Preventing pediatric backover trauma: The impact of a federally mandated car safety feature.

PURPOSE: Backover trauma occurs when a reversing motorized vehicle strikes a pedestrian, often a small child. Injuries carry significant morbidity and mortality. A federal mandate required newly manufactured motor vehicles to meet a rear visibility standard by May 2018. This study characterizes the mandate's impact on pediatric backover trauma.

METHODS

A retrospective pre-post observational study was conducted of children (<5 years) with backover trauma (01/2011-11/2024). Two datasets were utilized: trauma registries from two Level I pediatric trauma centers serving a single catchment area, and case lists curated by Kids and Car Safety (KACS) from publicly available injury reports (same region). Univariate analyses and Poisson/quasi-Poisson models compared backover rates and incidences, pre-mandate versus post-mandate.

RESULTS

From trauma registry data, 120 patients were identified: 85 pre-mandate, 35 post-mandate. Patients were median 2.1 years old (IQR: 1.6-2.8) and 65% male. Median ISS was 10.0 (IQR: 5.0-17.3) with no difference between groups (p = 0.68), but fewer severe injuries occurred post-mandate (12 pre-mandate, 5 post-mandate). Backover injury rate decreased from 11.6/year pre-mandate to 5.3/year post-mandate (RR: 0.46; 95% CI: 0.28-0.75), and incidence decreased from 17.3 to 7.1 per 100,000 (Incidence RR: 0.41; 95% CI: 0.27-0.60). From KACS data, 28 victims were identified: 22 pre-mandate, 6 post-mandate. Backover injury rate was higher pre-mandate (3.0/year) and decreased post-mandate to 0.9/year (RR: 0.30; 95% CI: 0.12-0.75). Fatalities decreased from 18 (82%) pre-mandate to 4 (67%) post-mandate (p = 0.58).

CONCLUSION

Pediatric backover rates decreased following full compliance with the federal mandate. Fewer severe injuries occurred, and publicly reported fatalities decreased by 78%. Reduced rate, incidence, and severity of backover injuries justify public health-driven regulatory requirements.