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. ?
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