O3308: The Impact of a Federally Mandated Car Safety Feature on Rate and Severity of Pediatric Backover Trauma

Background: Pedestrian collision with a motor vehicle-in-reverse is referred to as backover trauma. Resulting injuries carry significant morbidity and mortality, and they disproportionally occur in small children due to challenging visualization. For prevention, a federal mandate was passed on May 1, 2018 requiring all new vehicles to be equipped with a backup camera; however, older vehicles may still lack this safety feature. This study aims to evaluate the rate and severity of pediatric backover trauma before and after enactment of the federal mandate to characterize its impact.

Methods: A retrospective cohort study was conducted of patients less than 5 years of age with backover trauma between January 2011 and November 2024. Two sets of data were compared, electronic medical records of patients treated at a level one pediatric trauma center as identified by the institutional trauma registry (IRB#: HSC-MS-24-1247) and data curated by Kids and Car Safety from publicly available injury records of the surrounding metropolitan county, in order to externally validate institutional trends. Trauma registry abstraction included demographics, injury severity score (ISS), hospital course, and disposition. Severe injury in pediatric trauma was defined as ISS >25. Backover trauma rates and severity were compared pre-mandate (01/2011-04/2018) versus post-mandate (05/2018-11/2024). Descriptive statistics, univariate analyses, and Poisson rate tests were utilized.

Results: From trauma center data, 71 patients were identified: 53 (75%) pre-mandate, 18 (25%) post-mandate. Patients were a median age of 2 years (IQR: 1.6-2.8), 61% male, and 68% with governmental insurance. Overall ISS was 10 (IQR: 5-19): no difference between groups (p=0.83) (Figure1). There were 10 cases of severe trauma pre-mandate (19%) versus 2 cases post-mandate (11%) (p=0.72), with one pre-mandate, in-hospital death. The trauma rate pre-mandate was significantly higher at approximately 7.2 backovers/year compared to 2.7 backovers/year post-mandate: a rate ratio of 0.38 (95% CI: 0.21-0.66; p< 0.01) (Figure2). Similar trends were demonstrated in public injury records, from which 19 victims were identified: 13 (68%) pre-mandate, 6 (32%) post-mandate. Injuries were reported fatal on scene or shortly after emergency medical service transport in 10 pre-mandate cases (77%) and 4 post-mandate cases (67%) (p>0.99). Again, the trauma rate pre-mandate was higher at approximately 1.8 backovers/year compared to 0.9 backovers/year post-mandate: a rate ratio of 0.51 (95% CI: 0.16-1.45; p=0.25) (Figure2).

Conclusion: A significant decrease in the rate of backover trauma was observed following the 2018 federal mandate requiring backup cameras in all new vehicles. Severe injuries decreased by half, and the absolute number of publicly reported fatal cases decreased by 60%. Reduction in rate and severity of backover trauma justify public health-driven regulatory requirements. Installation of backup cameras should be prioritized and subsidized for all vehicles manufactured prior to the 2018 federal mandate.