Trends in Emergent Head Computed Tomography Utilization for Minor Head Trauma After Implementation of a Clinical Pathway.

OBJECTIVE: The aims of this study were to evaluate trends over time in computed tomography (CT) scan utilization after implementation of a clinical pathway in a tertiary care children's hospital emergency department (ED), to determine how ED throughput differs by CT utilization, and to determine provider reasoning for obtaining head CT in low-risk patients. METHODS: This was a retrospective cohort study of patients 21 years or younger discharged from our ED with head trauma (Glasgow Coma Scale score ≥13 and a head trauma International Classification of Diseases code) over a 5-year period, starting 1 year after pathway implementation (January 2012 to December 2016). A manual chart review of 10% of patients who received a CT was performed to determine reasoning for CT utilization and guideline compliance. RESULTS: In total, 6.3% (95% confidence interval [CI], 5.9%-6.6%) of 21,129 discharged patients received a head CT, decreasing annually by an average of 0.9%. Pediatricians were more likely to obtain a CT than pediatric emergency medicine physicians after adjusting for acuity (odds ratio, 1.37; 95% CI, 1.02-1.82). Those who received a CT stayed 90 minutes longer (95% CI, 79-101 minutes) than those who did not after propensity score matching. Thirty percent of patients who received a CT in our manual chart review met low-risk Pediatric Emergency Care Applied Research Network criteria. CONCLUSIONS: Head CT rates in patients with minor head trauma consistently decreased each year after guideline implementation. Children who received head CT did not have prolonged lengths of stay compared with those who did not. A minority of patients who received a CT and were discharged met low-risk criteria by standardized guidelines.

Association between New Jersey's Graduated Driver Licensing decal provision and crash rates of young drivers with learners' permits.

New Jersey (NJ) implemented the first-in-the-US Graduated Driver Licensing (GDL) decal provision in May 2010 for young drivers with learner's permits or intermediate licenses. Previous analyses found an association between the provision and crash reduction among intermediate drivers. The aim of this study is to examine the association between NJ's provision and GDL citation and crash rates among drivers aged <21 years with learner's permits. We estimated monthly per-driver rates from January 2006 through June 2012. Negative binomial modeling compared pre and post decal crash rates adjusted for gender, age, calendar month, and gas price. The monthly GDL citation rate was two per 10,000 drivers in the predecal and postdecal periods. Crashes were rare and rates declined similarly pre and post decal (adjusted rate ratio of postdecal vs predecal slope: 1.04 (0.97 to 1.12)). NJ's GDL decal provision was not associated with a change in citation or crash rates among young NJ drivers with learner's permits.

Extending the value of police crash reports for traffic safety research: collecting supplemental data via surveys of drivers.

BACKGROUND: Police crash reports have been used to advance motor vehicle safety research, though their value is limited by their focus on the crash event rather than outcomes of the crash. OBJECTIVE: To develop and evaluate the effect of enhanced recruitment methods, including a monetary incentive, on response rates of drivers identified on police reports in a national MVC surveillance system. METHODS: The National Automotive Sampling System-General Estimates System (NASS-GES) was used to identify passenger vehicle crashes between 1 July and 30 October 2012 involving drivers ≥16 years old with at least one child occupant ≤17 years old. We collected data from the driver via self-administered hardcopy or interviewer-administered telephone surveys. Within each survey mode, half the drivers were randomly assigned to receive a small monetary incentive. Response rates were calculated overall, and by mode of survey administration and incentive condition. RESULTS: 495 drivers were eligible, and 127 completed the survey, yielding an overall response rate of 25.7% (95% CI 21.8% to 29.5%). The response rate across the two modes was higher for those who received an incentive than for those who did not (35.6% vs 15.7%, p<0.01). The highest response rate (45.9%) was for drivers allocated to the telephone survey who received an incentive. CONCLUSIONS: The NASS-GES provides a surveillance system from which cases of interest can be identified and supplemental data collected via surveys of drivers identified on police reports. We adapted procedures commonly used in public health surveillance systems, including monetary incentives and branded recruitment materials, to improve driver response rates.

Engagement with the TeenDrivingPlan and diversity of teens' supervised practice driving: lessons for internet-based learner driver interventions.

OBJECTIVE: Inexperienced, less-skilled driving characterises many newly licensed drivers and contributes to high crash rates. A randomised trial of TeenDrivingPlan (TDP), a new learner driver phase internet-based intervention, demonstrated effectiveness in improving safety relevant, on-road driving behaviour, primarily through greater driving practice diversity. To inform future learner driver interventions, this analysis examined TDP use and its association with practice diversity. DESIGN: Posthoc analysis of data from teen/parent dyads (n=107), enrolled early in learner phase and assigned to treatment arm in randomised trial. METHODS: Inserted software beacons captured TDP use data. Electronic surveys completed by parents and teens assessed diversity of practice driving and TDP usability ratings at 24 weeks (end of study period). RESULTS: Most families (84%) used TDP early in the learner period; however, the number of TDP sessions in the first week was three times higher among dyads who achieved greater practice diversity than those with less. By week five many families still engaged with TDP, but differences in TDP use could not be detected between families with high versus low practice diversity. Usability was not a major issue for this sample based on largely positive user ratings. CONCLUSIONS: An engaging internet-based intervention, such as TDP, can support families in achieving high practice diversity. Future learner driver interventions should provide important information early in the learner period when engagement is greatest, encourage continued learning as part of logging practice drives, and incorporate monitoring software for further personalisation to meet family needs. TRIAL REGISTRATION: NCT01498575.

Pediatricians' self-reported knowledge, attitudes, and practices about child passenger safety.

OBJECTIVE: To evaluate pediatricians' self-reported knowledge, attitudes, and dissemination practices regarding the new American Academy of Pediatrics' (AAP) child passenger safety (CPS) policy recommendations. STUDY DESIGN: A cross-sectional survey was distributed to pediatric primary care physicians via AAP e-mail distribution lists. Knowledge, attitudes, and practices related to current AAP CPS recommendations and the revised policy statement were ascertained. RESULTS: There were 718 respondents from 3497 physicians with active e-mail addresses, resulting in a 20.5% response rate, of which 533 were eligible based on the initial survey question. All 6 CPS knowledge and scenario-based items were answered correctly by 52.9% of the sample; these respondents were identified as the "high knowledge" group. Pediatricians with high knowledge were more likely to be female (P < .001), to have completed a pediatrics residency (vs medicine-pediatrics) (P = .03), and have a child between 4 and 7 years of age (P = .001). CPS information was distributed more frequently at routine health visits for patients 0-2 years of age vs those 4-12 years of age. Those with high knowledge were less likely to report several specific barriers to dissemination of CPS information, more likely to allot adequate time and discuss CPS with parents, and had greater confidence for topics related to all CPS topics. CONCLUSIONS: Although CPS knowledge is generally high among respondents, gaps in knowledge still exist. Knowledge is associated with attitudes, practices, barriers, and facilitators of CPS guideline dissemination. These results identify opportunities to increase knowledge and implement strategies to routinely disseminate CPS information in the primary care setting.

Residual cognitive disability after completion of inpatient rehabilitation among injured children.

OBJECTIVE: To determine the prevalence and nature of residual cognitive disability after inpatient rehabilitation for children aged 7-18 years with traumatic injuries. STUDY DESIGN: This retrospective cohort study included children aged 7-18 years in the Uniform Data System for Medical Rehabilitation who underwent inpatient rehabilitation for traumatic injuries in 523 facilities from 2002-2011. Traumatic injuries were identified by standardized Medicare Inpatient Rehabilitation Facility-Patient Assessment Instrument codes. Cognitive outcomes were measured by the Functional Independence Measure instrument. A validated, categorical staging system derived from responses to the items in the cognitive domain of the functional independence measure was used and consisted of clinically relevant levels of cognitive achievement from stage 1 (total cognitive disability) to stage 7 (completely independent cognitive function). RESULTS: There were 13,798 injured children who completed inpatient rehabilitation during the 10-year period. On admission to inpatient rehabilitation, patients with traumatic brain injury (TBI) had more cognitive disability (median stage 2) than those with spinal cord injury or other injuries (median stage 5). Cognitive functioning improved for all patients, but children with TBI still tended to have significant residual cognitive disability (median stage on discharge, 4). CONCLUSIONS: Injured children gained cognitive functionality throughout inpatient rehabilitation. Those with TBI had more severe cognitive disability on admission and more residual disability on discharge. This is important not only for patient and family expectation setting but also for resource and service planning, as discharge from inpatient rehabilitation is a critical milestone for reintegration into society for children with serious injury.

Validation of a parent survey for reporting child injuries.

OBJECTIVE: To evaluate the validity of a parent-reported survey to identify children's moderate and serious injuries in seven specific body regions using medical records as the 'gold standard'. METHODS: A prospective validation study was conducted in three urban paediatric emergency departments (EDs). 798 parents of 859 children treated for injuries at participating EDs between August 2010 and July 2011 completed either a telephone interview or self-administered paper survey at 2 weeks post-ED visit. Parents were asked to report child injuries to seven body regions: head, face, neck/spine/back, thorax, abdomen, upper extremities and lower extremities. Injury data were abstracted from medical records using a standardised protocol. Body region injury severity levels of none/minor, moderate or serious were assigned to each subject based on the Abbreviated Injury Scale. RESULTS: The overall sensitivity, reflecting parents' ability to identify a documented moderate or greater severity injury, was 0.95 (95% CI 0.92 to 0.97). Sensitivities were >0.90 for the face, upper extremity and lower extremity regions; 0.80-0.90 for head, abdomen and neck/back/spine regions; and <0.60 for the thorax region. The overall sensitivity for identification of a serious injury was 0.71 (0.60 to 0.80). CONCLUSIONS: This survey enables parents to accurately identify moderate and greater severity injuries to body regions, though it does not accurately identify serious injuries in most body regions except the extremities. The survey could serve as a screening tool to identify moderate and greater severity injuries in population-based surveillance systems, or as the primary outcome of interest in injury prevention studies.

Safety belt laws and disparities in safety belt use among US high-school drivers.

OBJECTIVES: We compared reported safety belt use, for both drivers and passengers, among teenagers with learner's permits, provisional licenses, and unrestricted licenses in states with primary or secondary enforcement of safety belt laws. METHODS: Our data source was the 2006 National Young Driver Survey, which included a national representative sample of 3126 high-school drivers. We used multivariate, log-linear regression analyses to assess associations between safety belt laws and belt use. RESULTS: Teenaged drivers were 12% less likely to wear a safety belt as drivers and 15% less likely to wear one as passengers in states with a secondary safety belt law than in states with a primary law. The apparent reduction in belt use among teenagers as they progressed from learner to unrestricted license holder occurred in only secondary enforcement states. Groups reporting particularly low use included African American drivers, rural residents, academically challenged students, and those driving pickup trucks. CONCLUSIONS: The results provided further evidence for enactment of primary enforcement provisions in safety belt laws because primary laws are associated with higher safety belt use rates and lower crash-related injuries and mortality.

Children with special physical health care needs: restraint use and injury risk in motor vehicle crashes.

Physical disabilities may affect a child passenger's fit within a conventional motor vehicle restraint. The aim of this study is to describe and compare injury risk in motor vehicle crashes (MVC) among children with and without special physical health care needs (SPHCN). This analysis, conducted in 2007-2008, utilizes data collected between December 1998 and November 2002 in a cross-sectional study of children ≤15 years old involved in crashes of State-Farm insured vehicles in 15 states and the District of Columbia. Parent reports via telephone survey were used to define pre-crash SPHCN, restraint status, and occurrence of significant injuries using a validated survey. Complete data were collected for 18,852 children aged 0-15 years; 159 children were reported to have a SPHCN (0.8% and 0.7% of children aged 0-8 and 9-15 years, respectively). A greater proportion of children with SPHCN aged 0-8 years were appropriately restrained (P < 0.001), but there was no significant difference in restraint use among children with and without SPHCN aged 9-15 years. There was no significant association between the presence of a SPHCN and injury risk in either age group, after adjustment for child/driver characteristics (children aged 0-8 years: OR 1.27, 95% CI: 0.48-3.33; children aged 9-15 years: OR 1.51, 95% CI: 0.38-6.11). Children with and without SPHCN have similar injury risk in MVC, despite increased age-appropriate restraint usage among children aged 0-8 years. When counseling families about vehicle safety, practitioners should consider the fit of a child with SPHCN in a restraint system.

A longitudinal view of resident education in pediatric emergency interhospital transport.

OBJECTIVES: : The focus was to examine the educational structure and curricular planning involved in current pediatric emergency interhospital transport teams that use resident physicians as members of the team and to compare these current results with the findings from 2 previous, similar surveys complete during the past 2 decades. METHODS: : A 33-item questionnaire, assessing curricular components of the transport experience, was sent to a chief resident at all the officially listed nonmilitary pediatric residency program in contiguous United States. Comparisons were done for each similar item on all 3 questionnaires. RESULTS: : After 3 rounds of mailing and telephone follow-up to nonresponders, the overall response rates for the 2006 and 1998 surveys were 81% (n = 156) and 89% (n = 173), respectively. A similar survey on a smaller sample, published in 1990, used for comparison, had a response rate of 99% (n = 75). When asked about training provided to residents before going on transport, respondents varied in the specific experiences and skills required of the residents. In addition, programs reported variation in team backup during the pediatric emergency transport. The most common method of evaluation for the resident on completion of the transport was "no specific method" as reported by 62% of respondents in 2006 compared with 50% in 1998 and 55% in 1990 (P = not significant). The percentage of programs providing informal verbal feedback was reduced significantly in 2006 as compared with that in 1998 (P = 0.011). CONCLUSIONS: : The educational structure for residents serving in pediatric emergency interhospital transport teams remains variable, and the full educational value of pediatric transports continues to be somewhat unrealized particularly in the area of posttransport performance feedback and evaluation. Having medical command available has consistently been a strong point of the residents' experience on the transport team.

Effect of high-fidelity simulation on Pediatric Advanced Life Support training in pediatric house staff: a randomized trial.

OBJECTIVES: To assess the effect of high-fidelity simulation (SIM) on cognitive performance after a training session involving several mock resuscitations designed to teach and reinforce Pediatric Advanced Life Support (PALS) algorithms. METHODS: Pediatric residents were randomized to high-fidelity simulation (SIM) or standard mannequin (MAN) groups. Each subject completed 3 study phases: (1) mock code exercises (asystole, tachydysrhythmia, respiratory arrest, and shock) to assess baseline performance (PRE phase), (2) a didactic session reviewing PALS algorithms, and (3) repeated mock code exercises requiring identical cognitive skills in a different clinical context to assess change in performance (POST phase). SIM subjects completed all 3 phases using a high-fidelity simulator (SimBaby, Laerdal Medical, Stavanger, Norway), and MAN subjects used SimBaby without simulated physical findings (ie, as a standard mannequin). Performance in PRE and POST was measured by a scoring instrument designed to measure cognitive performance; scores were scaled to a range of 0 to 100 points. Improvement in performance from PRE to POST phases was evaluated by mixed modeling using a random intercept to account for within subject variability. RESULTS: Fifty-one subjects (SIM, 25; MAN, 26) completed all phases. The PRE performance was similar between groups. Both groups demonstrated improvement in POST performance. The improvement in scores between PRE and POST phases was significantly better in the SIM group (mean [SD], 11.1 [4.8] vs. 4.8 [1.7], P = 0.007). CONCLUSIONS: The use of high-fidelity simulation in a PALS training session resulted in improved cognitive performance by pediatric house staff. Future studies should address skill and knowledge decays and team dynamics, and clearly defined and reproducible outcome measures should be sought.

The role of mentors in addressing issues of work-life integration in an academic research environment.

INTRODUCTION: There is growing evidence for both the need to manage work-life conflict and the opportunity for mentors to advise their mentees on how to do this in an academic research environment. METHODS: A multiphase approach was used to develop and implement an evidence-informed training module to help mentors guide their mentees in issues of work-life conflict. Analysis of existing data from a randomized controlled trial (RCT) of a mentor training curriculum (n = 283 mentor/mentee dyads) informed the development of a work-life mentoring module which was incorporated into an established research mentor training curriculum and evaluated by faculty at a single academic medical center. RESULTS: Only 39% of mentors and 36% of mentees in the RCT indicated high satisfaction with the balance between their personal and professional lives. The majority (75%) of mentors and mentees were sharing personal information as part of the mentoring relationship which was significantly associated with mentees' ratings of the balance between their personal and professional lives. The effectiveness of the work-life module was assessed by 60 faculty mentors participating in a mentor training program at an academic medical center from 2013 to 2017. Among the respondents to the post-training survey, 82.5% indicated they were very/somewhat comfortable addressing work-life issues with their mentees as a result of the training, with significant improvements (p = 0.001) in self-assessments of mentoring skill in this domain. CONCLUSIONS: Our findings indicate that a structured training approach can significantly improve mentors' self-reported skills in addressing work-life issues with their mentees.

Validation of the Use of Electronic Health Records for Classification of ADHD Status.

OBJECTIVE: To validate an electronic health record (EHR)-based algorithm to classify ADHD status of pediatric patients. METHOD: As part of an applied study, we identified all primary care patients of The Children's Hospital of Philadelphia [CHOP] health care network who were born 1987-1995 and residents of New Jersey. Patients were classified with ADHD if their EHR indicated an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code of "314.x" at a clinical visit or on a list of known conditions. We manually reviewed EHRs for ADHD patients ( n = 2,030) and a random weighted sample of non-ADHD patients ( n = 807 of 13,579) to confirm the presence or absence of ADHD. RESULTS: Depending on assumptions for inconclusive cases, sensitivity ranged from 0.96 to 0.97 (95% confidence interval [CI] = [0.95, 0.97]), specificity from 0.98 to 0.99 [0.97, 0.99], and positive predictive value from 0.83 to 0.98 [0.81, 0.99]. CONCLUSION: EHR-based diagnostic codes can accurately classify ADHD status among pediatric patients and can be used by large-scale epidemiologic and clinical studies with high sensitivity and specificity.

Reliability and Construct Validity of the TBI-QOL Communication Short Form as a Parent-Proxy Report Instrument for Children With Traumatic Brain Injury.

Purpose The purpose of this study was to evaluate the internal consistency and construct validity of the Traumatic Brain Injury Quality of Life Communication Item Bank (TBI-QOL COM) short form as a parent-proxy report measure. The TBI-QOL COM is a patient-reported outcome measure of functional communication originally developed as a self-report measure for adults with traumatic brain injury (TBI), but it may also be valid as a parent-proxy report measure for children who have sustained TBI. Method One hundred twenty-nine parent-proxy raters completed the TBI-QOL COM short form 6 months postinjury as a secondary aim of a multisite study of pediatric TBI outcomes. The respondents' children with TBI were between 8 and 18 years old ( M age = 13.2 years old) at the time of injury, and the proportion of TBI severity mirrored national trends (73% complicated-mild; 27% moderate or severe). Results The parent-proxy report version of the TBI-QOL COM displayed strong internal consistency (ordinal α = .93). It also displayed evidence of known-groups validity by virtue of more severe injuries associated with more abnormal scores. The instrument also showed evidence of convergent and discriminant validity by displaying a pattern of correlations with other constructs according to their conceptual relatedness to functional communication. Conclusions This preliminary psychometric investigation of the TBI-QOL COM supports the further development of a parent report version of the instrument. Future development of the TBI-QOL COM with this population may include expanding the content of the item bank and developing calibrations specifically for parent-proxy raters. Supplemental Material https://doi.org/10.23641/asha.7616534.

Child Passenger Safety.

Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death to children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend the inclusion of child passenger safety anticipatory guidance at every health supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues affecting the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families.

Child Passenger Safety.

Child passenger safety has dramatically evolved over the past decade; however, motor vehicle crashes continue to be the leading cause of death for children 4 years and older. This policy statement provides 4 evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence: (1) rear-facing car safety seats as long as possible; (2) forward-facing car safety seats from the time they outgrow rear-facing seats for most children through at least 4 years of age; (3) belt-positioning booster seats from the time they outgrow forward-facing seats for most children through at least 8 years of age; and (4) lap and shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles. It is important to note that every transition is associated with some decrease in protection; therefore, parents should be encouraged to delay these transitions for as long as possible. These recommendations are presented in the form of an algorithm that is intended to facilitate implementation of the recommendations by pediatricians to their patients and families and should cover most situations that pediatricians will encounter in practice. The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health supervision visit.

Effect of booster seat laws on appropriate restraint use by children 4 to 7 years old involved in crashes.

OBJECTIVE: To quantify the independent contribution of recently enacted booster seat laws on appropriate restraint use by child passengers in motor vehicles. DESIGN: Longitudinal study of children involved in crashes with data collected via insurance claims records and a validated telephone survey. SETTING: Sixteen states and Washington, DC, from December 1, 1998, through December 31, 2004. PARTICIPANTS: Probability sample of 5198 vehicles in crashes involving 6102 children aged 4 to 7 years, representing 78 159 vehicles and 91 752 children. MAIN EXPOSURES: Booster seat law provisions, child age, state, and secular trends. MAIN OUTCOME MEASURE: Reported appropriate restraint use for this age group, including forward-facing child safety seats, belt-positioning booster seats, and combination seats. RESULTS: Children aged 4 to 7 years in states with booster seat laws were 39% more likely to be reported as appropriately restrained than were children in other states (prevalence ratio [PR], 1.39; 95% confidence interval [CI], 1.14-1.70). Children aged 4 to 5 years were 23% more likely (PR,1.23; 95% CI, 0.80-1.42) and children 6 to 7 years twice as likely (PR, 2.09; 95% CI, 1.46-2.99) to be reported as appropriately restrained. For children aged 6 to 7 years, when compared with no law, laws through age 7 years were most effective (PR, 3.71; 95% CI, 2.49-5.42), followed by laws through age 4 or 5 years (PR, 1.43; 95% CI, 0.89-2.24). CONCLUSION: Given the higher current use of age-appropriate restraints among children 4 to 5 years compared with older children, future upgrades to child restraint laws should include children through at least age 7 years to maximize the number of children properly restrained for their age.

Mechanisms of abdominal organ injury in seat belt-restrained children.

BACKGROUND: Previous research has identified key predictors of elevated abdominal injury risk in seat belt-restrained child vehicle occupants; however these data cannot be used to isolate specific mechanisms or sources of injury to suggest strategies for prevention. METHODS: Using a large child-focused crash surveillance system, cases of seat belt-restrained children who sustained an internal abdominal injury in a frontal crash were studied using standard crash investigation protocols. A second group of cases of restrained children in similar crashes without abdominal injury was investigated. Medical, crash, and child characteristics of each case were analyzed in the context of known biomechanics of abdominal injury to determine the mechanisms of injury and associated kinematics. RESULTS: Review of 21 cases of abdominal injury identified belt loading directly over the injured organ as the most common mechanism of injury. Three unique kinematic patterns were identified that varied by the initial position of the lap belt and kinematics of the upper torso. Sixty percent of the drivers and 90% of the other child occupants in these crashes sustained either no or minor injury. In the 16 no abdominal injury cases, all but one sustained external bruising to their abdomen and contact injury to the head and face. CONCLUSIONS: This evaluation of crashes in which belted children did and did not sustain abdominal injuries revealed key characteristics about their mechanism. In this data set, belt compression directly on the abdomen, manifested by improper initial placement of the seat belt, poor child posture, or misuse of the shoulder belt, resulted in abdominal injury in low-severity crashes in which other occupants sustained little injury. The cases pointed to control of torso excursion by consistent use of the shoulder belt and suggested that technologies such as lap belt pretensioners or belt-positioning booster seats might be a possible strategy, among others, for prevention.

Breathing difficulty and tinnitus among children exposed to airbag deployment.

OBJECTIVE: To assess the incidence of breathing difficulty and tinnitus in children involved in motor vehicle crashes with and without passenger airbag (PAB) deployment, and its relationship to seating position and to whether the airbag deployed was first versus second-generation. METHODS: We studied motor vehicle crashes with child passengers, over a 3-year period, in three large regions of the United States, by means of telephone interviews with the driver/parent. The crashes were classified into those with and without a PAB deployment. Complete data were collected on 7383 children in 4817 crashes, who, because of the sample design of the study, represent an estimated 120,987 children in 83,267 crashes. RESULTS: Among children involved in crashes with PAB deployment, 6.6% complained of breathing difficulty versus 1.4% without airbag deployment (OR 5.2, 95% CI 3.3-8.2). The corresponding figures for tinnitus were 5.0% versus 0.7% (OR 7.4, 95% CI 4.0-13.7). Analysis of data for children exposed to PABs indicated that 14.1% of children in the front seat versus 1.1% in the rear complained of tinnitus (OR 14.4, 95% CI 5.9-34.7). Seating row did not significantly affect the incidence of breathing difficulty. The type of airbag deployed did not significantly affect the incidence of breathing difficulty or of tinnitus. CONCLUSION: Breathing difficulty and tinnitus were much more common among children in crashes with PAB deployment as against those without PAB deployment. Among children in crashes with PAB deployment, tinnitus was about 14 times more likely for those sitting in the front versus rear seat. The incidence of breathing difficulty was not affected significantly by seating row. Introduction of second-generation airbags has not affected the incidence of breathing difficulty or of tinnitus.