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. 2002 Sep;8(3):216–220. doi: 10.1136/ip.8.3.216

Pediatric motor vehicle related injuries in the Navajo Nation: the impact of the 1988 child occupant restraint laws

K Phelan 1, J Khoury 1, D Grossman 1, D Hu 1, L Wallace 1, N Bill 1, H Kalkwarf 1
PMCID: PMC1730884  PMID: 12226119

Abstract

Background: Navajo motor vehicle mortality is the highest among the 12 Indian Health Service (IHS) administrative areas. In July 1988, the Navajo Nation enacted a primary enforcement safety belt use and a child restraint law.

Objective: Assess the impact of the laws on the rate and severity of pediatric (0–19 years) motor vehicle injury resulting in hospitalizations in the Navajo Nation.

Methods: Hospitalizations associated with motor vehicle related injury discharges were identified by International Classification of Diseases, 9th revision, CM E codes, 810–825 (.0,.1) from the Navajo IHS hospital discharge database. Age specific rates for the period before the law, 1983–88, were compared with those after enactment and enforcement, 1991–95. Severity of injury, measured by the abbreviated injury scale (AIS) score and new injury severity score (NISS), was determined with ICDMAP-90 software. Wilcoxon rank sum and χ2 tests were used for analysis.

Results: Discharge rates (SE) for motor vehicle injury (per 100 000) decreased significantly in all age groups: 0–4 years (62 (7) to 28 (4)), 5–11 years (55.3 (6) to 26 (4)), and 15–19 years (139 (14) to 68 (7)); p=0.0001. In children 0–4 years, the median AIS score decreased from 1.5 (1,3) (25th, 75th centile) to 1 (1,2), p=0.06, and the median NISS decreased from 3.5 (1,9) to 2 (1,5), p=0.07. The proportion of children with NISS scores >4 decreased significantly for the 0–4 year age group (p=0.03).

Conclusions: Concurrent with enactment of the Navajo Nation occupant and child restraint laws there was a reduction in the rate of motor vehicle related hospital discharges for children. Severity of injury declined in very young Navajo children. The effect of enactment and enforcement of this Native American child occupant restraint law may serve as an example of an effective injury control effort directed at Native American children.

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Selected References

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  1. Agran P. F., Dunkle D. E., Winn D. G. Effects of legislation on motor vehicle injuries to children. Am J Dis Child. 1987 Sep;141(9):959–964. doi: 10.1001/archpedi.1987.04460090036020. [DOI] [PubMed] [Google Scholar]
  2. Agran P. F., Winn D. G., Castillo D. N. Pediatric injuries in the back of pickup trucks. JAMA. 1990 Aug 8;264(6):712–716. [PubMed] [Google Scholar]
  3. Agran P., Winn D., Anderson C. Child occupant protection in motor vehicles. Pediatr Rev. 1997 Dec;18(12):413–423. [PubMed] [Google Scholar]
  4. Anderson C. L., Agran P. F., Winn D. G., Greenland S. Fatalities to occupants of cargo areas of pickup trucks. Accid Anal Prev. 2000 Jul;32(4):533–540. doi: 10.1016/s0001-4575(99)00075-5. [DOI] [PubMed] [Google Scholar]
  5. Baker S. P., Whitfield R. A., O'Neill B. Geographic variations in mortality from motor vehicle crashes. N Engl J Med. 1987 May 28;316(22):1384–1387. doi: 10.1056/NEJM198705283162206. [DOI] [PubMed] [Google Scholar]
  6. Bull M. J., Sheese J. Update for the pediatrician on child passenger safety: five principles for safer travel. Pediatrics. 2000 Nov;106(5):1113–1116. doi: 10.1542/peds.106.5.1113. [DOI] [PubMed] [Google Scholar]
  7. Centers for Disease Control (CDC) Safety-belt use and motor-vehicle-related injuries--Navajo Nation, 1988-1991. MMWR Morb Mortal Wkly Rep. 1992 Sep 25;41(38):705–708. [PubMed] [Google Scholar]
  8. Durbin D. R., Localio A. R., MacKenzie E. J. Validation of the ICD/AIS MAP for pediatric use. Inj Prev. 2001 Jun;7(2):96–99. doi: 10.1136/ip.7.2.96. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Grossman D. C., Sugarman J. R., Fox C., Moran J. Motor-vehicle crash-injury risk factors among American Indians. Accid Anal Prev. 1997 May;29(3):313–319. doi: 10.1016/s0001-4575(96)00085-1. [DOI] [PubMed] [Google Scholar]
  10. MacKenzie E. J., Morris J. A., Jr, Smith G. S., Fahey M. Acute hospital costs of trauma in the United States: implications for regionalized systems of care. J Trauma. 1990 Sep;30(9):1096–1103. doi: 10.1097/00005373-199009000-00005. [DOI] [PubMed] [Google Scholar]
  11. MacKenzie E. J., Steinwachs D. M., Shankar B. Classifying trauma severity based on hospital discharge diagnoses. Validation of an ICD-9CM to AIS-85 conversion table. Med Care. 1989 Apr;27(4):412–422. doi: 10.1097/00005650-198904000-00008. [DOI] [PubMed] [Google Scholar]
  12. Macarthur C., Hu X., Wesson D. E., Parkin P. C. Risk factors for severe injuries associated with falls from playground equipment. Accid Anal Prev. 2000 May;32(3):377–382. doi: 10.1016/s0001-4575(99)00079-2. [DOI] [PubMed] [Google Scholar]
  13. Margolis L. H., Bracken J., Stewart J. R. Effects of North Carolina's mandatory safety belt law on children. Inj Prev. 1996 Mar;2(1):32–35. doi: 10.1136/ip.2.1.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Morgenstern H. Ecologic studies in epidemiology: concepts, principles, and methods. Annu Rev Public Health. 1995;16:61–81. doi: 10.1146/annurev.pu.16.050195.000425. [DOI] [PubMed] [Google Scholar]
  15. Osberg J. S., Di Scala C. Morbidity among pediatric motor vehicle crash victims: the effectiveness of seat belts. Am J Public Health. 1992 Mar;82(3):422–425. doi: 10.2105/ajph.82.3.422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Pace B. W., Thailer R., Kwiatkowski T. G. New York State mandatory seatbelt use law: patterns of seatbelt use before and after legislation. J Trauma. 1986 Nov;26(11):1031–1033. doi: 10.1097/00005373-198611000-00012. [DOI] [PubMed] [Google Scholar]
  17. Phelan K. J., Khoury J., Kalkwarf H. J., Lanphear B. P. Trends and patterns of playground injuries in United States children and adolescents. Ambul Pediatr. 2001 Jul-Aug;1(4):227–233. doi: 10.1367/1539-4409(2001)001<0227:tapopi>2.0.co;2. [DOI] [PubMed] [Google Scholar]
  18. Quinlan K. P., Wallace L. J., Furner S. E., Brewer R. D., Bolen J., Schieber R. A. Motor vehicle related injuries among American Indian and Alaskan Native youth, 1981-92: analysis of a national hospital discharge database. Inj Prev. 1998 Dec;4(4):276–279. doi: 10.1136/ip.4.4.276. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Rivara F. P., Grossman D. C. Prevention of traumatic deaths to children in the United States: how far have we come and where do we need to go? Pediatrics. 1996 Jun;97(6 Pt 1):791–797. [PubMed] [Google Scholar]
  20. Rivara F. P. Pediatric injury control in 1999: where do we go from here? Pediatrics. 1999 Apr;103(4 Pt 2):883–888. [PubMed] [Google Scholar]
  21. Rivara F. P., Thompson D. C., Cummings P. Effectiveness of primary and secondary enforced seat belt laws. Am J Prev Med. 1999 Jan;16(1 Suppl):30–39. doi: 10.1016/s0749-3797(98)00113-5. [DOI] [PubMed] [Google Scholar]
  22. Scheidler M. G., Shultz B. L., Schall L., Ford H. R. Risk factors and predictors of mortality in children after ejection from motor vehicle crashes. J Trauma. 2000 Nov;49(5):864–868. doi: 10.1097/00005373-200011000-00012. [DOI] [PubMed] [Google Scholar]
  23. Smith S. M., Colwell L. S., Jr, Sniezek J. E. An evaluation of external cause-of-injury codes using hospital records from the Indian Health Service, 1985. Am J Public Health. 1990 Mar;80(3):279–281. doi: 10.2105/ajph.80.3.279. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Stevenson M., Segui-Gomez M., Lescohier I., Di Scala C., McDonald-Smith G. An overview of the injury severity score and the new injury severity score. Inj Prev. 2001 Mar;7(1):10–13. doi: 10.1136/ip.7.1.10. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Wagenaar A. C., Webster D. W. Preventing injuries to children through compulsory automobile safety seat use. Pediatrics. 1986 Oct;78(4):662–672. [PubMed] [Google Scholar]
  26. Williams A. F., Wells J. K., Lund A. K. Shoulder belt use in four states with belt use laws. Accid Anal Prev. 1987 Aug;19(4):251–260. doi: 10.1016/0001-4575(87)90060-1. [DOI] [PubMed] [Google Scholar]

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