Child restraint use in motor vehicles in Shanghai, China: a multiround cross-sectional observational study.

OBJECTIVES: While appropriate child restraint use in motor vehicles can reduce the risk of injuries or deaths, few previous studies have assessed child restraint practice in China. We aim to describe the prevalence of child restraint use and investigate risk factors affecting child restraint practice in Shanghai, China. DESIGN AND SETTING: A cross-sectional observational study was conducted near children's hospitals, kindergartens, entertainment places and shopping malls in Shanghai, China. PARTICIPANTS: Eight rounds of data were collected between October 2015 and April 2019 with a total sample size of 12 061 children. PRIMARY OUTCOME MEASURES: At each site, trained field workers observed and recorded child restraint use in all passing motor vehicles with at least one child passenger. RESULTS: The overall child safety restraint use rate was 6.42%. Child restraint use rate rose over time, from 5.12% in round 1% to 8.55% in round 8 (p<0.001). Results from the adjusted logistic regression model showed that children occupants with the following risk factors had a higher likelihood of child restraint use: children younger than 5 years compared with those aged 5-12 years (OR 2.12; 95% CI 1.78 to 2.53; p<0.001), sitting in rear seat compared with those in front seat (OR 31.80; 95% CI 4.45 to 227.14; p=0.001), children occupants observed near entertainment places (OR 2.34; 95% CI 1.67 to 3.28; p<0.001) or near shopping malls (OR 1.86; 95% CI 1.36 to 2.55; p<0.001) compared with those near children's hospitals and transportation in the morning compared with afternoon (OR 1.30; 95% CI 1.04 to 1.62; p=0.021). CONCLUSIONS: The overall child safety restraint use rate was low in Shanghai. Our findings may shed light on monitoring child restraint practice and have implications for intervention programmes for children occupants with the identified risk factors, which may help to promote child restraint use in motor vehicles and prevent road traffic injuries or deaths.

Performance of injury severity measures in trauma research: a literature review and validation analysis of studies from low-income and middle-income countries.

INTRODUCTION: Characterisation of injury severity is an important pillar of scientific research to measure and compare the outcomes. Although majority of injury severity measures were developed in high-income countries, many have been studied in low-income and middle-income countries (LMICs). We conducted this study to identify and characterise all injury severity measures, describe how widely and frequently they are used in trauma research from LMICs, and summarise the evidence on their performance based on empirical and theoretical validation​ analysis. METHODS: First, a list of injury measures was identified through PubMed search. Subsequently, a systematic search of PubMed, Global Health and EMBASE was undertaken on LMIC trauma literature published from January 2006 to June 2016, in order to assess the application and performance of injury severity measures to predict in-hospital mortality. Studies that applied one or more global injury severity measure(s) on all types of injuries were included, with the exception of war injuries and isolated organ injuries. RESULTS: Over a span of 40 years, more than 55 injury severity measures were developed. Out of 3862 non-duplicate citations, 597 studies from 54 LMICs were listed as eligible studies. Full-text review revealed 37 studies describing performance of injury severity measures for outcome prediction. Twenty-five articles from 13 LMICs assessed the validity of at least one injury severity measure for in-hospital mortality. Injury severity score was the most commonly validated measure in LMICs, with a wide range of performance (area under the receiver operating characteristic curve (AUROC) between 0.9 and 0.65). Trauma and Injury Severity Score validation studies reported AUROC between 0.80 and 0.98. CONCLUSION: Empirical studies from LMICs frequently use injury severity measures, however, no single injury severity measure has shown a consistent result in all settings or populations and thus warrants validation studies for the diversity of LMIC population.