Injuries and deaths among children left unattended in or around motor vehicles

Morbidity and Mortality Weekly Report, July 5, 2002

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 (NEIS-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[TM] 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 [lesser than or equal to]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[TM] database was used to describe specific incidents involving children aged [lesser than or equal to] 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 CARSTM identifies cases through 1) online searches of LexisNexis[TM], 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 (8 1.8%) injured children were treated and released from the ED. Most injuries occurred near the home (47.8%) or on public property (3 1.1%). 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.