Availability of Child Passenger Safety Resources to Emergency Physicians Practicing in Emergency Departments Within Pediatric, Adult, and Nontrauma Centers A National Survey
ABSTRACT More can be done to eliminate preventable motor vehicle collision (MVC)-related injuries through correct and consistent use of child passenger restraints. This study sought to determine emergency physician awareness of and referral patterns to child passenger safety resources and to compare awareness and referrals by practice setting.
This was a cross-sectional mailed survey of a national random sample of 1200 emergency physicians drawn from the American Medical Association Physician Masterfile.
Responses were returned by 638 (64%) of 1000 of physicians with a valid mailing address. Fifty-two percent reported working in an emergency department (ED) within a pediatric trauma center, 23% in an adult trauma center, and 25% in a nontrauma center. Police or fire department car seat installation programs were most frequently available (65% pediatric, 56% adult, 48% nontrauma center), and free/reduced-price booster seat programs least frequently available (46% pediatric, 30% adult, 23% nontrauma center) (P < 0.001). Half of pediatric trauma center physicians would always recommend replacement of a 3-year-old's car seat following a roll-over MVC compared with one third of adult and nontrauma center physicians (P < 0.001). There were no significant differences by practice setting for distribution of discharge instructions containing child passenger safety information or referrals to available resources.
Availability of child passenger safety resources for children discharged from EDs following an MVC varies by practice setting. Pediatric injury prevention outreach to general EDs is needed to increase the number of children who are benefiting from existing community child passenger resources.
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ABSTRACT: To determine the risk of significant injury associated with premature graduation of young (2- to 5-year-old) children to seat belts from child restraint systems (CRS). Advocates recommend use of child safety seats for children younger than age 4 and booster seats for children age 4 and older. Despite these recommendations, many children are prematurely taken out of these child restraints and placed in seat belts. Although data exist to support the use of child restraints over nonrestraint, no real-world data exist to evaluate the risk of significant injury associated with premature use of seat belts. Partners for Child Passenger Safety includes a child-focused crash surveillance system based on a representative sample of children ages 0 to 15 years in crashes involving 1990 and newer vehicles reported to State Farm Insurance Companies in 15 states and the District of Columbia. Driver reports of crash circumstances and parent reports of child occupant injury were collected via telephone interview using validated surveys. Results were weighted based on sampling frequencies to represent the entire population. Between December 1, 1998, and November 30, 1999, 2077 children aged 2 to 5 years were included and were weighted to represent 13 853 children. Among these young children, 98% were restrained, but nearly 40% of these children were restrained in seat belts. Compared with children in CRS, children in seat belts were more likely to suffer a significant injury (relative risk: 3.5; 95% confidence interval: [2. 4, 5.2]). Children in seat belts were at particular risk of significant head injuries (relative risk: 4.2; 95% confidence interval: [2.6, 6.7]) when compared with children in CRS. Premature graduation of young children from CRS to seat belts puts them at greatly increased risk of injury in crashes. A major benefit of CRS is a reduction in head injuries, potentially attributable to a reduction in the amount of head excursion in a crash.PEDIATRICS 07/2000; 105(6):1179-83. DOI:10.1542/peds.105.6.1179 · 5.30 Impact Factor
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ABSTRACT: Although more than a dozen states have ratified laws that require booster seats for children older than 4 years, most states continue to have child restraint laws that only cover children through age 4 years. Lack of booster seat effectiveness data may be a barrier to passage of stronger child restraint laws. To quantify the association of belt-positioning booster seats compared with seat belts alone and risk of injury among 4- to 7-year-old children and to assess patterns of injury among children in booster seats vs seat belts. Cross-sectional study of children aged 4 to 7 years in crashes of insured vehicles in 15 states, with data collected via insurance claims records and a telephone survey. A probability sample of 3616 crashes involving 4243 children, weighted to represent 56 593 children in 48 257 crashes was collected between December 1, 1998, and May 31, 2002. Parent report of clinically significant injuries. Injuries occurred among 1.81% of all 4- to 7-year-olds, including 1.95% of those in seat belts and 0.77% of those in belt-positioning booster seats. The odds of injury, adjusting for child, driver, crash, and vehicle characteristics, were 59% lower for children aged 4 to 7 years in belt-positioning boosters than in seat belts (odds ratio, 0.41; 95% confidence interval, 0.20-0.86). Children in belt-positioning booster seats had no injuries to the abdomen, neck/spine/back, or lower extremities, while children in seat belts alone had injuries to all body regions. Belt-positioning booster seats were associated with added safety benefits compared with seat belts to children through age 7 years, including reduction of injuries classically associated with improper seat belt fit in children.JAMA The Journal of the American Medical Association 07/2003; 289(21):2835-40. DOI:10.1001/jama.289.21.2835 · 30.39 Impact Factor
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ABSTRACT: A car occupant could be killed if struck by another occupant who was catapulted forward, backward, or sideways in a crash. To estimate the association between death of a car occupant (the target) and restraint use by other occupants. Matched-pair cohort study comparing the outcomes of 2 target occupants in the same passenger car that crashed. United States traffic crashes in 1988-2000, using data from the Fatality Analysis Reporting System. Target pairs, at least 1 of whom died: 61 834 front-seat pairs, 5278 rear-seat pairs, and 21 127 pairs on the left or right side. Adjusted risk ratio (RR) for death within 30 days of a crash. The risk of death was greater for a restrained front target occupant in front of an unrestrained occupant compared with a restrained front target in front of a restrained occupant (adjusted RR, 1.20; 95% confidence interval [CI], 1.10-1.31). For a restrained rear target occupant behind an unrestrained occupant compared with a restrained rear target occupant behind a restrained occupant, the adjusted RR was 1.22 (95% CI, 1.10-1.36). For a restrained side target occupant sitting next to an unrestrained occupant compared with a restrained side target occupant sitting next to a restrained occupant, the adjusted RR was 1.15 (95% CI, 1.08-1.22). Among unrestrained target occupants, the adjusted RRs were, for front targets, 1.04 (95% CI, 0.97-1.12), rear targets, 1.22 (95% CI, 1.10-1.36), and side targets, 0.85 (95% CI, 0.80-0.92). Persons who wish to reduce their risk of death in a crash should wear their own restraint and should ask others in the same car to use their restraints.JAMA The Journal of the American Medical Association 02/2004; 291(3):343-9. DOI:10.1001/jama.291.3.343 · 30.39 Impact Factor