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Cooper-Sood JB, Chan C, Cho CS. A Paper-Based Car Seat Safety Educational Intervention in the Pediatric Emergency Department. Pediatr Emerg Care 2021; 37:e784-e787. [PMID: 30998652 DOI: 10.1097/pec.0000000000001808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Motor vehicle crashes are a leading source of pediatric morbidity and mortality in children younger than 13 years. Proper car seat safety device (CSD) markedly reduces mortality, but the majority of families misuse them. Emergency department (ED)-based educational interventions can improve knowledge patient regarding proper CSD use but historically have been resource intensive. Our study evaluated the utility of a novel educational intervention in improving patient knowledge of proper CSD use and in evaluating for proper CSD installation. METHODS Parents of children younger than 14 years presenting to the ED were given a paper-based quiz followed by a CSD-educational handout. Improvement in patient knowledge and evaluation for proper CSD installation were evaluated by repeat quiz and a phone-based survey 2 to 4 weeks later. RESULTS Parents exhibited an 18% improvement in quiz answers evaluating knowledge of proper CSD use (P value < 0.0001). Eighty-two percent and 72% of families felt that the intervention improved their understanding of proper CSD use and increased their awareness of their importance, respectively, but only 18% had their CSD checked by a professional. CONCLUSIONS A paper-based educational intervention in the pediatric ED is well received by parents, may improve patient knowledge surrounding proper CSD use, and encourages some families to get their CSDs checked for proper installation.
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Affiliation(s)
| | | | - Christine S Cho
- Department of Emergency Medicine, Children's Hospital of Los Angeles, Los Angeles, CA
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Krepis P, Papasotiriou M, Tsolia MN, Soldatou A. Child Car Safety: A Parental Survey at a Tertiary Care Emergency Treatment Center in Greece. Pediatr Emerg Care 2021; 37:29-33. [PMID: 29489606 DOI: 10.1097/pec.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to assess parental behavior in terms of child restraint systems (CRS) use under emergency conditions while driving to the hospital's outpatient settings as well as their routine child car safety (CCS) practices. METHODS A cross-sectional survey of parents/caregivers transporting children 13 years or younger was conducted at the Emergency Treatment Center of a pediatric tertiary care center in Athens, Greece. Participants completed a questionnaire inquiring about the possession of CRS, and type and use of appropriate CRS while driving to the Emergency Treatment Center and under routine conditions. In addition, presence and type of parental education with regard to CCS and the use of seat belts among drivers were assessed. RESULTS Of 444 participants, 51.4% children were carried restrained, although 48.6% were fastened in an improper seat for their age, in contrast with 23.7% who travel unrestrained on a daily basis. Forward-facing restraint seats were most popular, with 53.9% total use even in children younger than 2 years or older than 4 years, whereas booster seats (9.4%) and rear-facing restraint seats (18.2%) were inappropriately disfavored. Children younger than 4 years, male drivers, and drivers who had received information on CCS had higher odds of using CRS. The proportion of those had never been provided any CCS education was 38.5%. CONCLUSIONS Child restraint systems use was inappropriately low under routine conditions and declined even further under emergency circumstances. Most children younger than 2 years and older than 4 years traveled inappropriately restrained in a forward-facing restraint seat. Parents should be more intensively educated on child car safety seat and the proper CRS use.
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Affiliation(s)
- Panagiotis Krepis
- From the Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Maria N Tsolia
- From the Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandra Soldatou
- From the Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Parental Knowledge of Appropriate Placement of Child Restraint Systems Before and After Educational Intervention in a Pediatric Emergency Department. Pediatr Emerg Care 2020; 36:43-49. [PMID: 31895201 DOI: 10.1097/pec.0000000000002020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to determine caregiver's knowledge of appropriate car restraint systems (CRSs) use and compare this with the actual use among children presenting to the pediatric emergency department (PED), and to determine the efficacy of PED-based intervention on improving knowledge. METHODS We conducted a prospective, intervention study of children (<8 years old) during a 12-month period in the PED. Based on their height and weight, children were assigned to group 1 (rear facing), group 2 (forward facing), or group 3 (booster). Caregivers were surveyed in their baseline CRS knowledge. Certified child passenger safety technicians evaluated each CRS and gave caregivers one-on-one education. Participants were called back to answer a posttest to determine if the information given was retained. RESULTS Of the 170 children enrolled, 64 (37.6%) were assigned to group 1, 68 (40%) to group 2, and 38 (22.3%) to group 3. Of these, 63% were not aware of the state law regarding CRS use. Among those without a CRS, 18% belonged to group 1, 36% to group 2, and 46% to group 3. Even among those who reportedly had CRS, 13% of children did not have one-on-on inspection. After inspection, 84% of group 1, 71% of group 2, and 70% of group 3 were in the appropriate one. Nearly 45% were not compliant with American Academy of Pediatrics guidelines of children riding in rear-facing CRS until 2 years of age. CONCLUSIONS A significant proportion of children visiting the PED are not in appropriate CRS, and caretaker knowledge about correct CRS types and installation is poor. Future educational efforts should focus on rear-facing and booster seat age-group children.
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Violano P, Aysseh N, Lucas M, Gawel M, Morrell P, Norway C, Alfano A, Bechtel K. Feasibility of providing child restraint devices after a motor vehicle crash in a pediatric emergency department. TRAFFIC INJURY PREVENTION 2019; 19:844-848. [PMID: 30657709 DOI: 10.1080/15389588.2018.1496243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 05/17/2018] [Accepted: 06/28/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Motor vehicle crashes (MVCs) cause disproportionate childhood morbidity and mortality. Ensuring that children are placed in appropriate child restraint devices (CRDs) would significantly reduce injuries and deaths as well as medical costs. The goal of the study is to evaluate the feasibility of providing child restraint devices after an MVC in a pediatric emergency department (PED). METHODS A guideline was developed to assess the need for CRDs for patients discharged from a PED after an MVC. Providers were educated on the use of the guideline. Caregivers were provided a brief educational intervention on legislation, proper installation, and best practices prior to distribution of a CRD. Quality assurance was conducted weekly to monitor for any missed opportunities. RESULTS From August 31, 2015, to August 31, 2016, 291 patients <7 years were evaluated in the PED of a level 1 trauma center following an MVC. Two hundred forty-seven children were correctly identified according to the guidelines (84.9%). Of these, 187 (75.7%) were identified as not requiring a replacement seat and 60 (24.3%) required a CRD replacement based on crash mechanisms and restraint use status and received a CRD replacement. Of the remaining 44 children, 38 (86.4%) whose crash mechanisms were severe enough or who were inappropriately restrained were not provided a CRD and thus missed; 6 (13.6%) received a replacement seat even though criteria were not met. Thus, PED providers correctly identified 61.2% (60/98) of children who required CRD replacement after an MVC. CONCLUSION Caring for children who present for evaluation after an MVC offers an opportunity for ED personnel to provide education to caregivers about the appropriate use of CRDs and state legislation. Establishing guidelines for the provision of a CRD for children who present to an ED following an MVC may help to improve the safety of children being transported in motor vehicles. Having a systematic process and adequate supply of CRDs readily available contributes to the success of children being discharged with the appropriate age- and weight-based CRD after being treated in an ED following an MVC.
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Affiliation(s)
- Pina Violano
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- b Injury Free Coalition for Kids of New Haven, Yale New Haven Children's Hospital , New Haven , Connecticut
| | - Nick Aysseh
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- b Injury Free Coalition for Kids of New Haven, Yale New Haven Children's Hospital , New Haven , Connecticut
| | - Monica Lucas
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- b Injury Free Coalition for Kids of New Haven, Yale New Haven Children's Hospital , New Haven , Connecticut
| | - Marcie Gawel
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- b Injury Free Coalition for Kids of New Haven, Yale New Haven Children's Hospital , New Haven , Connecticut
| | - Patricia Morrell
- c Trauma Department , Yale New Haven Hospital , New Haven , Connecticut
| | - Calvin Norway
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- c Trauma Department , Yale New Haven Hospital , New Haven , Connecticut
| | - April Alfano
- d Emergency Operations Center, Yale New Haven Health System , New Haven , Connecticut
| | - Kirsten Bechtel
- a Injury Prevention, Community Outreach & Research, Yale New Haven Hospital , New Haven , Connecticut
- b Injury Free Coalition for Kids of New Haven, Yale New Haven Children's Hospital , New Haven , Connecticut
- e Department of Pediatrics , Yale School of Medicine , New Haven , Connecticut
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Chong SL, Tyebally A, Chew SY, Lim YC, Feng XY, Chin ST, Lee LK. Road traffic injuries among children and adolescents in Singapore - Who is at greatest risk? ACCIDENT; ANALYSIS AND PREVENTION 2017; 100:59-64. [PMID: 28110260 DOI: 10.1016/j.aap.2017.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/30/2016] [Accepted: 01/13/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Pediatric road traffic injuries remain a significant cause of death and disability in many countries in Asia, despite the implementation of road traffic safety laws. We aim to describe the injuries, the use of restraints among road users, and risk factors associated with severe injuries for children in Singapore. METHODS We performed a retrospective chart review of road traffic injuries presenting to the only two pediatric tertiary care hospitals in Singapore, from January 2012 to April 2016. We included children <16years old presenting to the emergency departments within 24h after injury (pedestrian, bicycle, motorcycle, motor vehicle). We calculated the frequencies for specific injury mechanisms, injury severity scores (ISS), and in-hospital outcomes of severe injuries (death, urgent resuscitation and emergent surgery). We performed a multivariate logistic regression to determine risk factors associated with severe injury. RESULTS There were 2468 patients during the study period. The mean age was 7.9 years (SD 4.7); 60.1% of road injuries involved motor vehicle occupants (1483/2468). Most bicyclist/motorcyclists were not wearing helmets (70.0%, 245/350) and 51.1% of motor vehicle passengers (758/1483) were not restrained. Compared to motor vehicle passengers, pedestrians (adjusted OR 2.38, 95% CI 1.41-3.99), bicyclists (adjusted OR 2.12, 95% CI 1.04-4.32) and motorcyclists (adjusted OR 6.09, 95% CI 2.04-18.24) were more likely to sustain severe injuries. CONCLUSION Child pedestrians, bicyclists and motorcyclists are especially vulnerable for severe injures. Further injury prevention efforts must focus on the enforcement of legislation to protect these high-risk groups.
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Affiliation(s)
- Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore.
| | - Arif Tyebally
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore.
| | - Su Yah Chew
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
| | - Yang Chern Lim
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
| | - Xun Yi Feng
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore.
| | - Sock Teng Chin
- Department of Emergency Medicine, National University Health System, Singapore.
| | - Lois K Lee
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, United States.
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Chong SL, Chew SY, Feng JXY, Teo PYL, Chin ST, Liu N, Ong MEH. A prospective surveillance of paediatric head injuries in Singapore: a dual-centre study. BMJ Open 2016; 6:e010618. [PMID: 26908533 PMCID: PMC4769425 DOI: 10.1136/bmjopen-2015-010618] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study the causes of head injuries among the paediatric population in Singapore, and the association between causes and mortality, as well as the need for airway or neurosurgical intervention. DESIGN This is a prospective observational study utilising data from the trauma surveillance system from January 2011 to March 2015. SETTING Paediatric emergency departments (EDs) of KK Women's and Children's Hospital and the National University Health System. PARTICIPANTS We included children aged <16 years presenting to the paediatric EDs with head injuries who required a CT scan, admission for monitoring of persistent symptoms, or who died from the head injury. We excluded children who presented with minor mechanisms and those whose symptoms had spontaneously resolved. PRIMARY AND SECONDARY OUTCOME MEASURES Primary composite outcome was defined as death or the need for intubation or neurosurgical intervention. Secondary outcomes included length of hospital stay and type of neurosurgical intervention. RESULTS We analysed 1049 children who met the inclusion criteria. The mean age was 6.7 (SD 5.2) years. 260 (24.8%) had a positive finding on CT. 17 (1.6%) children died, 52 (5.0%) required emergency intubation in the ED and 58 (5.5%) underwent neurosurgery. The main causes associated with severe outcomes were motor vehicle crashes (OR 7.2, 95% CI 4.3 to 12.0) and non-accidental trauma (OR 5.8, 95% CI 1.8 to 18.6). This remained statistically significant when we stratified to children aged <2 years and performed a multivariable analysis adjusting for age and location of injury. For motor vehicle crashes, less than half of the children were using restraints. CONCLUSIONS Motor vehicle crashes and non-accidental trauma causes are particularly associated with poor outcomes among children with paediatric head injury. Continued vigilance and compliance with injury prevention initiatives and legislature are vital.
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Affiliation(s)
- Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - Su Yah Chew
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Jasmine Xun Yi Feng
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Penny Yun Lin Teo
- Department of Emergency Medicine, National University Health System, Singapore
| | - Sock Teng Chin
- Department of Emergency Medicine, National University Health System, Singapore
| | - Nan Liu
- Department of Emergency Medicine, Singapore General Hospital, Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore
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