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Injuries and Deaths Among Children Left Unattended in or Around Motor Vehicles --- United States, July 2000--June 2001

National attention concerning motor vehicles (MVs) and child safety has focused largely on protecting children as occupants transported in traffic on public roads. However, children who are unattended in or around MVs that are not in traffic also are at increased risk for injury and death. CDC and the nonprofit Trauma Foundation examined data from two databases on both nonfatal and fatal nontraffic MV-related incidents. This report summarizes the results of that analysis, highlights the major causes of this type of childhood death and injury, and underscores the need for effective interventions.

Nationally representative data on nonfatal injuries treated in hospital emergency departments (EDs) from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) were examined (1). Data on fatal injuries occurring across the country were reported from a database developed by the Trauma Foundation's KIDS 'N CARS™ program. During July 2000--June, 2001, data from these two programs documented an estimated 9,160 nonfatal injuries and 78 fatal injuries among children aged <14 years who were left unattended in or around MVs that were not in traffic.

NEISS-AIP, which is operated by the U.S. Consumer Product Safety Commission, collects data annually on approximately 500,000 cases from a nationally representative sample of 65 hospital EDs in the United States. National estimates of nonfatal injuries treated in hospital EDs were calculated by using the sum of sample weights of study cases; weights were derived based on the inverse of the probability of selection; confidence intervals (CIs) were computed by using a direct variance estimation procedure (1). Population estimates for computing rates were obtained from the U.S. Bureau of Census.

NEISS-AIP study case-patients were children treated in a U.S. hospital ED after being injured while left unattended in or around MVs (e.g., cars, trucks, vans, and SUVs) not in traffic. These nontraffic injuries included those associated with 1) parked MVs on or off the street and 2) MVs in motion off the street. Children injured during the normal course of getting in or out of stationary MVs were excluded.

NEISS-AIP obtains data routinely for each nonfatal injury on the principal diagnosis, body part primarily affected, ED discharge disposition, and locale of occurrence (e.g., home or public place). Narratives describing each injury event were used to identify the surface where the incident occurred (e.g., driveway, parking lot, or street) and type of event. A classification scheme assigned cases to the following types of events: run over or backed over by an MV, struck by an MV, fell out of an MV in motion, or fell off of the exterior of an MV (e.g., the bed of a pick-up truck), and other specified (e.g., bumped against, dragged by, submerged in, or overheated in an MV).

The KIDS 'N CARS™ database was used to describe specific incidents involving children aged <14 years who died as a result of being left unattended in or around MVs. National estimates of fatalities cannot be derived from this database. KIDS 'N CARS™ identifies cases through 1) online searches of LexisNexis™, a service providing access to thousands of newspapers and magazines worldwide; 2) keyword searches on Internet search engines, the registration of keyword preferences with Internet providers and news media sites, and searches within archives of newspaper websites; 3) news accounts from a clipping service; 4) contacts with child death review teams; and 5) information from an informal nationwide network of professional and personal contacts. Documentation from news media archives and other record sources is used to validate all cases identified.

A total of 192 NEISS-AIP study cases was identified, representing a national estimate of 9,160 (95% CI=5,344--12,976) children with nonfatal injuries treated in U.S. hospital EDs during July 2000--June 2001. Approximately 42% of injured children were aged <4 years, and 61.9% were male (Table 1). Injuries occurred predominantly to the head and neck region (30.4%) and the extremities (53.1%). Most (56.8%) injuries were minor contusions and abrasions; however, more serious injuries also were common (26.5% were fractures or internal injuries). Most (81.8%) injured children were treated and released from the ED. Most injuries occurred near the home (47.8%) or on public property (31.1%). Injuries occurred in driveways and parking lots in at least 27.2% of incidents (Table 2). The most common type of nonfatal incident was being struck by an MV, followed by being run over or backed over by an MV and falling out or off of an MV. For nonfatal incidents, approximately 70% of MVs were moving at a slow speed (e.g., moving forward or backward shortly after being set in motion), and approximately 20% were moving backward.

The KIDS 'N CARS™ database provided information on 78 children who died during July 2000--June 2001 in 76 separate incidents. Fatalities occurred in 28 states and the District of Columbia. Of the fatally injured children, 64 (82.1%) were aged <4 years, and 42 (53.8%) were male. In 57 (73.1%) cases, the MV was located near a home (e.g., driveway, unpaved area near home, or street in front of home); in 39 (50%) cases, the child lived at that home. The driver was the parent in 12 (57.1%) of the 21 cases in which a child was backed over. The most common type of fatal incident was exposure to excessive heat inside an MV (e.g., when a child was left inside an MV during hot weather) (34.6%), followed by being backed over and being hurt when a child put an MV in motion (26.9%). Approximately 82% of fatal injuries occurred among children aged <4 years (Figure).

Reported by: E McLoughlin, ScD, Trauma Foundation, San Francisco, California. JA Middlebrooks, MEd, JL Annest, PhD, P Holmgreen, MS, Office of Statistics and Programming; A Dellinger, PhD, Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note:

The findings in this report highlight the characteristics of nontraffic-related injuries and deaths among children. Many more U.S. children aged <14 years are injured (e.g., an estimated 37,115 [CI=21,029--53,200] injury-related ED visits in 2000) or killed (e.g., 533 deaths in 1999) by being struck by a moving MV while in the street. However, the nontraffic-related incidents described in this report are an important cause of injuries and deaths among children. These incidents are preventable, and effective interventions must be determined to protect children.

The findings in this report are subject to at least six limitations. First, NEISS-AIP captures only injuries treated in hospital EDs and does not include children seen in physicians' offices and clinics. Second, NEISS-AIP provides statistically valid national estimates but not state and local estimates. Third, types of nonfatal incidents were classified by using brief narratives transcribed from medical records; further details about each incident were not available. Fourth, KIDS 'N CARS™ data are not population-based and probably undercount the true number of fatal cases nationally. Fifth, media coverage of these incidents might contain incomplete information and might be less common in large urban areas. Finally, online media archives might exclude very small-circulation local newspapers. Because of these limitations, methods should be explored to obtain routine national data useful for characterizing and monitoring detailed circumstances of injuries and deaths from all types of nontraffic MV-related incidents involving children. The National Highway Traffic Safety Administration is assessing methods to identify cases of nontraffic MV-related injuries and deaths in children and to obtain details about injury-related circumstances (2).

The findings in this report are consistent with other studies that indicate that children left unattended in or around MVs are at increased risk for injury and death in incidents that involve parked MVs, slow-moving MVs, MVs moving backward in driveways and parking lots, MVs set in motion by a child, and trunk entrapment (3--10). In this report, excessive heat exposure while in an MV was the most common cause of death; however, scientific literature examining the circumstances of such incidents is minimal.

Several areas for possible intervention include education, legislation, regulation, and changes in vehicle design. Education campaigns aimed at parents and caregivers should communicate the following: 1) ensure adequate supervision when children are playing in areas near parked MVs; 2) never leave children alone in an MV, even when they are asleep or restrained; and 3) keep MVs locked in a garage or driveway and keep keys out of children's reach.

Laws related to endangering the life or health of a child by leaving the child unattended in an MV have been enacted by 11 states; the nature of these laws and associated penalties vary by state. In California, funds from 70% of fines resulting from noncompliance with its associated law will go to counties to support public education campaigns to address these preventable deaths and injuries.

Children might be protected further by commercially available vehicle enhancements, such as sensors that detect unseen obstacles behind an MV or devices that emit audible signals when an MV is in reverse. Evaluation of such interventions should be conducted to inform policy makers about their effectiveness in reducing nontraffic MV-related injuries and deaths among children.

Acknowledgments

This report was developed with contributions by J Fennell, T Struttman, KIDS 'N CARS™ program, Trauma Foundation, San Francisco, California. T Schroeder, C Downs, A McDonald, Div of Hazard and Injury Data Systems, Consumer Product Safety Commission. K Gotsch, Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC.

References

  1. CDC. National estimates of nonfatal injuries treated in hospital emergency departments---United States, 2000. MMWR 2001;50:340--6.
  2. National Highway Traffic Safety Administration. NHTSA pilot study: Non-traffic motor vehicle safety issues. An examination of selected 1997 death certificates and related activity. Technical Report. Washington, DC: U.S. Department of Transportation, 2002.
  3. Agran PF, Winn DG, Anderson CL. Differences in child pedestrian injury events by location. Pediatrics 1994;93:284--8.
  4. Agran PF, Winn D, Castillo D. Unsupervised children in vehicles: a risk for pediatric trauma. Pediatrics 1991;87:70--3.
  5. Mayr JM, Eder C, Wernig J, Zebedin D, Berghold A, Corkum SH. Vehicles reversing or rolling backwards: an underestimated hazard. Inj Prev 2001;7:327--8.
  6. Nadler EP, Courcoulas AP, Gardner MJ, Ford HR. Driveway injuries in children: risk factors, morbidity, and mortality. Pediatrics 2001;108:326--8.
  7. Patrick DA, Bensard KK, Moore EE, Partington MD, Karrer FM. Driveway crush injuries in young children: a highly lethal, devastating, and potentially preventable event. J Pediatr Surg 1998;33:1712--5.
  8. Robinson P, Nolan T. Pediatric slow-speed non-traffic fatalities: Victoria, Australia, 1985--1995. Accid Anal Prev 1997;29:731--7.
  9. Winn DG, Agran PF, Castillo DN. Pedestrian injuries to children younger than 5 years of age. Pediatrics 1991;88:776--82.
  10. CDC. Fatal car trunk entrapment involving children---United States, 1987--1998. MMWR 1998;47:1019--22.


Table 1

Table 1
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Table 2

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Figure

Figure 3
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