Research Papers

Effectiveness of booster seats in reducing injury and mortality in children 6 to 10 years of age: a systematic review of observational studies

Version 1
Date added June 30, 2016
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Category 2016 CARSP XXVI Halifax
Tags Research and Evaluation, Session 3C
Author/Auteur Mark Asbridge
Stream/Volet Research and Evaluation

Slidedeck Presentation not available (no paper submitted)


Background/Context: Booster seats are designed to elevate children to an appropriate height to allow the safe use of a lap/shoulder belt. Considerable empirical work has studied the impact of booster seats in reducing injury and death in child passengers. However, study results have been mixed; booster seats have been shown to be effective for preventing injury in younger children (under 8 years), whereas evidence of their effectiveness for older children (up to 10 years) is less clear.

While Canadian jurisdictions are consistent in their requirement that children should be at least 40lbs before they are moved from a car seat to a booster seat, the age, height, and weight at which a child is no longer required to use a booster differs by jurisdiction. At present, booster seat use is not required in 3 of 13 jurisdictions in Canada (AB, NT, NU), and those provinces with a policy have quite different regulations with respect to who must use a booster. To date, no formal synthesis of the evidence evaluating booster seat effectiveness in reducing injury morbidity and mortality in child passengers has been completed. Governmental and non-governmental organizations devoted to child health and road safety strongly endorse the use of booster seats to reduce childhood injury; effective advocacy for mandated booster seat use across Canada necessitates more definitive evidence.

Aims/Objectives: The primary objectives of this project are to: a) Determine if booster seat use among child passengers aged 6-10 years of age reduces injury morbidity and mortality from motor vehicle collisions; and b) determine if estimates of booster seat effectiveness are consistent for children of different ages.

Methods/Target Group: A standard systematic review and meta-analysis was completed. Multiple electronic databases were searched to identify all observational epidemiological studies evaluating the effectiveness of booster seat use on reducing child injury morbidity and mortality resulting from motor vehicle collisions, compared to children who use a standard shoulder/lap belt alone. Citation searches and inspection of previous literature reviews were conducted, along with examination of government reports. Two independent reviewers have assessed study quality and risk of bias, and collected data on key study features: study design (e.g. case control, cohort), booster seat details (age and weight restrictions, backless) and control group (seat belt only).

Results/Activities: If supported by the available data, a meta-analysis will be performed in winter, 2016 using random effects modeling to synthesize data on the effect of booster seat use on child injury morbidity and mortality. Relevant subgroup and sensitivity analyses will be conducted. If data do not support meta-analysis, descriptive findings will be presented.

Discussion/Deliverables: Evidence-informed policy making is especially critical when recommendations impact the health and safety of the population—and in particular the health and safety of vulnerable sub-populations, such as children. Study findings will provide definitive evidence around the effectiveness of booster seats in reducing morbidity and mortality for all children up to 10 years of age.

Conclusions: Enabled through ongoing consultation with decision makers, study findings will help to optimize provincial regulatory efforts directed to the reduction of injury and death among young motor vehicle passengers.

Mark Asbridge