Proper Restraint Use Research Articles

Safe Pediatric Ground Ambulance Transport

Background: Ambulance crashes that result in child injury or death are preventable with the use of proper restraints. This systematic review assesses aspects relevant to the proper use of pediatric restraints: EMS professionals’ resources and training, knowledge, attitudes, and behaviors. It also identifies barriers to using restraints.
 Methods: PubMed and Web of Science were searched using free-text search terms between the years 2000 and 2020. Inclusion criteria included human research, pediatric population, ambulance as the mode of transportation, peer-reviewed journals, and English full-texts. After initial screening and inclusion, a snowball methodology was used to further identify potentially relevant articles. The methodology was carried out by two independent reviewers. 
 Results: The original search yielded 80 publications after de-duplication between databases, and two additional articles were identified independently of the search through snowball sampling. Four publications met inclusion criteria for final analysis. Two studies were survey-based among EMS personnel aiming to identify knowledge, behaviors, and barriers to child transport. One study used qualitative data collection by interviews of ambulance personnel. The final study was a combination of survey and observational data. Of note, there were no studies that evaluated an intervention.
 Conclusion: Based on this review, there is a lack of research in the realm of safe pediatric ambulance transport. There is a need for quality improvement studies to address the barriers that were identified by previous literature and to improve the overall safety and compliance of pediatric safety restraints during transportation to the hospital.

A Bayesian Approach to Examine the Impact of Pavement Friction on Intersection Safety

The safety of intersections has been the focus of many studies since intersections are considered hazardous zones of road networks. Identifying the main contributing factors of severe traffic crashes at intersections is crucial to implementing appropriate countermeasures. We investigated the major contributing factors to crash injury severity at intersections, particularly pavement surface friction. Nine years of intersection crash data in Wyoming have been analyzed for this study. The random forest technique was employed to identify the importance of critical variables influencing crash injury severity risk. Subsequently, a Bayesian ordinal probit model was applied to examine the relationships between crash injury severity risk and these crash contributing factors. As per the random forest model’s results, pavement friction has a strong impact on crash injury severity risk along with using safety restraints, intersection type, signalized or unsignalized, reckless driving, and crash type. The results of the Bayesian model demonstrated that higher pavement surface friction levels and proper use of restraints reduced the likelihood of severe injury. Based on these findings, several countermeasures may be proposed, such as those pavement friction requirements, driver’s education, and traffic law enforcement to mitigate injury severity concerns at intersections.

Urban and Rural Child Deaths from Motor Vehicle Crashes: United States, 2015-2019

The objective of the study was to examine child deaths in motor vehicle crashes by rurality, restraint use, and state child passenger restraint laws. 2015-2019 Fatality Analysis Reporting System data were analyzed to determine deaths and rates by passenger and crash characteristics. Optimal restraint use was defined using age and the type of the restraint according to child passenger safety recommendations. Death rates per 100 000 population were highest for non-Hispanic Black (1.96; [1.84, 2.07]) and American Indian or Alaska Native children (2.67; [2.14, 3.20]) and lowest for Asian or Pacific Islander children (0.57; [0.47, 0.67]). Death rates increased with rurality with the lowest rate (0.88; [0.84, 0.92]) in the most urban counties and the highest rate (4.47; [3.88, 5.06]) in the most rural counties. Children who were not optimally restrained had higher deaths rates than optimally restrained children (0.84; [0.81, 0.87] vs 0.44; [0.42, 0.46], respectively). The death rate was higher in counties where states only required child passenger restraint use for passengers aged ≤6years (1.64; [1.50, 1.78]) than that in those requiring child passenger restraint use for passengers aged ≤7 or ≤8 years (1.06; [1.01, 1.12]). Proper restraint use and extending the ages covered by child passenger restraint laws reduce the risk for child crash deaths. Additionally, racial and geographic disparities in crash deaths were identified, especially among Black and Hispanic children in rural areas. Decision makers can consider extending the ages covered by child passenger restraint laws until at least age 9 to increase proper child restraint use and reduce crash injuries and deaths.

Child Restraint Use and Seating Position of Child Passengers in Motor Vehicles and Their Correlations: Application of a Random-Effects Bivariate Probit Model

Motor vehicle crashes are a leading cause of death and injury for children aged under 8 years. In the U.S.A., while some states are showing increases in the proportion of child restraint device use, only around half of child passengers aged from 4 to 7 years are being properly restrained. This study was undertaken to identify the factors contributing to the proper child restraint use and child passenger’s seating position through the direct observation surveys of more than 10,000 child passengers in 2015 and 2018 in Michigan. A bivariate probit model with random effects was developed to identify simultaneously the contributing factors for the proper restraint use and seating position of child passengers, accounting for the unobserved heterogeneity in the data. The bivariate framework is able to account for the correlation of the two dependent variables in the study. The results show that the two dependent variables are positively correlated, and this correlation is strongly significant. The key factors simultaneously influencing proper child restraint use and appropriate seating position of the child passenger include the age of the child, the number of child passengers in the vehicle, driver belt use, driver gender, age, and race, vehicle type, stratum, weather, and the time of the day and week. However, factors such as county-specific population, income, and education, and the type of location did not have any significant association with either child restraint use or the seating position of the child passenger.

Database selection matters: A case study in child restraint use and injury patterns using North Carolina motor vehicle traffic crash report and trauma registry data

Objective While proper restraint use is protective against motor traffic vehicle crash (MVTC)-associated morbidity and mortality, it is inconsistently measured across health and MVTC data sources. This project addresses this gap by assessing differences in child restraint measures between two North Carolina (NC) datasets and comparing the utility of these sources to evaluate patterns of child restraint use and associated health outcomes. Methods We analyzed 2018 NC MVTC and NC Trauma Registry (NCTR) data for children ≤15 years old, both separately and as linked MVTC-NCTR records. We calculated mean and standard deviation for continuous variables and frequency and proportion for categorical variables. Among linked records, we compared reported restraint use and performed age-adjusted logistic regression to estimate associations between restraint use and severe injury. Results A lower proportion of pediatric MVTC victims were reported as unrestrained in the MVTC (14.7%) versus NCTR (25.8%) data. Among linked MVTC-NCTR records, only 41.3% featured perfect concordance of restraint information between datasets. Among linked records, child restraint was reported for 31.3% of children, while the NCTR data allowed more granular coding of child restraint (30.3% overall), including child booster seat (13.5%), child car seat (8.7%), infant car seat (4.8%), and unrestrained in child car seat (3.4%). Age-adjusted regression analyses of the linked data revealed that lap/shoulder seatbelt use was significantly associated with lower likelihood of severe injury compared to being unrestrained whether informed by MVTC (OR = 0.39; 95% CI: 0.16, 0.93) or NCTR (OR = 0.38; 95% CI: 0.15, 0.96) data. While the association between reported use of a child car seat and severe injury was not statistically significant in the MVTC data (OR = 0.50; 95% CI: 0.19, 1.32), child car seat use reported in the NCTR data revealed a significant association (OR = 0.16; 95% CI: 0.03, 0.93). Conclusions Linked crash and trauma center data allow for identifying important patterns of restraint use among pediatric passengers in MVTCs. Dataset-dependent differences in measuring restraint use have critical public health implications and illustrate the importance of careful dataset selection prior to analysis, as the use of different data sources may impact overall study conclusions.

Adequacy of Emergency Department Documentation of Child Restraint Use After a Motor Vehicle Crash.

There are limited data on how often providers collect and document adequate restraint information in children seen in the emergency department (ED) after motor vehicle crashes (MVCs). The objectives of this study are to determine (1) how often adequate child restraint information to determine age-appropriate use is documented after MVC; (2) the frequency of incorrect use of the child restraint when adequate details are documented; and (3) for those discharged from the ED with identified incorrect use, the frequency of provision of information on child passenger safety (CPS). Retrospective chart review of visits of children younger than 13 years with an International Classification of Diseases, Tenth Revision code for MVC to an urban, academic, level 1 pediatric trauma center, from October 2015 to September 2018. Adequate documentation of child restraint use was defined as identification of location of the child in the car (front vs rear row), type of restraint used, and forward or rear facing for children 24 months or younger. A total of 165 visits qualified for inclusion. There was adequate documentation in 46% of visits. Of those, incorrect child restraint use was identified in 49%. Of discharged patients with incorrect use, 10% had documentation of provision of CPS information. Adequate details to determine proper age-appropriate restraint use are documented in only half of ED visits for MVC. Very few are given CPS instructions on discharge, even when incorrect use has been identified. Identification of incorrect restraint use in the ED is an opportunity for a teachable moment that is being underused.

Maxillofacial trauma following road accidents-An 11-year multi-center study in Israel.

Road traffic collisions (RTC) are known to be one of the major causes of maxillofacial trauma (MFT). The road user factor is of crucial importance in the prevalence, severity, and treatment of maxillofacial injuries. The aims of the study were to determine the prevalence of maxillofacial trauma among road users, to illustrate injury patterns and to identify road users at high risk. This historical prospective multi-center study was based on Israel's Trauma Registry between 2008-2018, which included 4829 hospitalized patients following RTC with MFT. Data were analyzed according to six road user types (vehicle driver, passenger, bicyclist, motorcyclist, pedestrian, and e-bike/scooter), maxillofacial injury location, and maxillofacial treatment. MFT, which accounted for 5% of the hospitalized RTC injuries, was not equally distributed among road users, as bicyclists and e-bike/scooters were more prone to maxillofacial trauma (7.2% and 10.1%, respectively) than vehicle drivers (3.2%). Children (age 0-14years) comprised almost half of the cyclists, 25% of the pedestrians and 20% of the passengers. Some MFT patients experienced multiple injuries, with the majority involving jaw and facial bones and to a lesser extent the mouth, teeth, gingivae, and alveolar bone (mouth and dento-alveolar (DA) trauma). Approximately 30% of hospitalized road casualties with MFT underwent MF surgery, with the need for surgery lowest among pedestrians. Hospitalized road casualties had different types of MFT in terms of prevalence, location, severity, and treatment, depending on the road user type.

Alcohol is a predictor of mortality in motor vehicle collisions

IntroductionIt is well recognized that driving while intoxicated increases the probability of a motor-vehicle collision (MVC). The effect of alcohol on the chance of surviving the MVC is less clear. Method: Using data from the Fatality Analysis Reporting System (FARS) we conducted analyses for the outcome of mortality using alcohol and other variables as predictors. We also selected alcohol positive (AP) and alcohol negative (AN) persons from the same MVC and vehicle to control for confounding characteristics. Results: The odds ratio (OR) for mortality for alcohol positive drivers was 2.57, (p < 0.001 for all the following OR). Other harmful predictive factors were age OR 1.01 per year, vehicle age OR 1.05 per year, male sex OR 1.23, avoidance maneuver OR 1.09, speed related OR 2.89, rollover mechanism OR 2.75, and collision with a fixed object OR 6.70. Protective factors were proper restraint use – OR 0.19 and collision with another moving vehicle, OR 0.21. In the multivariate analysis the OR of mortality for AP vs AN was 1.46. Proper restraint use (OR 0.27) remained protective along with collision with another moving vehicle. When AP and AN persons from the same MVC and the same vehicle were compared, the adjusted OR’s for mortality were 1.46 and 2.08, respectively. Conclusions: Alcohol is an independent predictor of mortality in an MVC. Proper restraint use is the strongest protective factor. This finding allows a more complete understanding of the risks of driving while intoxicated, not only a higher probability of an MVC, but decreased survival once the MVC occurs. Practical Applications: Identification of alcohol as an independent predictor of mortality in an accident may improve risk assessment and influence drivers to avoid driving while intoxicated.

Child Passenger Safety.

Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death to children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend the inclusion of child passenger safety anticipatory guidance at every health supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues affecting the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families.

The Impact of Child Safety Restraint Status and Age in Motor Vehicle Collisions in Predicting Type and Severity of Bone Fractures and Traumatic Injuries.

Although morbidity and mortality in children increases in motor vehicle collisions (MVC) if child restraints are not used, no data exist correlating specific injuries with proper or improper use of safety restraints or age. The purpose of this study was to evaluate correlations between childhood MVC injuries, age, and restraint status. A medical record search for pediatric patients involved in a MVC was conducted at a pediatric hospital (level 1 trauma). Charts were reviewed for demographics and injury-specific information. Patients were grouped by age, restraint use, and injuries. Nine hundred sixty-seven patients ≤12 years (average age 6.39 y) were identified. Being properly restrained was most common in all age groups except the 4- to 8-year age group in which being improperly restrained was most common. Unrestrained patients were most commonly found in the 9- to 12-year age group. A statistically significant difference was not observed for orthopaedic injuries among the restraint groups, but internal thoracic injuries, open head wound, and open upper extremity wounds were significantly more common in improperly or unrestrained patients. Improperly restrained infants had a significantly higher rate of intracranial bleeds and abrasions than those properly restrained. Unrestrained and improperly restrained 9- to 12-year olds had significantly more open head, open upper extremity, and vascular injuries. When comparing injury types with age groups, upper extremity fractures, femoral fractures, dislocations, and spinal fractures were found to be significantly higher in older children. Preventing orthopaedic injuries in older children may be accomplished by changes in regulations or automotive safety equipment. Rear-facing child safety seats could possibly be improved to prevent head trauma in the youngest patients. There is a continued need to reinforce the importance of proper use of child safety devices to parents. Knowledge of the patient's age, along with restraint status, might aid in diagnosis of less obvious MCV injuries. Level III.

School transportation mode, by distance between home and school, United States, ConsumerStyles 2012

IntroductionMotor-vehicle crashes are a leading cause of death among children in the United States, and almost one-fourth of all trips by school-aged children are trips to and from school. This study sought to determine how children (5–18years) travel to and from school and, among those living ≤1mile of school, to explore the role of school bus service eligibility on school travel mode. MethodsWe used national 2012 survey data to determine prevalence of usual school travel mode, stratified by distance from school. For those living ≤1mile of school, multivariable regression was conducted to assess the association between bus service eligibility and walking or bicycling. ResultsAlmost half (46.6%) of all children rode in passenger vehicles (PV) to school and 41.8% did so for the trip home. Results were similar among those living ≤1mile (48.1%, PV to school; 41.3%, PV to home). Among those living ≤1mile, 21.9% and 28.4% of children walked or bicycled to and from school, respectively. Ineligibility for school bus service was strongly associated with walking or bicycling to school [adjusted prevalence ratio (aPR: 5.36; p<0.001)] and from school (aPR: 5.36; p<0.001). ConclusionsRegardless of distance from school, passenger vehicles were a common mode of travel. For children who live close to school, the role that school bus service eligibility plays in walking or bicycling deserves further consideration. Practical applicationsGiven the large proportion of children who use passenger vehicles for school travel, effective interventions can be adopted to increase proper child restraint and seat belt use and reduce crash risks among teen drivers. Better understanding of conditions under which bus service is offered to children who live close to school could inform efforts to improve pedestrian and bicyclist safety for school travel.

Using a Decision Wheel to Reduce Use of Restraints in a Medical-Surgical Intensive Care Unit.

Little information is available on the use of tools in intensive care units to help nurses determine when to restrain a patient. Patients in medical-surgical intensive care units are often restrained for their safety to prevent them from removing therapeutic devices. Research indicates that restraints do not necessarily prevent injuries or removal of devices by patients. To decrease use of restraints in a medical-surgical intensive care unit and to determine if a decision support tool is useful in helping bedside nurses determine whether or not to restrain a patient. A quasi-experimental study design was used for this pilot study. Data were collected for each patient each shift indicating if therapeutic devices were removed and if restraints were used. An online educational activity supplemented by 1-on-1 discussion about proper use of restraints, alternatives, and use of a restraint decision tool was provided. Frequency of restraint use was determined. Descriptive statistics and thematic analysis were used to examine nurses' perceptions of the decision support tool. Use of restraints was reduced 32%. No unplanned extubations or disruption of life-threatening therapeutic devices by unrestrained patients occurred. With implementation of the decision support tool, nurses decreased their use of restraints yet maintained patients' safety. A decision support tool may help nurses who are undecided or who need reassurance on their decision to restrain or not restrain a patient.

An exploratory investigation of child safety seat use among citizens of the United Arab Emirates

ABSTRACTChild car safety has significantly improved in Western nations with the use of proper child restraints over the last 40 years, but progress lags in other nations. High-income but developing Eastern Mediterranean countries experience one of the world's highest road traffic-injury mortality rates for children. This study provides a preliminary investigation of child safety seat utilization among United Arab Emirates (UAE) citizen parents. Cross-sectional survey research was used to determine child safety seat utilization proportions. Data were collected from a convenience sample composed of target citizens, which make up approximately 15% of the total population of the country. A total of 366 parents with at least one child younger than age 13 years participated. Despite prevalent car-seat giveaway campaigns and regardless of car-seat ownership, the overall percentage of car seat use among Emirati parents was low: less than 20% for their children younger than age 24 months. Additionally, of those who use a car seat, parents reported improper use. The UAE currently has no compulsory child safety seat legislation. The findings suggest the need for further studies on car-seat usage in the UAE, as well as intervention research to inform locally relevant and culturally appropriate public information campaigns.

The Effects of Restraint Type on Pattern of Spine Injury in Children

While the use of vehicular restraints has reduced the morbidity and mortality of children involved in motor vehicle collisions (MVC), to our knowledge, no study has examined the relationship between restraint type and patterns of pediatric spinal injuries. The purpose of this study is to evaluate this association and review the spinal injuries sustained in children involved in MVC. We completed an IRB-approved, retrospective chart review of all patients below 10 years of age presenting to a level 1 pediatric trauma hospital with spine injuries sustained in MVC from 2003 to 2011. We reviewed prehospital data, medical records, and radiographs to establish the restraint type and characterize the spinal injuries sustained. A total of 97 patients were identified with spinal trauma secondary to MVC with appropriate and documentation of restraint type. Results are reported regardless of whether the restraint employed was properly used per established guidelines. Car seat/booster seat (C/B) patients sustained significantly higher rates of cervical spine (62%) and ligamentous (62%) injuries than the 2-point (2P) (10%) and 3-point (3P) restraint (24%) groups (P<0.001). Two-point and 3P restraint use was associated with significantly higher rates of thoracolumbar injuries (67% and 62%, respectively) than the C/B (14%) and unrestrained (0%) groups (P<0.001). Two-point and 3P passengers also had a higher rate of flexion-distraction injuries (P<0.001). Patients in the unrestrained group sustained a significantly higher rate of cervical spine (80%) and ligamentous (40%) injuries than the 2P and 3P groups (P<0.001). No differences were found in the type or location of injury between the 2P and 3P groups. Significant differences in proper restraint use were identified between age groups with younger children demonstrating higher rates of proper restraint use (P<0.01). Two-point or 3P seatbelt use is associated with lower rates of cervical spine trauma but higher rates of thoracic and lumbar trauma, particularly flexion-distraction injuries, when compared with car or booster seats. Children in C/B and those who are unrestrained sustain high rates of cervical spine injury. Level III-prognostic study.

Restraints: Patient Safety and Regulatory Compliance - Extended Version

The use of restraints in health care facilities is necessary but fraught with regulatory dangers, patient safety risks and negative optics. Proper use of restraints within regulatory guidelines can enhance patient safety and outcomes, but every use of restraints must be viewed as a risk event for the facility and the professionals involved.

Roadside observational surveys of restraint use by young children in Qatar: Initial results and recommendations

In a report by the WHO Eastern Mediterranean Region(1), the non-use of child restraints for children was identified as a key risk factor that can be addressed by the adoption and enforcement of legislation that will increase their use. Currently, there are no child restraint laws in Qatar. The objective of the study is to report baseline data on child restraint use and to provide evidence to inform the passage of child passenger restraint laws in Qatar. This roadside observational survey was conducted as part of the Young Kids in Safe Seats Project funded by the Qatar Foundation. Trained observers conducted roadside observations of passenger restraint use in vehicles with children, less than 5 years, at 12 sampling sites. Standard data was collected per observation: seating position, restraint used and appropriateness of restraint used. Of 2232 observations of young child passengers: 41% were properly restrained, 21% improperly restrained and 38% unrestrained, 10.9% were on an adult’s lap. The most common seating location was right second row followed by left second row. These 2 locations also had the highest rates of proper restraint use. The positions with the lowest restraint use were the front and second row middle seat. One in 9 children observed was illegally seated in the front row, most on the lap of an adult [38.3%] or unrestrained [34.4%]. This is the first observational study in Qatar that measures child restraint rates in children younger than 5. Less than half of these children are traveling safely. Priority areas for intervention include: enforcement of existent laws banning children in the front seat, education about the risks for children in an adult’s lap and encouraging the proper use of age/size appropriate restraint systems. These findings can inform the development of national child passenger restraint laws. Reference: 1. Road safety in the Eastern Mediterranean Region Facts from the Global Status Report on Road Safety 2013.

Motor Vehicle Crashes, Medical Outcomes, and Hospital Charges Among Children Aged 1–12 Years — Crash Outcome Data Evaluation System, 11 States, 2005–2008

Motor vehicle crashes are a leading cause of death among children. Age- and size-appropriate restraint use is an effective way to prevent motor vehicle-related injuries and deaths. However, children are not always properly restrained while riding in a motor vehicle, and some are not restrained at all, which increases their risk for injury and death in a crash. 2005-2008. The Crash Outcome Data Evaluation System (CODES) is a multistate program facilitated by the National Highway Traffic Safety Administration to probabilistically link police crash reports and hospital databases for traffic safety analyses. Eleven participating states (Connecticut, Georgia, Kentucky, Maryland, Minnesota, Missouri, Nebraska, New York, Ohio, South Carolina, and Utah) submitted data to CODES during the reporting period. Descriptive analysis was used to describe drivers and child passengers involved in motor vehicle crashes and to summarize crash and medical outcomes. Odds ratios and 95% confidence intervals were used to compare a child passenger's likelihood of sustaining specific types of injuries by restraint status (optimal, suboptimal, or unrestrained) and seating location (front or back seat). Because of data constraints, optimal restraint use was defined as a car seat or booster seat use for children aged 1-7 years and seat belt use for children aged 8-12 years. Suboptimal restraint use was defined as seat belt use for children aged 1-7 years. Unrestrained was defined as no use of car seat, booster seat, or seat belt for children aged 1-12 years. Optimal restraint use in the back seat declined with child's age (1 year: 95.9%, 5 years: 95.4%, 7 years: 94.7%, 8 years: 77.4%, 10 years: 67.5%, 12 years: 54.7%). Child restraint use was associated with driver restraint use; 41.3% of children riding with unrestrained drivers also were unrestrained compared with 2.2% of children riding with restrained drivers. Child restraint use also was associated with impaired driving due to alcohol or drug use; 16.4% children riding with drivers suspected of alcohol or drug use were unrestrained compared with 2.9% of children riding with drivers not suspected of such use. Optimally restrained and suboptimally restrained children were less likely to sustain a traumatic brain injury than unrestrained children. The 90th percentile hospital charges for children aged 4-7 years who were in motor vehicle crashes were $1,630.00 and $1,958.00 for those optimally restrained in a back seat and front seat, respectively; $2,035.91 and $3,696.00 for those suboptimally restrained in a back seat and front seat, respectively; and $9,956.60 and $11,143.85 for those unrestrained in a back seat and front seat, respectively. Proper car seat, booster seat, and seat belt use among children in the back seat prevents injuries and deaths, as well as averts hospital charges. However, the number, severity, and cost of injuries among children in crashes who were not optimally restrained or who were seated in a front seat indicates the need for improvements in proper use of age- and size-appropriate car seats, booster seats, and seat belts in the back seat. Effective interventions for increasing proper child restraint use could be universally implemented by states and communities to prevent motor vehicle-related injuries among children and their resulting costs.

Restraint use in motor vehicle crash fatalities in children 0 year to 9 years old.

Despite improvements in child passenger safety legislation and equipment, motor vehicle crashes (MVCs) continue to be the leading cause of death in children younger than 10 years. The objective of this study was to describe factors associated with restraint use in fatal MVC in children 0 year to 9 years old. The Fatality Analysis Reporting System, maintained by the National Highway Transportation Safety Administration, was used to obtain data on MVC fatalities from 2001 to 2010 in children 0 year to 9 years old. The main outcome was restraint use. Demographic information (age, sex, and race) and crash characteristics including vehicle type (sedan, van, truck, sports utility vehicle) and seat position in the vehicle were analyzed with the χ statistic to evaluate these factors for any restraint use compared with no restraint use in MVC fatalities. There were 7,625 MVC fatalities in children 0 year to 9 years old from 2001 to 2010.Among these fatalities, 4,041 (53%) had any restraint use. Front seat passengers accounted for 20.9% (1,595 of 7,625) of the fatalities. Children 0 year to 3 years old had a higher proportion of restraint use than children 4 years to 9 years old (p < 0.001). White children compared with black children had higher use of restraints (p < 0.001). Children riding in sedans/vans compared with sport utility vehicles/trucks and those riding in the rear seats of the vehicle compared with those in front seats were significantly more likely to use restraints (p < 0.001). Overall, only half of children 0 year to 9 years old who died in an MVC were wearing any child restraint in the vehicle, and 20% were sitting in the front seat. Continued efforts must be made to enforce legislation and educate the public about best practices regarding child passenger safety to improve proper restraint use and to decrease MVC fatalities in children. Prognostic/epidemiologic study, level II.

Examining the relative effectiveness of different message framing strategies for child passenger safety: Recommendations for increased comprehension and compliance

BackgroundAge-appropriate child restraints and rear seating dramatically reduce injury in vehicle crashes. Yet parents and caregivers struggle to comply with child passenger safety (CPS) recommendations, and frequently make mistakes when choosing and installing restraints. The purpose of this research was to evaluate various methods of framing CPS recommendations, and to examine the relative effectiveness on parents’ knowledge, attitudes, and behavioral intentions related to best practices and proper use of child restraints. Emphasis framing is a persuasion technique that involves placing focus on specific aspects of the content in order to encourage or discourage certain interpretations of the content. MethodA 5 (flyer group) X 2 (time) randomized experiment was conducted in which 300 parent participants answered a pre-survey, viewed one of four flyer versions or a no-education control version, and completed a post-survey. Surveys measured CPS knowledge, attitudes, perceptions of efficacy and risk, and behavioral intentions. The four flyers compared in this study all communicated the same CPS recommendations, but several versions were tested which each employed a different emphasis frame: (1) recommendations organized by the natural progression of seat types; (2) recommendations which focused on avoiding premature graduation; (3) recommendations which explained the risk-reduction rationale behind the information given; or (4) recommendations which were organized by age. In a fifth no-education (control) condition, participants viewed marketing materials. ResultsAnalyses of covariance and pairwise comparisons indicated the risk-reduction rationale flyer outperformed other flyers for many subscales, and significantly differed from no-education control for the most subscales, including restraint selection, back seat knowledge, rear-facing knowledge and attitudes, total efficacy, overall attitudes, and stated intentions. ConclusionsThis research provides insight for increasing caregiver understanding and compliance with CPS information. Recommendations for the field include communicating the rationale behind the information given, using behavior-based directives in headers, avoiding age-based headers, and incorporating back-seat positioning directives throughout.

Program fidelity measures associated with an effective child restraint program: Buckle-Up Safely.

We sought to identify the program fidelity factors associated with successful implementation of the Buckle-Up Safely program, targeting correct use of age-appropriate child car restraints. In 2010, we conducted a cluster randomized controlled trial of 830 families with children attending preschools and long day care centers in South West Sydney, New South Wales, Australia. Families received the Buckle-Up Safely program in the intervention arm of the study (13 services). Independent observers assessed the type of restraint and whether it was used correctly. This detailed process evaluation showed that the multifaceted program was implemented with high fidelity. Program protocols were adhered to and messaging was consistently delivered. Results from multilevel and logistic regression analyses show that age-appropriate restraint use was associated with attendance at a parent information session hosted at the center (adjusted odd ratio [AOR]=3.66; 95% confidence interval [CI]=1.61, 8.29) and adversely affected by the child being aged 2 to 3 years (AOR=0.14; 95% CI=0.07, 0.30) or being from a family with more than 2 children (AOR=0.34; 95% CI=0.17, 0.67). Findings highlight the importance of parents receiving hands-on education regarding the proper use of age-appropriate child restraints.