Assessing child restraint misuse by parental survey

Differences in participant characteristics and observed child restraint use between population-based and restraint fitting service samples

OBJECTIVE

To compare characteristics and restraint use between a population-based and fitting service sample of child restraint users.

METHOD

Characteristics of the two samples were compared using chi-squared tests. Differences in errors in restraint use observed in the two samples were modeled using logistic regression.

RESULTS

There were significant differences in child age (p < 0.001), and restraint types (p < 0.001) between the two samples, with more younger children in the fitting service sample. Controlling for differences in restraint type, the odds that adult participants were female were 61% less in the fitting service sample than in the population-based sample (OR 0.39, 95%CI 0.21-0.71). The odds that adult participants perceived a large risk associated with restraint misuse (OR 3.62, 95%CI 1.33-9.84), had a household income in the highest bracket (OR 3.89, 95%CI 1.20-12.62) and were living in areas of highest socioeconomic advantage (OR 2.72, 95%CI 1.22-6.06) were approximately three times higher in the fitting service sample. Overall, more participants had errors in restraint use in the population-based sample (p = 0.021). However, after controlling for restraint type, securing errors were three times more likely (OR 3.34, 95%CI 1.12-10.2), and serious installation errors were almost twice as likely (OR 1.91, 95% CI 1.09-3.39) in the fitting service sample.

CONCLUSIONS

While less resource intensive, convenience and/or fitting service samples may be less representative than population-based samples. Given the need for efficiency, methods that combine randomized population-based invitations to participate in restraint fitting check day events across geographically representative areas may be useful for ongoing surveillance of child restraint use.

Study protocol: a randomised non-inferiority trial using interactive virtual presence to remotely assist parents with child restraint installations

BACKGROUND

Motor vehicle crashes are the third-leading cause of death to American children aged 1-5 years. When installed correctly, child restraints (car seats) reduce risk of serious injury and death. However, most restraints are installed incorrectly. The current gold standard for correct installation is systematic car seat checks, where certified technicians help parents, but car seat checks are highly underused due to barriers in access, scheduling and resources.

METHODS

The present study protocol describes plans to evaluate use of interactive virtual presence technology (interactive merged reality)-joint, simultaneous remote verbal and visual interaction and exposure to the same 3D stimuli-to assist remotely located parents installing child restraints. If effective, this technology could supplement or replace in-person checks and revolutionise how government, industry and non-profits help parents install child restraints properly. Building from preliminary studies, we propose a randomised non-inferiority trial to evaluate whether parents who install child restraints while communicating with remote expert technicians via interactive virtual presence on their smartphones achieve installations and learning not inferior in safety to parents who install restraints with on-site technicians. We will randomly assign 1476 caregivers at 7 US sites to install child restraints either via interactive virtual presence or live technicians. Correctness of installation will be assessed using objective checklists, both following installation and again 4 months later.

CONCLUSION

We aim to demonstrate that child restraint installation is accurate (>90% correct) when conducted remotely, that such installations are not inferior to installation accuracy with live experts and that parents learn and retain information about child restraint installation.

Effects of child restraint misuse on dynamic performance

Objective: Estimates of child restraint misuse rates in the United States range from 49% to 95%, but not all misuse modes have similar consequences in terms of restraint effectiveness. A series of laboratory sled tests was conducted to determine the effects of common misuses and combinations of misuses, including loose harness, loose installation, incorrect installation angle, incorrect belt path, loose/no tether, and incorrect harness clip usage.Methods: Three commercial convertible child restraint models were loaded with the Hybrid III 3-year-old anthropomorphic test device (ATD) and secured by either LATCH or seat belt on a modified FMVSS No. 213 bench. Tests were conducted in forward-facing (FF) and rear-facing (RF) modes. The response variables included ATD accelerations, excursions, and restraint kinematics. Belt/LATCH loads, tether loads, ATD kinematics, and restraint structural response data were also documented. A fractional factorial test design on 8 factors was used to define an initial series of 32 tests. The first series also included 4 tests of correct CRS, 2 forward facing and 2 rearward facing. The analysis of those data determined the selection of conditions for the remaining 20 tests to focus on factors and interactions of high interest and significance.Results: In the RF condition, misrouting the LATCH belt or seat belt through the incorrect belt path was the only misuse that significantly affected outcomes of interest and was associated with high levels of undesirable CRS rotation. In FF tests, loose installation and tether misuse had large adverse effects on 3 of 4 key response variables.Conclusion: The study provides strong evidence for prioritizing tight restraint installation and proper tether use for FF restraints. In particular, use of the tether helped offset the adverse effects of loose installation or loose harness. Because the results show that performance of a RF child restraint system (CRS) installation is less affected by user error, they also provide support for extended RF restraint use. In addition, packaging convertible child restraints with the LATCH belt routed through the RF belt path could help prevent the most consequential RF CRS misuse.

Observed child restraint misuse in a large, urban community: Results from three years of inspection events

PROBLEM

Child restraints (CRs) are vital for optimizing child passenger safety and reducing the risk of pediatric injury and fatality in motor vehicle crashes. However, most CRs are installed improperly.

METHODS

This present study was an assessment of observed instances of CR misuse. Participants were recruited through advertisements for CR inspection events in Los Angeles County, California. Child Passenger Safety Technicians collected information about each child passenger, vehicle, and aspects of CR selection and installation.

RESULTS

Of 693 CRs installed upon arrival, only 3.8% were used with no instances of misuse. The most common misuses were inappropriate use of the top tether and failure to secure the seatbelt in locked mode.

CONCLUSIONS

The majority of observed CRs were installed with instances of misuse. CRs in newer vehicles were less likely to be installed in front of airbags and more likely to have the seatbelt routed inappropriately compared to those in older vehicles. Older children were more likely to be prematurely restrained in the front vehicle seat.

PRACTICAL APPLICATIONS

The majority of CRs are installed improperly. We identified specific instances of CR misuse that are common in a large, urban community and present recommendations to improve child passenger safety practices and education.

Attitudes towards child restrains and seat belts usage in the learned population of Karachi, Pakistan

BACKGROUND

Motor vehicles crashes (MVCs) are the leading cause of injury related morbidity and mortality in developed countries. Recent evidence proves that properly used child seat belts can dramatically reduce the risk of severe and life-threatening injury from MVCs. There are rarities of thought and inspiration regarding the use of child seat belts in our society and region, therefore we lack of data regarding factors and paucity of usage of child seat belts in motor vehicles. This study aimed to assess the knowledge and attitudes of child seat belt usage among the educated population in Karachi, Pakistan.

METHODS

Altogether 304 employees were investigated. They were employees of Aga Khan University who were using their cars and having children younger than 10 years old. A cross sectional observational study was designed, and a 36-item questionnaire in English was used to collect data on participants' demographic details, designation, educational level, economic status, validity of driving license, number of children and cars, availability of adult seat belts and child seat belts along with their functionality, awareness, knowledge and attitude toward its use, and reason of not using these devices. SPSS version 20 for Windows was used to analyze the data and the Chi-square test was used.

RESULTS

Totally 290 participants were recruited with a response rate of 72% (212). Of 212 participants, 126 (59%) were male. 154 (72.6%) participants had valid driver licenses, and 154 (72.6%) had adult seat belts in their vehicles. Only 32 (15%) reported regular use of adult seat belts. Although 168 (79.2%) participants had some knowledge about child restrains (CRs), only 65 (22%) had CRs in their cars. Eighty-two (38.7%) participants got the knowledge about CRs and seat belts from media. Mothers were more concerned about the use of CRs than fathers. Only 14 (6.6%) parents were found to use both adult and child seat belts all the time. Of the 157 parents who did not us use CRs, 42 considered unnecessary, 35 lacked relevant knowledge. But 15 parents used CR against their children's wills.

CONCLUSIONS

The pattern of CR usage among the employees at Aga Khan University, Karachi is dictated by the unavailability of CR, followed by ignorance, inconvenience, and non-acceptance by their children. The important issue of CR has consistently been ignored over the years and it has never gained enough popularity in Pakistan.

Discrepancies between knowledge and practice of childhood motor vehicle occupant safety in Nova Scotia--a population-based study

OBJECTIVES

To determine discrepancies between knowledge and practice of childhood motor vehicle restraints (CMVRs) and vehicle seating position amongst parents within the province of Nova Scotia.

DESIGN

Random telephone survey.

SETTING

The Canadian province of Nova Scotia.

SUBJECTS

Four hundred and twenty-six households with at least one child under the age of 12 years, totaling 723 children.

MAIN OUTCOME MEASURES

The proportion of parents whose children who should be in a specific stage of CMVR and sitting in the rear seat of the vehicle, and who demonstrate correct knowledge of that restraint system and seating position, yet do not use that restraint system/seating position for their child (demonstrate practice discrepant from their knowledge).

RESULTS

Awareness of what restraint system to use is good (>80%). However, knowledge of when it is safe to graduate to the next stage is low (30-55%), most marked for when to use a seatbelt alone. Awareness of the importance of sitting in the rear seat of a vehicle was universal. Discrepancies between knowledge and practice were most marked with booster seats and rear-seating of older children. Factors influencing incorrect practice (prematurely graduated to a higher-level restraint system than what is appropriate for age and weight) included lower household income, caregiver education level, and knowledge of when to graduate from forward-facing car seats and booster seats. Incorrect practice was also more commonly observed amongst children of weight and/or age approaching (but not yet reaching) recommended graduation parameters of the appropriate CMVR.

CONCLUSIONS

Discrepancies between knowledge and practice are evident through all stages of CMVRs, but most marked with booster seats. The roles of lower socioeconomic status and gaps in CMVR legislation, in influencing discrepant practice, must be acknowledged and suggest the need for targeted education concurrent with development of comprehensive all-stages CMVR policies.

Front versus rear seat placement of children aged 12 or younger within vehicles: a rural/urban comparison in North Dakota

OBJECTIVE

Research has shown that rear-seated children are 36 to 40 percent safer than front-seated children. Because of the substantial differences in traffic safety culture that appear to exist in rural areas and the limited research regarding seat placement and rurality, this study seeks to contribute to the safety literature by determining at what rate children are riding in the front seat and whether differences exist between rural and urban areas in regards to child front seat placement.

METHODS

Current child placement frequencies within vehicles were ascertained through direct observations of morning child drop-offs at randomly selected urban and rural elementary schools in eastern North Dakota during November and December of 2009, with a focus on children aged 12 or younger. Two observers wearing orange safety vests and carrying observation sheets were stationed at each elementary school a minimum of 45 min prior to each school's designated start time. Based on the vehicles that entered the school's parking lot/drop-off circle and from which a minimum of one child exited, observers were instructed to record vehicle type, presence of children in the front seat appearing to be younger than 13 years old, availability of room in the back seat, and placement of other children in the vehicle.

RESULTS

During November and December of 2009 a total of 537 vehicles were observed at urban schools and 150 vehicles were observed at rural schools. Of the 537 vehicles observed at urban schools, 28.7 percent had children seated in the front seat, whereas 41.3 percent of the 150 vehicles observed at rural schools had front-seated children. Significant urban/rural differences exist in child seat placement, with vehicles in rural areas much more likely to be carrying front-seated children than vehicles in urban areas.

CONCLUSIONS

Based on a sample of vehicles observed at urban and rural elementary schools in North Dakota, the results of this study indicate that there are significant rural/urban differences in child seat placement.

Does the transition to parenthood influence driving?

Most parents remember the first time they drove with a newborn child in the car. Feeling the need to protect the infant, they avoided sharp turns and drove more slowly and carefully than normal. But how long do these behaviors persist? Do parents ultimately revert to their previous driving patterns, or does some of the early protectiveness and caution continue to characterize their driving as their infant grows into a toddler and preschooler? In an attempt to answer these questions, two studies were conducted on parents of young children: a qualitative study consisting of personal interviews (16 parents); and a quantitative study in the form of a national telephone survey (165 parents). The results show that the most dominant reported effect of the transition to parenthood on driving is increased apprehension of traffic crashes and a stronger sense of responsibility. However, these changes were found to influence the reported actual driving behavior of only a portion of the parents. Possible explanations of the findings are discussed.

An exploratory study of parents' use and knowledge of car safety seats in Beijing, China

As the number of vehicles in China rapidly increases and there is no child safety seat law, the issue of road safety for children is a growing concern. The purpose of this study was to examine parents' use and knowledge of car safety seats in Beijing, China. Using a convenience sample of 843 parents, survey results showed that only 64.8% of parents used a safety restraint for their children; the remaining 35.2% of children, of which most were toddlers or school-aged children, travelled unrestrained in vehicles. Among parents who used a safety restraint, only 24.2% were using it correctly based on the child's age (for infants), weight and height. Common reasons for not using a safety seat included difficulty finding safety seats (56.6%), cost (26.1%), and a preference to hold the child (18.1%). Moreover, a large proportion of parents prematurely transitioned their child from a safety seat to seat belt. The results highlight the need to develop injury prevention interventions that communicate the benefits and encourage the use of child safety restraints in China.

Buckle up safely: a cluster randomised trial to evaluate the effectiveness of a pre-school based program to increase appropriate use of child restraints

BACKGROUND

Road traffic crashes for car occupants are a leading cause of death and serious injury in children from high and middle income countries globally. Correct use of appropriate child restraints can significantly reduce death and serious injury but there is a need for well powered trials to examine effectiveness of programs to increase optimal child restraint practices. The aim of this trial is to examine the effectiveness of a comprehensive intervention to increase the use of appropriate child restraints, and decrease incorrect use of child restraints in pre-school aged children traveling in cars.

METHODS AND DESIGN

A cluster randomised controlled trial will be conducted, involving 28 pre-school or childcare centres in low income areas of Sydney, Australia, over one calendar year. The intervention is an educational program involving an in-service for centre staff, distribution of educational materials to parents, a parent workshop demonstrating restraint use, subsidised restraints for parents in need, and vouchers for a free restraint checking service. Blinded assessors will observe restraint use at all centres at the end of the calendar year. Data will be analysed on an intention-to-treat basis; the primary analysis will compare the proportion of each of the two outcome measures (use of appropriate restraints, and incorrect use of restraints) at each centre between intervention and control groups. Detailed process evaluation will be conducted, including examination of implementation and utilisation of various elements of the program by both centres and families.

DISCUSSION

This assessor blinded cluster randomised trial is powered to provide credible evidence about the efficacy of an education and distribution program in a pre-school setting to increase appropriate use, and decrease incorrect use of child restraints.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12609000612213.

Parental awareness and perception for correct use of child occupant restraints in Korea

OBJECTIVE

To determine the rate of correct use of child occupant restraints (CORs) and to evaluate the parental awareness and perception associated with the use of CORs.

METHODS

A cross-sectional survey using self-report questionnaires was performed at 10 different hospitals. A total of 1573 parents and 2209 of their children 6 years of age or younger were studied.

RESULTS

The overall percentage of parents using CORs or adult seat belt was 57.7 percent. However, only 44.4 percent of those parents, which corresponds to 25.6 percent of all parents recruited, were correctly using the restraints for their children. The overall percentage of children using CORs or adult seat belt was 53 percent. However, the percentage of children correctly using the restraints was 14.3 percent for infants (<12 months of age), 42 percent for children one years old, 43.8 percent for children 2 years old, 28.7 percent for children 3 years old, 18.9 percent for children 4 years old, 13.9 percent for children 5 years old, and 10.5 percent for children 6 years old. The logistic regression analysis revealed that the mother's level of education, number of children in each household, child's age when parents started to use the CORs, and parental awareness about the fine for violation of car seat laws were the most influential variables associated with the correct use of CORs. The rates of correct use of CORs and parental preferences about CORs, respectively, differed by ages of their children. Most parents showed a negative perception of placing children in the front passenger seat. However, many parents were prematurely using adult seat belts for children without realizing the risk of injury.

CONCLUSION

More aggressive educational campaigns and increased enforcement of the car seat laws are needed to improve the awareness of parents on the efficacy of CORs.

Children with special physical health care needs: restraint use and injury risk in motor vehicle crashes

Physical disabilities may affect a child passenger's fit within a conventional motor vehicle restraint. The aim of this study is to describe and compare injury risk in motor vehicle crashes (MVC) among children with and without special physical health care needs (SPHCN). This analysis, conducted in 2007-2008, utilizes data collected between December 1998 and November 2002 in a cross-sectional study of children ≤15 years old involved in crashes of State-Farm insured vehicles in 15 states and the District of Columbia. Parent reports via telephone survey were used to define pre-crash SPHCN, restraint status, and occurrence of significant injuries using a validated survey. Complete data were collected for 18,852 children aged 0-15 years; 159 children were reported to have a SPHCN (0.8% and 0.7% of children aged 0-8 and 9-15 years, respectively). A greater proportion of children with SPHCN aged 0-8 years were appropriately restrained (P < 0.001), but there was no significant difference in restraint use among children with and without SPHCN aged 9-15 years. There was no significant association between the presence of a SPHCN and injury risk in either age group, after adjustment for child/driver characteristics (children aged 0-8 years: OR 1.27, 95% CI: 0.48-3.33; children aged 9-15 years: OR 1.51, 95% CI: 0.38-6.11). Children with and without SPHCN have similar injury risk in MVC, despite increased age-appropriate restraint usage among children aged 0-8 years. When counseling families about vehicle safety, practitioners should consider the fit of a child with SPHCN in a restraint system.

A longitudinal study of the effectiveness of a multi-media intervention on parents' knowledge and use of vehicle safety systems for children

Motor-vehicle crashes are the leading cause of death and serious injury for children under the age of 14 in Canada and in the United States despite mandatory use of vehicle restraints since 1977. Using a pre- and post-test design, the present study tests the effectiveness of a multi-media intervention study on parents' knowledge of car safety seat use for children (0-12 years). The sample included 201 parents from four Ontario cities. Results indicate that parents' knowledge of when to accurately and safely transition a child to the appropriate car safety seat based on child's age, weight and height was retained at the 1 year post-test for children 4-8 years of age. The rates of correct use of safety seats significantly increased 1 year following the intervention program. Other factors that influenced parent's knowledge included being a parent versus non-parents, gender, income, education, sources of information, and regional location. The results of this study can help guide the development and implementation of future intervention programs and injury prevention policy.

Children with special health care needs: patterns of safety restraint use, seating position, and risk of injury in motor vehicle crashes

OBJECTIVES

Special health care needs associated with behavioral conditions may influence a child's safety in motor vehicle crashes. The aim of this study was to describe and compare variation in restraint use, seating position, and injury risk in motor vehicle crashes among children with and without special health care needs likely to affect behavior.

PATIENTS AND METHODS

This study uses data collected between December 1, 1998, and November 30, 2002, in a cross-sectional study of children <16 years of age who were involved in crashes of State Farm-insured vehicles in 15 states. Parent reports via a validated telephone survey were used to define precrash special health care needs, restraint status, seating position, and the occurrence of clinically significant injuries by using a previously validated survey instrument.

RESULTS

Complete data were collected for 14654 children aged 4 to 15 years, representing 171633 children in crashes. Of these, 152 children were reported to have a special need likely to affect behavior, representing 1883 children. A greater proportion of children with special needs likely to affect behavior were appropriately restrained, particularly among children aged 4 to 8 years. Drivers of children with special needs likely to affect behavior were more often restrained and more often were the child passenger's parent. There were no differences in the rates of front-row seating. There was no significant association between the presence of a special need likely to affect behavior and risk of injury, after adjustment for child/driver characteristics and crash severity.

CONCLUSIONS

Despite a greater proportion of children with special needs likely to affect behavior using proper vehicle restraint, their injury risk was similar to that of children without these special needs. Primary care pediatricians providing best practices for vehicle safety should consider the unique riding experience and risk of injury among children with special health care needs likely to affect behavior.

Children at risk: predictors of car safety seat misuse in Ontario

When used correctly, child safety seats can reduce the risk of death and serious injury by 54% in toddlers and 71% in infants [National Highway Traffic Safety Administration (NHTSA), 2001. Traffic Safety Facts 2001. Children (DOT HS 809 471), U.S. Department of Transportation, Washington, DC]. The purpose of this study was to identify factors that predict correct use of car safety seats. The study was conducted in a large urban area in Southwestern Ontario and a small urban and rural area in Northern Ontario. Participants were 1263 caregivers who completed a self-report survey on their knowledge and use of car safety seats for their children (N=2199). Logistic regression analysis revealed that female caregivers, caregivers with higher levels of education, and caregivers who reported that finding information about the correct use of child safety seats was "difficult" were more likely to report correctly using car safety seats. The results also showed that children aged 7 months to 8 years old had substantially lower odds of being in the correct car safety seat compared to children aged 6 months or younger, or children aged 9 years or older. The high risk nature of misuse of child seats for infants and younger children may be an important cue to action for health professionals to develop comprehensive prevention strategies.

How children with special needs travel with their parents: observed versus reported use of vehicle restraints

OBJECTIVES

The difficulties entailed in transporting children with special physical and behavioral needs could influence child restraint misuse and nonuse within this population. Although parental interview is often used to assess child vehicle restraint use, little research had been performed to validate this approach, and none has been done in the special-needs population. The objectives of this study were to assess the prevalence of nonuse and misuse of child restraints in the special-needs population and to assess the validity of using parental report as a measure of child restraint use.

METHODS

Restraint use in 115 children with special needs, aged 0 to 18 years, was observed on their arrival at the parking lot of the Alyn Hospital Pediatric Rehabilitation Center in Jerusalem. The observation noted type of restraint used or absence thereof. If a restraint was used, correct use/misuse was recorded. In 94 cases, the parents were interviewed later that day in the clinic.

RESULTS

Seventy percent of the children were observed as traveling unrestrained or with a restraint that was grossly misused to the extent that it provided no meaningful protection. The remaining children were observed displaying a variety of errors in the selection or use of the restraint that compromised their safety to varying degrees. Analysis of the observation results versus parental reporting revealed a 44% overreporting of child restraint use. Sensitivity was 71%, and specificity was 86%.

CONCLUSIONS

The high prevalence of restraint nonuse and misuse within the special-needs population defines this as a population at risk and emphasizes the need for intervention. Cautious interpretation is required of information acquired from parental reporting of child restraint use. The results of this study should raise awareness among professionals working with children with special needs as to the need for tailored assessment and intervention in the area of child-passenger safety.

Child restraint misuse: a case example and strategies for injury prevention

Motor vehicle crashes are a leading cause of death and serious injury for children. Emergency nurses can play a key role in encouraging parents and caregivers to use child restraints consistently and correctly. This article will discuss a case scenario where a young child is seriously injured in a motor vehicle crash where his child car seat was not used correctly. Injury prevention strategies for emergency nurses will be reviewed.

Suboptimal restraint affects the pattern of abdominal injuries in children involved in motor vehicle crashes

BACKGROUND

Both solid and hollow visceral abdominal injuries have been associated with the use of seat belts in children involved in motor vehicle crashes. The relationship between the types of restraint used and the pattern of abdominal injury is unknown.

METHODS

A probability sample of restrained children involved in crashes was enrolled in an ongoing crash surveillance system (1998 through 2002) linking insurance claims data to telephone survey and crash investigation data. Significant abdominal injuries were considered when the Abbreviated Injury Scale (AIS) score was > or =2 and were defined as hollow visceral (HV; intestine, bladder), or solid visceral (liver, spleen, pancreas, kidney). Restraint type was categorized as optimal restraint (OR) or suboptimal restraint (S-OR) based on the child's age and size.

RESULTS

For the 33 months of review, interviews were obtained for 13,558 restrained children aged 0 to 15 years, of which, 56% were OR (n = 7,591) and 44% were S-OR (n = 5,967). A significant abdominal injury was recorded in 78 children. A hollow visceral injury was recorded in 38 (9 OR and 29 S-OR), and a solid visceral injury in 32 (18 OR and 14 S-OR). Both hollow and solid visceral injuries were present in 8 children (2 OR and 6 S-OR). Suboptimally restrained children had a higher risk for hollow visceral injury when compared with optimally restrained children (Odds Ratio, 4.14 [95% Confidence Interval 1.33 to 13.22, P <.01]).

CONCLUSIONS

Among restrained children with intraabdominal injuries, those who were suboptimally restrained were 4 times more likely to have a hollow visceral than a solid visceral injury when compared with those who were optimally restrained. This suggests that the mechanism of injury for hollow viscus may be directly related to the improper positioning of the restraint.

The role of restraint and seat position in pediatric facial fractures

BACKGROUND

Recently, head and brain injuries were identified as consequences of the inappropriate use of seat belts by children. The proposed mechanism of these injuries might also place a child at risk for facial fracture.

METHODS

A probability sample of children under age 16 involved in crashes were enrolled in an ongoing crash surveillance system (1998-2001) that links insurance claims data to telephone survey and crash investigation data (unweighted, n = 12,659; weighted, n = 131,717). Incidence of facial fracture was estimated and a series of cases were examined using in-depth crash investigation to identify the mechanisms of these injuries, specifically, the role of seating position and restraint use in the mechanism of injury.

RESULTS

Ninety-two children suffered a fracture of the facial bones (0.07% of all children in crashes). Among restrained children with facial fractures (n = 68), those inappropriately restrained were at a 1.6-fold higher risk (95% confidence interval, 1.2-2.1; p = 0.001) of significant injury than those appropriately restrained for their age. The in-depth investigations revealed that excessive head excursion resulting from suboptimal torso restraint caused facial impact, which resulted in the facial injuries described.

CONCLUSION

The potential for disfigurement associated with these facial injuries may resonate strongly with parents, and prevention of disfigurement may provide additional motivation for proper restraint, in particular, booster seats and rear seat location, for this pediatric population.

Factors influencing pediatric injury in side impact collisions

BACKGROUND

Side impact collisions pose a great risk to children in crashes, but information about the injury mechanisms is limited.

METHODS

This study involves a case series of children in side impact collisions who were identified through Partners for Child Passenger Safety, a large, child-focused crash surveillance system. The aim of the current study was to use in-depth crash investigations to identify injury mechanisms to children in side impact collisions.

RESULTS

Ninety-three children in 55 side impact crashes were studied. Twenty-three percent (n = 22) of the children received an Abbreviated Injury Scale (AIS) score > or = 2 (clinically significant) injury. In these 22 children, head (40%), extremity (23%), and abdominal injuries (21%) were the most common significant injuries. Cases that illustrate body region-specific injury mechanisms are discussed.

CONCLUSION

The cases revealed that serious injuries, particularly head injuries, occur even in minor crashes, and efforts should be made to make the interiors of vehicles more child occupant friendly. Lower extremity and abdominal injuries occurred because of contact with the intruding door. Design of vehicles to minimize crush should mitigate the occurrence and severity of these injuries.