Relationship Between Restraint System Use and Brachial Plexus Injuries in Motor Vehicle Accidents: A Case-Control Study from the National Trauma Databank.

INTRODUCTION: High-speed motor vehicle accidents (MVAs) are an important cause of brachial plexus injury (BPI). Some case reports have demonstrated shoulder seat belt use resulting in traction injuries to the brachial plexus. We used a national trauma registry to determine the association between seat belt use and brachial plexus injury in MVAs. METHODS: The authors queried the National Trauma Databank between 2016 and 2017 for patients with a hospital admission following an MVA. Cases with BPI were identified using International Classification of Diseases, Tenth Edition, Clinical Modification, diagnosis codes. Case-control matching by age and sex was performed to identify 2 non-BPI controls for every case of BPI. Multivariable conditional logistic regression adjusting for body mass index, alcohol use, and drug use was then performed to determine the adjusted association between safety equipment use (seat belt use and airbag deployment) and BPI. RESULTS: A total of 526,007 cases of MVAs were identified, of which 704 (0.13%) sustained a BPI. The incidences of BPI in patients were the following without any protective device (0.16%), with airbag deployment alone (0.08%), with seat belt use alone (0.08%), and with combined airbag deployment and seat belt use (0.07%). Following 1:2 case-control matching by age and sex and multivariable conditional logistic regression, seat belt use (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.42-0.71; P < 0.001) and airbag deployment (OR 0.52; 95% CI 0.33-0.82; P = 0.004) were found to be associated with decreased odds for BPI, with the least odds observed with combined seat belt use and airbag deployment (OR 0.49; 95% CI 0.33-0.74; P = 0.001). CONCLUSIONS: Despite anecdotal evidence suggesting increased likelihood of BPI with shoulder seat belt use, case-control analysis from a national trauma registry demonstrated that both seat belt use and airbag deployment are associated with lower odds of sustaining BPIs in MVAs, with the greatest protective effect observed with combined use. Future studies adjusting for rider location (passenger vs. driver) and other potential confounders such as make, type and speed of vehicle may help further characterize this association.

Transportation of Older Adults: Common Behaviors Interfering With Safety.

There is a dearth of evidence on safely transporting frail older adults in the community. Therefore, the purpose of the current study was to gain a better understanding of behavioral expression exhibited by older adults during van transportation and to learn what actions van assistants and van drivers take to prevent or address behavioral expressions, which can create potential challenges to safe transportation. A qualitative descriptive approach was used and included four focus groups of van assistants and van drivers (N = 32) at one urban Program of All-Inclusive Care for the Elderly (PACE), which routinely transports approximately 90% of enrollees to and from the PACE center. Conventional content analysis was used to analyze the data. Four themes emerged. The first two themes were common behaviors: Removing Seat Belts and Verbal Behaviors. The remaining two themes addressed unusual behaviors that left lasting impressions: Physical Aggression and Conflict Between Passengers. Van assistants and van drivers used redirection and reassurance as preventive interventions to keep everyone safe. Transportation of PACE enrollees requires well-trained and astute van assistants and van drivers skilled with preventing and diffusing potentially unsafe behaviors. [Res Gerontol Nurs. 2019; 12(4):184-192.].

Transporting Children With Special Health Care Needs.

Children with special health care needs should have access to proper resources for safe transportation as do typical children. This policy statement reviews important considerations for transporting children with special health care needs and provides current guidance for the protection of children with specific health care needs, including those with airway obstruction, orthopedic conditions or procedures, developmental delays, muscle tone abnormalities, challenging behaviors, and gastrointestinal disorders.

Clinical Significance of the Seat Belt Sign as Evidence of a Compromised Occupant-Seat Belt Relationship.

BACKGROUND: Seat belt marks are seen frequently on occupants after motor vehicle accidents. Over the years, the clinical significance of these marks has changed as restraint systems have evolved. With modern restraint systems, signs of a compromised occupant-restraint relationship are an important and easily identified bedside finding. OBJECTIVES: We sought to learn to recognize seat belt marks that demonstrate an abnormal occupant-restraint system relationship and to cultivate an understanding of significant soft tissue biomechanical loading associated with marks caused by a compromised occupant-restraint relationship. DISCUSSION: A review of case studies from the literature combined with forensic work demonstrate a strong correlation between significant injury and improper seatbelt use. When evidence of a compromised occupant-restraint relationship exists, incorporating computed tomography angiography and observation may be clinically indicated. CONCLUSION: The recognition of seat belt marks made by a compromised occupant-restraint relationship is an important finding that allows risk stratification of the patient at the bedside. Further investigation with a prospective trial at a trauma center is warranted.

Analysis of mechanics of side impact test defined in UN/ECE Regulation 129.

OBJECTIVE: This article discusses differences between a side impact procedure described in United Nations/Economic Commission for Europe (UN/ECE) Regulation 129 and scenarios observed in real-world cases. METHODS: Numerical simulations of side impact tests utilizing different boundary conditions are used to compare the severity of the Regulation 129 test and the other tests with different kinematics of child restraint systems (CRSs). In the simulations, the authors use a validated finite element (FE) model of real-world CRSs together with a fully deformable numerical model of the Q3 anthropomorphic test device (ATD) by Humanetics Innovative Solution, Inc. RESULTS: The comparison of 5 selected cases is based on the head injury criterion (HIC) index. Numerical investigations reveal that the presence of oblique velocity components or the way in which the CRS is mounted to the test bench seat fixture is among the significant factors influencing ATD kinematics. The results of analyses show that the side impact test procedure is very sensitive to these parameters. A side impact setup defined in Regulation 129 may minimize the effects of the impact. CONCLUSIONS: It is demonstrated that an artificial anchorage in the Regulation 129 test does not account for a rotation of the CRS, which should appear in the case of a realistic anchorage. Therefore, the adopted procedure generates the smallest HIC value, which is at the level of the far-side impact scenario where there are no obstacles. It is also shown that the presence of nonlateral acceleration components challenges the quality of a CRS and its headrest much more than a pure lateral setup.

Assessing tether anchor labeling and usability in pickup trucks.

OBJECTIVE: The objective of this study was to investigate vehicle factors associated with child restraint tether use and misuse in pickup trucks and evaluate 4 labeling interventions designed to educate consumers on proper tether use. METHODS: Volunteer testing was performed with 24 subjects and 4 different pickup trucks. Each subject performed 8 child restraint installations among the 4 pickups using 2 forward-facing restraints: a Britax Marathon G4.1 and an Evenflo Triumph. Vehicles were selected to represent 4 different implementations of tether anchors among pickups: plastic loop routers (Chevrolet Silverado), webbing routers (Ram), back wall anchors (Nissan Frontier), and webbing routers plus metal anchors (Toyota Tundra). Interventions included a diagram label, Quick Response (QR) Code linked to video instruction, coordinating text label, and contrasting text tag. RESULTS: Subjects used the child restraint tether in 93% of trials. However, tether use was completely correct in only 9% of trials. An installation was considered functional if the subject attached the tether to a tether anchor and had a tight installation (ignoring routing and head restraint position); 28% of subjects achieved a functional installation. The most common installation error was attaching the tether hook to the anchor/router directly behind the child restraint (near the top of the seatback) rather than placing the tether through the router and attaching it to the anchor in the adjacent seating position. The Nissan Frontier, with the anchor located on the back wall of the cab, had the highest rate of correct installations but also had the highest rate of attaching the tether to components other than the tether anchor (seat adjustor, child restraint storage hook, around head restraint). None of the labeling interventions had a significant effect on correct installation; not a single subject scanned the QR Code to access the video instruction. Subjects with the most successful installations spent extensive time reviewing the vehicle manuals. CONCLUSION: Current implementations of tether anchors among pickup trucks are not intuitive for child restraint installations, and alternate designs should be explored. Several different labeling interventions were ineffective at achieving correct tether use in pickup trucks.

Child seat belt guidelines: Examining the 4 feet 9 inches rule as the standard.

BACKGROUND: Current American Academy of Pediatrics recommendations regarding transition from child safety/booster seat to adult safety belt use indicate that children should be at least 4 feet 9 inches, 8 years old, or 80 pounds. Proper fit in the vehicle seat, assessed with a five-point fit test, should also be met. Although most children reach 4 feet 9 inches around age 8 years, each child and vehicle presents a unique combination; thus a child may not fit appropriately in all vehicle types using only the 4 feet 9 inches requirement. METHODS: We enrolled children, aged 7 years to 12 years, into our study. Height, weight, and demographic data were obtained. A Child Passenger Safety Technician then performed the five-point fit test in each of a uniform lineup of five vehicles. Data were collected on fit in the standard vehicle seat and also in a booster seat. We set 90% as the threshold proportion of children who meet all criteria for proper fit to validate current recommendations of a height of 4 feet 9 inches. RESULTS: Data were collected on 388 children. The percentage of 90% proper fit was met in the compact car and small sport-utility vehicle (SUV). However, only 80 (77%) of 104 students (p < 0.0001) that were 4 feet 9 inches or higher fit properly in the large SUV, only 87 (83%) of 105 students (p = 0.02) fit properly in the pickup truck, and only 91 (89%) of 102 students (p = 0.74) fit properly in the minivan. CONCLUSION: Substantial proportions of children meeting current height guidelines for an adult seat belt do not meet safety requirements for fit, especially in larger, commonly used vehicles (large SUVs and trucks). This emphasizes the need for evaluation of fit by a trained personnel and/or development of standard back seat dimensions in all vehicles for maximum safety. LEVEL OF EVIDENCE: Epidemiologic level 1.

Child seat belt guidelines: Examining the 4 feet 9 inches rule as the standard.

BACKGROUND: Current American Academy of Pediatrics recommendations regarding transition from child safety/booster seat to adult safety belt use indicate that children should be at least 4 feet 9 inches, 8 years old, or 80 pounds. Proper fit in the vehicle seat, assessed with a five-point fit test, should also be met. Although most children reach 4 feet 9 inches around age 8 years, each child and vehicle presents a unique combination; thus a child may not fit appropriately in all vehicle types using only the 4 feet 9 inches requirement. METHODS: We enrolled children, aged 7 years to 12 years, into our study. Height, weight, and demographic data were obtained. A Child Passenger Safety Technician then performed the five-point fit test in each of a uniform lineup of five vehicles. Data were collected on fit in the standard vehicle seat and also in a booster seat. We set 90% as the threshold proportion of children who meet all criteria for proper fit to validate current recommendations of a height of 4 feet 9 inches. RESULTS: Data were collected on 388 children. The percentage of 90% proper fit was met in the compact car and small sport-utility vehicle (SUV). However, only 80 (77%) of 104 students (p < 0.0001) that were 4 feet 9 inches or higher fit properly in the large SUV, only 87 (83%) of 105 students (p = 0.02) fit properly in the pickup truck, and only 91 (89%) of 102 students (p = 0.74) fit properly in the minivan. CONCLUSION: Substantial proportions of children meeting current height guidelines for an adult seat belt do not meet safety requirements for fit, especially in larger, commonly used vehicles (large SUVs and trucks). This emphasizes the need for evaluation of fit by a trained personnel and/or development of standard back seat dimensions in all vehicles for maximum safety. LEVEL OF EVIDENCE: Epidemiologic study, level III; Therapeutic study, level V.

Paired vehicle occupant analysis indicates age and crash severity moderate likelihood of higher severity injury in second row seated adults in frontal crashes.

The majority of advances in occupant protection systems for motor vehicle occupants have focused on occupants seated in the front row of the vehicle. Recent studies suggest that these systems have resulted in lower injury risk for front row occupants as compared to those in the second row. However, these findings are not universal. In addition, some of these findings result from analyses that compare groups of front and second row occupants exposed to dissimilar crash conditions, raising questions regarding whether they might reflect differences in the crash rather than the front and second row restraint systems. The current study examines factors associated with injury risk for pairs of right front seat and second row occupants in frontal crashes in the United States using paired data analysis techniques. These data indicate that the occupant seated in the front row frequently experiences the more severe injury in the pair, however there were no significant differences in the rate of occurrence of these events and events where the more severe injury occurs in the second row occupant of the pair. A logistic regression indicated that the likelihood of the more severe injury occurring in the second row seated occupant of the pair increased as crash severity increased, consistent with data from anatomic test dummy (ATD) tests. It also indicated that the second row occupant was more likely to have the more severe injury in the pair if that occupant was the older occupant of the pair. These findings suggest that occupant protection systems which focus on providing protection specifically for injuries experienced by older occupants in the second row in higher severity crash conditions might provide the greatest benefit.

Seat and seatbelt accommodation in fire apparatus: Anthropometric aspects.

This study developed anthropometric information on U.S. firefighters to guide fire-apparatus seat and seatbelt designs and future standards development. A stratified sample of 863 male and 88 female firefighters across the U.S. participated in the study. The study results suggested 498 mm in width, 404 mm in depth, and 365-476 mm in height for seat pans; 429-522 mm in width and 542 mm in height for seat back; 871 mm in height for head support; a seat space of 733 mm at shoulder and 678 mm at hip; and a knee/leg clearance of 909 mm in fire truck cab. Also, 1520 mm of lap belt web effective length and 2828 mm of lap-and-shoulder belt web effective length were suggested. These data for fire-truck seats and seatbelts provide a foundation for fire apparatus manufacturers and standards committees to improve firefighter seat designs and seatbelt usage compliance.

Factors affecting tether use and correct use in child restraint installations.

INTRODUCTION: Field studies show that top tethers go unused in half of forward-facing child restraint installations. METHOD: In this study, parent volunteers were asked to use the Lower Anchors and Tethers for Children (LATCH) to install child restraints in several vehicles to identify tether anchor characteristics that are associated with tether use. Thirty-seven volunteers were assigned to four groups. Each group tested two forward-facing child restraints in four of 16 vehicle models. Logistic regression models were used to identify predictors of tether use and correct use. RESULTS: Subjects used the tether in 89% of the 294 forward-facing child restraint installations and attached the tether correctly in 57% of the installations. Tethers were more likely to be used when the anchor was located on the rear deck as typically found in sedans compared with the seatback, floor, or roof. Tethers were less likely to be attached correctly when there was potentially confusing hardware present. No vehicle tether hardware characteristics or vehicle manual directions were associated specifically with correct tether routing and head restraint position. CONCLUSION: This study provides laboratory evidence that specific vehicle features are associated with tether use and correct use. PRACTICAL APPLICATIONS: Modifications to vehicles that make tether anchors easier to find and identify likely will result in increases in tether use and correct use.

Are parents following the recommendations for keeping children younger than 2 years rear facing during motor vehicle travel?

PURPOSE: Between 2007 and 2012 there have been several recommendations that infants and toddlers ride in a car safety seat (CSS) rear facing until 2 years of age. This study reports the effect of these recommendations on the observed direction of travel for infants and toddlers transported in motor vehicles between 2007 and 2012. METHODS: This is an observational, cross-sectional survey of drivers transporting children collected at 25 convenience locations selected in Indiana during summer 2007 through 2012. Observations were conducted by Certified Child Passenger Safety Technicians. As drivers completed a written survey, the Certified Child Passenger Safety Technician recorded the vehicle seating location, type of restraint, CSS direction and use of the CSS harness or safety belt as appropriate, and demographic data. The infant and toddler's age and weight were collected. Data from 2007 through 2012 for ages birth through 23 months were compared in order to determine if recommendations impacted observed direction of travel. RESULTS: During the study period, the percent of infants and toddlers (birth through 23 months) observed rear facing in a motor vehicle varied from 44.2% (2007) to 59.1% (2012). For infants (birth through 11 months) observed rear facing, it was 85.1% (2009) to 91.6% (2012). The percent of toddlers (12 months through 23 months) observed rear facing ranged from 3.3% (2008) to 18.2% (2012). CONCLUSIONS: During the study period, the proportion of toddlers rear facing increased approximately 15% (p=0.03). Counselling by primary care providers should continue and be strengthened to increase parent and caregiver awareness of the latest child passenger safety recommendations.

Structural Design Strategies for Improved Small Overlap Crashworthiness Performance.

In 2012, the Insurance Institute for Highway Safety (IIHS) began a 64 km/h small overlap frontal crash test consumer information test program. Thirteen automakers already have redesigned models to improve test performance. One or more distinct strategies are evident in these redesigns: reinforcement of the occupant compartment, use of energy-absorbing fender structures, and the addition of engagement structures to induce vehicle lateral translation. Each strategy influences vehicle kinematics, posing additional challenges for the restraint systems. The objective of this two-part study was to examine how vehicles were modified to improve small overlap test performance and then to examine how these modifications affect dummy response and restraint system performance. Among eight models tested before and after design changes, occupant compartment intrusion reductions ranged from 6 cm to 45 cm, with the highest reductions observed in models with the largest number of modifications. All redesigns included additional occupant compartment reinforcement, one-third added structures to engage the barrier, and two modified a shotgun load path. Designs with engagement structures produced greater glance-off from the barrier and exhibited lower delta Vs but experienced more lateral outboard motion of the dummy. Designs with heavy reinforcement of the occupant compartment had higher vehicle accelerations and delta V. In three cases, these apparent trade-offs were not well addressed by concurrent changes in restraint systems and resulted in increased injury risk compared with the original tests. Among the 36 models tested after design changes, the extent of design changes correlated to structural performance. Half of the vehicles with the lowest intrusion levels incorporated aspects of all three design strategies. Vehicle kinematics and dummy and restraint system characteristics were similar to those observed in the before/after pairs. Different combinations of structural improvement strategies for improving small overlap test performance were found to be effective in reducing occupant compartment intrusion and improving dummy kinematics in the IIHS small overlap test with modest weight increase.

Observational study of child restraining practice on Norwegian high-speed roads: restraint misuse poses a major threat to child passenger safety.

OBJECTIVE: Restraint misuse and other occupant safety errors are the major cause of fatal and, severe injuries among child passengers in motor vehicle collisions. The main objectives of the present, study were to provide estimates of restraining practice among children younger than 16 years, traveling on Norwegian high-speed roads, and to uncover the high-risk groups associated with, restraint misuse and other safety errors. METHODS: A cross-sectional observational study was performed in conjunction with regular traffic, control posts on high-speed roads. The seating and restraining of child occupants younger than 16, years were observed, the interior environment of the vehicles was examined, and a structured, interview of the driver was conducted according to a specific protocol. RESULTS: In total, 1260 child occupants aged 0-15 years were included in the study. Misuse of restraints, was observed in 38% of cases, with this being severe or critical in 24%. The presence of restraint, misuse varied significantly with age (p<0.001), with the frequency being highest among child, occupants in the age group 4-7 years. The most common error in this group was improperly routed, seat belts. The highest frequency of severe and critical errors was observed among child occupants in, the age group 0-3 years. The most common errors were loose or improperly routed harness straps and, incorrect installations of the child restraint system. Moreover, 24% of the children were seated in, vehicles with heavy, unsecured objects in the passenger compartment and/or the trunk that were, likely to move into the compartment upon impact and cause injury. No totally unrestrained children, were observed. CONCLUSIONS: This study provides a detailed description of the characteristics of restraint misuse and, the occupant's exposure to unsecured objects. Future education and awareness campaigns should, focus on children aged <8 years. The main challenges are to ensure correct routing and tightness of, harness straps and seat belts, correct installation of child restraints, and avoidance of premature, graduation from child restraints to seat belts only. Information campaigns should also advocate the use, of chest clips and address the potential risks of hard, heavy objects in the passenger compartment and, the importance of the placement and strapping of heavy objects in the trunk.

Optimizing the rear seat environment for older children, adults, and infants.

OBJECTIVE: Our recent rear seat safety research found that more-forward and higher lap belt anchorage locations and much shorter and stiffer seat cushions can improve the protection of older children from 6 to 12 years old who are using the vehicle belt without a booster. The objective of this study was to investigate whether the optimal rear seat restraint systems for adults and infants are consistent with those for older children. METHODS: We conducted sensitivity analyses and design optimizations for adults and for infants in a rear-facing child restraint system (CRS) using a set of MADYMO models, an automated simulation framework, and occupant belt-fit and posture prediction models from our previous studies. A series of 12 sled tests was also used to validate the computational models. RESULTS: The optimal belt anchorage locations and the seat cushion length for older children, adults, and rear-facing CRS-seated infants conflict with each other. In particular, more-forward lap belt anchorage locations that prevent submarining for older children would reduce the protection to both adults and CRS-seated infants, although the protection is still acceptable based on regulated injury criteria. A shorter seat cushion could provide optimal protection to older children and adults but would significantly increase the CRS rotation. CONCLUSIONS: The findings of this study suggested that adaptive/adjustable restraint systems are necessary to simultaneously improve the rear seat occupant protection for all age groups. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Rear seat restraint system optimization for older children in frontal crashes.

OBJECTIVE: Analyses of crash injury data have shown that injury risk increases when children transition from belt-positioning boosters to the vehicle seat belt alone. The objective of this study is to investigate how to improve the restraint environment for these children. METHODS: A parametric analysis was conducted to investigate the effects of body size, seat belt anchorage locations, and rear seat design parameters on the injury risks in frontal crashes of children aged 6 to 12 years old using a newly developed parametric child anthropomorphic test dummy (ATD) model. Restraint design optimizations were also conducted to obtain ranges of optimal restraint system configurations that provide best protections for 6-, 9-, and 12-year-old children. RESULTS: Simulation results showed that child body size was the dominant factor affecting outcome measures. In general, lower and more rearward D-rings (upper belt anchorages), higher and more forward lap belt anchorages, and shorter, stiffer, and thinner seat cushions were associated with improved restraint performance. In these simulations, children with smaller body sizes require more-forward D-rings, inboard anchors, and outboard anchor locations to avoid submarining. However, these anchorage locations increase head excursions relative to more-rearward anchorages. CONCLUSIONS: The balance of reducing head and knee excursions and preventing submarining indicates that an optimization approach is necessary to improve protection for 6- to 12-year-old child occupants. The findings of this study provided design guidelines for future rear seat restraint system.

Los niños con necesidades especiales y su seguridad como ocupantes de automóviles / The safety of children with special needs as car occupants

Objetivo: el objetivo de este artículo es abrir un debate en España sobre la seguridad en el automóvil de los niños con necesidades especiales. Material y métodos: se han revisado y resumido los principales manuales y guías sobre la materia existentes en EE. UU., Canadá y Suecia. Se han tabulado las soluciones técnicas recomendadas para alrededor de 30 condiciones o necesidades especiales. Se ha realizado un análisis de mercado inicial, vía e-mail, de soluciones técnicas disponibles en España. Resultados: se estima que en España hay al menos 60 000 niños con necesidades especiales desde el punto de vista de su transporte seguro en el automóvil. Son varios los países que ofrecen manuales o guías sobre la materia: EE. UU., Canadá y Suecia. Este no es el caso de España. Mientras que algunos niños con necesidades especiales pueden utilizar asientos infantiles convencionales, otros necesitan soluciones técnicas especializadas. No todas están disponibles en España; de hecho, el mercado nacional es muy limitado. Los asientos especiales pueden ser caros y necesitarse durante cortos periodos de tiempo. Conclusiones: se espera que el presente resumen sirva como punto de partida para un debate posterior, liderado por la comunidad pediátrica española, sobre el transporte seguro en el automóvil de niños con necesidades especiales. El debate debería finalizar con la redacción y difusión de una guía para profesionales médicos, padres y tutores (existen ya ejemplos a nivel internacional). Sería recomendable la promoción de programas de ayuda económica y préstamos de asientos especiales para determinadas condiciones médicas especiales (AU)

Objective: to open a debate in Spain about the safety of children with special needs as car passengers. Material and methods: a review of the international literature has been undertaken in order to identify related articles, handbooks and guides. Several ones have been found in EE.UU., Canada and Sweden. Findings have been summarized in a table with technical solutions for around 30 different medical conditions. A preliminary market analysis in Spain has been performed. Results: the number of children with special needs from the point of view of their safety in the automobile has been estimated in Spain in around 60,000. Several countries have developed handbooks or guides on this matter. This is not the case in Spain. Some children with special needs can use conventional child safety seats; others need specialized (medical) seats. Not all technical solutions available in other countries are sold in Spain; the number of solutions in the Spanish market, in fact, is very small. Special needs seats are normally very expensive; in some cases they are only needed during a short period of time. Conclusions: the authors aim to trigger a more profound debate in Spain about the safety of special needs children as car passengers. This debate should be steered by the Spanish pediatrician community. The final outcome should be a handbook for medicine practitioners, parents and tutors (several examples exist at international level). It is recommended to implement purchase and loans programs to support the use of specialized child seats (AU)

Comparing the performance of residential fire sprinklers with other life-safety technologies.

Residential fire sprinklers have long proven themselves as life-safety technologies to the fire service community. Yet, about 1% of all one- and two-family dwelling fires occur in homes protected by sprinklers. It has been argued that measured sprinkler performance has ignored factors confounding the relationship between sprinkler use and performance. In this analysis, sprinkler performance is measured by comparing 'like' structure fires, while conditioning on smoke detection technology and neighborhood housing and socioeconomic conditions, using propensity score matching. Results show that residential fire sprinklers protect occupant and firefighter health and safety, and are comparable to other life-safety technologies.

Driver report of improper seat belt position among 4- to 9-year-old children.

OBJECTIVE: To determine the frequency with which drivers report improper seat belt positions among children 4-9 years of age and the frequency with which reported problems were attributable to the lap belt, shoulder belt, or both. SUBJECTS AND METHODS: Analysis of driver responses to 5 questions related to seat belt positioning from the cross-sectional, phone-based 2007 Motor Vehicle Occupant Safety Survey. Belt position problems categorized as related to (1) shoulder belt and (2) lap belt. Improper belt position was compared across age groups (4-6 years, 7-8 years, and 9 years) and use of a child safety seat with χ(2) statistics or Fisher exact tests as appropriate. RESULTS: Seat belt use was reported for 334 of 891 (37%) 4- to 9-year-old child passengers, and 261 (78%) drivers reported improper belt fit among these child passengers. Improper shoulder belt position (44%) was less common than improper lap belt position (62%). At least one improper belt position was reported by 78% of drivers of 4- to 6-year-old children, 77% of 7- to 8-year-old children, and 79% of 9-year-old children (P = .87). There were no significant differences in report of improper belt position among children who never and those who occasionally use a child safety seat were compared. CONCLUSIONS: Drivers frequently report improper lap and shoulder belt positions for their 4- to 9-year-old child passengers yet persist in restraining children by the use of seat belts alone. Clinicians can promote the use of size-appropriate child passenger restraint systems, including car seats and booster seats, to overcome the improper belt positions identified in this study.