Back over Injuries Among Children in Car Accidents

Nonfatal Motor Vehicle Related Back over Injuries Among Children - United States

Motor-vehicle (MV)-- related backovers (i.e., incidents involving kids being struck by or rolled over by an automobile moving in reverse) represent a danger for severe injury and death. To identify nonfatal MV back over injuries amongst children, CDC evaluated data from the National Electronic Injury Surveillance System All Injury Program. This report summarizes the results of that analysis, which determined that, during 2001-- 2003, an estimated 7,475 kids (2,492 per year) aged 1-- 14 years were dealt with for nonfatal MV back over injuries in U.S. health center emergency situation departments. The report likewise highlights distinctions in type and severity of MV back over injuries by age and highlights the need for reliable interventions. NEISS-AIP information can increase the understanding of nonfatal MV back over injuries and assist guide the advancement of avoidance techniques, such as education, ecological improvements, and modifications in automobile design, that might help reduce these injuries amongst children.

NEISS-AIP offers information on approximately 500,000 customer item-- and injury-related ED cases each year. Run by the U.S. Consumer Item Security Commission, the program gathers data on initial sees for all types and reasons for injuries dealt with in EDs (3 ). NEISS-AIP information are drawn from a nationally representative subsample of 66 of 100 hospitals chosen as a stratified likelihood sample of U.S. health centers with a minimum of six beds and a 24-hour ED.

For this study, MV back over injury cases were recognized from narratives abstracted from medical records. NEISS-AIP obtains data for each nonfatal injury concerning the principal medical diagnosis, body part primarily affected, external cause of injury, ED discharge personality, and location of the event (e.g., home or public place). Cases were defined as nonfatal injuries to children aged 1-- 14 years as an outcome of being struck by or rolled over by an MV (e.g., vehicle, truck, van, or sport energy lorry) relocating reverse in a driveway, parking area, or on a street. Cases including child pedestrians (i.e., children standing, sitting, lying, playing, or strolling) or kids riding bikes or tricycles near or behind an MV were consisted of. Cases including children injured while getting into or out of fixed MVs were left out.

Each case was appointed a sample weight based on the inverted probability of choice; these weights were summed to offer nationwide quotes of MV back over injuries. Price quotes were based upon weighted information for 168 kids treated for MV back over injuries at NEISS-AIP medical facility EDs throughout 2001-- 2003. Population approximates for 2001-- 2003 were obtained from the U.S. Census Bureau to compute injury rates. A direct variation estimate procedure was used to calculate 95% confidence periods (CIs) and to represent the complex sample design.

Of the 168 cases identified, 81 (48.2%) involved children aged 1-- 4 years; 92 (54.8%) of the children were male. Injuries occurred mainly to the head, face, and neck region (47 cases [28.0%] and to the extremities (90 cases [53.6%].

  • Injuries to the head, face, and neck region decreased with age, from a high of 31 (38.3%) among children aged 1--4 years to a low of three (7.5%) among those aged 10--14 years. Injuries to the extremities, specifically the lower part of the body, increased with age, from 24 (29.6%) among children aged 1--4 years to 29 (72.5%) among those aged 10--14 years.
  • Ninety-four (56.0%) children sustained minor contusions and abrasions, and these varied by age group, from 40 (49.4%) among those aged 1--4 years to 25 (62.5%) among those aged 10--14 years. More serious injuries, such as fractures and internal injuries, occurred among 47 (28.0%) children; this proportion decreased with age, from 32 (39.5%) among children aged 1--4 years to seven (17.5%) among those aged 10--14 years.
  • The 168 study cases were weighted to provide estimates for the United States overall. During 2001--2003, an estimated 7,475 (CI = 4,453--10,497) children were treated in EDs for nonfatal MV back over injuries, at an annual rate of 4.40 per 100,000 age-specific population (CI = 2.62--6.18) (Table). Among all ages, the rate for females (4.60) was slightly higher than that for males (4.21).

Approximately 86% of the injured children were classified as pedestrians; these children sustained MV back over injuries at a rate six times greater (3.78) than that of children who were riding a bicycle or tricycle (0.62). Nontraffic events (i.e., those not occurring on public roadways) accounted for approximately 61% of MV back over incidents, a rate of 2.67. Location of the incident was known in approximately 80% of cases; the majority of injuries occurred either at home (47.4%) or on public property (31.9%). For at least 40% of all cases, injuries occurred in driveways or parking lots. A majority of injured children (78.1%) were treated and released from the ED.

Reported by: R Patel, MPH, AM Dellinger, PhD, Div of Unintentional Injury Prevention; JL Annest, PhD, Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC.

Editorial Note:

The findings in this report suggest that an approximated 2,492 kids aged 1-- 14 years were injured yearly after being struck by or rolled over by an MV moving in reverse. Numerous were pedestrians near or behind an MV and were at house when the incident occurred. The bulk were treated and launched from healthcare facilities. A study by the National Highway Traffic Security Administration analyzed death certificate data and recognized around 47 deaths in 1998 amongst children under the age of 19 years that were attributable to MV back over injuries (4 ). Of these deaths, 21 took place in driveways. The results of this study are consistent with those of other research studies that show the risk children face when left ignored near or behind an MV (1,2,5-- 7).

The findings in this report are subject to at least 4 restrictions. Initially, NEISS-AIP catches only injuries dealt with in medical facility EDs and does not include kids seen in doctor workplaces and clinics or who may not have gotten treatment. Second, NEISS-AIP provides nationwide estimates just and does not allow for quotes by region, state, or local jurisdiction. Third, cases were recognized from narratives acquired from medical records, but not all medical charts consisted of total descriptions of occasions, such as whether a car was in reverse. Finally, in cases with numerous injuries, only information regarding the most serious injury are taped.

Various prevention strategies, including education, ecological modifications, and modifications in automobile design, may minimize the risk for MV back over injuries among kids. Public education to increase awareness among parents and caregivers need to highlight the following: 1).
grownups ought to adequately supervise kids who are playing in areas near parked MVs, 2) drivers need to look carefully for children prior to and while backing up, and 3) MVs must be secured garages or driveways with secrets stayed out of reach of kids (6,8). Possible environmental modifications consist of fenced driveways, fenced play areas away from driveways and streets, and circular driveway designs that get rid of the have to back out. Prospective car adjustments include back-up warning alarms when automobiles are put in reverse or mirrors, noticing gadgets, or cameras to alert motorists to out-of-sight objects, such as small children (1 ). Research is needed to identify the effectiveness of such approaches.

Information from injury surveillance systems such as NEISS-AIP highlight the avoidable morbidity and mortality arising from MV-related back over injuries in children. Efficient engineering and ecological methods to avoid MV-related back over injuries have to be recognized, assessed, and disseminated to public health and transport officials and policy makers for application nationwide. On the other hand, motorists and caretakers can take basic precautions to prevent these injuries. To this end, kid MV safety programs and health specialists ought to make sure that parents, caregivers, and the public are aware of the risks for injury connected with MV backovers and appropriate prevention procedures.



This report is based on information contributed by T Schroeder, MS, C Irish, and other staff, Div of Hazard and Injury Data Systems, US Consumer Product Safety Commission. K Gotsch, MPH, P Holmgreen, MS, Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC.


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2. Agran PF, Winn D, Castillo D. Unsupervised children and youth in vehicles: a risk for pediatric trauma. Pediatrics 1991;87:70--3.

3. CDC. National estimates of nonfatal injuries treated in hospital emergency departments---United States, 2000. MMWR 2001;50:340--6.

4. National Highway Traffic Safety Administration. Data collection study: deaths and injuries resulting from certain non-traffic and non-crash events. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration; May 2004. Available at

5. Brison RJ, Wicklund K, Mueller BA. Fatal pedestrian injuries to young children and youth: a different pattern of injury. Am J Public Health 1988;78:793--5.

6. Nadler EP, Courcoulas AP, Gardner MJ, Ford HR. Driveway injuries in children and youth: risk factors, morbidity, and mortality. Pediatrics 2001;108:326--8.

7. CDC. Injuries and deaths among children and youth left unattended in or around motor vehicles---United States, July 2000--June 2001. MMWR 2002;51:570--2.

8. Wright MS. Non ambulatory"pedestrians": infants injured by motor vehicles in driveways. Clin Pediat 1998;37:515--8

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