Patterns and correlates of supervision in child pedestrian injury. The Kids 'N' Cars Research Team.

Described supervision in 142 child pedestrian injuries (PI), based on presence and proximity of supervisors and/or peers. Children (5-12 years), families, sites, and PI events were described via record reviews, interviews, questionnaires, and site investigation. Supervision of PI victims varied with family size and cohesion, and with children's age, self-help skills, nearness to home, and activity (playing or journey). Peer presence was associated with more impulsive behavior among supervised (but not among unsupervised) PI victims. Definitions of supervision parameters offered here can aid research on the complex relationship between supervision and PI risk.

Supervision in childhood injury cases: a reliable taxonomy.

This paper describes the development of the "Chicago Children's Supervision Taxonomy" which operationally defines supervision based on the age of an injured child and the ages, familiarity, and proximity of that child's companions. The reliability, coverage, and utility of this taxonomy are illustrated by its application to 142 cases of urban childhood pedestrian injury. All cases were unambiguously classified with good interrater reliability. Most injured children were in unsupervised groups (42%) but 36% had supervisors nearby, thus, supervisor presence does not guarantee protection. Supervising more than one child (especially likely when the supervisor was a teenager) may increase injury risk compared with one-to-one supervision. The taxonomy provides a needed framework adaptable for describing direct supervision in most child injury situations and can facilitate studies of more complex aspects of supervision.

Evaluation of a systematic approach for identifying injury scenarios. Kids'n' Cars Teams.

OBJECTIVE: To assess the effectiveness of a new multidisciplinary method for reconstructing the causal sequences that lead to child pedestrian injuries. SETTING: Subjects were 5-12 year old residents of Chicago, Illinois, USA, presenting for care due to pedestrian injury at one pediatric trauma center. METHODS: The interactions of medical, child, psychosocial, and traffic factors contributing to the injury were analysed. For 142 cases, information about the victim, his/her family, the injury site, and the activities just before the injury, was used in a structured manner by a multidisciplinary team to produce injury scenarios. Each scenario comprised a list of contributing factors, an estimate of the importance of each, and a narrative description of the causal sequence leading to the injury event. Face validity was assessed by two outside teams that performed a structured review of a subsample of cases (n = 11). Reliability was evaluated by comparison of the results of parallel teams assessing the same cases (n = 14). Process consistency and bias were assessed by analysis of the correlations of factor-importance rating patterns between members and over time. RESULTS: The outside team's agreement scores were based on a 1-5 Likert scale; these showed a mean of 3.6 and median of 4.0. Parallel teams consistently showed agreement greater than 85% on global attributes of cases. Intraclass correlation coefficient scores showed fair or better agreement for all classes of contributors, and excellent agreement for more than one third. Rating pattern analyses showed strong agreement by team members. Agreement did not increase over the period of the study. CONCLUSIONS: This causal sequence reconstruction method has acceptable face validity, reliability, and internal consistency. Although labor intensive and thus costly, it can produce unique, rich information for understanding injury causation and for guiding the search for promising interventions.

Child pedestrian injury taxonomy based on visibility and action.

With data from multidisciplinary investigations of child pedestrian injuries in Chicago, a new and simpler four-category taxonomy is presented based on the process that led to the collision. Two dimensions are recognized: the visibility of the child and/or the vehicle immediately prior to the event and the rapidity of action, either movement or change in direction, of the victim or the vehicle. The taxonomy is neutral with respect to responsibility for the collision and accommodates the findings of other researchers. This classification scheme is tested empirically using objective data elements such as child gender and age and event location. It is further tested using the results of a multidisciplinary causal sequence reconstruction of each injury event, based on such factors as child's psychological character, traffic risks, driver behavior, visibility obstructions, whether the child negotiated part of the street before being struck, and child's activities immediately prior to the injury. The results show that events in the categories in this new taxonomy are distinctly different from each other, and that the structure is useful for identifying and organizing interventions.

Childhood pedestrian injury: a pilot study concerning etiology.

For U.S. children of preschool and school age, fatal pedestrian injury is more common than fatal passenger injury, but there is no agreement on preventive approaches and their efficacy. Development of preventive measures requires understanding of how and why such injuries occur, which in turn requires better methods to sort out the many factors which appear to contribute to the problem. In an attempt to develop the broadest possible picture of the dynamics of child pedestrian injury, a multidisciplinary process was developed to collect and interpret medical, traffic, social, psychological and behavioral information concerning specific injury events. In a pilot study, the process was used to study six pedestrian injuries. The pilot study indicated that: the multidisciplinary approach identified possible etiologic factors missed without it; this approach requires the availability of high quality medical information and police accident records; biological, psychological, and social characteristics of victims, victim families and communities appear to affect the occurrence of child pedestrian injuries; and, such victim factors must be considered in development of countermeasures. It is concluded that the technique of multidisciplinary analysis merits further application as a productive way to generate quantitatively testable hypotheses concerning childhood pedestrian injury causality and potential countermeasures.

Threats to the validity of emergency medical services evaluation: a case study of mobile intensive care units.

Much of the literature concerning emergency medical services evaluation has been criticized as unconvincing. Several sources of invalidity have comprised the interpretability of these studies. When true randomized experiments cannot be accomplished, quasi-experimental research designs offer greater interpretability than the more often used pre-experimental designs. In using quasi-experimental research designs, special attention must be given to threats to internal validity. A case study describes an evaluation of mobile intensive care units. The paper describes eighteen threats to the validity of the evaluation, as well as the methods used for their control. Whether or not evaluators can control all of the threats to the validity of their studies, these threats should be identified and their potential effects assessed wherever possible.