Feasibility of providing child restraint devices after a motor vehicle crash in a pediatric emergency department.

OBJECTIVE: Motor vehicle crashes (MVCs) cause disproportionate childhood morbidity and mortality. Ensuring that children are placed in appropriate child restraint devices (CRDs) would significantly reduce injuries and deaths as well as medical costs. The goal of the study is to evaluate the feasibility of providing child restraint devices after an MVC in a pediatric emergency department (PED). METHODS: A guideline was developed to assess the need for CRDs for patients discharged from a PED after an MVC. Providers were educated on the use of the guideline. Caregivers were provided a brief educational intervention on legislation, proper installation, and best practices prior to distribution of a CRD. Quality assurance was conducted weekly to monitor for any missed opportunities. RESULTS: From August 31, 2015, to August 31, 2016, 291 patients <7 years were evaluated in the PED of a level 1 trauma center following an MVC. Two hundred forty-seven children were correctly identified according to the guidelines (84.9%). Of these, 187 (75.7%) were identified as not requiring a replacement seat and 60 (24.3%) required a CRD replacement based on crash mechanisms and restraint use status and received a CRD replacement. Of the remaining 44 children, 38 (86.4%) whose crash mechanisms were severe enough or who were inappropriately restrained were not provided a CRD and thus missed; 6 (13.6%) received a replacement seat even though criteria were not met. Thus, PED providers correctly identified 61.2% (60/98) of children who required CRD replacement after an MVC. CONCLUSION: Caring for children who present for evaluation after an MVC offers an opportunity for ED personnel to provide education to caregivers about the appropriate use of CRDs and state legislation. Establishing guidelines for the provision of a CRD for children who present to an ED following an MVC may help to improve the safety of children being transported in motor vehicles. Having a systematic process and adequate supply of CRDs readily available contributes to the success of children being discharged with the appropriate age- and weight-based CRD after being treated in an ED following an MVC.

Availability of child passenger safety resources to emergency physicians practicing in emergency departments within pediatric, adult, and nontrauma centers: a national survey.

OBJECTIVES: More can be done to eliminate preventable motor vehicle collision (MVC)-related injuries through correct and consistent use of child passenger restraints. This study sought to determine emergency physician awareness of and referral patterns to child passenger safety resources and to compare awareness and referrals by practice setting. METHODS: This was a cross-sectional mailed survey of a national random sample of 1200 emergency physicians drawn from the American Medical Association Physician Masterfile. RESULTS: Responses were returned by 638 (64%) of 1000 of physicians with a valid mailing address. Fifty-two percent reported working in an emergency department (ED) within a pediatric trauma center, 23% in an adult trauma center, and 25% in a nontrauma center. Police or fire department car seat installation programs were most frequently available (65% pediatric, 56% adult, 48% nontrauma center), and free/reduced-price booster seat programs least frequently available (46% pediatric, 30% adult, 23% nontrauma center) (P < 0.001). Half of pediatric trauma center physicians would always recommend replacement of a 3-year-old's car seat following a roll-over MVC compared with one third of adult and nontrauma center physicians (P < 0.001). There were no significant differences by practice setting for distribution of discharge instructions containing child passenger safety information or referrals to available resources. CONCLUSIONS: Availability of child passenger safety resources for children discharged from EDs following an MVC varies by practice setting. Pediatric injury prevention outreach to general EDs is needed to increase the number of children who are benefiting from existing community child passenger resources.

Evaluation of an education, restraint distribution, and fitting program to promote correct use of age-appropriate child restraints for children aged 3 to 5 years: a cluster randomized trial.

OBJECTIVES: We evaluated an education, distribution, and fitting program for increasing age-appropriate and correct child restraint use. METHODS: We performed a cluster randomized trial involving 28 early childhood education centers in low socioeconomic status areas in Sydney, Australia. The main outcome was optimal restraint use defined as age-appropriate restraints, installed into the vehicle correctly and used correctly. RESULTS: One service withdrew after randomization, so data are presented for 689 child passengers, aged 3 to 5 years, from 27 centers. More children attending intervention centers were optimally restrained (43% vs 31%; P = .01; allowing for clustering). More 3-year-olds were using forward-facing seats rather than booster seats, more 4- to 5-year-olds were using booster seats instead of seat belts alone, and there were fewer errors in use at intervention centers. Among non-English-speaking families, more children attending intervention centers were optimally restrained (43% vs 17%; P = .002; allowing for clustering). CONCLUSIONS: The program increased use of age-appropriate restraints and correct use of restraints, which translates to improved crash injury protection. Multifaceted education, seat distribution, and fitting enhanced legislation effects, and the effect size was larger in non-English-speaking families.