Infant car safety seats and risk of head injury.

BACKGROUND/PURPOSE: We observed a high incidence of traumatic brain injuries (TBI) in properly restrained infants involved in higher speed motor vehicle crashes (MVCs). We hypothesized that car safety seats are inadequately protecting infants from TBI. METHODS: We retrospectively queried scene crash data from our State Department of Transportation (2007-2011) and State Department of Public Health data (2000-2011) regarding infants who presented to a trauma center after MVC. RESULTS: Department of Transportation data revealed 94% of infants in MVCs were properly restrained (782/833) with average speed of 44.6 miles/h when there was concern for injury. Department of Public Health data showed only 67/119 (56.3%) of infants who presented to a trauma center after MVC were properly restrained. Properly restrained infants were 12.7 times less likely to present to a trauma center after an MVC (OR=12.7, CI 95% 5.6-28.8, p<0.001). TBI was diagnosed in 73/119 (61.3%) infants; 42/73 (57.5%) properly restrained, and 31/73 (42.5%) improperly/unrestrained (p=0.34). Average head abbreviated injury scale was similar for properly restrained (3.2±0.2) and improperly/unrestrained infants (3.5±0.2, p=0.37). CONCLUSION: Car safety seats prevent injuries. However, TBI is similar among properly restrained and improperly/unrestrained infants involved in higher speed MVCs who present to a trauma center.

Impact of errors in age estimates on the classification of proper child occupant restraint use: an observational survey.

BACKGROUND: Proper classification of child occupant restraint use is dependent on the age of the child occupant. Observations of vehicle restraint use involve estimating child age. If estimates of age are incorrect, then a potential for misclassification of restraint use exists. OBJECTIVE: To compare estimated and confirmed child occupant age and calculate the impact of errors in age estimates on the proportion of children classified as properly restrained. METHODS: Observations of restraint use were completed for occupants 0-8 years of age at two health clinics. After initial observation, we approached the driver to confirm the child's age. Each child's restraint use was classified as either compliant or not compliant with state law, based on type of restraint used and based on the child's estimated and confirmed ages. RESULTS: Classification of age categories for child occupants (n=218) was correct in 86.3% of observations. For 48.6%, the confirmed and estimated age matched exactly, and for 98.1%, age matched within ±1 year. Overall, compliant restraint use based on estimated age was 39.4%, and based on confirmed age was 38.5%. In paired comparisons, restraint use based on estimated age versus confirmed age was concordant for more than 95% of children. CONCLUSIONS: The level of accuracy for age estimates was sufficient for making estimates of compliant restraint use. Errors in estimated age resulted in a less than 1 percentage point difference in overall proper restraint use calculations. The results suggest that such observations can be a reliable measure of proper child occupant restraint use.

Static analysis of harness fit inforward-facing child restraints

O presente estudo tem a finalidade de avaliar o sistema de proteção dos dispositivos de retenção infantil, tais como a passagem do cinto de cinco pontos, referentes às tiras do torso e abdominais, e também avaliar a localização de componentes de proteção. Três modelos de dispositivos foram analisados em laboratório simulador no banco traseiro de veículo usando um dummy de três anos da família Hybrid III. A coleta de dados foi feita por meio de marcas predeterminadas no dummy e nos dispositivos e registradas tridimensionalmente por um equipamento digitalizador de pontos em 3D (FaroArm). Para isso, o dummy foi instalado nos assentos após sua fixação no carro seguindo os padrões da norma norte-americana nº 213, da Federal Motor Vehicle Safety Standard – FMVSS “Child Restraint Systems” (NHTSA, 2005). Os resultados mostraram uma grande variação no posicionamento dos componentes de proteção entre os modelos analisados. O cinto do torso apresentou diferenças em sua passagem no tórax superior conforme a altura de regulagem. A posição do cinto abdominal também variou entre os modelos, sendo observada a passagem do mesmo na região do abdômen ao invés de locais mais rígidos, como os ossos da pélvis. Além disso, a localização do componente lateral de proteção da cabeça sofreu grande variação em relação ao centro de gravidade de cabeça do dummy, indicando que, em alguns casos, a cabeça da criança pode não ser protegida lateralmente por se deslocar amplamente no caso de impacto lateral do carro, o que provocaria lesão. Os resultados deste trabalho sugerem que o design de assentos infantis ainda apresenta falhas quanto ao posicionamento dos componentes de proteção em relação às características anatômicas da criança, considerando a ampla faixa etária para que são fabricados.

A material suitable for craniofacial reconstruction must be easy to implant, have the appropriate shape, have the strength and deformation similar to the original bone, be eventually substitutedfor natural bone, be widely available and present affordable costs. As such as material, with all theses characteristics is still not available, it is important to search for new materials, new compositions and new design. Different biomaterials are used nowadays for craniofacial reconstruction surgeries, each one presenting its advantages and limitations. Among these materials are the titanium, the poli(methilmetacrilate) and the calcium phosphate cements. Titanium presents hard conformation; poli(methilmetacrilate)’spolymerization reaction is exothermic, which may cause necrosis of the adjacent tissues; calcium phosphate cement is brittle, an usual characteristic of ceramic materials. In this way, this study evaluated different materials used for craniofacial reconstruction and its mechanical properties when submitted to bending test, such as poli(methilmetacrilate), calcium phosphate cement and calcium phosphate cement reinforced with titanium. It was verified the improvement in the mechanical properties of the calcium phosphatecement when reinforced with titanium mesh. In addition, this study presents a method for design and manufacturing of customized craniofacial implants using calcium phosphate cement reinforced with titanium mesh, validated through four cases of craniofacial reconstruction surgery indication.