Pediatric pedestrian trauma study: a pilot project

Preventing Unintentional Injuries in School-Aged Children: A Systematic Review

BACKGROUND AND OBJECTIVES

Unintentional injuries constitute the leading causes of death and long-term disabilities among children aged 5 to 15 years. We aimed to systematically review published literature on interventions designed to prevent unintentional injuries among school-aged children.

METHODS

We searched MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO and screened the reference lists of included studies and relevant reviews. We included randomized controlled trials, controlled before-and-after studies, and interrupted time series studies. The focus of included studies was on primary prevention measures. Two reviewers collected data on type of study design, setting, population, intervention, types of injuries, outcomes assessed, and statistical results.

RESULTS

Of 30 179 identified studies, 117 were included in this review. Most of these studies were conducted in high-income countries and addressed traffic-related injuries. Evidence from included studies reveals that multicomponent educational interventions may be effective in improving safety knowledge, attitudes, and behaviors in school-aged children mainly when coupled with other approaches. Laws/legislation were shown to be effective in increasing cycle helmet use and reducing traffic-related injury rates. Findings reveal the relevance of infrastructure modification in reducing falls and improving pedestrian safety among children.

CONCLUSIONS

Additional studies are needed to evaluate the impact of unintentional injury prevention interventions on injury, hospitalizations, and mortality rates and the impact of laws and legislation and infrastructure modification on preventing unintentional injuries among school-aged children.

WalkSafe Keeps Walking for 15 Years: A Program Review

Unintentional injury is the leading cause of death among children aged 5 to 14 years. The WalkSafe program was developed in response to the number of children admitted to Miami–Dade County, Florida, level-1 trauma centers. WalkSafe was piloted in an initially high-risk neighborhood, which now exhibits a low density of pedestrian crashes. Following countywide implementation of WalkSafe, trauma data exhibit a 78% decrease in pediatric injuries. This article provides a 15-year review of WalkSafe and its role in decreasing pediatric pedestrian injuries in Miami–Dade County. Every year, an alarming number of child pedestrians are injured on the nation’s roadways. In Miami–Dade County, Florida, the WalkSafe program aims to reduce pediatric injury through targeted education and multitiered collaboration with community partners.

Sustaining a Pediatric Injury Prevention Program Through Educational Curriculum Dissemination

Objective To examine the process of implementing, disseminating, and sustaining a pediatric pedestrian safety program in Miami-Dade County Public Schools as well as its utilization by education practitioners. Method A review of the programmatic phases, grant funding, publications, partnerships, curriculum completion data, teacher trainings, and 31 WalkSafe Curriculum Dissemination Surveys. Results The program has maintained partnerships with the school district, trauma centers, and other important stakeholders since the program's inception while grant funding has enabled the development, growth, and continuation of the program. Survey responses indicated the curriculum is easy to use and age-appropriate for learning, as well as identified sustainable measures for the future. Conclusion A multicomponent approach is essential for piloting, implementing, and sustaining an evidence-based pedestrian safety program in South Florida's public schools. Sustainable partnerships, policy through school board support, continued grant funding, community involvement, and evolving with the needs of schools and their communities are vital to sustaining program presence in the community.

Child pedestrian anthropometry: evaluation of potential impact points during a crash

This paper highlights the potential impact points of a child pedestrian during a crash with the front end of a vehicle. Child anthropometry was defined for ages between 3 and 15 years. It was based on the measurement of seven different segment body heights (knee, femur, pelvis, shoulder, neck, chin, vertex) performed on about 2,000 French children. For each dimension, the 5(th), 50(th) and 95(th) percentile values were reported, and the corresponding linear regression lines were given. Then these heights were confronted with three different vehicle shapes, corresponding to a passenger car, a sport utility vehicle and a light truck, to identify impact points. In particular, we show that the thigh is directly hit by the bumper for children above 12 years of age, whereas the head principally impacts the hood. The influence of child anthropometry on the pedestrian trajectory and the comparison with test procedures in regulation are discussed.

Establishing an injury prevention program to address pediatric pedestrian collisions

The implementation of a pedestrian safety education program in public schools can change the knowledge and beliefs about safe pedestrian behaviors among students and their parents or caregivers with the goal of reducing morbidity and mortality of children. WalkSafe is a well-established, multiphase pedestrian safety intervention program. This program has been shown to improve pedestrian safety knowledge of school-aged children in kindergarten through grade 5 after receiving a 3-day educational curriculum. A reduction in pediatric pedestrian struck injuries is anticipated following program implementation in an urban area with significantly increased incidence of such injuries.

Pedestrian injury and the built environment: an environmental scan of hotspots

Background

Pedestrian injury frequently results in devastating and costly injuries and accounts for 11% of all road user fatalities. In the United States in 2006 there were 4,784 fatalities and 61,000 injuries from pedestrian injury, and in 2007 there were 4,654 fatalities and 70,000 injuries. In Canada, injury is the leading cause of death for those under 45 years of age and the fourth most common cause of death for all ages Traumatic pedestrian injury results in nearly 4000 hospitalizations in Canada annually. These injuries result from the interplay of modifiable environmental factors. The objective of this study was to determine links between the built environment and pedestrian injury hotspots in Vancouver.

Methods

Data were obtained from the Insurance Corporation of British Columbia (ICBC) for the 6 year period from 2000 to 2005 and combined with pedestrian injury data extracted from the British Columbia Trauma Registry (BCTR) for the same period. High incident locations (hotspots) for pedestrian injury in the City of Vancouver were identified and mapped using geographic information systems (GIS), and the characteristics of the built environment at each of the hotspot locations were examined by a team of researchers.

Results

The analysis highlighted 32 pedestrian injury hotspot locations in Vancouver. 31 of 32 hotspots were situated on major roads. Likewise, the majority of hotspots were located on downtown streets. The 'downtown eastside' was identified as an area with multiple high-incident locations, including the 2 highest ranked pedestrian injury hotspots. Bars were present at 21 of the hotspot locations, with 11 of these locations being judged to have high alcohol establishment density.

Conclusion

This study highlighted the disproportionate burden of pedestrian injury centred on the downtown eastside area of Vancouver. The environmental scan revealed that important passive pedestrian safety countermeasures were only present at a minority of high-incident locations. More importantly, bars were highly associated with risk of pedestrian injury. This study is the basis for potential public health intervention by clearly indicating optimal locations for signalized pedestrian crosswalks.

Preventing pediatric pedestrian injuries

Pedestrian-related crashes cause an estimated 1.2 million deaths and 50 million injuries worldwide. There were 32,590 nonfatal injuries reported among children 0 to 14 years of age in the United States in 2006. The incidence of pedestrian injuries seems to be decreasing due to improvements in trauma care and a nationwide decline in walking. This article is a special communication and overview of selected literature regarding efforts to decrease the frequency of pediatric pedestrian trauma. WalkSafe an elementary school-based pedestrian injury prevention program will be discussed as an example of a program that has been able to demonstrate a decrease in injuries in children.

The WalkSafe Program: developing and evaluating the educational component

BACKGROUND

Miami-Dade County, FL, has one of the highest numbers of pediatric pedestrian injuries in the country. To respond to this problem, WalkSafe an elementary school-based pedestrian injury prevention program was created. The purpose of this study was to evaluate the effectiveness of the 3-day WalkSafe educational curriculum in a high-risk district.

METHODS

Sixteen elementary schools were identified and enrolled in the study. Children (n = 10,621) in grades K-5 participated in the WalkSafe program in October 2006. Four of the 16 schools were randomly selected to receive pre-, post-, and 3-month posteducational testing of pedestrian safety knowledge. Teachers (n = 462) were asked to complete teacher surveys to gain feedback about the program.

RESULTS

A total of 2,987 tests were collected during the three different testing times. Grades were combined to form groups (K-1), (2-3), and (4-5). Significant differences were observed (p value <0.05) between pre- and posttesting for grades K-1 and 2-3. No significant differences were found between pre- and posttesting for (4-5) and between post- and 3-month testing across all grades (p value >0.05). There were 154 (30%) of the teacher surveys returned.

CONCLUSION

The 3-day WalkSafe educational curriculum implemented in a high-risk district was shown to increase the pedestrian safety knowledge of elementary school age children. From recommendations made by teachers and multiple agencies, the modified 3-day program was approved to implement on a yearly basis in all public elementary schools in Miami-Dade County. Further studies will investigate the transfer of knowledge gain to behavioral change among elementary school-aged children.

Comparison of Poisson and Bernoulli spatial cluster analyses of pediatric injuries in a fire district

Background

With limited resources available, injury prevention efforts need to be targeted both geographically and to specific populations. As part of a pediatric injury prevention project, data was obtained on all pediatric medical and injury incidents in a fire district to evaluate geographical clustering of pediatric injuries. This will be the first step in attempting to prevent these injuries with specific interventions depending on locations and mechanisms.

Results

There were a total of 4803 incidents involving patients less than 15 years of age that the fire district responded to during 2001–2005 of which 1997 were categorized as injuries and 2806 as medical calls. The two cohorts (injured versus medical) differed in age distribution (7.7 ± 4.4 years versus 5.4 ± 4.8 years, p < 0.001) and location type of incident (school or church 12% versus 15%, multifamily residence 22% versus 13%, single family residence 51% versus 28%, sport, park or recreational facility 3% versus 8%, public building 8% versus 7%, and street or road 3% versus 30%, respectively, p < 0.001). Using the medical incident locations as controls, there was no significant clustering for environmental or assault injuries using the Bernoulli method while there were four significant clusters for all injury mechanisms combined, 13 clusters for motor vehicle collisions, one for falls, and two for pedestrian or bicycle injuries. Using the Poisson cluster method on incidence rates by census tract identified four clusters for all injuries, three for motor vehicle collisions, four for fall injuries, and one each for environmental and assault injuries. The two detection methods shared a minority of overlapping geographical clusters.

Conclusion

Significant clustering occurs overall for all injury mechanisms combined and for each mechanism depending on the cluster detection method used. There was some overlap in geographic clusters identified by both methods. The Bernoulli method allows more focused cluster mapping and evaluation since it directly uses location data. Once clusters are found, interventions can be targeted to specific geographic locations, location types, ages of victims, and mechanisms of injury.

WalkSafe: a school-based pedestrian safety intervention program

OBJECTIVE

To evaluate the effectiveness of the WalkSafe program, an elementary school-based pedestrian safety program in a single high-risk district in Miami-Dade County.

METHODS

Sixteen elementary schools were identified in a single high-risk district and enrolled in a one-year study. All schools implemented the WalkSafe program on the last week of January 2003. A pre, post, and three-month post testing of pedestrian safety knowledge was conducted. An observational component was also implemented at four schools that were randomly chosen. Engineering recommendations and law enforcement initiatives were also performed.

RESULTS

A total of 6467 children from K-5th grade from 16 elementary schools participated in the program. Of these 5762 tests were collected over three different testing times. A significant difference (p-value < 0.001) was found between the pre and post testing conditions across all grade levels. There was no significant difference found between the post and three-month post testing conditions across all grade levels (p-value > 0.05). The observational data collected at four schools across the different testing times demonstrated a significant difference found between pre and post testing conditions for Group A (stop at the curb and look left, right, left) and also for Group B (midstreet crossing and darting out) (p-value < 0.05). There was no difference found between comparing the pre-test or post-test condition with the three-month post-test time. There were many environmental modifications that were recommended and actually performed.

CONCLUSION

The WalkSafe program implemented in a single high-risk district was shown to improve the pedestrian safety knowledge of elementary school children. The observational data demonstrated improved crossing behaviors from pre-test to post-testing conditions. Future research will focus on sustaining the program in this district and expanding the program throughout our county.