Free child passenger restraints for patients in an urban pediatric medical home: effects on caregiver behavior.
(4/29)
CONTEXT: Motor vehicle crashes are a leading cause of death in children despite the availability of effective child passenger restraints that reduce morbidity and mortality. Inappropriate restraint is more common in minority and low-income populations. Removing barriers by distributing child passenger restraint systems (CPRS) and providing education has been 1 approach to improve child safety. The objective of this study was to evaluate the efficacy of providing no-cost CPRS in combination with targeted education to improve restraint use for low-income, minority, and urban children in a medical home. DESIGN: This prospective, non-randomized, community-based cohort study used a certified car seat technician to provide CPRS and training to the caregivers of 101 children when those caregivers reported not owning the appropriate type of restraint system during the index clinic visit. RESULTS: In the first 3 months of follow-up, caregivers were 2.4 times more likely to report appropriate use of CPRS: relative risk 2.4 (95% confidence interval [CI] 1.7 to 3.5). Reported improvement declined slightly between months 4 and 9. CONCLUSIONS: Appropriate restraint significantly improved, yet rates remained suboptimal. Multifactoral approaches are needed to understand why the set of patients studied and other at-risk populations may not use child restraints properly even when given access and information. (+info)
Relative benefits of population-level interventions targeting restraint-use in child car passengers.
(5/29)
Abdominal injuries in belt-positioning booster seats.
(6/29)
Previous studies have demonstrated that booster seats reduce the risk of abdominal injuries by improving the fit of the seat belt on young children and encouraging better posture and compatibility with the vehicle seat. Recently, several studies have reported cases of abdominal injuries in booster seated children questioning the protective effects of these restraints. The objective of this study was to examine cases of abdominal injuries in booster seated children through parametric modeling to gain a thorough understanding of the injury causation scenarios. The Partners for Child Passenger Safety and CIREN in-depth crash investigation databases were queried to identify children in belt-positioning booster seats with abdominal injuries. The injury causation scenarios for these injuries were delineated using the CIREN Biotab method. The cases were modeled, using MADYMO with variations in key parameters, to determine the ranges of loads and loading rates for the abdomen and thorax. A parametric study was completed examining the influence of pretensioners and load limiters on the injury metrics obtained. Query of the two databases revealed three cases involving abdominal injuries to booster seated children. Children in two of the cases sustained a thoracic injury (AIS 3/AIS 4) in addition to their abdominal injuries (AIS 2) and review of these cases pointed to the role of shoulder belt loading in the injury causation. Modeling of these cases revealed chest compressions and accelerations of 30-53 mm and 41-89 g, respectively and abdominal deflection and velocity of 7.0-13.3 mm and 1.2-2.2 m/s, respectively. Parametric study suggested that coupling shoulder belt load limiting and lap belt buckle pretensioning resulted in improved chest and abdominal metrics while reducing head excursion, indicating that these technologies may provide injury reduction potential to pediatric rear seat occupants. (+info)
Performance evaluation of child safety seats in far-side lateral sled tests at varying speeds.
(7/29)
Protection of children in Child Safety Seats (CSS) in side impact crashes has been a topic of recent studies. The objective of this study was to evaluate the performance of CSS in far-side impacts through a series of sled tests conducted at varying test speeds. Forty eight sled tests were conducted at three speeds (24 km/h, 29 km/h and 36 km/h), under two different CSS attachment conditions (LATCH and seat belt attached), using rear facing and forward facing CSS from four different manufacturers. Analyses were conducted to examine head retention within the CSS, velocity of the head as it passes an imaginary plane (cross over into other occupant space or door), lateral trajectory of the head and knee; head, chest and pelvis accelerations; neck and lumbar loads and moments. In addition to these parameters, the CSS were visually inspected for structural integrity after each test. Results from these sled tests highlighted the differential performance of CSS in far-side impacts. During the tests, all CSS experienced significant lateral movement irrespective of attachment type. In rear facing CSS tests, one of the designs failed as the seat disengaged from its base. In forward facing CSS tests, it was observed that the seat belt attached CSS experienced less rotational motion than the LATCH attached CSS. ATD head retention within the seat was not achieved with either CSS attachments at any speed. The findings from this study augment the current efforts to define regulatory sled setup procedure for far-side impact crashes involving children in CSS, which currently does not exist and will eventually further the protection of children in automobiles. (+info)
Effectiveness of hands-on education for correct child restraint use by parents.
(8/29)