Upload
university-of-michigan-department-of-emergency-medicine
View
98
Download
0
Embed Size (px)
Citation preview
Increasing Child Passenger SafetyResearch and Impact
Michelle L. Macy, MD, MSWilliam G. Barsan
Emergency Medicine Research ForumApril 27, 2016
Disclosures
• No financial relationships or conflicts of interest to resolve.
A newborn and an NPR story
Booster Seat Laws – by Age, 2016
From the Insurance Institute for Highway Safety website: http://www.iihs.org/laws/childrestraint.aspx
Trends in Child Passenger Deaths per Million Children; 1975-2013
Insurance Institute for Highway Safety analysis of Dept. of Transportation Fatality Reporting System. http://www.iihs.org/iihs/topics/t/child-safety/fatalityfacts/child-safety accessed April 21, 2015
Toward Zero Deaths
Passenger Safety Needs and Child Development
5 pounds
20 pounds
30 pounds
40 pounds
50 pounds
60 pounds
70 pounds
80 pounds
Infant-only seat, rear-facing, never in front seat with passenger-side airbag
Convertible safety seat, rear-facing until child is at least 1 year of age and 20 lbs, then forward-facing to max weight/height allowed by seat
Combination seat with internal harness that transitions to a belt-positioning booster seat, forward-facing only, weight varies
Forward-facing seat with internal harness, weight varies Integrated child seat; toddler seat with harness (20-40 lb) or some as belt-positioning
booster seat with lap/shoulder belt (>35-40 lb) as long as child fits Belt-positioning booster seat with lap/shoulder belt as long as child fits 2002 AAP Guidelines – Selecting and using the most appropriate car safety seats for growing children.
The safest place in a vehicle for all children is in the rear seat.
Retired Guidelines – American Academy of Pediatrics 2002
Rear-Facing Car Seat to 1 year and 20 pounds
Forward-Facing Car Seat to 4 years and 40 pounds
Booster Seat to 8 years and 80 pounds
5 pounds
20 pounds
30 pounds
40 pounds
50 pounds
60 pounds
70 pounds
80 pounds
Infant-only seat, rear-facing, never in front seat with passenger-side airbag
Convertible safety seat, rear-facing until child is at least 1 year of age and 20 lbs, then forward-facing to max weight/height allowed by seat
Combination seat with internal harness that transitions to a belt-positioning booster seat, forward-facing only, weight varies
Forward-facing seat with internal harness, weight varies Integrated child seat; toddler seat with harness (20-40 lb) or some as belt-positioning
booster seat with lap/shoulder belt (>35-40 lb) as long as child fits Belt-positioning booster seat with lap/shoulder belt as long as child fits
The safest place in a vehicle for all children is in the rear seat.
Updated Guidelines – American Academy of Pediatrics 2011
Infant-only or convertible child safety seat used rear-facing until 2 years of age or until they reach the highest weight or height limit allowed by the seat manufacturer
Convertible or combination child safety seat used forward-facing for as long as possible [children 2 years of age and older (or those less than 2 years old who have outgrown their seat’s rear-facing weight or height limit)]
Booster seat for all children whose weight or height is above the forward-facing limit for their child safety seat until the vehicle lap and shoulder belt fits properly
2011 AAP Guidelines for Child Passenger Safety – Policy Statement originally published online March 21, 2011
Images for child safety seats used with permission fromthe Children’s Hospital of PhiladelphiaCenter for Injury Research and Prevention
The safest place in a vehicle for all children is in the rear seat.
Disparities Continue
Results: Restraint Use 1-3 Year OldsMichigan Law Requires Car Seat
Rear-Fa
cing C
ar Se
at
Forw
ard-Fa
cing C
ar Se
at
Booster S
eat
Seat
Belt or U
nrestrain
ed0%
20%
40%
60%
80%
100%
White Nonwhite
Results: Restraint Use 4-7 Year OldsMichigan Law Requires Booster Seat
Car Seat Booster Seat Seat Belt Unrestrained0%
10%20%30%40%50%60%70%80%90%
100%
White Nonwhite
Results: Restraint Use 8-12 Year OldsMichigan Law Requires Seat Belt
Booster Seat Seat Belt Unrestrained0%
10%20%30%40%50%60%70%80%90%
100%
White Nonwhite
Variation in Appropriateness CriteriaAppropriate by
Restraint Type
Michigan Law
National Guidelines*
Typical Seat Weight Limit
Typical Seat Height Limit
<4 years <2 years <36 pounds <37 inches
<4 years 2-4 years 36-65 pounds 37-50 inches
4-7 years 5-11 years 66-100 pounds 51-56 inches
≥8 years ≥12 years >100 pounds >56 inches
*Parents encouraged to follow manufacturer specified weight/height limits of child safety seats
Room for ImprovementAppropriate by
Restraint Type
Michigan Law
National Guidelines*
Typical Seat Weight Limit
Typical Seat Height Limit
100% 100% 100% 100%
98% 100% 98% 9% 14%
84% 42% 13% 16%
78% N/A 13% N/A
*Parents encouraged to follow manufacturer specified weight/height limits of child safety seats
Appropriateness across Criteria
Michigan Law
National Guidelines
Typical Seat Weight Limits
Typical Seat Height Limits
Size
90% 58% 23% 29% 34%
• Michigan Law X Size, kappa = 0.10
• National Guidelines X Size, kappa = 0.53
• Typical Seat Weight X Height Limits, kappa = 0.58
Focus Group DataParent’s Advice for the Experts on Car Seat Safety
• “Don’t do it by age. Do it by height and weight. And then once you get to this height and this weight, they need to go to this type of car seat… because it gets confusing. You don’t know what’s recommended and what’s the law.”
• “Be more clear on the car seat laws vs. what's recommended. Better access to research studies so we can see what went into changing the laws.”
Weight Limits for Child Safety Seats U.S. Market in 2012
Op-Eds: Local Impact
Michigan Child Passenger Safety Law
Acknowledgements• Grants from the NICHD K23 HD070913 and The Michigan Center for
Advancing Safe Transportation Throughout the Lifespan (MCASTL)
• Mentors: C. Raymond Bingham, Ken Resnicow, Gary L. Freed, Rebecca M. Cunningham
• Collaborators: Mary L. Smiley, Peter D. Jacobson
• Research Team: Brigitte McCool, Deepika Kandasamy, Tricia Jacobson, Amy Teddy, Amber Kroeker, Aaron Cheek, Bethany Buschmann, Genevieve Davis, Randy Dowding, Chelsea Kittridge, Lynn Massey, Laura Spera, Julie Weber
Questions?
Contact InformationMichelle L. Macy, MD, MSAssistant ProfessorDepartments of Emergency Medicine and Pediatrics, Child Health Evaluation and Research (CHEAR) UnitUniversity of MichiganEmail: [email protected]: 734.936.8338www.chear.org
Leaving More Protected than They Came
On DepartureOn Arrival Rear-
FacingForward-
FacingBooster Belt Missing
Rear-Facing n=630
95% 4% 0 <1% 1%
Forward-Facing n=273
9% 84% 5% 0 1%
Booster n=150
1% 26% 72% 0 1%
Belt n=52
0 11% 40% 48% 0
Missing n=224
59% 11% 21% 4.0% 4%
Focus Group DataViews on ED for Receipt of Child Passenger Safety Information
• “So there’s always a lot of downtime. So I think that parents would be receptive to getting information on child safety.”
• “I think if you say something like we care about your children, we care about you. You know?”
• “If it’s a pamphlet or some kind of literature, ‘Here, I’m handing this about car seats.’ then, I guess that’s fine.
• “Even if you did it at the end of the service, it’s like, ‘OK, I’ve been here for however long. I’m ready to go.”
• “I honestly can’t imagine any scenario where I would not find that annoying.”
• “But if I’m at emergency I don’t want to sit down and talk to you. I want to find out what’s wrong with my kid…”
• 1 in 3 emergency doctors did not know if a car seat inspection program was available in their area
Percent STRONGLY AGREE/AGREE PEM EM p-value
It is my role to educate parents about child passenger safety
95% 82% <0.001
Parents in the ED should be made aware of child passenger restraint laws
89% 79% <0.001
Results – Behaviors PEM vs. EM
RARELY/NEVER Responses PEM EM p-value
Recommend this family replace the car seat even if no signs of damage
12% 46% <0.001
Recommend the family purchase a booster seat for their 3-year-old child
59% 65% 0.157
• Scenario 1: A 3-year-old was restrained in a forward-facing car seat during a roll-over MVC.
Results – Behaviors PEM vs. EM
RARELY/NEVER ResponsesPEM EM p-value
Inform the parent a 6-year-old child is too young to sit in the front seat
4% 12% <0.001
Recommend this child use a booster seat
6% 16% <0.001
• Scenario 2: A 6-year-old front seat passenger is brought into the ED by their parent after a minor MVC.