5-star safety rating; head-on collision; car crash; FARS; vehicle safety; accidents, traffic/ statistics & numerical data; accidents, traffic/mortality; automobiles; equipment design; risk factors


Clinical Epidemiology | Emergency Medicine | Patient Safety | Trauma



Car safety ratings are routinely utilized in making automobile purchase decisions. These 1- to 5-star ratings are based on crash test data comparing vehicles of similar type, size and weight.


We hypothesized that car safety ratings are less important than vehicle factors such as vehicle type and weight in predicting outcomes of head-on crashes.


A retrospective study was conducted on severe head-on motor vehicle crashes entered into the FARS (Fatality Analysis Reporting System) database between 1995 and 2010. This database includes all US motor vehicle crashes that resulted in a death within 30 days of the accident. Outcomes of SUV versus passenger car and passenger car versus passenger car head-on crashes were compared by safety rating. Exclusion criteria was added to eliminate collisions with insufficient information or unbelted passengers. The paired crash results were entered into a logistic regression model with driver death as the outcome of interest.


The database contained 83,251 vehicles of any type that were involved in head-on crashes. In head-on crashes where the passenger car front driver crash rating was superior to the SUV’s, the odds of death were 4.52 times higher for the driver of the passenger car (95% CI: 3.06–6.66). Ignoring crash ratings, the odds of death were 7.64 times higher for the passenger car driver (95% CI: 5.59–10.44). In passenger car versus passenger car head-on crashes, a lower car safety rating was associated with a 1.28 times higher odds of death (95% CI: 1.05–1.57). In passenger car vs. passenger car head-on crashes, each one point lower car safety rating resulted in a 1.22 times higher odds of death (95% CI: 1.03–1.44).


Vehicle type (passenger car versus SUV) is a much more important predictor of death than crash safety ratings in SUV versus passenger car head-on crashes.