Characteristics of child passenger deaths and injuries involving drinking drivers.

CONTEXT: Motor vehicle-related injury is the leading cause of death for children and young adults aged 1 to 24 years in the United States. Approximately 24% of child traffic deaths involve alcohol. OBJECTIVE: To examine characteristics of crashes involving child passenger deaths and injuries associated with drinking drivers to identify opportunities for prevention. DESIGN, SETTING, AND PARTICIPANTS: Descriptive epidemiological analysis of 1985-1996 datafrom the Fatality Analysis Reporting System on deaths among US child passengers (aged 0-14 years) and 1988-1996 data from the General Estimates System on nonfatal injuries. MAIN OUTCOME MEASURES: Child passenger death or injury by driver characteristics (eg, driver age, blood alcohol concentration, and driving history). RESULTS: In 1985-1996, there were 5555 child passenger deaths involving a drinking driver. Of these deaths, 3556 (64.0%) occurred while the child was riding with a drinking driver; 67.0% of these drinking drivers were old enough to be the parent or caregiver of the child. Of all drivers transporting a child who died, drinking drivers were more likely than nondrinking drivers to have had a previous license suspension (17.1% vs 7.1%) or conviction for driving while intoxicated (7.9% vs 1.2%). Child restraint use decreased as both the child's age and the blood alcohol concentration of the child's driver increased. In 1988-1996, an estimated 149,000 child passengers were nonfatally injured in crashes involving a drinking driver. Of these, 58,000 (38.9%) were riding with a drinking driver when injured in the crash. CONCLUSIONS: These data indicate that the majority of drinking driver-related child passenger deaths in the United States involve a child riding unrestrained in the same vehicle with a drinking driver. Typically, the drinking driver transporting the child is old enough to be the child's parent or caregiver.

Injury prevention practices as depicted in G-rated and PG-rated movies.

BACKGROUND: Previous studies on alcohol, tobacco, and violence suggest that children's behavior can be influenced by mass media; however, little is known about the effect of media on unintentional injuries, the leading cause of death among young persons in the United States. OBJECTIVE: To determine how injury prevention practices are depicted in G-rated (general audience) and PG-rated (parental guidance recommended) movies. DESIGN: Observational study. SETTING: The 25 movies with the highest domestic box-office grosses and a rating of G or PG for each year from 1995 through 1997. Movies that were predominantly animated or not set in the present day were excluded from analysis. SUBJECTS: Movie characters with speaking roles. MAIN OUTCOME MEASURES: Safety belt use by motor vehicle occupants, use of a crosswalk and looking both ways by pedestrians crossing a street, helmet use by bicyclists, personal flotation device use by boaters, and selected other injury prevention practices. RESULTS: Fifty nonanimated movies set in the present day were included in the study. A total of 753 person-scenes involving riding in a motor vehicle, crossing the street, bicycling, and boating were shown (median, 13.5 person-scenes per movie). Forty-two person-scenes (6%) involved falls or crashes, which resulted in 4 injuries and 2 deaths. Overall, 119 (27%) of 447 motor vehicle occupants wore safety belts, 20 (18%) of 109 pedestrians looked both ways before crossing the street and 25 (16%) of 160 used a crosswalk, 4 (6%) of 64 bicyclists wore helmets, and 14 (17%) of 82 boaters wore personal flotation devices. CONCLUSIONS: In scenes depicting everyday life in popular movies likely to be seen by children, characters were infrequently portrayed practicing recommended safe behaviors. The consequences of unsafe behaviors were rarely shown. The entertainment industry should improve its depiction of injury prevention practices in G-rated and PG-rated movies.

Expanding the National Electronic Injury Surveillance System to monitor all nonfatal injuries treated in US hospital emergency departments.

STUDY OBJECTIVE: Injury is a major cause of morbidity and mortality in the United States. Although the National Vital Statistics System provides data on injury-related deaths, a national surveillance system is needed for timely identification of emerging nonfatal injury problems and continuous monitoring of severe nonfatal injuries. This work assesses the feasibility of expanding the National Electronic Injury Surveillance System (NEISS) to monitor all types and causes of nonfatal injuries treated in US hospital emergency departments and reports national estimates generated by a pilot study of this system. METHODS: At a stratified sample of US hospital EDs, persons receiving first-time treatment for an injury were monitored from May 1 through July 31, 1997. National estimates of the annual number and rate of ED-treated injuries overall, by patient characteristics, injury diagnosis, and external cause of injury were generated, and the sensitivity of the system for detecting ED-treated injuries was assessed. RESULTS: An estimated 29. 1 million injuries were treated in US EDs in 1997 (rate of 108.6/1, 000 population). The leading causes of injury were falls, being struck by or striking against an object or person, cutting or piercing, and motor vehicle traffic. Of 593 cases of injury detected by investigators from the Centers for Disease Control and Prevention during visits to 6 of the 21 NEISS hospitals in the study, 490 were also detected by NEISS coders for an overall sensitivity of 82.6%. CONCLUSION: Expanding the NEISS is a feasible means of timely and continuous monitoring of all types and causes of nonfatal injuries treated in US hospital EDs.

Exposure to and compliance with pediatric injury prevention counseling--United States, 1994.

BACKGROUND: Because injuries are the leading cause of death in children, injury prevention counseling is recommended as part of routine pediatric care. Increasing such counseling is a national health objective. Estimating the proportion of US children who receive such counseling and assessing their compliance with safety recommendations may help improve counseling efforts. METHODS: Respondents to a 1994 random digit-dial telephone survey of the US population were asked about receipt of age-appropriate injury prevention counseling at a medical visit and related safety practices for a randomly selected child 0 to 14 years of age in the household (N = 1596). RESULTS: Receiving any injury prevention counseling was reported for 39.3% of children 0 to 14 years old who had a medical visit in the past year and was more common among children who were younger, lived in urban areas, and lived in poverty. In general, receiving counseling was associated with safer behaviors. Counseling about ipecac was reported for 17.2% of children 0 to 6 years old; having ipecac in the home was more likely for those counseled (73.4% vs 32.0%). Counseling about posting the poison control number was reported for 24.9% of children 0 to 6 years old; posting this number was more common among those counseled (79.3% vs 52.6%). Counseling about bicycle helmets was reported for 18.6% of children 5 to 14 years old; a report of always wearing a helmet was more common among those counseled (43.9% vs 19.1%). Counseling about car seats and safety belts was reported for 25.4% of children 0 to 14 years old; a report of always using occupant restraints was more common among those counseled (89.0% vs 78.2%). CONCLUSIONS: Injury prevention counseling is associated with reported preventive safety practices among US children, but a relatively small proportion of households with young children report receiving such counseling. Health care providers should increase efforts to provide injury prevention counseling. counseling, wounds and injuries, child, accident prevention.

Motor vehicle related injuries among American Indian and Alaskan Native youth, 1981-92: analysis of a national hospital discharge database.

OBJECTIVE: To describe national trends in hospitalizations for motor vehicle related injuries among children and youth (0-24 years) of the United States Indian Health Service (IHS) from 1981-92. DESIGN: Descriptive epidemiologic study of the E coded national hospital discharge database of the IHS. RESULTS: From 1981 to 1992, the age standardized annual incidence of motor vehicle related injury hospitalizations (per 100,000 population) among American Indian and Alaskan Native (AI/AN) youth decreased more than 65% from 269 to 93. Substantial declines in hospitalization rates for all age and sex groups, all IHS areas, and most injury types were seen over this time. Injuries to vehicle occupants accounted for 78% of all motor vehicle related injury hospitalizations. The annual incidence of hospitalization (per 100,000 population) ranged from 291 in the Billings (Wyoming/Montana) and Aberdeen (the Dakotas) areas to 38 in the Portland area (Pacific Northwest). CONCLUSIONS: National motor vehicle related injury hospitalization rates of AI/AN children and youth decreased significantly from 1981-92. This may be due to a reduction in the incidence of severe motor vehicle related trauma, changing patterns of medical practice, and changes in the use of services. Additional measures, such as passage and enforcement of tribal laws requiring the use of occupant restraints and stronger laws to prevent alcohol impaired driving, might further reduce the incidence of serious motor vehicle related injuries in this high risk population.

Injury control in practice. Home radiator burns in inner-city children.

OBJECTIVE: To describe thermal burns from radiators in the homes of children in the inner city and an intervention to decrease the risk for this pediatric injury. SETTING: Academic medical center in Chicago. PATIENTS: Case series of 10 radiator-related burns. RESULTS: The burns described were found to be clustered in an area of a public housing project served by steam radiators. No burns were associated with hot water radiators. Just 14% of housing units with young children had adequate radiator covers and radiator pipe insulation. Radiator covers and insulation have now been replaced or repaired in all units of the 11 housing project buildings served by steam radiators. CONCLUSIONS: Steam radiators in the home represent a particular childhood burn hazard. Community-based clinicians are in a unique position to recognize local patterns of injury and work with other agencies in injury control efforts.

Vitamin A and respiratory syncytial virus infection. Serum levels and supplementation trial.

OBJECTIVE: To determine the benefit of oral vitamin A supplementation for acute respiratory syncytial virus (RSV) infection. DESIGN: An observational study of vitamin A and retinol binding protein (RBP) levels in RSV-infected inpatients and two control groups; and a randomized, controlled trial of vitamin A supplementation for RSV-infected inpatients. SETTING: Two tertiary care, urban teaching hospitals. PARTICIPANTS: Thirty-two RSV-infected inpatients (aged 2 to 58 months), 35 hospitalized children without respiratory infections (aged 2 to 19 months), and 39 healthy outpatient controls (aged 2 to 67 months). INTERVENTION: The RSV-infected group was randomized to receive a single dose of 100,000 IU oral vitamin A or placebo. MAIN OUTCOME MEASURES: Serum vitamin A and RBP levels of all participants and clinical indicators of severity such as days of hospitalization, oxygen use, intensive care, intubation, and a daily severity score. RESULTS: Mean vitamin a and RBP levels were lower in RSV-infected children than in healthy controls (P > .05). Among RSV-infected children, those admitted to the intensive care unit had lower mean vitamin A (P = .03) and RBP levels (P = .04) than those not in intensive care. Among children hospitalized without respiratory infection, those admitted to the intensive care unit had lower mean vitamin A levels (P = .02) than those not in intensive care. In the RSV-infected children, no significant difference was seen between the vitamin A group (n = 21) and the placebo group (n = 11) in improvement in severity score, mean days of hospitalization, intensive care, or receipt of supplemental oxygen. CONCLUSIONS: Serum vitamin A and RBP levels were low in children hospitalized with RSV infection and were lower in children admitted to the intensive care unit. Hospitalized control patients in intensive care also had lower levels than those treated on the ward. We observed no benefit from oral vitamin A supplementation for children hospitalized with RSV infection.