Car Restraint Research Articles

Hypoxemia from Car Restraints

Newborns, especially premature babies, tend to flex their necks while sitting in car seats; the resulting closure of the mouth, pressing of the tongue

Implementing Achievable Benchmarks in Preventive Health: A Controlled Trial in Residency Education

To evaluate the Preventive Health Achievable Benchmarks Curriculum, a multifaceted improvement intervention that included an objective, practice-based performance evaluation of internal medicine and pediatric residents' delivery of preventive services. The authors conducted a nonrandomized experiment of intervention versus control group residents with baseline and follow-up of performance audited for 2001-2004. All 130 internal medicine and 78 pediatric residents at two continuity clinics at the University of Alabama School of Medicine, Birmingham, participated. Performance of preventive care was assessed by structured chart review. The multifaceted feedback curriculum included individualized performance feedback, academic detailing by faculty, and collective didactic sessions. The main outcome was difference in receipt of preventive care for patients seen by intervention and control residents, comparing baseline and follow-up. Charts were reviewed for 3,958 patients. Receipt of preventive care increased for patients of intervention residents, but not for patients of control residents. For the intervention group, significant increases occurred for five of six indicators in internal medicine: smoking screening, quit smoking advice, colon cancer screening, pneumonia vaccine, and lipid screening; and four of six in pediatrics: parental quit smoking advice, car seats, car restraints, and eye alignment (p < .05 for all). For control residents, no consistent improvements were seen. There was greater improvement for intervention than for control residents for four of six indicators in internal medicine, and two of six in pediatrics. Using a multifaceted feedback curriculum, the authors taught residents about the care they provide and improved documented patient care.

An Emergency Department Intervention to Increase Booster Seat Use for Lower Socioeconomic Families

To evaluate the effectiveness of booster seat education within an emergency department (ED) setting for families residing in lower socioeconomic neighborhoods. This was a prospective, randomized study of families with children aged 4 to 7 years and weighing 40 to 80 lb who presented to a pediatric ED without a booster seat and resided in lower socioeconomic communities. Subjects were randomly assigned to one of three groups: 1) received standard discharge instructions, 2) received five-minute booster seat training, and 3) received five-minute booster seat training and free booster seat with installation. Automobile restraint practices were obtained initially and by telephone at one month. A total of 225 children were enrolled. Before randomization in the study, 79.6% of parents reported that their child was usually positioned in the car with a lap/shoulder belt and 13.3% with a lap belt alone. Some parents (16.4%) had never heard of a booster seat, and 44.9% believed a lap belt was sufficient restraint. A total of 147 parents (65.3%) were contacted for follow-up at one month. Only one parent (1.3%) in the control group and four parents (5.3%) in the education group purchased and used a booster seat after their ED visit, while 55 parents (98.2%) in the education and installation group reported using the booster seat; 42 (75.0%) of these parents reported using the seat 100% of the time. Education in a pediatric ED did not convince parents to purchase and use booster seats; however, the combination of education with installation significantly increased booster seat use in this population.

Child abdominal injuries in car restraint systems—An intra-abdominal pressure sensor for the Q-dummy family and proposed viscous injury criterion based on detailed accident analysis and their reconstructions

Child abdominal injuries in car restraint systems—An intra-abdominal pressure sensor for the Q-dummy family and proposed viscous injury criterion based on detailed accident analysis and their reconstructions

Anticipatory Guidance Topics: Are More Better?

Anticipatory guidance is a cornerstone of primary care pediatrics. Despite the fact that retention of information is essential for later action, data are lacking on what parents recall immediately after the visit and 1 month later and how the total number of topics discussed affects this outcome. Parents and practitioners completed postvisit surveys of anticipatory guidance topics discussed during health-maintenance visits for children ages 2-11. Postvisit and 1 month later, parental recall was compared with provider report of topics discussed. We examined the relationship between parental recall and the total number of topics discussed. Families with children ages 2-11 years from across the United States participated in this study (N = 861). Providers reported discussing the topics of nutrition, car restraints, dental care, and reading aloud most often (72%- 93%). Concordance between parent and provider was high for all topics (72%-90%). Immediately postvisit, parents reported 6.33 (SD 2.9) as the mean number of topics discussed while providers reported 6.9 (SD 2.7) as the mean number of topics discussed. However, parental recall decreased significantly with more topics (> or =9) discussed. The same trend existed 1 month later. Providers and parents have good agreement about topics discussed or not discussed during a well-child visit; however, parental recall dwindles with increasing numbers of topics discussed. Rethinking well-child care to limit the total number of topics discussed is warranted.

Trauma in pregnancy

The objective of this article was to review the existing standards of practice regarding trauma which occurs during pregnancy. The design of this study was to review the available data from the surgical and obstetrical literature regarding trauma during pregnancy. The design was also to incorporate the contemporary recommendations from the trauma resuscitation courses relating to trauma during pregnancy. Trauma occurs in 5% of pregnancies. A fetus is not considered to be viable until week 25. Motor vehicle accidents account for more than 50% of all trauma during pregnancy, with 82% of fetal deaths occurring during these automobile accidents. With life threatening trauma a 50% fetal loss rate exists. As anatomy, physiology, and even laboratory findings change during pregnancy, the clinician must consider both patients, the mother and fetus. Following blunt trauma abruption of the placenta is the more common cause of fetus loss. Anterior abdominal penetrating trauma almost never fails to injury the uterus and fetus in the last half of pregnancy. Preventive strategies exist in the areas of social violence, automobile restraints and use of alcohol and drugs by the mother. Perimortem caesarian section is rarely successful. Trauma during pregnancy is uncommon, but with increasing trauma severity leads to increased fetal loss. Preventive strategies exist and when admitted monitoring standards should be followed.

Group interventions for the prevention of injuries in young children: a systematic review

Objective: This systematic review examined group based injury prevention interventions that targeted young children to determine the effectiveness of such strategies in enhancing children’s safety behaviors. Methods: A comprehensive (manual...

Seatbelt Use During Pregnancy: A Comparison of Women in Two Prenatal Care Settings

This study examines knowledge of proper automobile restraint use during pregnancy and attitudes toward restraint use. This manuscript, the second in a series, compares knowledge and attitudes in two populations of pregnant women, those receiving prenatal care at several county clinics and those receiving care in a private practice. A survey requesting demographic information and frequency and knowledge of proper automobile restraint use was administered during prenatal visits. County clinic patients (n = 450, 70% black) were younger and less educated than private practice patients (n = 203, 75% non-Hispanic white). Fewer county patients (49%) always wore seatbelts prior to the pregnancy than private practice patients (88%). Correct use was reported by fewer county clinic patients (67%) than private practice patients (83%). Few (25-28%) in either setting reported receiving information on seatbelt use. Despite existing knowledge with respect to the consequences of seatbelt non-use in pregnant women, the proportion of women receiving information about correct seatbelt use during pregnancy appears to be low, regardless of care source.

The Association between Chance Fractures and Intra-abdominal Injuries Revisited: A Multicenter Review

The association between Chance fractures and intra-abdominal injuries is reported to be as high as 89 per cent. Because prior studies were small series or case reports, we conducted a multicenter review to learn the true association between Chance fractures and intra-abdominal injuries as well as diagnostic trends. Trauma registry data, medical records, and radiology reports from 7 trauma centers were used to characterize 79 trauma patients with Chance fractures. Initial methods of abdominal assessment were computed tomography (CT) scan (79%), clinical examination (16%), and diagnostic peritoneal lavage (DPL) (5%). Twenty-six (33%) patients had intraabdominal injuries of which hollow viscus injuries predominated (22%). Twenty patients (25%) underwent laparotomy. The presence of an abdominal wall contusion and automobile restraint use were highly predictive of intra-abdominal injury and the need for laparotomy. The association between a Chance fracture and intra-abdominal injury is not as high as previously reported. CT scan has become the primary modality to assess the abdominal cavity of patients with Chance fractures, whereas the role of DPL has diminished.

A maternity hospital-based infant car-restraint loan scheme: Public health and economic evaluation of an intervention for the reduction of road traffic injuries

The results of an infant car-restraint loan scheme and evaluate its cost-effectiveness are presented. The intervention programme was initiated in 1996. Car-restraints, donated by manufacturers, were lent for a six-month period to eligible prospective parents for a modest fee. Specially trained health visitors performed in-person interviews with the participating parents. The data were collected and recorded on a pre-coded questionnaire. Cross-tabulations and multiple logistic regression were performed to analyse the data. Subsequent purchase of a next-stage car restraint, suitable for older children (up to four years of age) was considered as a proxy measure of the success of the programme. This information, along with the detailed operational and financial data collected during the implementation phase of the programme, was used to develop a model to assess the cost-effectiveness of a countrywide intervention. During a two-year period 188 families participated in a survey. On return of the infant car restraint, 92% of the participants reported proper use of the device and 82% had already purchased the second-stage car restraint. Parental age, gender, or educational status was not predictive of positive parental road safety practices for the newly born, whereas history of parental seat-belt use--as a proxy of personal road safety behaviour--was positively correlated with the likelihood of purchasing a second-stage car-restraint device. The cost-effectiveness ratio varies between 418.00 euro and 3,225.00 euro per life-year saved, depending on whether the modest administrative fee is considered. On the basis of plausible assumptions, a loan programme of infant car-restraints was shown to be particularly cost effective.

Community-based programs to promote car seat restraints in children 0–16 years – a systematic review

Study Objective: Community-based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing injury due to inadequate car seat restraint use in children 0–16 years of age. Methods: A comprehensive search of the literature was performed using the following study selection criteria: community-based intervention study; target population was children aged 0–16 years of age; outcome measure was either injury rates due to motor vehicle crashes or observed changes in child restraint use; and use of community control or historical control in the study design. Quality assessment and data abstraction was guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. Results: This review found eight studies, that met all the inclusion criteria. In the studies that measured injury outcomes, significant reductions in risk of motor vehicle occupant injury (33–55%) were reported in the study communities. For those studies reporting observed car seat restraint use the community-based programs were successful in increasing toddler restraint use in 1–5 year aged children by up to 11%; child booster seat use in 4–8 year aged children by up to 13%; rear restraint use in children aged 0–15 years by 8%; a 50% increase in restraint use in pre-school aged children in a high-risk community; and a 44% increase in children aged 5–11 years. Conclusion: While this review highlights that there is some evidence to support the effectiveness of community-based programs to promote car restraint use and/or motor vehicle occupant injury, limitations in the evaluation methodologies of the studies requires the results to be interpreted with caution. There is clearly a need for further high quality program evaluation research to develop an evidence base.

Knowledge, Beliefs, and Practices Concerning Seat Belt Use During Pregnancy

This study seeks to evaluate the comprehension of and attitudes toward proper restraint use among women attending prenatal care clinics. Four-hundred and fifty women were asked to complete a survey during prenatal care visits at county health department clinics; the response rate was 92.0%. Women were asked to provide demographic information and report their frequency and knowledge of proper automobile restraint use. Nearly all subjects (95.4%) either maintained or increased their pre-pregnancy frequency of restraint use. Three-hundred (72.5%) subjects demonstrated that they wore their restraints in the correct location, with women who wore restraints more frequently being more likely to report correct placement. Two-hundred and forty-nine (60.1%) of women reported that restraints would protect their baby if they were involved in a collision, while 48 (11.6%) thought the restraints would cause injury to their baby, and 153 (37.0%) were unsure. Women who reported that restraints would protect them and their baby if involved in a collision were significantly more likely to report always wearing restraints compared with those who were unsure or had negative perceptions of restraints (84.4% vs. 64.6%; p < 0.0001). The most commonly reported reasons for lack of restraint use were lack of comfort (52.8%) and forgetfulness (42.5%). Only 36.9% percent of women reported receiving information regarding restraint use during their current pregnancy. Many gravid women lack information regarding proper seat belt use and their role in injury prevention. Consequently, the frequency of seat belt use and its correct placement are negatively impacted. Health care workers should take an active role in educating pregnant gravid women about proper restraint use.

An in-car safety campaign for children in Southern Derbyshire

Part of my role as the Paediatric Emergency Liaison Nurse for Southern Derbyshire is to co-organise the annual ‘‘Rideout’’. This is a campaign where health care professionals and police officers combine forces to promote the need for ‘and correct use of’ children’s car seats. The event is run in June of each year to coincide with the National Child Safety Week. ‘‘Each year, over 5500 children are killed or injured while travelling unrestrained in the rear of cars, and of these deaths and injuries, about two thirds could have been prevented by the proper use of child restraints’’ (RoSPA). These statistics have been the driving force behind the ‘‘Rideout Campaign’’ in Southern Derbyshire. Each year during National Child Safety Week, a team of health care professionals and police officers have spent time promoting the use of child car restraints and assisting parents and carers to check their own. Derbyshire Constabulary devoted three traffic officers and their cars to the five days of the event. Our aim was for a traffic officer to be paired with at least one health care professional. Volunteers were recruited from the Accident and Emergency (A&E) department, Children’s Hospital, Minor Injuries Units and various community staff. Some staff incorporated this as part of their working day, including myself. Others participated in their own time. Staff were able to volunteer for whole or half days and for as many days as they were able to. Through goodwill and management support a

Unusual cervical spine injury in a 1 year old

The introduction of mandatory car seat restraints for children has reduced the mortality from road traffic accidents (RTAs) [ [1] Porter R.S. Zhao N. Patterns of injury in belted and unbelted individuals presenting to a trauma centre after motor vehicle crash: seat belt syndrome revisited. Ann. Emerg. Med. 1998; 32: 418-424 Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar ]. The pattern of injuries which are now presenting to emergency departments are being influenced by mechanism of injury, the age of the child and the type of car seat restraint used [ 2 Fuchs S. Barthel M.J. Flannery A.M. Christoffel K.K. Cervical spine fractures sustained by young children in forward-facing car seats. Paediatrics. 1989; 84: 348-354 PubMed Google Scholar , 3 Givens T.G. Polley K.A. Smith G.F. Hardin W.D. Paediatric cervical spine injury: a 3-year experience. J. Trauma: Injury Infect. Crit. Care. 1996; 41: 310-314 Crossref PubMed Scopus (92) Google Scholar , 4 Hoffman M.A. The paediatric passenger: trends in seat belt use and injury patterns. J. Trauma. 1987; 27: 974-976 Crossref PubMed Scopus (43) Google Scholar ]. There are various designs appropriate to the age and weight of the child, including lap belts, lap sash restraints and 4- or 5-point seat restraints.

Evaluation of a New Zealand indigenous community injury prevention project

Objective: To evaluate the Turanganui-a-kiwa Community Injury Prevention Project, based in a provincial town on the North Island of New Zealand with an extensive indigenous population (Maori). Method: The evaluation design was quasi-experimental and included process, impact and outcome measures. Results: Process evaluation findings indicated that adopting an holistic lifespan approach to injury prevention was successful in this Maori community. The three main areas of activities were: child road safety; safer alcohol use in the roading, sporting and home environments for young people and adults; and fire safety for older people. Significant increases in awareness of injury prevention initiatives were found among Turanganui-a-kiwa whanau (families) (p < 0.001). A large increase in the take-up of car restraints among Maori young children was demonstrated (pre 10%, post 74%). The safe alcohol dual message approach also resulted in significant increases in the number of respondents wearing protective equipment for sports (p < 0.05). The result of the fire safety initiative was that 120 kaumatua homes now have correctly installed smoke alarms and there is now a commitment from the Fire Service to maintain these alarms. Outcome evaluation findings showed that there was a significant decrease in hospitalization injury rates across the lifespan in Turanganui-a-kiwa (p < 0.05). Conclusion: Despite the challenges associated with conducting community injury prevention projects the conduct of this evaluation provides previously unknown information on an indigenous (Maori) injury prevention programme. The success of the programme would appear to be that the project was perceived as an intervention for Maori operating within a Maori framework which addressed Maori aspirations. Implications: As so little is known about injury prevention initiatives in indigenous populations, the findings presented in this article will provide important information for the future development of other indigenous injury prevention programmes.

The Social Consequences of Public Policy: A Market-Based Assessment

The social consequences of public policy decision making are assessed in the case of recently enacted NHTSA regulations regarding automobile child restraint systems. This is accomplished with the use of a practical, market-based approach, which relies on information about consumer purchase and use behavior, and information on the market impact of the new regulations. It is concluded that, with the use of information such as that presented here, public policy makers can better assess unforeseen effects and negative social consequences of policy decisions in the market place.

Experience from a multivenue program to increase the use of car restraints in Greece

Objectives To evaluate a multivenue educational campaign aimed at increasing the use of car restraints in Greater Athens, Greece. Methods From October 1997 to June 1998, the campaign was implemented by a road safety coalition comprising 50 governmental and non-governmental organizations, while during the same period, seat belt law enforcement was not intensified. A pre-intervention survey was conducted in the summer of 1996 among the occupants of 1400 passenger cars and a post-intervention survey was carried out in the summer of 1998 (2250 cars). Both surveys followed the same protocol, focusing on the availability and use of seat belts. The data from the two surveys were modeled through multiple logistic regression. Results The odds ratio of seat belt use was significantly higher in 1998 than in 1996 (1.8 with 95% confidence interval = 1.5-2.1). Improvement was evident in highway traffic and among 25-64 year-old car occupants, but it was minimal among rear seat passengers, younger occupants, and in low-speed city and suburban traffic. There is evidence from the 1998 surveys that among front seat occupants, those travelling in larger engine capacity cars, frequently equipped with airbags, were less likely to use seat belts, whereas seat belting was more frequent among occupants of newer car models. Conclusion An education and information campaign in a Southern European country resulted in increased prevalence of seat belt use. A more intensive and sustained effort is required, however, to increase seat belt use in low-speed traffic and among rear seat occupants.

A preschool program for safety and injury prevention delivered by home visitors

Objective—To evaluate the feasibility, acceptability, and effectiveness of an injury prevention program delivered by school based home visitors to the families of low income children attending preschool enrichment programs in...

Car Seatbelts in Pregnancy: The Practice and Knowledge of Pregnant Women Remain Causes for Concern

Objective To evaluate current knowledge and practice among pregnant women about the use of car restraint systems during pregnancy. Design A structured questionnaire. Setting District hospital antenatal clinic. Participants Two hundred pregnant women attending for their routine mid-pregnancy anomaly scan. Main outcome measures The women were asked about seatbelt and airbag usage, source of information about restraint systems and the legal requirements and recommendations regarding car safety systems. Results One hundred fifty-nine women (80%) completed the questionnaire. Ninety-eight percent wore seatbelts in the front, 68% wore seatbelts in the back of a car, 48% correctly identified where to place the seatbelt and 37% had received information on seatbelt use while pregnant. The latter were more likely to correctly position their restraints than those who had received no information (P= 0.03). Thirty-nine percent had an airbag system fitted and one woman had de-activated it. Fifty-eight percent were aware seatbelt use was a legal requirement for driver and passengers when fitted. Conclusions Many pregnant women are ignorant of the correct usage of seatbelts, their positioning and legal requirements. This puts their own wellbeing, and that of the fetus, at risk. Women should receive written instructions and advice from well informed health professionals and be encouraged always to wear a correctly positioned seatbelt. Education increases compliance and correct usage.

Car seatbelts in pregnancy: the practice and knowledge of pregnant women remain causes for concern

To evaluate current knowledge and practice among pregnant women about the use of car restraint systems during pregnancy. A structured questionnaire. District hospital antenatal clinic. Two hundred pregnant women attending for their routine mid-pregnancy anomaly scan. The women were asked about seatbelt and airbag usage, source of information about restraint systems and the legal requirements and recommendations regarding car safety systems. One hundred fifty-nine women (80%) completed the questionnaire. Ninety-eight percent wore seatbelts in the front, 68% wore seatbelts in the back of a car, 48% correctly identified where to place the seatbelt and 37% had received information on seatbelt use while pregnant. The latter were more likely to correctly position their restraints than those who had received no information (P = 0.03). Thirty-nine percent had an airbag system fitted and one woman had de-activated it. Fifty-eight percent were aware seatbelt use was a legal requirement for driver and passengers when fitted. Many pregnant women are ignorant of the correct usage of seatbelts, their positioning and legal requirements. This puts their own wellbeing, and that of the fetus, at risk. Women should receive written instructions and advice from well informed health professionals and be encouraged always to wear a correctly positioned seatbelt. Education increases compliance and correct usage.