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Anderson DM, Peterson RW. Rear-facing child safety seat effectiveness: evidence from motor vehicle crash data. Inj Prev 2023; 29:320-326. [PMID: 36918272 DOI: 10.1136/ip-2022-044815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION In 2018, the American Academy of Pediatrics updated their car safety seat (CSS) guidelines to recommend that children ride rear-facing as long as possible, yet evidence from observational studies on rear-facing CSS effectiveness is limited. This study estimated the association between rear-facing CSS use and injuries among children aged 0-4 years who were involved in motor vehicle crashes (MVCs). METHODS This study analysed data on all MVCs involving children aged 0-4 years reported to the Kansas Department of Transportation from 2011 to 2020. Children who were in a rear-facing CSS were compared with children who rode in a forward-facing device. Logistic regression was used to adjust for potential confounders. RESULTS In unadjusted models, rear-facing CSS use was associated with a 14% reduction in the odds of suffering any injury versus riding in a forward-facing CSS (OR 0.860, 95% CI 0.805 to 0.919). In models adjusted for potential confounders, rear-facing CSS use was associated with a 9% reduction in the odds of any injury relative to riding forward-facing (OR 0.909, 95% CI 0.840 to 0.983). These estimates were driven by children seated in the back outboard positions. Rear-facing CSS use was also negatively associated with incapacitating/fatal injuries, but these estimates were imprecise. CONCLUSIONS Children aged 0-4 years are less likely to be injured in an MVC if they are restrained in a rear-as opposed to forward-facing CSS. These results are particularly relevant because a number of state CSS laws do not require children of any age to ride rear-facing.
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Affiliation(s)
- D Mark Anderson
- Agricultural Economics & Economics, Montana State University, Bozeman, Montana, USA
- National Bureau of Economic Research, Cambridge, Massachusetts, USA
| | - Ridge W Peterson
- Agricultural Economics & Economics, Montana State University, Bozeman, Montana, USA
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Pressley JC, Puri N, He T. Fatal Motor Vehicle Crashes in Upstate and Long Island New York: The Impact of High Visibility Seat Belt Enforcement on Multiple Risky Driving Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:920. [PMID: 36673678 PMCID: PMC9859000 DOI: 10.3390/ijerph20020920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Despite an observed daytime front-seat seat belt use that exceeds 90%, nearly half of motor vehicle occupants who die in New York State (NYS) each year are not wearing a seat belt. Crash outcomes were examined by occupant, vehicle, environmental and traffic enforcement patterns related to the annual Click It or Ticket high visibility seat belt enforcement campaign. Three periods of enforcement were examined: pre-enforcement, peri-enforcement (during/immediately after), and post-enforcement. Of the 14.4 million traffic citations, 713,990 (5.0%) were seat belt violations. Relative risk with 95% CI was assessed using deaths from the Fatality Analysis Reporting System (FARS) and SAS Glimmix 9.4 software. Mortality was lower peri-enforcement (32.9%) compared to pre- (40.9%) or post-enforcement (37.1%) (p < 0.001) and tended to be elevated in low enforcement response areas (43.6%). Fatalities were 30% lower (0.7, 95% CI 0.6−0.9) during peri-enforcement in models adjusted for demographics, law coverage, enforcement response, rural, weekend, impairment, speeding, and vehicle type. Adjusted mortality was higher in rural (1.9, 1.6−2.6), alcohol-involved (1.8, 1.4−2.9), and speeding-involved (2.0, 1.7−2.5) crashes. Peri-enforcement alcohol- and speed-involved fatalities tended to be lower in restrained, unrestrained and occupants missing belt status. The finding of lower mortality in both belted and unbelted occupant’s peri-enforcement—in the context of fewer fatal speed and alcohol-involved crashes—suggests that the mechanism(s) through which high visibility seat belt enforcement lowers mortality is through impacting multiple risky driving behaviors.
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Affiliation(s)
- Joyce C. Pressley
- Departments of Epidemiology and Health Policy and Management, Columbia University, New York, NY 10032, USA
| | - Nirajan Puri
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Tianhui He
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Diez M, Abajo J, Negro A, Escalante SM, Fernández MT. Study on the influence of seating orientation during frontal impacts by child occupant human body model response analysis. TRAFFIC INJURY PREVENTION 2022; 23:135-139. [PMID: 35191806 DOI: 10.1080/15389588.2022.2026936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 11/29/2021] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Autonomous driving cars must be developed to ensure that children will have the highest level of protection in case of collision. Changes to the vehicle cabin design (different seat orientations, fully reclining seats, etc.) may significantly impact child occupant safety. Understanding child occupant responses under these new conditions is necessary to decrease risk and enhance child safety. In this study, child occupant response in different seating orientations exposed to frontal impacts with a focus on the head injuries and kinematics was analyzed. METHODS Finite elements simulations were performed using the PIPER 6-year-old human body model (HBM). All simulations were carried out in a generic full vehicle environment. The child model was positioned in an adequate generic car restraint system (CRS) in the left rear vehicle seat in 4 seating orientations: 0° (forward-facing position), 30°, 60°, and 90° (living room position). Two scenarios were evaluated for all seating orientations according to the left front seat backrest position: reclined position nominal upright and rest position (55°). All seat configurations were subjected to the mobile progressive deformable barrier frontal impact (European New Car Assessment Programme [Euro NCAP] frontal impact testing protocol). A total of 8 scenarios were simulated in LS-DYNA. RESULTS Based on the Euro NCAP injury risk rate, 90° seating orientation (living room position) was the safest among all selected scenarios independent of the left front seat backrest position. The worst case was found in 60° seat rotation. The highest values for Head Injury Criterion (HIC) and head acceleration (Acc 3 ms) were noted for this case. Higher Brain Injury Criterion (BrIC) values were observed at higher seat rotation angles. Hence, a 90° seating orientation showed the highest BrIC value. Attending to the skull stress, greater head injuries were caused principally by contact with the vehicle interior (seat headrest). Maximum stress values were reached at 30° and 60° seating orientations with the front seat in rest position. In 90° seating orientation, high stress values were also identified. CONCLUSIONS These results show that attending to these new seating orientations, current child safety standards are not sufficient to ensure children the highest level of protection. Other additional criteria such as BrIC or skull stress that offer a way to capture brain injuries should be used.
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Affiliation(s)
- Mónica Diez
- CIDAUT Foundation (Investigación y Desarrollo en Transporte y Energía), Boecillo, Valladolid, Spain
| | - Julio Abajo
- CIDAUT Foundation (Investigación y Desarrollo en Transporte y Energía), Boecillo, Valladolid, Spain
| | - Alberto Negro
- CIDAUT Foundation (Investigación y Desarrollo en Transporte y Energía), Boecillo, Valladolid, Spain
| | - Susana M Escalante
- CIDAUT Foundation (Investigación y Desarrollo en Transporte y Energía), Boecillo, Valladolid, Spain
| | - M Teresa Fernández
- CIDAUT Foundation (Investigación y Desarrollo en Transporte y Energía), Boecillo, Valladolid, Spain
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Doh KF, Sheline EK, Wetzel M, Xiang Y, Morris CR, Simon HK. Pediatric firearm and motor vehicle collision injuries in the United States: Diverging trends. Am J Emerg Med 2021; 53:59-62. [PMID: 34979410 DOI: 10.1016/j.ajem.2021.12.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kiesha Fraser Doh
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America; Children's Healthcare of Atlanta, Atlanta, GA, United States of America.
| | - Erica K Sheline
- Children's Hospital of Colorado and Denver Health Medical Center, University of Colorado School of Medicine, Anschutz Medical Campus, United States of America
| | - Martha Wetzel
- Department of Pediatrics, Biostatistics Core, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Yijin Xiang
- Department of Pediatrics, Biostatistics Core, Emory University School of Medicine, Atlanta, GA, United States of America; Department of Pediatrics, Biostatistics Core, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Claudia R Morris
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America; Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Harold K Simon
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States of America; Children's Healthcare of Atlanta, Atlanta, GA, United States of America
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Adeyemi OJ, Arif AA, Paul R. Exploring the relationship of rush hour period and fatal and non-fatal crash injuries in the U.S.: A systematic review and meta-analysis. ACCIDENT; ANALYSIS AND PREVENTION 2021; 163:106462. [PMID: 34717204 DOI: 10.1016/j.aap.2021.106462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 10/02/2021] [Accepted: 10/17/2021] [Indexed: 06/13/2023]
Abstract
Road crashes are preventable causes of morbidity and mortality. In the U.S., substantial crashes occur during the rush hour period. The rush hour represents the period of the day during which the density of humans and vehicles in the road environment is highest. In the U.S., the rush hour period is bi-modal, occurring in the morning and the afternoon, at times that vary by state and urban-rural status. This systematic review and meta-analysis aimed to evaluate the association between the rush hour period and fatal and non-fatal crash injuries. Selected articles were limited to peer-reviewed full-text articles that measured crash injury as an outcome and rush hour as either a predictor, covariate, stratification, or a control variable. A total of 17 articles were identified for systematic review and nine articles were included in the meta-analysis. Across the selected studies, the rush-hour period signified the period of "peak traffic flow." During the rush hour period, aggressive driving behavior, truck driving, bicycle riding, and precipitation were associated with increased crash events or crash injuries. Across the nine studies included in the meta-analysis, the effective sample size was 236,433. The rush-hour period was associated with a 28% increased risk of fatal crash injury (Pooled RR: 1.28; 95% CI: 1.11-1.45) and the morning rush hour period was associated with 36% increased crash injury risk (Pooled RR: 1.36; 95% CI: 1.13-1.59). The rush hour period, though less commonly studied as a predictor of fatal and non-fatal crash injuries, represents an important domain in need of crash injury prevention attention. The knowledge of the pattern of crash injuries, as it varies across countries, states, regions, and county can inform policy and intervention, in the presence of competing public health needs.
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Affiliation(s)
- Oluwaseun John Adeyemi
- Department of Public Health, University of North Carolina at Charlotte, NC 28223, USA; Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York 10016, USA.
| | - Ahmed A Arif
- Department of Public Health, University of North Carolina at Charlotte, NC 28223, USA.
| | - Rajib Paul
- Department of Public Health, University of North Carolina at Charlotte, NC 28223, USA.
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Bauer M, Hines L, Pawlowski E, Luo J, Scott A, Garnett M, Uriell M, Pressley JC. Using Crash Outcome Data Evaluation System (CODES) to examine injury in front vs. rear-seated infants and children involved in a motor vehicle crash in New York State. Inj Epidemiol 2021; 8:32. [PMID: 34148551 PMCID: PMC8215803 DOI: 10.1186/s40621-021-00328-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In New York State (NYS), motor vehicle (MV) injury to child passengers is a leading cause of hospitalization and emergency department (ED) visits in children aged 0-12 years. NYS laws require appropriate child restraints for ages 0-7 years and safety belts for ages 8 and up while traveling in a private passenger vehicle, but do not specify a seating position. METHODS Factors associated with injury in front-seated (n = 11,212) compared to rear-seated (n = 93,092) passengers aged 0-12 years were examined by age groups 0-3, 4-7 and 8-12 years using the 2012-2014 NYS Crash Outcome Data Evaluation System (CODES). CODES consists of Department of Motor Vehicle (DMV) crash reports linked to ED visits and hospitalizations. The front seat was row 1 and the rear rows 2-3. Vehicle towed from scene and air bag deployed were proxies for crash severity. Injury was dichotomized based on Maximum Abbreviated Injury Severity (MAIS) scores greater than zero. Multivariable logistic regression (odds ratios (OR) with 95% CI) was used to examine factors predictive of injury for the total population and for each age group. RESULTS Front-seated children had more frequent injury than those rear-seated (8.46% vs. 4.92%, p < 0.0001). Children in child restraints experienced fewer medically-treated injuries compared to seat belted or unrestrained children (3.80, 6.50 and 13.62%, p < 0.0001 respectively). A higher proportion of children traveling with an unrestrained vs. restrained driver experienced injury (14.50% vs 5.26%, p < 0.0001). After controlling for crash severity, multivariable adjusted predictors of injury for children aged 0-12 years included riding in the front seat (1.20, 1.10-1.31), being unrestrained vs. child restraint (2.13, 1.73-2.62), being restrained in a seat belt vs. child restraint (1.20, 1.11-1.31), and traveling in a car vs. other vehicle type (1.21, 1.14-1.28). Similarly, protective factors included traveling with a restrained driver (0.61, 0.50-0.75), a driver aged < 25 years (0.91, 0.82-0.99), being an occupant of a later vehicle model year 2005-2008 (0.68, 0.53-0.89) or 2009-2015 (0.55, 0.42-0.71) compared to older model years (1970-1993). CONCLUSIONS Compared to front-seated children, rear-seated children and children in age-appropriate restraints had lower adjusted odds of medically-treated injury.
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Affiliation(s)
- Michael Bauer
- New York State Department of Health, Bureau of Occupational Health & Injury Prevention, Center for Environmental Health, Corning Tower, Room 1325, Empire State Plaza, Albany, NY 12237 USA
| | - Leah Hines
- New York State Department of Health, Bureau of Occupational Health & Injury Prevention, Center for Environmental Health, Corning Tower, Room 1325, Empire State Plaza, Albany, NY 12237 USA
| | - Emilia Pawlowski
- New York State Department of Health, Bureau of Occupational Health & Injury Prevention, Center for Environmental Health, Corning Tower, Room 1325, Empire State Plaza, Albany, NY 12237 USA
| | - Jin Luo
- New York State Department of Health, Bureau of Occupational Health & Injury Prevention, Center for Environmental Health, Corning Tower, Room 1325, Empire State Plaza, Albany, NY 12237 USA
| | - Anne Scott
- New York State Department of Health, Bureau of Occupational Health & Injury Prevention, Center for Environmental Health, Corning Tower, Room 1325, Empire State Plaza, Albany, NY 12237 USA
| | - Matthew Garnett
- New York State Department of Health, Bureau of Occupational Health & Injury Prevention, Center for Environmental Health, Corning Tower, Room 1325, Empire State Plaza, Albany, NY 12237 USA
| | - Morgan Uriell
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
| | - Joyce C. Pressley
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
- Departments of Epidemiology and Health Policy and Management and the Center for Injury Epidemiology and Prevention at Columbia, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
- Columbia Center for Injury Science and Prevention, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
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Kendi S, Howard MB, Mohamed MA, Eaddy S, Chamberlain JM. So much nuance: A qualitative analysis of parental perspectives on child passenger safety. TRAFFIC INJURY PREVENTION 2021; 22:224-229. [PMID: 33661063 DOI: 10.1080/15389588.2021.1877276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore barriers and facilitators to optimal child restraint system (CRS) use for diverse parents of newborn infants and to obtain input from parents on the use of technology-assisted remote car seat checks as tools for promoting optimal CRS use. METHODS Parents were recruited using purposive sampling. Interviews were conducted with English- or Spanish-speaking parents with a full term newborn and regular access to a car. Interviews were conducted by phone, and recorded and transcribed verbatim. Interviews were conducted until thematic saturation was reached. Data were organized for analysis using Atlas.ti, and codes grouped by theme using constant comparison. RESULTS 30 parents were enrolled. Barriers and facilitators to optimal CRS use were classified into three themes, as were thoughts on the pros and cons regarding remote car seat checks. Themes on barriers and facilitators included motor vehicle and CRS features (such as age and size of the motor vehicle and presence of the Lower Anchors and Tethers for Children LATCH system), resources (availability, accessibility, and accuracy of resources), and parental factors (parental emotions and characteristics). Themes related to pros and cons of remote car seat checks included the ability (and challenge) of remote car seat checks to identify and correct errors, the potential use of remote car seat checks in certain situations (such as CRS transitions and periods of growth), and convenience of remote car seat checks (including increased availability and ease of access). Subthemes with further detail were arranged within each theme identified. CONCLUSION From a parent perspective, there are several identified barriers and facilitators of optimal CRS use. Although car seat checks were identified as a resource, in-person accessibility was an issue, and there were mixed opinions on technology-assisted remote car seat checks. These results provide a foundation for additional study on targeted interventions, including remote interventions for which there is an increased need due to the COVID-19 pandemic.
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Affiliation(s)
- Sadiqa Kendi
- Children's National Hospital, Washington, DC
- The George Washington University School of Medicine and Health Sciences, Washington, DC
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Mary Beth Howard
- Children's National Hospital, Washington, DC
- The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Mohamed A Mohamed
- The George Washington University School of Medicine and Health Sciences, Washington, DC
- The George Washington University Hospital, Washington, DC
| | - Samuel Eaddy
- Children's National Hospital, Washington, DC
- Nova Southeastern University Dr. Kiran C Patel College of Osteopathic Medicine, Fort Lauderdale, Florida
| | - James M Chamberlain
- Children's National Hospital, Washington, DC
- The George Washington University School of Medicine and Health Sciences, Washington, DC
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Smola C, Sorrentino A, Shah N, Nichols M, Monroe K. Child passenger safety education in the emergency department: teen driving, car seats, booster seats, and more. Inj Epidemiol 2020; 7:26. [PMID: 32532359 PMCID: PMC7291416 DOI: 10.1186/s40621-020-00250-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The leading cause of death in children less than 19 years old is motor vehicle crashes (MVC). Non-use or improper use of motor vehicle car seats significantly adds to the morbidity and mortality. Emergency department (ED) encounters provide an opportunity for caregiver education. Our objective was to determine the effect of an educational intervention on knowledge and counseling behaviors of pediatric ED nurses regarding child passenger safety (CPS). METHODS A pre/post educational intervention study was conducted with nursing staff in an urban ED. Responses to CPS related knowledge and counseling behaviors were collected using surveys administered before and after the intervention. The ED nurse education intervention was a one-hour lecture based on the American Academy of Pediatrics (AAP) CPS guidelines and Alabama state law regarding ages for each car seat type and teen driving risky behaviors. Individual data from pre and post surveys were matched, and nominal variables in pre-post matched pairs were analyzed using McNemar's test. To compare categorical variables within pre or post test data, we used the Chi-square test. RESULTS Pretests were administered to 83/110 ED nurses; 64 nurses received the educational intervention and posttest. On the pretests, nurses reported "never" or "occasionally" counseling about CPS for the following: 56% car seats, 62% booster seat, 56% teen driving, 32% seat belts. When comparing the pretest CPS knowledge between nurses working 0-1 year vs. ≥ 2 years there was no statistically significant difference. Two CPS knowledge questions did not show significance due to a high correct baseline knowledge rate (> 98%), including baseline knowledge of MVC being the leading cause of death. Of the remaining 7 knowledge questions, 5 questions showed statistically significant improvement in knowledge: age when children can sit in front seat, state GDL law details, seat belt state law for back seat riders, age for booster seat, and rear facing car seat age. All four counseling behavior questions showed increases in intent to counsel families; however, only intent to counsel regarding teen driving reached statistical significance. CONCLUSIONS Educational efforts improved pediatric ED nursing knowledge regarding CPS. Intent to counsel was also improved following the education.
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Affiliation(s)
- Cassi Smola
- Department of Pediatrics, Hospital Medicine Division, University of Alabama Birmingham, 1600 7th Ave So, Suite 110 CPP, Children’s of Alabama, Birmingham, Al 35233 USA
| | - Annalise Sorrentino
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama Birmingham, 1600 7th Ave So, Suite 110 CPP, Children’s of Alabama, Birmingham, Al 35233 USA
| | - Nipam Shah
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama Birmingham, 1600 7th Ave So, Suite 110 CPP, Children’s of Alabama, Birmingham, Al 35233 USA
| | - Michele Nichols
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama Birmingham, 1600 7th Ave So, Suite 110 CPP, Children’s of Alabama, Birmingham, Al 35233 USA
| | - Kathy Monroe
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama Birmingham, 1600 7th Ave So, Suite 110 CPP, Children’s of Alabama, Birmingham, Al 35233 USA
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Restraint Factors and Child Passenger Deaths in New South Wales, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041147. [PMID: 32059428 PMCID: PMC7068408 DOI: 10.3390/ijerph17041147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 11/30/2022]
Abstract
Inappropriate or incorrect use of child restraints can influence crash injury outcome. This study examined the role of restraint factors in child passenger deaths and the effect of legislation requiring appropriate restraint systems up to 7 years old. Data for child (0–12 years) passenger deaths occurring in New South Wales (NSW) from 2007 to 2016 were collected by the child death review team including photographs, reports of in-depth crash investigation, witness reports and medical reports. Restraint use, type of restraint, appropriateness of the restraint for the age of the child and correctness of restraint use were examined. The primary contributor to death was determined in each case. Sixty-four child passengers died in NSW during the data period. Twenty-nine (29/64, 45%) were properly restrained. Thirteen children (13/64, 20%) were unrestrained. In 20 cases (20/64, 31%), children were using a restraint that was either inappropriate for their age (6) or not used correctly (14). Restraint factors were a primary contributor in 22 (22/64, 34%) child deaths. Compared to pre-legislation, appropriate restraint use was more common post-legislation (13/22. 59% vs. 30/42, 71%). However, incorrect use was also greater (3/22, 14% vs. 11/42, 26%). Interventions targeting increasing restraint use and reduction of common ‘use’ errors are needed to prevent further restraint factor-related deaths.
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