Child Safety Restraints: Linking Medicine and the Crash to Prevent Injuries

Brian D. Robertson, PhD, MPH

June 5, 2013

Objectives

• Overview of Injury Prevention at Children’s

• Overview of Child Passenger Safety

• Discuss a Research Project & How Research is Used

• Open Dialogue on Collaboration

2

Injury Prevention at Children’s

• 3 Pillars of Injury Prevention

– Community Outreach

– Advocacy in Legislature

– Research

• Research is the foundation

– Trends

– Specific Cases / Problems

• Top Causes and Top Injuries1

Putting Research Into Practice

Research

Community Outreach

Legislative Advocacy

Child Passenger Safety

• Texas Law2

– Everyone must be buckled

– A child must be rear facing until they are 1 year old and weigh 20 pounds

– Child must be in a car seat until 4’9” tall or 8 years old

• Best Practice

– AAP

– Our recommendations

• Research

– Use is high, accurate use is low3

– 4 out of 5 car seats are not installed correctly4

– Dallas County is 94% inaccurate5

Anatomy of a Car Crash - Pilot

• Better understand the nature of TBI in MVC

• Inclusion – All inpatients with TBI from MVC

– CT or MRI imaging

– Positive findings on CT/MRI

• Three Data Levels – Crash

– Clinical course

– Outcome

• Two Primary Sources: – Medical charts

– Crash reports

• N = 30

Restraint Use • Recommended Restraints

– Lap and Shoulder (n = 6)

– Forward Facing (n = 8)

– Rear Facing (n = 3)

– Booster (n = 4)

• Restraints Used

– None (n = 6)

– Lap & Shoulder (n = 6)

– Booster (n = 3)

– Rear-Facing (n = 2)

– Lap Belt Only (n = 1)

– Forward-Facing (n = 3)

• Restraints Appropriate?

– Yes (n = 11)

– No (n = 10)

– Pending (n = 9)

Car Seats Used vs. Recommended

Recommended Restraint

Lap & Shoulder

Booster Forward-Facing

Rear-Facing

Total P-value

Incorrect Restraint 0.672

Lap & Shoulder - 1 1 - 2

Lap Only - - 1 - 1

Booster - - 1 - 1

None 2 - 3 1 6

Totals 2 1 6 1 10

Crash Characteristics Road Conditions

Dry Icy Wet

Type of Collision

Collision with Moving Object Collision with Fixed ObjectOverturning

Type of Roadway

US Highway Farm to Market Intetstate HighwayCounty Road Local Road State Highway

Initial Impact

Side - Passenger Frontal Rear Other Side - Driver

Clinical Presentation Analysis

Restraint Appropriate

Restraint Inappropriate

Total P-value

Arrival GCS 10.8 8.8 10.1 0.316

Injury Severity Score 23.82 18.89 21.6 0.406

Trauma Score 9.09 9.22 9.15 0.935

TRISS 0.74 0.83 0.78 0.558

Intubated / Sedated 54% 60% 57% 0.801

Injury State 0.757

- Head-Only 36% 30% 33%

- Head + Other 63% 70% 67%

TBI Characteristics

Restraint Appropriate

Restraint Inappropriate

Total P-value

Severity 0.561

- Mild 62.5% 37.5% 38%

- Moderate 60% 40% 24%

- Severe 37.5% 62.5% 38%

Skull Fracture 63% 70% 67% 0.757

Intracranial Bleeding 64% 80% 71% 0.407

Contusions 27% 80% 52% 0.016

Midline Shift 9% 20% 14% 0.446

Diffuse Axonal Injury 9% 20% 14% 0.476

ICP Monitoring 3 days 6.75 days 6 days 0.662

Outcome Assessments Restraint

Appropriate Restraint

Inappropriate Total P-value

LOS (days) 3.8 8 5.1 0.126

ICU LOS (days) 1.91 5.9 3.8 0.113

D/C Status 0.278

- Alive 82% 80% 81%

- Dead 18% 20% 19%

GOS-E

- Upper Good 1 1 2

- Lower Good 1 1 2

- Upper Moderate 1 0 1

- Upper Severe 0 1 1

- Death 2 2 4

So What’s the Point?

Identify common injuries

Understand injury

mechanisms

Understand crash characteristics causing injuries

Understand behaviors

Link common injuries to behaviors

Work with communities to

change behaviors Save lives

Putting Research into Practice

Results of Research

Community Education Initiatives

Legislative Changes

Improved Structures

Questions?

References

1. Trauma Registry of Children’s Medical Center, Dallas, Texas

2. http://www.dmv.org/tx-texas/safety-laws.php

3. Lucille Packard Children’s Hospital at Stanford. Motor vehicle safety: Identifying

high-risk situations. Downloaded on July 21, 2011 from

http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/safety/mvshrsk.html

4. National Highway Traffic & Safety Administration (NHTSA)

5. ?