Use of child safety seats during transportation of newborns / 소아과

PURPOSE: Child safety seats (CSS) are critical for the protection of children, in case of motor vehicle accidents. Although the national legislation mandates that all newborns must be placed in an appropriately installed CSS during transportation, people often do not perceive the importance of CSS and do not use it as recommended. The purpose of this survey was to understand the use of CSS for the safe transport of newborns from hospital to home. METHODS: We interviewed parents of newborn infants, using a structured questionnaire, at the time of their discharge from Cheil General Hospital & Women’s Health Care Center, between May 2014 and July 2014. RESULTS: A total of 403 participants were interviewed. The rate of CSS use was only 14.9%. Overall, 76.4% of the families interviewed were not aware about the recommendations on CSS use for newborns when travelling in a car. The provision of education on using CSS significantly influenced their rate of use. Parents who were educated about mounting the CSS in a car used it more as compared with others (25.7% vs. 12.2%) (P=0.002). Furthermore, if parents had heard about the importance or necessity of CSS, they used it more than others did (19.5% vs. 10.6%, P=0.032). CONCLUSION: Despite the legal regulation, most parents transport their newborn infants without a CSS while traveling from hospital to their home. The rate of CSS use was influenced by parental education and their knowledge about its necessity. Education programs for parents must be reinforced to increase the CSS use.

TRANSPORTING CHILDREN IN CARS AND THE USE OF CHILD SAFETY RESTRAINT SYSTEMS

ABSTRACT Objective: To evaluate the transport of children in automobiles and the use of child restraints systems (CRS). Methods: This is a transversal descriptive study which included 200 vehicle drivers who carried 0-10 year old children in the city of São Luis, MA, Brazil. The drivers' passengers' and children's features were properly identified. The children's transportation using CRS were analyzed according to the Resolution 277/8 of the Brazilian National Traffic Department. Results: The transportation of children was classified as inappropriate in 70.5% of the vehicles analyzed. The most common way for children transportation was free on the back seats (47%) or on the lap of passengers/drivers (17%). The main reasons to justify the improper transportation were either not understanding the importance of CRS use (64.5%) or not having financial resources to buy the devices. The child safety seat was the most used CRS (50.8 %) among vehicles with proper child transportation system. Conclusion: The transportation of children was inappropriate in most of the vehicles analyzed, reflecting the need for creating awareness among automobile drivers, including education, supervision and improvement of policies for health improvement and prevention of accidents involving children transportation. Level of Evidence III, Cross Sectional Study.

Preventive Effects of Seat Belt on Clinical Outcomes for Road Traffic Injuries

Proper seat belt use saves lives; however, the use rate decreased in Korea. This study aimed to measure the magnitude of the preventive effect of seat belt on case-fatality across drivers and passengers. We used the Emergency Department based Injury In-depth Surveillance (EDIIS) database from 17 EDs between 2011 and 2012. All of adult injured patients from road traffic injuries (RTI) in-vehicle of less than 10-seat van were eligible, excluding cases with unknown seat belt use and outcomes. Primary and secondary endpoints were in-hospital mortality and intracranial injury. We calculated adjusted odds ratios (AORs) of seat belt use and driving status for study outcomes adjusting for potential confounders. Among 23,698 eligible patients, 15,304 (64.6%) wore seat belts. Driver, middle aged (30-44 yr), male, daytime injured patients were more likely to use seat belts (all P < 0.001). In terms of clinical outcome, no seat belt group had higher proportions of case-fatality and intracranial injury compared to seat belt group (both P < 0.001). Compared to seat belt group, AORs (95% CIs) of no seat belt group were 10.43 (7.75-14.04) for case-fatality and 2.68 (2.25-3.19) for intracranial injury respectively. In the interaction model, AORs (95% CIs) of no seat belt use for case-fatality were 11.71 (8.45-16.22) in drivers and 5.52 (2.83-14.76) in non-driving passengers, respectively. Wearing seat belt has significantly preventive effects on case-fatality and intracranial injury. Public health efforts to increase seat belt use are needed to reduce health burden from RTIs.

Erros de utilização de assentos de segurança infantil por menores de 4 anos / Child safety seat usage errors in under-4s

Objetivo: Analisar erros de utilização de assentos de segurança infantil por crianças matriculadas em creches e fatores relacionados. Métodos: Estudo observacional transversal de coleta de dados prospectiva e eixo analítico retrospectivo. Resultados: Um total de 42,7% das crianças apresentava erros de utilização. O modelo de regressão logística evidenciou maiores chances de erros na presença de duas ou mais crianças no veículo (odds ratio = 5,10, p = 0,007) e menores níveis de escolaridade e renda dos pais (renda e escolaridade médias: odds ratio = 7,00, p = 0,003; renda e escolaridade baixas: odds ratio = 3,40, p = 0,03). Conclusão: Os dados são coerentes com publicações internacionais.

Objective: To analyze child safety seat usage errors among children enrolled at daycare. Methods: This was a cross-sectional, observational study with prospective data collection and a retrospective analytical axis. Results: Overall, 42.7% of the children studied were in incorrectly used seats. A logistic regression model showed that the likelihood of usage errors was higher if there were two or more children in the vehicle (odds ratio = 5.10, p = 0.007) and was dependent on parents' educational level and income (medium income and educational level: odds ratio = 7.00, p = 0.003; low income and educational level: odds ratio = 3.40, p = 0.03). Conclusion: The results of this study are in line with findings reported in international publications.

Injury to the Abdominal Aorta from a Seat Belt in a Frontal Motor Vehicle Collision

In traffic accidents, wearing a seatbelt can cause abdominal aortic injury due to an abrupt deceleration. We report a case of abdominal aorta dissection caused by a seat belt in a frontal motor vehicle collision. The initial symptoms and signs were vague or uncertain. However, he complained severe abdominal pain with seat belt sign below the umbilicus. Abdominal computed tomography scans showed an initial flap of the abdominal aorta with hematoma and hazy stranding of the mesentery.

Road safety legislation in the Americas / Legislación sobre seguridad vial en las Américas

Legislating five of the main risk factors for road traffic injuries (RTIs), as much as enforcing the law, is essential in forging an integral culture of road safety. Analysis of the level of progression in law enforcement allows for an evaluation of the state of world regions. A secondary analysis of the 2009 Global status report on road safety: time for action survey was undertaken to evaluate legislation on five risk factors (speed management, drinking and driving, motorcycle helmet use, seatbelt use, and use of child restraints) in the Americas. Laws were classified depending on their level of progression: the existence of legislation, whether the legislation is adequate, a level of law enforcement > 6 (on a scale of 0-10), and whether the law is considered comprehensive. A descriptive analysis was performed. The totality of the countries has national or subnational legislation for at least one of the five risk factors. However, 63% have laws on the five risk factors studied, and none of them has comprehensive laws for all five. Seatbelt use appears to be the most extended enforced legislation, while speeding laws appear to be the least enforced. There are positive efforts that should be recognized in the region. However, the region stands in different stages of progression. Law enforcement remains the main issue to be tackled. Laws should be based on evidence about what is already known to be effective.

La legislación sobre cinco de los principales factores de riesgo de sufrir lesiones causadas por el tránsito, así como el cumplimiento de la ley, son esenciales para forjar una cultura integral de seguridad vial. El análisis del nivel de progresión en el cumplimiento de la ley permite evaluar el estado de las regiones del mundo. Se llevó a cabo un análisis secundario de la encuesta Informe sobre la situación mundial de la seguridad vial: es hora de pasar a la acción, de 2009, para evaluar la legislación sobre cinco factores de riesgo (control de la velocidad, conducir bajo la influencia del alcohol, uso del casco al conducir motocicletas, uso de cinturones de seguridad y uso de sistemas de retención para niños) en las Américas. Las leyes se clasificaron según su nivel de progresión: la existencia de legislación, si la legislación es adecuada, un nivel de cumplimiento de la ley > 6 (en una escala de 0-10) y si la ley se considera integral. Se realizó un análisis descriptivo. Todos los países tienen legislación nacional o subnacional al menos con respecto a uno de los cinco factores de riesgo; sin embargo, 63% tienen leyes sobre los cinco factores de riesgo estudiados, y ninguno de ellos tiene leyes integrales para los cinco. La legislación sobre uso de cinturones de seguridad parece ser la de mayor cumplimiento, mientras que las leyes de exceso de velocidad parecen ser las que menos se cumplen. En la región hay esfuerzos positivos que deben reconocerse; sin embargo, existen diferentes etapas de progresión. El cumplimiento de la ley sigue siendo el principal tema por abordar. Las leyes deben basarse en datos de eficacia reconocida.

Modelo conceptual para identificar factores relevantes en la seguridad de los niños en los autobuses escolares / Conceptual model for identifying factors relevant to the safety of children in school buses

OBJETIVO: Elaborar un modelo conceptual que permita comprender las relaciones entre las variables que llevan a los niños a adoptar posturas en los vehículos de transporte escolar que incrementan los efectos lesivos en caso de accidentes de tránsito. MÉTODOS: Para la identificación de las variables se recolectó información directa de la actividad del transporte escolar por medio de grupos de enfoque, con asistentes de ruta y conductores de estos vehículos, la filmación interior de autobuses durante el transporte de los niños, y el registro de dimensiones de componentes en diferentes tipos de autobuses escolares. El análisis de la información recolectada se hizo mediante el software Atlas ti v6 y, la construcción del modelo, por medio de un proceso deductivo. RESULTADOS: Se encontraron relaciones importantes entre la adopción de posturas potencialmente riesgosas por parte de los niños durante el transporte escolar y las características dimensionales de los asientos y cinturones de seguridad, las características del servicio de transporte y el rol del asistente de ruta. CONCLUSIONES: Para llevar a cabo intervenciones coherentes y específicas en el ámbito de la seguridad en el transporte escolar, se deben considerar no solo aspectos técnicos concernientes al vehículo o condiciones posturales controladas en pruebas de choque en laboratorio, sino también las variables específicas de la actividad que llevan a los niños a adoptar posturas que incrementan el riesgo de lesiones.

OBJECTIVE: Prepare a conceptual model that facilitates understanding of the relationships between the variables that lead children to adopt postures in school transportation vehicles that increase injuries in traffic accidents. METHODS: For identification of the variables, direct information on school transportation was collected through focus groups, with bus aides and bus drivers, on-board filming during the transport of children, and recording of the dimensions of components in different types of school buses. The information collected was analyzed using the Atlas.ti v6 software and the construction of a model through deduction. RESULTS: Important relationships were found between adoption of potentially hazardous postures by children during transport to and from school and the seat and seat belt dimensions, the characteristics of the transportation service, and the role of bus aides. CONCLUSIONS: In order to adopt coherent interventions in school transportation safety, it is necessary to consider not only the technical aspects of the vehicle or posture that are controlled in crash tests but the specific variables of the activities that lead children to adopt postures that put them at greater risk of injury.

Facial trauma in the largest city in Latin America, São Paulo, 15 years after the enactment of the compulsory seat belt law

Traffic accidents are a reality throughout Brazil. The face is one of the anatomic parts most affected by these accidents, especially when a seat belt is not used. These accidents are costly for the public health system and have a significant impact on society and the lives of families involved. The compulsory use of seat belts in Brazil, especially in São Paulo, has decreased the rate of facial trauma. This suggests that the public health policies and measures adopted by the Brazilian authorities have benefited the population 15 years after the enactment of the law of compulsory seat belts in the city of São Paulo.

Utilização de assentos de segurança por crianças matriculadas em creches / Child safety restraint use among children attending day care centers

OBJETIVO: Estimar a prevalência de utilização de assentos de segurança infantil e fatores associados. MÉTODOS: Estudo transversal observacional, com amostragem estratificada, realizado em 15 creches da cidade de Maringá, PR, entre os meses de março e maio de 2007. Cada creche foi visitada em apenas um dia letivo. O desfecho considerado foi a utilização de assento de segurança infantil por crianças de até quatro anos de idade. Carros (N=301) que transportavam crianças menores de quatro anos de idade foram abordados e as informações foram coletadas por meio de questionários semi-estruturados. Variáveis relacionadas a distribuição de adultos e crianças nos assentos do veículo, situação de restrição dos ocupantes e sexo do condutor foram analisadas. Para análise dos dados aplicou-se o teste exato de Fisher, qui-quadrado de Mantel-Haenszel e regressão logística. RESULTADOS: Entre os motoristas abordados, 51,8 por cento usavam cinto de segurança (60,4 por cento das mulheres, 44,9 por cento dos homens). Entre as crianças, 36,1 por cento usavam assentos de segurança infantil, 45,4 por cento eram transportadas soltas, 16,0 por cento estavam no colo de adultos, 2,7 por cento usavam o cinto de segurança. Segundo a regressão logística, os fatores que mais influenciaram o uso dos assentos de segurança infantil foram: idade da criança inferior a 15 meses (OR= 3,76), uso de cinto de segurança pelo condutor (OR= 2,45) e crianças pertencentes aos estratos sociocupacionais de maior renda e escolaridade (OR= 1,37). CONCLUSÕES: A utilização de assentos de segurança infantil mostrou-se associada à idade da criança, uso de cinto de segurança pelo condutor e estrato sociocupacional da creche. Frente ao baixo índice de utilização, o uso dos assentos de segurança infantil surge como desafio à medicina preventiva no Brasil, exigindo atenção e atuação para sua disseminação na população.

OBJECTIVE: To estimate the prevalence of child safety restraint use and factors associated. METHODS: Observational cross-sectional study using a stratified sampling conducted in the city of Maringá, Southern Brazil, between March and May 2007. Each day care center was visited at one day only. The outcome was use of child safety restraints by children under four. Vehicles (N=301) driving children under four were approached and information was collected using semi-structured questionnaires. Variables regarding child and adult seat distribution, use of safety restraints by occupants and driver's gender were analyzed. Data analyses included Fisher's exact test, Mantel-Haenszel chi-square test, and logistic regression. RESULTS: Of the drivers approached, 51.8 percent were using seat belts (60.4 percent among women, 44.9 percent among men). Among children, 36.1 percent were using child safety seats, 45.4 percent were unrestrained during traveling, 16.0 percent were seated on an adult lap, and 2.7 percent were using seat belts. The logistic regression showed the following factors affecting child safety restraint use: child age under 15 months (OR = 3.76); seat belt use by the driver (OR = 2.45); and children from socio-occupational condition with higher income and education (OR = 1.37). CONCLUSIONS: Child safety restraint use was associated to child age, seat belt use by the driver, and socio-occupational condition of day care centers. The finding of low rates of child safety restraint use poses a challenge to preventive medicine in Brazil, requiring attention and action to promote its widespread use.

El respeto a las normas de tránsito en la cuidad de Santa Fe, Argentina / Traffic law compliance in the city of Santa Fe, Argentina

Se realizó un estudio de campo observacional descriptivo para evaluar el cumplimiento de algunas normas de tránsito en la ciudad de Santa Fe, Argentina, y comparar los resultados con mediciones realizadas anteriormente. Para ello, entre el 2 y el 4 de enero de 2006, se verificó en 13 sitios de la ciudad el cumplimiento de las normas que obligan a los automovilistas a usar cinturón de seguridad y a llevar a los menores de 10 años en el asiento trasero, y a los motociclistas, a conducir con casco y a no transportar menores. Las observaciones abarcaron 4 173 automóviles y 1 013 motocicletas. Solo 9 por ciento de los conductores de automóviles usaban el cinturón de seguridad. En 56 por ciento de los 246 automóviles que transportaban menores, estos se hallaban en el asiento delantero. En cuanto a los motociclistas, solo 12 por ciento usaba casco y 6,7 por ciento transportaba niños. Al comparar estas observaciones con cinco registros anuales anteriores, se comprobó que en los últimos tres años disminuyeron los porcentajes de acatamiento de estas normas de tránsito. Los resultados de este estudio sugieren que la mayoría de los conductores de vehículos de la ciudad argentina de Santa Fe viola las normas de tránsito consideradas. Para lograr disminuir la elevada mortalidad por accidentes viales no basta con contar con leyes de tránsito y organizar campañas de información, sino que, además, es necesario implementar sistemas que vigilen el cumplimiento de las normas.

An observational, descriptive study was conducted to evaluate compliance with certain traffic regulations in city of Santa Fe, Argentina, and compare these with measurements taken in prior years. During January 2-4, 2006, at 13 sites across the city, compliance with the following traffic rules was measured: for car drivers: seat belt use and restricting minors to the rear seat; and for motorcycle drivers: helmet use and not carrying a minor on board. At total of 4 173 cars and 1 013 motorcycles were observed. Only 9 percent of the car drivers wore seatbelts. Of the 246 cars carrying minors, 56 percent had a minor in the front seat. Regarding the motorcycles drivers, only 12 percent wore a helmet and 6.7 percent had a child on board. When these observations were compared with those of the previous five years, findings showed that over the past three years compliance rates had decreased. The results of this study suggest that most drivers in city of Santa Fe do not obey the stated traffic laws. In order to reduce the high rate of mortality from traffic accidents, in addition to legislation and public-awareness campaigns, a system for enforcing compliance is needed.

Injury Patterns of Front-seat Passengers without Seat Belts in Traffic Crashes

PURPOSE: This study aimed to investigate the injury patterns of unrestrained front-seat passengers in traffic crashes. METHODS: Using 2000~2003 data from the Jeonbuk Provincial Police Agency and medical-chart review, we estimated the relationship between crash patterns and individual variables, such as age, sex, Injury Severity Score, prehospital care, outcome, injury types, passenger seats, velocity, and alcohol consumption. We also investigated whether the Injury Severity Score correlated with crash patterns, passenger seats, velocity, prehospital care, and alcohol consumption. RESULTS: The mean Injury Severity Scores in frontal and rollover crashes were 15.0(+/-0.7) and 22.6(+/-3.3), respectively and the difference was statistically significant (p<0.05). The mortality rate was higher in rollover crashes than in frontal crashes (p<0.05). The most common type of injury in unrestrained passengers during frontal and rollover crashes was head and face injury. In addition, chest and lumbar spine injuries were more common in rollover crashes than in frontal crashes, and this difference had statistical significance (p<0.05). The Injury Severity Score correlated with the crash patterns (rho=0.25, p<0.01), overspeeding (rho=0.44, p<0.01), prehospital care (rho=0.25, p<0.01), and alcohol consumption (rho=0.18, p<0.05). CONCLUSION: We estimate that rollover crashes are associated with an increased risk of injury to and death for frontseat passengers compared to frontal collisions. Knowledge of injury mechanisms should help emergency physicians to promptly evaluate all areas at risk, as well as the potential for fatality.