The Effect of Changing the Angle of the Passenger Car Seat Backrest on the Head Trajectories of the 50th Percentile Male Dummy.

The aim of the study is to compare the head displacement of the KPSIT C50 dummy during a frontal collision at a speed of 20 km/h, along with the change in the angle of the car seat backrest. Passenger car manufacturers recommend setting the backrest angle of the car seat between 100 and 125 degrees. It should be noted that the driver's position is of great importance in the event of a collision injury. In the event of a rear-end collision, the position of the headrest of the car seat is an element that affects the degree of the driver's injuries. In extreme cases, incorrect positioning of the headrest, even at low speed, can lead to serious injuries to the cervical spine and even death. The article is part of a large-scale study on low-speed crash testing. The research problem concerned the influence of the seat backrest angle on the head displacement during a low-speed collision. The article compares the displacement of the head of the KPSIT C50 dummy during a series of crash tests, where the angle of the car seat backrest was changed. On the basis of the research, it was found that the optimal angle of the car seat backrest is 110 degrees. In addition, a preliminary analysis of the displacements of the dummy's head showed a high risk of whiplash injury in people sitting in a fully reclined seat.

Seat belt use and cardiac arrest immediately after motor vehicle collision: Nationwide observational study.

Objective: Motor vehicle collisions (MVCs) are known to cause traumatic cardiac arrest; it is unclear whether seat belts prevent this. This study aimed to evaluate the association between seat belt use and immediate cardiac arrest in cases of MVCs. Method: This cross-sectional observational study used data from a nationwide EMS-based severe trauma registry in South Korea. The sample comprised adult patients with EMS-assessed severe trauma due to MVCs between 2018 and 2019. The primary, secondary, and tertiary outcomes were immediate cardiac arrest, in-hospital mortality, and death or severe disability, respectively. We calculated the adjusted odds ratios (AORs) of immediate cardiac arrest with seat belt use after adjusting for potential confounders. Results: Among the 8178 eligible patients, 6314 (77.2 %) and 1864 (29.5 %) were wearing and not wearing seat belts, respectively. Immediate cardiac arrest, mortality, and death/severe disability rates were higher in the "no seat belt use" group than in the "seat belt use" group (9.4 % vs. 4.0 %, 12.4 % vs. 6.2 %, 17.7 % vs. 9.9 %, respectively; p < 0.001). The former group was more likely to experience immediate cardiac arrest (AOR [95 %CI]: 3.29 [2.65-4.08]), in-hospital mortality (AOR [95 %CI]: 2.72 [2.26-3.27]), and death or severe disability (AOR [95 %CI]: 2.40 [2.05-2.80]). Conclusion: There was an association between wearing seat belts during MVCs and a reduced risk of immediate cardiac arrest.

Breast Reconstruction after Blunt Breast Trauma: Systematic Review and Case Report Using the Ribeiro Technique.

Blunt breast trauma occurs in 2% of blunt chest injuries. This study aimed to evaluate the evidence on breast reconstruction after blunt trauma associated with the use of a seat belt. Also, we describe the first case of breast reconstruction using the Ribeiro technique. In November 2022, a systematic search of MEDLINE, EMBASE, and Google Scholar databases was conducted. The literature was screened independently by two reviewers, and the data was extracted. Our search terms included breast, mammoplasty, blunt injury, and seat belts. In addition, we present the case of a woman with a left breast deformity and her reconstruction using the inferior Ribeiro flap technique. Six articles were included. All included studies were published between 2010 and 2021. The studies recruited seven patients. According to the Teo and Song classification, seven class 2b cases were reported. In five cases a breast reduction was performed in the deformed breast with different types of pedicles (three superomedial flaps, one lower flap, one superior flap). Only one case presented complications. The case here presented was a type 2b breast deformity in which the lower Ribeiro pedicle was used successfully without complications during follow-up. Until now there has been no consensus on reconstructive treatment due to the rarity of this entity. However, we must consider surgical treatment individually for each patient. We believe that the Ribeiro technique is a feasible and safe alternative in the treatment of posttraumatic breast deformities, offering very good long-term results.

The effect of seatbelt pre-tensioners and load limiters in the reduction of MAIS 2+, MAIS 3+, and fatal injuries in real-world frontal crashes.

Contemporary research has pointed out that while newer cars are contributing to the decrease of AIS2+ and AIS3+ injuries in several body regions, this effect is not shown for thoracic injuries like rib or sternal fractures. The objective of this study is to assess the effectiveness of advanced seat belt systems incorporating pre-tensioners and load limiters in the prevention of fatal, AIS2+ and AIS3+ injuries overall and then focus only on the head-face-neck and thoracic areas. Data from the NASS CDS database between 2000 and 2015 was augmented with specific vehicle information taken from NHTSA's NCAP tests to identify the characteristics of the seat belt of each vehicle involved in a collision. Multivariate logistic regressions were developed to assess the likelihood of injuries for belted front seat occupants in frontal impacts. The presence of pre-tensioners and load limiters with a low load limiter (<4.5 kN) was significantly associated with a decreased risk of fatal and AIS3+ in the whole body (OR = 0.31 (p < 0.05) and OR = 0.70 (p < 0.1)), while high load limiters were significant in the prevention of fatal injuries (OR = 0.42). These effects should be considered always in combination with the delta-v of the collision, as the interaction term between delta-v and advanced seat belt features was significant. In the crashes considered, the model predicted a higher risk of injury for women compared to men, controlling for other occupant and crash factors. Impacts with a slightly oblique component increased the risk of injury compared to pure frontal impacts. After controlling for the presence of pre-tensioners and load limiters, the vehicle model year variable was found to be insignificant in any of the regression models. This study shows that the real-world effectiveness of advanced seat belts still requires further analysis. Other effects like age or impact direction might be more influential in the injury outcome than these seat belt features.

Piloting a hospital-based road traffic injury surveillance system in Nairobi County, Kenya, 2018-2019.

BACKGROUND: Kenya's estimated road traffic injury (RTI) death rate is 27.8/100,000 population, which is 1.5 times the global rate. Some RTI data are collected in Kenya; however, a systematic and integrated surveillance system does not exist. Therefore, we adopted and modified the World Health Organization's injury surveillance guidelines to pilot a hospital-based RTI surveillance system in Nairobi County, Kenya. METHODS: We prospectively documented all RTI cases presenting at two public trauma hospitals in Nairobi County from October 2018-April 2019. RTI cases were defined as injuries involving ≥1 moving vehicles on public roads. Demographics, injury circumstances, and outcome information were collected using standardized case report forms. The Kampala Trauma Score (KTS) was used to assess injury severity. RTI cases were characterized with descriptive statistics. RESULTS: Of the 1,840 RTI cases reported during the seven-month period, 73.2% were male. The median age was 29.8 years (range 1-89 years). Forty percent (n = 740) were taken to the hospital by bystanders. Median time for hospital arrival was 77 min. Pedestrians constituted 54.1% (n = 995) of cases. Of 400 motorcyclists, 48.0% lacked helmets. Similarly, 65.7% of bicyclists (23/35) lacked helmets. Among 386 motor vehicle occupants, 59.6% were not using seat belts (19.9% unknown). Seven percent of cases (n = 129) reported alcohol use (49.0% unknown), and 8.8% (n = 161) reported mobile phone use (59.7% unknown). Eleven percent of cases (n = 199) were severely injured (KTS <11), and 220 died. CONCLUSION: We demonstrated feasibility of a hospital-based RTI surveillance system in Nairobi County. Integrating information from crash scenes and hospitals can guide prevention.

Seat belt laws and prevalence of use among high school students in the United States.

PURPOSE: To examine the association between state seat belt laws and the prevalence of seat belt use among a nationally representative sample of teenagers in the United States, taking into consideration state-specific child restraint laws that could affect teenagers of different ages. METHODS: Data were from the 2019 state Youth Risk Behavior Survey. We estimated prevalence ratios using modified Poisson regression with robust variance estimates to evaluate associations between state seat belt laws and seat belt use. RESULTS: Among, 81,929 high school students under 18 from 36 states, 56% always wore a seat belt when someone else was driving. Relative to students in states with secondary enforcement of seat belt laws, students living in states with primary enforcement were 5% more likely (aPR = 1.05, 95% CI: 0.99, 1.11), and students covered by a child restraint law were 6% more likely to always wear a seat belt (aPR = 1.06, 95% CI: 0.99, 1.12) after adjusting for age, sex, race/ethnicity, and graduated driver licensing laws. CONCLUSIONS: States with secondary seat belt enforcement should consider upgrading seat belt laws to potentially improve the prevalence of seat belt use among adolescents, potentially reducing injuries and deaths due to motor vehicle crashes.

Changes in Pediatricians' Child Passenger Safety Counseling With Initiation of a Booster Seat Program.

Booster seats reduce injury in motor vehicle crashes, yet they are used less frequently than car seats and seat belts. Primary care providers are well positioned to educate and encourage families to use booster seats. We aimed to assess how a booster seat distribution program affected the documentation of restraint usage and anticipatory guidance at well-child visits at a pediatric primary care practice. We performed a retrospective chart review of patients aged 4 to 12 years from June to December in 2019 and 2020, representing before and after a booster seat program. The most frequently documented restraints in 2019 and 2020 were seat belts (51% vs 30%), booster seats (25% vs 27%), and not documented/unclear (17% vs 25%) (P < .001). The program significantly increased referrals for booster seats (P < .001). Despite significant differences in the proportion of children in each restraint category, overall booster seat use was similar between years.

Evaluating pediatric car safety compliance in motor vehicle collisions: Identifying high-risk groups for improper restraint usage.

PURPOSE: To identify patient factors associated with improper restraint usage and worse trauma outcomes for pediatric patients involved in motor vehicle collisions (MVCs). METHODS: Retrospective study performed at a Level I pediatric trauma center for patients (≤18 yr) evaluated after MVC between 2008 and 2018. The Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage (NSD) levels based on the patient's home address. Trauma registry data was correlated to ADI and used to analyze appropriate restraint usage by NSD. Proper restraint practices were defined based on national guidelines and state laws. Demographics and clinical outcomes were also analyzed. Chi-square analysis with Bonferroni corrections was used to assess the association of ADI, race, and ethnicity with proper restraint usage. RESULTS: Among 1152 patients included, approximately 50% were male, the median age was 7 years [IQR 4-10], and 53% were of Hispanic ethnicity. Hispanic patients comprised 73% of children in ADI quintile 5 (greatest NSD), yet only 26% of children in ADI quintile 1 (least NSD). No differences were observed across clinical data and outcomes. Hispanic children <8 yr were significantly less likely to be in a car seat/booster seat compared to non-Hispanic children (OR 0.69, 95% CI 0.50-0.95, p = 0.025). Furthermore, those with greatest NSD (ADI quintile 5) had the largest proportion of unrestrained patients (21%, see Fig. 1). CONCLUSION: Hispanic children, especially those who require infant or booster seats (<8 yr), and children living in areas with greater neighborhood socioeconomic disadvantage demonstrated poorer restraint practices. ADI can successfully identify high-risk groups for targeted injury prevention programs and improved compliance in the most vulnerable neighborhoods. TYPE OF STUDY: Retrospective Study.

Recreational off-highway vehicle exposure, safety behaviors and crash experiences among adolescents.

BACKGROUND: Recreational off-highway vehicles (ROVs), often called utility task vehicles (UTVs), are designed to be driven by those ≥ 16 years and manufacturers recommend passengers be at least 12 years old. This study's objective was to determine Iowa adolescents' exposure to ROVs, riders' use of restraint devices, and crash prevalence. METHODS: Adolescents participating in the Safety Tips for ATV Riders (STARs) program at their schools were anonymously surveyed by the Iowa Off-Road Vehicle Safety Task Force from Fall 2014-Fall 2019. Frequency, bivariate (chi square and Fisher's exact test) and logistic regression analyses were performed using SAS software, V.9.4. RESULTS: A total of 4,023 students (9-18 years) from 18 school districts participated. Overall, 68% reported having ridden in an ROV. The proportions having ridden an ROV by where participants lived were farm (85%) > country/not farm (73%) > town (60%), p < 0.0001. Of those asked additional ROV questions (n = 2152), 39% of ROV riders reported riding at least weekly in the previous 12 months. Of those riding ROVs in the past year, 29% reported having at least one crash. Males and respondents living on farms had higher percentages reporting crashes, as compared to females (31% vs. 24%, p = 0.005) and those living elsewhere (35% vs. 24%, p = 0.0003). Thirty-seven percent of ROV riders never or almost never wore their seatbelt. Seatbelt use was inversely proportional to age, p < 0.001. A higher proportion of females reported always or almost always wearing a seat belt (42% vs. 36%, p = 0.0016). Percentages never or almost never wearing seatbelts by residence were farm (47%) > country/not farm (38%) > town (32%), p = 0.0005. Almost daily riders and those reporting having been in a crash were both 1.7 times more likely to never or almost never wear a seatbelt as compared to infrequent riders and those without a crash, respectively. CONCLUSIONS: Iowa adolescents frequently ride ROVs and often without a seatbelt, putting them at greater risk for serious injury or death in a crash. Almost 30% of riders reported an ROV-related crash in the past year. Our study identified a high-risk population that could be targeted for ROV safety education and other injury prevention efforts.

The effectiveness of mass media campaigns in increasing the use of seat belts: A systematic review.

OBJECTIVE: This systematic review and meta-analysis was conducted to determine the effectiveness of mass media campaigns for increasing the use of seat belts among drivers and front seat passengers. METHODS: We systematically searched the PubMed, EMBASE, Web of Science (WOS), and Scopus databases from November 1974 until June 2020 to identify before-after studies investigating the effect of mass media campaigns on seat belt use. The quality of all included studies was assessed using the National Institute of Health (NIH) tool. Chi-Squared tests and the I2 statistic were used to evaluate inter-study heterogeneity, while the odds ratio (OR) was used as a measure of effect size. RESULTS: Of the 793 records initially identified, twenty articles were found to be appropriate for the current meta-analysis. Of these, 13, 5, and 2 studies were rated as good, fair, and poor quality, respectively. The meta-analysis finding using random effects model showed that mass media campaigns resulted in statistically significant increases in seat belt usage among drivers (OR= 1.40, 95% CI: 1.18- 1.68) and front seat passengers (OR= 1.54, 95% CI: 1.31- 1.82). Due to the presence of heterogeneity (I2: 99.7% for drivers; I2: 99.1% for front passengers), additional analyses were also undertaken. Sensitivity analyses showed that the pooled ORs remained consistent after removing each study one by one. Statistically significant increases in seat belt use among drivers were found in mass media campaigns which: had measurement periods longer than 12 months, were used in combination with enforcement activities, were published after 2000, and had good quality scores. CONCLUSION: The current meta-analysis found that mass media campaigns can lead to an increase in seat belt use among drivers and front passengers. However, these results should be interpreted with some degree of caution, due to the high degree of heterogeneity between studies and the fact that most of the studies were from high-income countries without control groups. Despite the apparent favorable impact of mass media campaigns, more robust long term studies are needed.

Differences in rural and urban drivers' attitudes and beliefs about seat belts.

In the United States, a disproportionate number of motor vehicle crash fatalities occur in rural areas. While many factors likely contribute to the discrepancy between fatality rates in rural and urban areas, prior studies suggest that rural drivers may be more likely to engage in risky driving behaviors like seat belt non-use. Although having favorable attitudes or beliefs about seat belts increases the likelihood of wearing them, few studies have investigated the possibility that lower rates of seat belt use in rural areas may result from a greater prevalence of unfavorable seat belt attitudes and beliefs-one part of a distinct rural "traffic safety culture." In the current study, we analyzed responses from the 2016 Motor Vehicle Occupant Safety Survey (MVOSS) to test the hypotheses that rural drivers are more likely than urban drivers to hold unfavorable attitudes and beliefs about seat belts, and that these unfavorable attitudes and beliefs predict lower self-reported seat belt use. We found that rural and urban drivers differed significantly on several seat belt attitudes and beliefs and that these differences persisted after controlling for possible demographic differences between rural and urban drivers. We also found that drivers who hold less favorable attitudes and beliefs were less likely to always wear their seat belts. However, even after accounting for demographic factors and differences in attitudes and beliefs, rural drivers continued to be less likely to report full-time seat belt use than urban drivers. Our findings suggest that rural drivers should be treated as a distinct market segment for seat belt messaging and public awareness campaigns, and that interventions designed to change the unfavorable attitudes and beliefs about seat belts held by rural drivers may help reduce the disparity between rural and urban traffic fatality rates.

Preventive effects of seat belts on traumatic brain injury in motor vehicle collisions classified by crash severities and collision directions.

PURPOSE: This study aimed to measure the preventive effect of seat belt on traumatic brain injury (TBI) and to compare the effect according to the crash severities and collision directions. METHODS: Korea In-Depth Accident Study (KIDAS) has collected vehicle and demographic data on injured occupants involved in motor vehicle collisions (MVCs) who visited three emergency medical centers for calendar years 2011-2016. Primary and secondary end points were TBI (abbreviated injury score 2+) and in-hospital mortality. Crush extent (CE) was classified into 1-2, 3-4, 5-6, and 7-9 according to the crash severity. We calculated adjusted odds ratios (ORs) of seat belts and CE for study outcomes and developed an interaction model in each collision direction using multivariate logistic regression analysis. RESULTS: Of the 2,245 occupants who were injured in MVCs, 295 (13.1%) occupants sustained TBI. In univariate analysis, old age, unbelted status, lateral collision, and higher CE were factors associated with TBI in MVCs. Occupants with belted status was less likely to have TBI and in-hospital mortality compared with those with unbelted status [AORs (95% CI) 0.48 (0.37-0.62) and 0.49 (0.30-0.81), respectively]. In interaction analysis, preventive effects of seat belts on TBI from MVCs were retained within CE 5-6 in frontal MVCs and within CE 1-2 in near side lateral MVCs, and those of seat belts on in-hospital mortality were reserved within CE 3-4 in frontal and rollover MVCs. CONCLUSIONS: The preventive effects of seat belts on TBI and in-hospital mortality are preserved within a limited crash severity in each collision direction.

State-level seat belt use in the United States, 2011-2016: Comparison of self-reported with observed use and use by fatally injured occupants.

INTRODUCTION: Despite 49 states and the District of Columbia having seat belt laws that permit either primary or secondary enforcement, nearly half of persons who die in passenger vehicle crashes in the United States are unbelted. Monitoring seat belt use is important for measuring the effectiveness of strategies to increase belt use. OBJECTIVE: Document self-reported seat belt use by state seat belt enforcement type and compare 2016 self-reported belt use with observed use and use among passenger vehicle occupant (PVO) fatalities. METHODS: We analyzed the Behavioral Risk Factor Surveillance System (BRFSS) self-reported seat belt use data during 2011-2016. The Pearson correlation coefficient (r) was used to compare the 2016 BRFSS state estimates with observed seat belt use from state-based surveys and with unrestrained PVO fatalities from the Fatality Analysis Reporting System. RESULTS: During 2011-2016, national self-reported seat belt use ranged from 86-88%. In 2016, national self-reported use (87%) lagged observed use (90%) by 3 percentage points. By state, the 2016 self-reported use ranged from 64% in South Dakota to 93% in California, Hawaii, and Oregon. Seat belt use averaged 7 percentage points higher in primary enforcement states (89%) than in secondary states (82%). Self-reported state estimates were strongly positively correlated with state observational estimates (r = 0.80) and strongly negatively correlated with the proportion of unrestrained PVO fatalities (r = -0.77). CONCLUSION: National self-reported seat belt use remained essentially stable during 2011-2016 at around 87%, but large variations existed across states. Practical Applications: If seat belt use in secondary enforcement states matched use in primary enforcement states for 2016, an additional 3.98 million adults would have been belted. Renewed attention to increasing seat belt use will be needed to reduce motor-vehicle fatalities. Self-reported and observational seat belt data complement one another and can aid in designing targeted and multifaceted interventions.

Using change in a seat belt law to study racially-biased policing in South Carolina.

Seat belt laws have increased seat belt use in the US and contributed to reduced fatalities and injuries. However, these policies provide the potential for increased discrimination. The objective of this study is to determine whether a change in seat belt use enforcement led to a differential change in the number of stops, arrests, and searches to White, Black and Hispanic drivers in one US state. We used data on 1,091,424 traffic stops conducted by state troopers in South Carolina in 2005 and 2006 to examine how the change from secondary to primary enforcement of seat belt use in December 2005 affected the number of stops, arrests, and searches to White, Black, and Hispanic drivers using quasi-Poisson and logistic regressions. We found that the policy led to a 50% increase in the number of non-speeding stops for White drivers, and that this increase was 5% larger among Black drivers [RR (95% CI) = 1.05 (1.00, 1.10)], but not larger among Hispanic drivers [1.00 (0.93, 1.08)]. The policy decreased arrests and searches among non-speeding stops, with larger decreases for Black vs. White drivers [RR searches = 0.86 (0.81, 0.91) and RR arrests = 0.90 (0.85, 0.96)]. For Hispanic drivers, effects of the policy change were also found among stops for speeding, which failed the falsification test and suggested that other changes likely affected this group. These findings may support the hypothesis of differential enforcement of seat belt policy in South Carolina for Black and White drivers.

Factors contributing to serious and fatal injuries in belted rear seat occupants in frontal crashes.

Objectives: Earlier research has shown that the rear row is safer for occupants in crashes than the front row, but there is evidence that improvements in front seat occupant protection in more recent vehicle model years have reduced the safety advantage of the rear seat versus the front seat. The study objective was to identify factors that contribute to serious and fatal injuries in belted rear seat occupants in frontal crashes in newer model year vehicles. Methods: A case series review of belted rear seat occupants who were seriously injured or killed in frontal crashes was conducted. Occupants in frontal crashes were eligible for inclusion if they were 6 years old or older and belted in the rear of a 2000 or newer model year passenger vehicle within 10 model years of the crash year. Crashes were identified using the 2004-2015 National Automotive Sampling System Crashworthiness Data System (NASS-CDS) and included all eligible occupants with at least one Abbreviated Injury Scale (AIS) 3 or greater injury. Using these same inclusion criteria but split into younger (6 to 12 years) and older (55+ years) cohorts, fatal crashes were identified in the 2014-2015 Fatality Analysis Reporting System (FARS) and then local police jurisdictions were contacted for complete crash records. Results: Detailed case series review was completed for 117 rear seat occupants: 36 with Maximum Abbreviated Injury Scale (MAIS) 3+ injuries in NASS-CDS and 81 fatalities identified in FARS. More than half of the injured and killed rear occupants were more severely injured than front seat occupants in the same crash. Serious chest injury, primarily caused by seat belt loading, was present in 22 of the injured occupants and 17 of the 37 fatalities with documented injuries. Nine injured occupants and 18 fatalities sustained serious head injury, primarily from contact with the vehicle interior or severe intrusion. For fatal cases, 12 crashes were considered unsurvivable due to a complete loss of occupant space. For cases considered survivable, intrusion was not a large contributor to fatality. Discussion: Rear seat occupants sustained serious and fatal injuries due to belt loading in crashes in which front seat occupants survived, suggesting a discrepancy in restraint performance between the front and rear rows. Restraint strategies that reduce loading to the chest should be considered, but there may be potential tradeoffs with increased head excursion, particularly in the absence of rear seat airbags. Any new restraint designs should consider the unique needs of the rear seat environment.

Seat belts-related behaviors in car drivers with cardiac implantable electronic devices.

BACKGROUND: Seat belt use is the single most effective means of reducing fatal injuries in road traffic accidents. The presence of a cardiac implantable electronic device (CIED) might influence seat belt-related behaviors due to the physical proximity of the seat belt and left subclavian area in which the device is usually implanted. Understanding the underlying mechanisms of improper seat belt use may improve safety of these patients. METHODS: We performed a prospective study using a structured questionnaire with 120 CIED recipients (age, 63.9 ± 10.9 years) attending a pacing outpatient clinic. All study participants were active drivers and predominantly male. The majority of patients (79%) had undergone high-energy device implantation. RESULTS: We found that 18% of study participants do not fasten seat belts on a regular basis or use the seat belt in an atypical fashion (such as under the armpit). Moderate or high level of discomfort from the interaction between seat belt and CIED was present in 27%, while more than half (51%) were afraid of seat belt-induced CIED damage. In multifactorial analysis, we found the following independent predictors of improper seat belt use: (1) at least moderate level of discomfort at the CIED site (P = 0.02); (2) fear of CIED damage (P = 0.009); and (3) irregular seat belt use prior to CIED implantation (P = 0.037). CONCLUSIONS: Improper seat belt-related behaviors are common in CIED recipients. They arise from previous habits and from CIED-related physical and psychological factors. Patients' education regarding the importance and safety of proper seat belt use is a priority.

Position of the abdominal seat belt sign and its predictive utility for abdominal trauma.

OBJECTIVE: In a motor vehicle crash, compressive forces from the lap component of the seat belt may produce an abdominal abrasion/contusion known as the 'seat belt sign', and is associated with abdominal and lumbar injuries. Previous research has not taken into account the position of this sign in relation to the anterior superior iliac spine (ASIS). Our aim was to demonstrate an association between the seat belt sign position in relation to ASIS and the presence of abdominal/lumbar injury. METHODS: A mixed prospective and retrospective observational study of patients involved in a motor vehicle crash was conducted. The presence of a seat belt sign was recorded as above ASIS, at/below ASIS, or none. Injury data were extracted from discharge summaries, radiology reports and operation reports. Proportions of patients with injuries were compared across the three groups. RESULTS: Four hundred and sixty-four participants were enrolled. For participants with a seat belt sign above ASIS, compared to those with no seat belt sign, the positive likelihood ratio for a seat belt related injury was 4.2 (95% CI 2.6-6.8). When the seat belt sign was at/below the level of ASIS the positive likelihood ratio was 1.5 (95% CI 0.4-5.7). CONCLUSION: The seat belt sign is associated with abdominal and lumbar injury; however, the location is important. This association is strong when the seat belt sign is above ASIS, but when the sign is at/below the ASIS the injury rate is similar to participants with no seat belt sign. Routine imaging of the abdomen may be appropriate only for those with a seat belt sign above ASIS.

Use of child safety seats during transportation of newborns.

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.

The effectiveness of child restraint and seat belt legislation in reducing child injuries: The case of Serbia.

OBJECTIVE: The objective of this study is to determine the short- and long-term impacts of Serbia's 2009 update of child restraint and seat belt legislation on the incidence of pediatric motor vehicle-related injury. With this new law, the use of child restraints in children age 0-3 became mandatory, and children 4-12 had to wear seat belts in the rear seats. METHODS: A unique data set with assembled information from public institutions of the Republic of Serbia from January 2004 to December 2014 and analyses based on interrupted time series were carried out. Eight outcome variables were assessed: monthly rate of injured children for 2 age groups 0-3 and 4-12 per child population, number of registered motor vehicles, number of passengers transported, and number of passengers' kilometers traveled. Independent variables were short- and long-term impacts of Serbia's legislation update (June 2009). Data on injuries were obtained from Serbia's Road Traffic Safety Agency. Child population and other transport-related data were obtained from the Statistical Office of the Republic of Serbia. We excluded fatalities from the analysis. RESULTS: In the first year of the updated legislation there was a reduction of 2.0% (confidence interval [CI], 0.1; 3.9) of injured children aged 0-3 and a reduction of 2.5% (CI, 0.6; 4.3) of injured children aged 4-12. Six years after enactment of the legislation, a significant reduction of 8.2% (CI, 3.5; 13.0) of injured children aged 4-12 was observed, but a nonsignificant reduction of 1.1% (CI, -5.8; 3.5) was found for injured children aged 0-3. By December 2014, 369 (CI, 186; 555) injuries among children aged 4-12 were avoided. CONCLUSIONS: The case of Serbia suggests that the new law was effective in reducing injuries among children aged 0-3 in the short term and injuries among children aged 4-12 in both the short term and long term. To understand these results, we suggest 2 hypotheses. First, low proper usage of child restraint and weak police enforcement were likely to explain the short-term effect among children aged 0-3. Second, access to seat belts in rear seats was probably a condition that facilitated the use of these devices among children aged 4-12, protecting them during the period of the study.

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.