Belt Restraint Use Research Articles

Alcohol Intoxication Is Associated With Bladder Injury and Bladder Surgical Repair in Patients Sustaining Motor Vehicle Collisions.

Alcohol intoxication is a known risk factor for motor vehicle collisions. We hypothesize ethanol intoxication increases the risk of bladder injury and surgical repair, especially at higher blood alcohol content levels. We identified all patients involved in motor vehicle collisions from the National Trauma Data Bank from 2017-2019. Patients were categorized into an intoxication and intoxication negative group. Variables collected included age, sex, blood alcohol content level, driver status, seat belt restraint use, nonalcoholic intoxication, pelvic fracture, and Injury Severity Scale. Primary outcome measures of bladder injury and bladder surgical repair were assessed and interaction with pelvic fracture and restraint use were measured. We identified 594,484 patients and 97,831 (16.5%) had a positive alcohol screen. Patients in the intoxication group were more likely to be intoxicated with other substances (32.8% vs 14.6%, P < .001), have a bladder injury (1% vs 0.4%, P < .001) and receive bladder surgical repair (0.7% vs 0.15%, P < .001). Injury Severity Scale and pelvic fracture were statistically significant predictors of bladder injury. In adjusted analysis, higher blood alcohol content was associated with both outcomes. Above the legal limit, alcohol intoxication was more predictive of bladder surgical repair than pelvic fracture. The association of alcohol intoxication with both outcomes did not differ by pelvic fracture, but strengthened with seat belt use at higher intoxication levels. Alcohol intoxication is independently associated with increased risk of bladder injury and subsequent bladder surgical repair following motor vehicle collisions. Trauma providers should have a high index of suspicion for bladder injuries in alcohol intoxicated patients, particularly those using seat belt restraints.

De weg naar een bandenloze zorg in Nederland

The use of physical restraints still is highly prevalent in institutional long term care settings for older people. We know that the use of restrictive measures, such as belt restraints, do have many negative consequences for residents, and even can be harmful to their health. However, this knowledge does not result in a reduction of physical restraints. This paper describes the search for an intervention (EXBELT) aiming to safely reduce and prevent the use of belt restraints in nursing homes. EXBELT consists of a promotion of institutional policy change that discourages use of belt restraints, nursing home staff education, availability of alternative interventions, and consultation by a nurse specialist. Effect evaluations show that EXBELT is effective on the short and long term. According to a process evaluation, EXBELT was largely performed according to protocol and very well received by nursing home staff and resident's relatives. However, concurrently it is stated that the reduction of physical restraints in Dutch nursing home care runs slowly. The conclusion is that continuing focus is needed to reduce physical restraints in nursing homes and to prevent its use in home care.

Process Evaluation of a Multicomponent Intervention Program (EXBELT) to Reduce Belt Restraints in Nursing Homes

The current study describes the process evaluation of a multicomponent intervention program (Expelling Belts [EXBELT]) to reduce the use of belt restraints in psychogeriatric nursing homes. The aim was to assess the feasibility and ascertain suggestions for optimization of the EXBELT program. A descriptive study comprising longitudinal elements. Fifteen psychogeriatric nursing home wards in 6 Dutch nursing homes. The study population consisted of 4 different groups of participants who took part in the intervention arm of the quasi-experimental study examining the effectiveness of EXBELT: nursing home staff who attended the final session of the educational program; 2 nurse specialists who delivered the educational program and did the consultations; 4 groups of delegates representing the nursing home associations where the EXBELT program was implemented; and the relatives of those residents in the intervention group who were restrained with a belt at the start of the study. Both quantitative and qualitative data were collected from the study population. Data were assessed by means of self-administered questionnaires, recording forms, group interviews, telephone interviews, and monthly meetings. The EXBELT study was largely performed according to protocol and very well received by nursing home staff as well as resident's relatives. Suggestions to improve the EXBELT program include the addition of examples of how to communicate about the policy change, improving the reach of the intended target population, adding more case-based learning strategies, and embedding the available consultants more proactively. The implementation of EXBELT was highly successful in the current research population and is likely to be feasible in psychogeriatric nursing homes in general.

Reduction of Belt Restraint Use: Long‐Term Effects of the EXBELT Intervention

To assess the long-term effects of the EXBELT intervention program, which was designed to reduce belt restraint use and was found to be effective immediately after implementation, after 24 months. Quasi-experimental longitudinal design. Thirteen nursing homes: seven assigned to control group and six to intervention group. A panel group (n = 225) of residents present at baseline and 24 months after baseline and a survey group (n = 689) of all residents present 24 months after baseline. The survey group included the panel group. EXBELT included four components: a policy change, an educational program, consultation, and availability of alternative interventions. The use of belt restraints 24 months after baseline was the primary outcome measure. Secondary outcomes included other types of physical restraints. An independent observer collected data four times during a 24-hour period. EXBELT resulted in a 65% decrease in belt use between baseline and 24 months after baseline in the panel group (odds ratio 0.35, 95% confidence interval = 0.13-0.93; P = .04). In the survey group, the proportion of residents using belts was 13% in the control and 3% in the intervention group (P < .001) 24 months after baseline. The use of the most restrictive types of restraints was significantly lower in the intervention group than the control group in the panel and survey groups. The EXBELT intervention was associated with long-term minimization of belt restraint usage in older nursing home residents. A multicomponent intervention including institutional policy change, education, consultation, and the availability of alternative interventions had an enduring effect on successful restraint reduction.

Preventing belt restraint use in newly admitted residents in nursing homes: A quasi-experimental study

BackgroundPhysical restraints are commonly used in psychogeriatric nursing home residents despite reports of negative consequences. Most research has focused on restraint reduction without addressing methods to prevent initiation of restraints in nursing homes. EXBELT has been found to decrease belt restraint use but should also be evaluated for its use in preventing restraints. ObjectiveTo investigate the effectiveness of the EXBELT intervention to prevent the use of belt restraints on psychogeriatric residents newly admitted to nursing homes. DesignQuasi-experimental study design. SettingTwenty-six nursing home wards from thirteen Dutch nursing homes. ParticipantsNewly admitted residents (n=104) during a four month period. InterventionsFifteen wards (intervention group) implemented the EXBELT intervention, which consisted of four components: a policy change, education, consultation and the availability of alternative interventions. MethodsData on the use of belt restraints, other types of physical restraints, falls and fall-related injuries and psychoactive drug use were collected at T2 (4 months) and T3 (8 months) after baseline (T1) for those resident who were newly admitted after baseline and before T2 (4 months). Physical restraint use data were collected by a trained, blinded observer four times during a 24-h period. ResultsA total of 104 residents were newly admitted after baseline (T1) and before T2. Of those, 82 were present on T2 and T3. Informed consent was obtained from legal representatives of 49 out of the 82 residents. In the control group (n=20), 15% and 20% used belts at T2 (4 months) and T3 (8 months), respectively. In the intervention group (n=29), these proportions were 3% and 0%, respectively (OR=0.08; 95% CI (0.01–0.76); p=0.03). There was no increase in the intervention group in the use of other physical restraints, falls and fall-related injuries or psychoactive drug use. ConclusionThe EXBELT intervention effectively seems to prevent the use of belt restraints in newly admitted residents in psychogeriatric nursing homes.

Belt Restraint Reduction in Nursing Homes: Effects of a Multicomponent Intervention Program

To test the effects of a multicomponent intervention program to reduce the use of belt restraints in psychogeriatric nursing homes. A quasi-experimental longitudinal design. Study duration was 8 months. Twenty-six psychogeriatric nursing home wards in 13 Dutch nursing homes were assigned to intervention or control groups. Seven hundred fourteen residents were selected for participation. Legal representatives of 520 residents agreed on participation; complete data are available for 405 residents. The intervention program included four major components: promotion of institutional policy change that discourages use of belt restraint, nursing home staff education, consultation by a nurse specialist aimed at nursing home staff, and availability of alternative interventions. The primary outcome measure was the frequency of belt restraint use. Secondary outcomes included other types of physical restraints, psychoactive drug use, falls, and fall-related injuries. These data were collected at baseline and after 4 and 8 months. A trained, blinded observer measured the use of belts and other physical restraints types four times during a 24-hour period. The intervention resulted in a 50% decrease in belt use (odds ratio = 0.48, 95% confidence interval = 0.28-0.81; P = .005). No increase occurred in the use of other types of restraints. No marked differences between the groups were found regarding psychoactive drugs, falls, and fall-related injuries. A multicomponent intervention program led to a substantial reduction in use of belts, full-enclosure bedrails, and sleep suits without increasing the use of other physical restraints, psychoactive drugs, or falls and fall-related injuries.

Using in-depth investigations to identify transportation safety issues for wheelchair-seated occupants of motor vehicles

In-depth investigations of motor-vehicle crashes involve detailed inspection, measurement, and photodocumentation of vehicle exterior and interior damage, evidence of belt-restraint use, and evidence of occupant contacts with the vehicle interior. Results of in-depth investigations thereby provide the most objective way to identify current and emerging injury problems and issues in occupant safety and crash protection, and provide important feedback on the real-world performance of the latest restraint-system and vehicle crashworthiness technologies. To provide an objective understanding of real-world transportation safety issues for wheelchair-seated travelers, the University of Michigan Transportation Research Institute (UMTRI) has been conducting and assembling data from in-depth investigations of motor-vehicle crashes and non-crash adverse moving-vehicle incidents, such as emergency vehicle braking, turning, and swerving, in which there was at least one vehicle occupant sitting in a wheelchair. The results of 39 investigations involving 42 wheelchair-seated occupants have been assembled and entered into a wheelchair-occupant crash/injury database. In addition, a biomechanical analysis of each case has been performed to identify key safety issues for wheelchair-seated travelers. The wheelchairs of 34 of the 42 occupants who were seated in wheelchairs while traveling in motor vehicles were effectively secured by either a four-point, strap-type tiedown system or a docking securement device, and all but one of these properly secured wheelchairs remained in place during the crash or non-collision event. However, 30 of the 42 occupants were improperly restrained, either because of non-use or incomplete use of available belt restraints, or because the belt restraints were improperly positioned on the occupant's body. Twenty-six of the 42 occupants sustained significant injuries and 10 of these occupants died as a direct result of injuries sustained, or from complications resulting from those injuries. These findings, when combined with the analyses of the individual cases, point to a need for better driver and caregiver education and training on how to properly secure wheelchairs and position belt restraints on wheelchair-seated passengers. They also point to a need for improved restraint systems used by wheelchair-seated drivers, and a need for wheelchair designs that facilitate the proper use and positioning of vehicle-anchored belt restraints.

Reducing the burden of road traffic injury: translating high-income country interventions to middle-income and low-income countries

Objective:To increase seat belt restraint use in Guangzhou City, People’s Republic of China.Design:Comparison group pre-test, post-test design.Setting:Guangzhou City.Interventions:Interventions to increase the prevalence of seat belt use in high-income countries (enhanced...

Fetal Outcome in Motor-Vehicle Crashes: Effects of Crash Characteristics and Maternal Restraint

Objective This project was undertaken to improve understanding of factors associated with adverse fetal outcomes of pregnant occupants involved in motor-vehicle crashes. Study Design In-depth investigations of crashes involving 57 pregnant occupants were performed. Maternal and fetal injuries, restraint information, measures of external and internal vehicle damage, and details about the crash circumstances were collected. Crash severity was calculated using vehicle crush measurements. Chi-square analysis and logistic regression models were used to determine factors with a significant association with fetal outcome. Results Fetal outcome is most strongly associated with crash severity ( P P = .002). Proper maternal belt-restraint use (with or without airbag deployment) is associated with acceptable fetal outcome (odds ratio=4.5, P = .033). Approximately half of fetal losses in motor-vehicle crashes could be prevented if all pregnant women properly wore seat belts. Conclusion Higher crash severity, more severe maternal injury, and lack of proper seat belt use are associated with a higher risk of adverse fetal outcome. These results strongly support recommendations that pregnant women use properly positioned seatbelts.

Fetal outcome in motor-vehicle crashes: effects of crash characteristics and maternal restraint

This project was undertaken to improve understanding of factors associated with adverse fetal outcomes of pregnant occupants involved in motor-vehicle crashes. In-depth investigations of crashes involving 57 pregnant occupants were performed. Maternal and fetal injuries, restraint information, measures of external and internal vehicle damage, and details about the crash circumstances were collected. Crash severity was calculated using vehicle crush measurements. Chi-square analysis and logistic regression models were used to determine factors with a significant association with fetal outcome. Fetal outcome is most strongly associated with crash severity (P < .001) and maternal injury (P = .002). Proper maternal belt-restraint use (with or without airbag deployment) is associated with acceptable fetal outcome (odds ratio = 4.5, P = .033). Approximately half of fetal losses in motor-vehicle crashes could be prevented if all pregnant women properly wore seat belts. Higher crash severity, more severe maternal injury, and lack of proper seat belt use are associated with a higher risk of adverse fetal outcome. These results strongly support recommendations that pregnant women use properly positioned seatbelts.

The Impact of Safety Belt Use on Liver Injuries in Motor Vehicle Crashes: The Importance of Motor Vehicle Safety Systems

Liver injuries (LIs) are one of the most serious and common consequences of motor vehicle crashes (MVCs). In the unstable patient, early detection of LI based on clinical suspicion will improve acute trauma care and outcomes. The specific objectives of this analysis are to identify crash scene and occupant risk factors for LI from MVC. Crash Injury Research and Engineering Network data were used to identify risk factors for LI; age, sex, safety belt use, air bag deployment, DeltaV (change in velocity), principal direction of force, vehicle crush, and intrusion. Occupants with LI were compared with four control groups without LI; (1) no abdominal (ABD) injury (NO_ABD), (2) any ABD (ANY_ABD), (3) ABD Abbreviated Injury Scale score of 1 to 2 (ABD_1-2), and (4) ABD Abbreviated Injury Scale score of 3 or more (ABD_3+). LI occupants were compared with each control group and odds ratios (OR) for risk of LI were computed. There were 311 Crash Injury Research and Engineering Network subjects aged 5 or more years with LI. The total mean Injury Severity Score was 37.6. LI was strongly and significantly associated with safety belt restraint use without air bag deployment, compared with each control group: Liver injury - restrained + air bag not deployed versus (1) NO_ABD, N = 1,519; OR = 4.4, (2) ANY_ABD, N = 317; OR = 2.6, (3) ABD_1 to 2, N = 155; OR = 3.1, (4) ABD_3+, N = 217; OR = 2.4 (p < 0.001). This association was independent of driver or passenger status and principal direction of force. LIs were also strongly and significantly associated with greater vehicle interior intrusion. LIs were strongly associated with a safety belt restraint in use in the absence of air bag deployment during MVC. This data may have profound importance to the trauma surgeon as an early indicator for LI during resuscitation. These findings also have important implications for future research efforts to improve safety systems in motor vehicles and reduce morbidity and mortality from MVCs in the United States.

Injury patterns for occupants of small trucks

A limited number of studies have been completed on the factors contributing to accident-related injuries sustained by occupants of pickup trucks. The increasing number and changing pattern of use of light trucks necessitates the need to critically review this vehicle type with respect to contributing accident factors and associated injuries. This paper investigates the injury mechanisms of occupants of pickup trucks and the surfaces that the occupants contact in roadway accidents. Selection of cases from the Canadian vehicle database was based on the location of the vehicles' most severe impact deformation. The overall occupant injury severity was examined with respect to impact location, impact speed, and magnitude of occupant compartment intrusion. The results of the investigation illustrate the benefits of seat belt restraint use. In addition, identification of frequent injury contact surfaces establishes a reference for improved vehicle design initiatives and standards.