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The effect of verified pediatric trauma centers, state laws, and crash characteristics on time trends in adolescent motor vehicle fatalities, 1999-2015

Notrica, David M., MD; Sayrs, Lois W., PhD; Krishna, Nidhi, MSc

Journal of Trauma and Acute Care Surgery: November 2018 - Volume 85 - Issue 5 - p 944–952
doi: 10.1097/TA.0000000000001972

BACKGROUND Motor vehicle crashes are a leading cause of adolescent death from trauma. A recent study found American College of Surgeons–verified pediatric trauma centers (vPTC) were inversely correlated with pediatric mortality, but the analysis was limited to a single year. This study assesses the contribution of vPTCs, crash characteristics, and state driver laws on 15- to 17-year-old motor vehicle crash mortality for all 50 states from 1999 to 2015.

METHODS Prospective data on motor vehicle fatalities, crash characteristics, state driving laws, and American College of Surgeons–verified trauma centers were collected from publicly available sources for 50 US states from 1999 to 2015. A mixed fixed/random effects multivariate regression model was fitted to assess the relative contribution of crash characteristics, state laws, and vPTCs while controlling for state variation and time trends.

RESULTS The final regression model included driver and crash characteristics, verified trauma centers, and state laws. Camera laws ([B = −0.57 [p < 0.001]) were associated with a 57% decrease in the rate of change in adolescent crude fatalities. The lagged Level 1 vPTC crude rate (B = −0.12 [p < .001]) was protective and contributed independently to a 12% decline in the rate of change in teen fatalities over the time period. Seat belt laws (B = −0.15 [p < 0.001]), graduated driver’s license passenger restrictions (B = −0.07[p < 0.001]), graduated driver’s license learner permit period (B = −0.04 [p < 0.002]), nondeployed airbag (B = −0.003 [p < 0.001]), and Hispanic heritage (B = −0.003 [p < 0.05]) were protective. Increased risk of fatality was associated with minivan (B = 0.01 [p < 0.001]), speed > 90 mph (B = 0.004 [p < 0.001]), rural roads (B = 0.002 [p < 0.002], unknown seat belt compliance (B = 0.004 [p < 0.001]), and dry road surface (B = 0.005 [p < 0.001]).

CONCLUSIONS State camera laws during the study time frame are associated with a 57% decrease in the rate of change in adolescent crude fatalities; vPTCs during the study time period reduced overall rate of change in the crude fatality rate by 12%. State laws, restrictions on teenage passengers and longer learner’s permit periods, and seat belt laws are associated with significant decreases in the crude teen mortality rate.

LEVEL OF EVIDENCE Prospective study and prevention, level III.

From the Level 1 Pediatric Trauma Center, Phoenix Children’s Hospital, Phoenix, Arizona (D.M.N., L.W.S., N.K.); University of Arizona College of Medicine–Phoenix, Phoenix, Arizona (D.M.N., L.W.S.); and Mayo Clinic School of Medicine, Phoenix and Scottsdale, Arizona (D.M.N.).

Submitted: February 15, 2018, Revised: April 23, 2018, Accepted: April 27, 2018, Published online: May 22, 2018.

Address for reprints: David Notrica, MD, FAAP, Trauma Medical Director, Phoenix Children’s Hospital, 1919 East Thomas Rd, Phoenix, AZ 85006; email:

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© 2018 Lippincott Williams & Wilkins, Inc.