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Advocacy Morning Report Car Safety Seats: Current Trends and Recommendations

Click to edit Master subtitle style Eddie Fisher, MD PGY-1

December 9, 2011

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Car Safety Seats and MVCs


MVCs are the leading cause of death for children > 3

yrs

> 5000 deaths per year in children and adolescents <

21 yrs

For every fatality, 400 children seek medical attention

for injuries related to MVC

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Car Safety Seats and MVAs


Female drivers were more likely to be driving children

correctly-restrained in booster seats

In non-fatal crashes, child was more likely to sit in

front seat if driver was male or not a parent


Likelihood of child to be properly restrained

If driver wearing seatbelt: 92% If driver not wearing seatbelt: 54%


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Car Safety Seats and MVAs


Mortality in MVCs highest in black and American

Indian/Alaska Natives, lowest in Asian/Pacific Islander (Pressley 2007)

Coordinated, community-level campaigns have been

successful in promoting use of booster seats in culturally diverse neighborhoods (Ebel 2003)

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Car Safety Seats and Seating Position


Improperly restrained children: 2x risk of injury

Unrestrained children: 3.2x risk of injury

Children seated in front seat: 1.4x risk of injury

(Durbin 2005)

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Car Seat Installation


If CSS can be moved more than 1 inch in any

direction, it is not tight enough

70-80% of car seats installed incorrectly

Can secure CSS with seatbelt or LATCH system

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Seatbelt Installation

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LATCH Installation
Lower Anchors and Tethers for Children

Uses dedicated attachment points in vehicle, rather

than the seatbelt

Included in all vehicles manufactured in US after

2002

Easier for parents to install


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LATCH Installation

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Child Passenger Committee on Injury, Violence, and Poison Prevention Safety Pediatrics 2011;127;788; originally published online March 21, 2011; DOI: 10.1542/peds.2011-0213

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1.

Infants and toddlers should ride in rear-facing CSS until age 2 OR until they reach CSS height/weight restriction

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Excessive

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ligamentous laxity, incomplete vertebral ossification put children at increased risk of head and spinal cord injury CSS better support

Rear-facing
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2.

All children 2 years and older, and younger children who have outgrown their rear-facing CSS, should use a forward-facing CSS with harness as long as possible

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Children in correctly used forward-facing car safety

seats have 71% lower risk of death/serious injury than unrestrained children (Kahane 1986)

Similar benefit even when compared with seatbelts

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3.

Children who have outgrown their forward-facing CSS should use belt-positioning booster seat until lap-andshoulder seat belt fits properly

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Shoulder belt

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lies across middle of chest and shoulder, not neck/face


Lap belt low

across hips and pelvis, not abdomen


Child is tall

enough to sit comfortably against vehicle seat back with

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Booster seats confer 59% lower risk of injury vs seat

belts (Durbin 2003)

Estimated 57% reduction in fatalities (Corden 2005)

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4.

When children are old and large enough to use the vehicle seat belt alone, they should always use lap-and-shoulder seat belts

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Only since ~2001 have all cars had lap and shoulder

belts in rear seats

Presence of shoulder belt reduced risk of injury by

81% in children in center rear seat (Arbogast 2004)

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5.

Children younger than 13 years should be restrained in rear seats of vehicle

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Risk of injury 40-70% greater for children riding in

front seat

Benefit not observed in children > 12 yrs (Durbin 2005)

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Air Bags
Risk in front seat due to airbags Case series describing 8 deaths due to airbags (CDC 1995) Rear-facing CSS: skull, brain injuries Older children: slide forward into path of airbag

deployment

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Additional Car Safety Seat Tips


Do not use a car seat after its expiration date (typically

6 yrs)

Do not purchase a used car seat

Check with manufacturer about using a car seat that

has been in a MVC

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Additional Car Safety Seat Tips


Do not use accessories that did not come with car seat

Blankets, bulky coats, etc should be outside the car

seat harness

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Resources
http://www.aap.org/healthtopics/carseatsafety.cfm

http://www.youtube.com/user/PrimaryChildrens

http://intermountainhealthcare.org/hospitals/primarych

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References
Arbogast KB et al. Evaluation of pediatric use patterns

and performance of lap shoulder belt systems in the center rear. Annu Proc Assoc Adv Automot Med. 2004;48:57-72.

CDC . Injury prevention & control, Web-based Injury

Statistics Query and Reporting System (WISQARS). Available at www.cdc.gov/injury/wisqars/index.html. use: how many Wisconsin Childhood deaths and hospitalizations could have been prevented in 19982002? WMJ. 2005;104(1):42-45.

Corden TE et al. Analysis of booster seat and seat belt

5/4/12 Daly L et al. Risk of injury to child passengers in sport