdomen, neck/spine/back, or lower
extremities, while children in seat belts
alone had injuries to all body regions.
Conclusion Belt-positioning booster seats
were associated with added safety benefits
compared with seat belts to children through
age 7 years, including reduction of injuries classically
associated with improper seat belt fit in
children.
Author Affiliations: Department of
Pediatrics, Children's Hospital of Philadelphia (Drs
Durbin and Winston), and the Center for Clinical
Epidemiology and Biostatistics, University of
Pennsylvania School of Medicine (Dr Elliott),
Philadelphia.
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