1
|
Macy ML, Carter P, Kendi S, Pollock B, Miguel LS, Goldstick J, Resnicow K. “Tiny Cargo, Big Deal! Abróchame Bien, Cuídame Bien” an emergency department-based intervention to promote child passenger safety: Protocol for an adaptive randomized trial among caregivers of 6-month through 10-year-old children. Contemp Clin Trials 2022; 120:106863. [DOI: 10.1016/j.cct.2022.106863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 11/03/2022]
|
2
|
Oglesbee SJ, Schafer KR, Kadish MP, Orozco R, Chao Z, Sapién RE. A Cross-Sectional Geographic Information Systems Study of a Pediatric Emergency Department Child Restraint System Distribution Program. J Emerg Nurs 2022; 48:278-287. [PMID: 35396094 DOI: 10.1016/j.jen.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A pediatric ED program sought to promote injury prevention through distribution of child restraint systems. Program funds are paid for child passenger safety technician certification of all personnel. Pediatric emergency nurses distributed child restraint systems at hospital discharge and dedicated technicians at fitting stations. Researchers described program characteristics, developed a baseline understanding of program outreach using geographic information systems, and evaluated adherence to manufacturer guidelines with a sensitivity analysis. METHODS This retrospective cross-sectional study used distribution forms linked to hospital records from 2013 to 2016. Testing for differences used nonparametric methods. Median values and interquartile ranges for weight and height of children were compared with manufacturer guidelines. Geographic information systems visualized recipients' street addresses and motor vehicle crashes on an underlying base map. RESULTS There were 312 child restraint systems distributed: of which 179 (57.4%) at the hospital, 126 (40.4%) at fitting stations, and 7 (2.2%) missing a location. Among those on Medicaid, 64.4% received a child restraint system at the hospital compared with 35.6% at fitting stations (χ2 = 5.40, P < .02). Fitting stations had limited outreach to rural residents. Finally, results from the sensitivity analysis showed that devices were issued according to manufacturer guidelines. DISCUSSION Despite the workplace pressures of clinical care, pediatric emergency nurses delivered educational information and demonstrated hands-on installation at similar rates to dedicated technicians. Distribution of child restraint systems through the hospital reached a uniquely underserved population. Further research should investigate methods to improve fitting station outreach among Medicaid recipients.
Collapse
|
3
|
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.
Collapse
|
4
|
Macy ML, Kandasamy D, Resnicow K, Cunningham RM. Pilot Trial of an Emergency Department-based Intervention to Promote Child Passenger Safety Best Practices. Acad Emerg Med 2019; 26:770-783. [PMID: 30637887 PMCID: PMC6626697 DOI: 10.1111/acem.13687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/19/2018] [Accepted: 12/26/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite demonstrated effectiveness of child restraint systems (CRSs), use remains suboptimal. In this randomized pilot trial, we sought to determine the feasibility, acceptability, and potential efficacy of "Tiny Cargo, Big Deal" an ED-based intervention to promote guideline-concordant size-appropriate CRS use. METHODS Parents of children < 11 years old were recruited in two EDs and randomized in a 2 × 2 factorial design to four conditions: 1) generic information sheet, 2) tailored brochure mailed after the ED visit, 3) a single motivational interviewing-based counseling session in the ED, and 4) full intervention (counseling session plus tailored brochure). We assessed feasibility (recruitment, completion, follow-up rates) and acceptability (parent attitudes, uptake of information) in the ED, at 1 month and at 6 months. We obtained preliminary estimates of effect sizes of the intervention components on appropriate CRS use at 6-month follow-up. RESULTS Of the 514 parents assessed for eligibility, 456 met inclusion criteria and 347 consented to participate. Enrolled parents were mostly mothers (88.1%); 48.7% were 18 to 29 years old; 52.5% were non-Hispanic, white; and 65.2% reported size-appropriate CRS use. Completion rates were 97.7% for baseline survey, 81.6% for counseling, 51.9% for 1-month follow-up, and 59.3% for 6-month follow-up. In the ED, 70.5% rated thinking about child passenger safety in the ED as very helpful. At 1 month, 70.0% expressed positive attitudes toward the study. Of 132 parents who reported receiving study mailings, 78.9% reviewed the information. Parents randomized to the full intervention demonstrated an increase (+6.12 percentage points) and other groups a decrease (-1.69 to -9.3 percentage points) in the proportion of children reported to use a size-appropriate CRS at 6-month follow-up. CONCLUSIONS Suboptimal CRS use can be identified and intervened upon during a child's ED visit. A combined approach with ED-based counseling and mailed tailored brochures shows promise to improve size-appropriate CRS use.
Collapse
Affiliation(s)
- Michelle L. Macy
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, Michigan; The Child Health Evaluation and Research (CHEAR) Center, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan; The University of Michigan Injury Prevention Center, Ann Arbor, Michigan; Current affiliation: Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL;
| | - Deepika Kandasamy
- The Child Health Evaluation and Research (CHEAR) Center, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan; Current affiliation: Department of Emergency Medicine, University of Colorado-Denver, Aurora, Colorado;
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, Michigan;
| | - Rebecca M. Cunningham
- Department of Emergency Medicine, Michigan Medicine, Ann Arbor, Michigan; The University of Michigan Injury Prevention Center, Ann Arbor, Michigan; School of Public Health, University of Michigan, Ann Arbor, Michigan;
| |
Collapse
|
5
|
Ishikawa T, Mâsse LC, Brussoni M. Changes in parents' perceived injury risk after a medically-attended injury to their child. Prev Med Rep 2019; 13:146-152. [PMID: 30591856 PMCID: PMC6305837 DOI: 10.1016/j.pmedr.2018.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/31/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022] Open
Abstract
Unintentional injuries are a major cause of hospitalization and death for children worldwide. Since children who sustain a medically-attended injury are at higher risk of recurrence, it is crucial to generate knowledge that informs interventions to prevent re-incidence. This study examines when, in the year following a medically-attended injury, parents perceive the greatest risk of injury recurrence. Since perception of injury risk is associated with parental preventive behavior, this can inform decisions on the timing of parent-targeted interventions to prevent re-injury. Study participants were 186 English-fluent parents of children 0 to 16 years, presenting at the British Columbia Children's Hospital for an unintentional pediatric injury. Parents were excluded if their child had a disability or chronic health condition. Perceived risk of the same and of any injury recurring were elicited from parents, when they sought treatment at the hospital, as well as one, four, and twelve months later. The study ran between February 2011 and December 2013. Mixed-effects models were used to analyze changes in parents' responses. Analysis indicates that perceived risk of the same injury recurring did not change. However, perceived risk of any injury recurring increased from baseline to first follow-up, then decreased during the rest of the year. Overall, perceived risk of any injury was higher for parents whose child had a history of injuries. Visits to the Emergency Department for a pediatric injury may not be optimal timing to deploy injury prevention interventions for parents. Follow-up visits (when parents' perceived risk is highest) may be better.
Collapse
Affiliation(s)
- Takuro Ishikawa
- Department of Pediatrics, University of British Columbia: Rm 2D19, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- British Columbia Children's Hospital Research Institute, F503, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- BC Injury Research and Prevention Unit, F508, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Louise C. Mâsse
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
- British Columbia Children's Hospital Research Institute, F503, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Mariana Brussoni
- Department of Pediatrics, University of British Columbia: Rm 2D19, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
- British Columbia Children's Hospital Research Institute, F503, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
- BC Injury Research and Prevention Unit, F508, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Melzer-Lange MD, Zonfrillo MR, Gittelman MA. Injury prevention: opportunities in the emergency department. Pediatr Clin North Am 2013; 60:1241-53. [PMID: 24093906 DOI: 10.1016/j.pcl.2013.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because injury is the leading cause of morbidity and mortality in young patients, emergency departments have a significant opportunity to provide injury-prevention interventions at a teachable moment. The emergency department has the ability to survey injuries in the community, use the hospital setting to screen patients, provide products, offer resources to assist families within this setting to change their risky behaviors, and connect families to community resources. With a thoughtful, collaborative approach, emergency departments are an excellent setting within which to promote injury prevention among patients and families.
Collapse
Affiliation(s)
- Marlene D Melzer-Lange
- Emergency Department Trauma Center, Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA; Section of Emergency Medicine, Department of Pediatrics, Children's Corporate Center, Medical College of Wisconsin, C550, 999 North 92nd Street, Milwaukee, WI 53226, USA.
| | | | | |
Collapse
|