Interventions to change parental parenting behaviour to reduce unintentional childhood injury: a randomised controlled trial.

OBJECTIVE: The previous study has shown the impact of paternal involvement in childcare on unintentional childhood injury; yet the causality is unknown. The purpose of this study is to investigate whether the intervention of an educational video on paternal involvement in childcare can prevent unintentional injury among young children. METHODS: A randomised controlled trial of parents of children born at two obstetrics wards in Japan (n=451, intervention group: 223, control group: 228) was conducted. Parents in the intervention group watched an educational video that promote paternal involvement in childcare, while parents in the control group watched an educational video on the prevention of shaken baby syndrome. The participants were followed for up to 18 months after the birth of their child. The primary outcome of this study was unintentional injury at 3, 6, 12 and 18 months. The secondary outcome was paternal involvement in childcare based on maternal observation. Unintentional injury-free rates over time were assessed using the Cox proportional hazard model. RESULTS: Children in the intervention group were less likely to have unintentional injury, such as burn (HR: 0.29 (95% CI: 0.09 to 0.87)) and caught by a door (HR: 0.66 (95% CI: 0.48 to 0.91)) compared with the control group. Fathers in the intervention group showed higher frequency of taking their children for a walk (coefficient: 0.19 (95% CI: 0.05 to 0.32)). CONCLUSIONS: Educational videos promoting paternal involvement in childcare is effective to prevent unintentional childhood injury.

Use of a serious game simulation to build early childhood staff capacity for reducing unintentional childhood injuries.

INTRODUCTION: Unintentional home injuries are common and costly, with over 1.6 million occurring among U.S. children ages 0-4 in 2018. Home visitors and other early childhood professionals can provide valuable prevention education and intervention to reduce unintentional injury risk for children. This proof-of-concept study aimed to test the feasibility of the first phase of Home Safety Hero, a software-based serious game simulation that trains users in identification of home safety risks, as a capacity building tool for early childhood professionals. METHODS: The game simulation's potential for knowledge promotion and engagement in a sample of home visitors was explored based on play of the first phase. Repeated measures ANOVAs were used to assess learning via reaction time, and engagement was measured via the User Engagement Scale (UES). RESULTS: Reaction time (i.e., average time to identify hazards) improved from the first to last levels in both single and mixed category levels in this trial. Participant indicated agreement with four subscales of engagement measured by the UES, and neutral to agree on a fifth subscale, focused attention. CONCLUSIONS: We propose that this game simulation can meet the unique training needs of early childhood professionals while promoting home safety knowledge that can improve prevention work with families. Participant feedback was largely positive, and results suggest that the game simulation is engaging and contributes to knowledge. PRACTICAL APPLICATIONS: The Home Safety Hero serious game simulation is a flexible training option that appeared to be feasible for reducing time to hazard identification among home visitors in this proof-of-concept study. The design of the game simulation has utility in meeting the specialized training needs of early childhood professionals and potential to build their capacity to provide direct intervention around home safety, reducing risk for unintentional injury among children.

The impact of helmet use on neurosurgical care and outcomes after pediatric all-terrain vehicle and dirt bike crashes: a 10-year single-center experience.

OBJECTIVE: All-terrain vehicle (ATV) and dirt bike crashes frequently result in traumatic brain injury. The authors performed a retrospective study to evaluate the role of helmets in the neurosurgical outcomes of pediatric patients involved in ATV and dirt bike crashes who were treated at their institution during the last decade. METHODS: The authors analyzed data on all pediatric patients involved in ATV or dirt bike crashes who were evaluated at a single regional level I pediatric trauma center between 2010 and 2019. Patients were excluded if the crash occurred in a competition (n = 70) or if helmet status could not be determined (n = 18). Multivariable logistic regression was used to analyze the association of helmet status with the primary outcomes of 1) neurosurgical consultation, 2) intracranial injury (including skull fracture), and 3) moderate or severe traumatic brain injury (MSTBI) and to control for literature-based, potentially confounding variables. RESULTS: In total, 680 patients were included (230 [34%] helmeted patients and 450 [66%] unhelmeted patients). Helmeted patients were more frequently male (81% vs 66%). Drivers were more frequently helmeted (44.3%) than passengers (10.5%, p < 0.001). Head imaging was performed to evaluate 70.9% of unhelmeted patients and 48.3% of helmeted patients (p < 0.001). MSTBI (8.0% vs 1.7%, p = 0.001) and neurosurgical consultation (26.2% vs 9.1%, p < 0.001) were more frequent among unhelmeted patients. Neurosurgical injuries, including intracranial hemorrhage (16% vs 4%, p < 0.001) and skull fracture (18% vs 4%, p < 0.001), were more common in unhelmeted patients. Neurosurgical procedures were required by 2.7% of unhelmeted patients. One helmeted patient (0.4%) required placement of an intracranial pressure monitor, and no other helmeted patients required neurosurgical procedures. After adjustment for age, sex, driver status, vehicle type, and injury mechanism, helmet use significantly reduced the odds of neurosurgical consultation (OR 0.250, 95% CI 0.140-0.447, p < 0.001), intracranial injury (OR 0.172, 95% CI 0.087-0.337, p < 0.001), and MSTBI (OR 0.244, 95% CI 0.079-0.758, p = 0.015). The unadjusted absolute risk reduction provided by helmet use equated to a number-needed-to-helmet of 6 riders to prevent 1 neurosurgical consultation, 4 riders to prevent 1 intracranial injury, and 16 riders to prevent 1 MSTBI. CONCLUSIONS: Helmet use remains problematically low among young ATV and dirt bike riders, especially passengers. Expanding helmet use among these children could significantly reduce the rates of intracranial injury and MSTBI, as well as the subsequent need for neurosurgical procedures. Promoting helmet use among recreational ATV and dirt bike riders must remain a priority for neurosurgeons, public health officials, and injury prevention professionals.

How to help runners steer clear of injury.

Assess risk factors, then work to address modifiable ones, such as wearing the right running shoes and building up slowly. Don't let overweight or OA dampen enthusiasm.

Crash rates of convertible cars.

OBJECTIVE: Convertible cars have existed since among the first automobiles, and the lack of substantial roof structure creates some safety concerns. Though crash tests have demonstrated that convertibles can resist excessive intrusion in front and side crashes and that strong A-pillars and roll bars can help maintain survival space in rollovers, little work has been done examining the real-world crash experience of these vehicles. The objective of this study was to compare the crash experience of recent convertibles with nonconvertible versions of the same cars using the most recent crash data. METHODS: Crash and exposure data were obtained from the U.S. Department of Transportation and IHS Markit, respectively. Rates of driver deaths and police-reported crash involvements were compared for 1- to 5-year-old convertible cars and their nonconvertible versions during 2014-2018. Exposure measures included registered vehicle years (RVY) and vehicle miles traveled (VMT). These rates were compared using the standardized mortality ratio to account for possible differences in exposure distribution. Crash circumstances (e.g., point of impact, rollover, ejection) and behavioral outcomes (e.g., speeding, alcohol impairment, seat belt use) were compared for drivers killed in crashes. RESULTS: Convertibles had lower driver death rates and police-reported crash involvement rates on the basis of both RVY and VMT. However, the differences in driver death rates were not statistically significant. Driver deaths per 10 billion VMT were 11% lower for convertibles, and driver involvement in police-reported crashes per 10 million VMT was 6% lower. On average, convertibles were driven 1,595 fewer miles per year than the nonconvertible versions of these cars. Among fatally injured drivers, convertibles had slightly higher rates of ejection, and behavioral differences were minimal. The number of rollovers was small and their rate did not substantially differ between convertibles and their nonconvertible versions. CONCLUSIONS: Safety concerns associated with convertibles' retractable roof structures were not supported by the results of this study.

Evaluating disparities in child occupant protection using a proportion-eliminated approach to mediation.

OBJECTIVE: While there are clear racial/ethnic disparities in child restraint system (CRS) use, to date no studies have identified mediators that quantitatively explain the relationship between race and CRS use. Therefore, the objective of this study was to provide an example of how a proportion-eliminated approach to mediation may be particularly useful in understanding the complex relationship between race and CRS use. METHODS: Sixty-two mothers with a child between 4-8 years old completed a survey and had their CRS use assessed by a Child Passenger Safety Technician using a structured assessment based on the 2018 American Academy of Pediatrics' Best Practice guidelines. Recruitment and data collection occurred in Birmingham, Alabama between June 2018 and January 2019. We used chi-squared tests, logistic regressions, and a proportion-eliminated approach to mediation to compare our variables of interest and to estimate the amount of the association between racial group membership and errors in restraint use that may be explained by sociodemographic, psychosocial, and parenting variables. RESULTS: Before mediation, Nonwhite mothers in this sample had a 7.38 greater odds of having an error in CRS use than White mothers. Mediation analyses indicated that being married and self-reported seatbelt use explained 47% and 35% of the effect of race on CRS use errors, respectively. CONCLUSION: A proportion-eliminated approach to mediation may be particularly useful in child passenger safety research aiming to inform the development of interventions tailored for racial minority populations.

Road traffic injury mortality and morbidity by country development status, 2011-2017.

PURPOSE: This research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 - to halve the number of global deaths and injuries from road traffic accidents by 2020. METHODS: Data for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017. RESULTS: Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%-16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68-1.90 per 100,000 population) and morbidity (110.45-112.72 per 100,000 population for incidence and 487.48-491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07-4.50 per 100,000 population) but the highest morbidity (428.74-467.78 per 100,000 population for incidence and 1025.70-1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths. CONCLUSION: Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

Anomalous innominate artery complicating tracheal surgical procedures.

OBJECTIVE: To highlight the importance of imaging in reducing an accidental injury to the anomalous brachiocephalic trunk and its branches during tracheal surgery. CASE REPORT: This paper reports two cases of accidental injury to the great vessels in the neck during tracheal surgery. The first incident occurred during a repeat tracheostomy, when the right common carotid artery was injured. On reviewing the computed tomography images, the bifurcation of the brachiocephalic artery was seen to the left of the midline, and the right common carotid artery was adherent just below the tracheostomy site. The second incident happened during surgery for tracheal stenosis, when there was an inadvertent injury to the main brachiocephalic trunk, which was adherent to the trachea in the lower neck region. CONCLUSION: For airway surgeons, radiological assessment of vascular structures in relation to the trachea prior to surgery is as important as the endoluminal airway assessment for the best outcome.

Machine Learning in Aging: An Example of Developing Prediction Models for Serious Fall Injury in Older Adults.

BACKGROUND: Advances in computational algorithms and the availability of large datasets with clinically relevant characteristics provide an opportunity to develop machine learning prediction models to aid in diagnosis, prognosis, and treatment of older adults. Some studies have employed machine learning methods for prediction modeling, but skepticism of these methods remains due to lack of reproducibility and difficulty in understanding the complex algorithms that underlie models. We aim to provide an overview of two common machine learning methods: decision tree and random forest. We focus on these methods because they provide a high degree of interpretability. METHOD: We discuss the underlying algorithms of decision tree and random forest methods and present a tutorial for developing prediction models for serious fall injury using data from the Lifestyle Interventions and Independence for Elders (LIFE) study. RESULTS: Decision tree is a machine learning method that produces a model resembling a flow chart. Random forest consists of a collection of many decision trees whose results are aggregated. In the tutorial example, we discuss evaluation metrics and interpretation for these models. Illustrated using data from the LIFE study, prediction models for serious fall injury were moderate at best (area under the receiver operating curve of 0.54 for decision tree and 0.66 for random forest). CONCLUSIONS: Machine learning methods offer an alternative to traditional approaches for modeling outcomes in aging, but their use should be justified and output should be carefully described. Models should be assessed by clinical experts to ensure compatibility with clinical practice.

Hit-and-runs more common with pedestrians lying on the road: Analysis of a nationwide database in Japan.

PURPOSE: To determine the trends with fatally or otherwise injured pedestrians lying on the road and the relationship to hit-and-run incidents in Japan. METHODS: We extracted data for 2012-2016 from the records of the Institute for Traffic Accident Research and Data Analysis, Japan, a nationwide traffic accident database. All the injured and fatally injured pedestrians were selected. We examined the levels of pedestrian injury, vehicle speed immediately before the collision, whether or not the pedestrian was lying on the road, and hit-and-run incidents. Chi-square test was employed to make a statistical comparison between the two groups. RESULTS: The database contained data on 286,383 pedestrian casualties and 7256 fatalities; 8.3% of fatalities (602 persons) and 0.6% of casualties (1827 persons) involved pedestrians lying on the road. The rates of fatalities and severe injuries were significantly higher for pedestrians who were lying on the road than for those who were not. Hit-and-run incidents were evident in 4.0% of casualties and 7.3% of fatalities. The rate of hit-and-run cases was also significantly higher among pedestrians who were lying on the road. Among fatally injured pedestrians not lying on the road, the rates with speeds of ≥30 km/h did not differ significantly between hit-and-run and other cases. However, when the pedestrians were lying on the road, the rate was significantly increased in hit-and-run cases. CONCLUSION: This is the first report to focus on pedestrians lying on the road and being involved in hit-and-run incidents. In addition to preventing hit-and-run incidents, prevention of pedestrians lying on the road could also decrease fatalities.

Prevention of Unintentional Childhood Injury.

Unintentional injury accounts for one-third of deaths in children and adolescents each year, primarily from motor vehicle crashes. Children younger than 13 years should be restrained in the back seat, and infants and toddlers should remain rear-facing until at least two years of age. Infants should be positioned on their backs in a crib, on a mattress with only a fitted sheet to avoid suffocation, and all items that could potentially entrap or entangle the child should be removed from the sleep environment. Fencing that isolates swimming pools from the house is effective in preventing drownings. Swimming lessons are recommended for all children by four years of age. Inducing vomiting after toxic ingestions is not recommended. Installing and maintaining smoke detectors, having a home escape plan, and teaching children how to respond during a fire are effective strategies for preventing fire-related injuries or death. The most effective way to prevent gun-related injuries in children and adolescents is the absence of guns from homes and communities. Family physicians should counsel patients with guns in the home to keep them locked, unloaded, and with ammunition stored in a separate locked location. Fall injuries can be reduced by avoiding walkers for infants and toddlers. Consistent helmet use while bicycling reduces head and brain injuries. Although direct counseling by physicians seems to improve some parental safety behaviors, its effect on reducing childhood injuries is unclear. Community-based interventions can be effective in high-risk populations.

Global road traffic injury statistics: Challenges, mechanisms and solutions.

High-quality data are the foundation to monitor the progress and evaluate the effects of road traffic injury prevention measures. Unfortunately, official road traffic injury statistics delivered by governments worldwide, are often believed somewhat unreliable and invalid. We summarized the reported problems concerning the road traffic injury statistics through systematically searching and reviewing the literature. The problems include absence of regular data, under-reporting, low specificity, distorted cause spectrum of road traffic injury, inconsistency, inaccessibility, and delay of data release. We also explored the mechanisms behind the problematic data and proposed the solutions to the addressed challenges for road traffic statistics.

Epidemiologic study of traffic crash mortality among motorcycle users in Iran (2011-2017).

PURPOSE: Motorcycle accident is a major cause of road traffic injuries and the motorcyclists are considered as vulnerable road users. The present study aimed to determine the epidemiological characteristics of fatal motorcycle crashes in Iran. METHODS: In this cross-sectional study, a total of 28,356 motorcycle traffic fatalities registered in the Legal Medicine Organization of Iran were analyzed during the period between March 2011 and March 2017. The examined variables included demographic characteristics, helmet use, crash mechanisms, crash location, position state, type of counterpart vehicle, cause of death and place of death. In the study, road traffic mortalities involving drivers and/or passenger of motorcycles were included. Cases or events registered without these conditions were excluded from the study. To analyse the data, SPSS statistics 25 and GraphPad Prism 8 softwares were used. RESULTS: Of the 122,682 fatal traffic injury cases, 28,356 (23.1%) were motorcycle users, of whom 95.3% were male and 4.7% were female. Most of the motorcycle fatalities belonged to the age group of 18-24 years (29.1%). Head trauma was the major cause of death (59.0%). Also, the overall proportion of safety helmet use among motorcycle crash victims was estimated at 37.4%. Most of the road traffic crash cases (46.8%) happened out of city and half of people (49.9%) died in hospital. About 77.4% of the victims were motorcycle riders and 21.1% were pillion passengers. The highest rate of mortality belonged to the self-employed (38.4%) and then workers (21.8%) and students (10.2%). In addition, most fatalities occurred in people with low education (77.5%) and the least occurred in university graduates (5.5%). Among 31 provinces of Iran, Fars had the highest (9.3%) occurrence rate and Kohgiluyeh and Buyer-Ahmad had the lowest (0.5%). Most of the crash mechanisms were due to motorcycle-vehicle crashes (80.2%), followed by rollover (9.8%). CONCLUSION: Comprehensive public education and special rules are needed to reduce the rate of deaths in motorcycle crashes.

A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries.

BACKGROUND: Injuries from falls are major contributors to complications and death in older adults. Despite evidence from efficacy trials that many falls can be prevented, rates of falls resulting in injury have not declined. METHODS: We conducted a pragmatic, cluster-randomized trial to evaluate the effectiveness of a multifactorial intervention that included risk assessment and individualized plans, administered by specially trained nurses, to prevent fall injuries. A total of 86 primary care practices across 10 health care systems were randomly assigned to the intervention or to enhanced usual care (the control) (43 practices each). The participants were community-dwelling adults, 70 years of age or older, who were at increased risk for fall injuries. The primary outcome, assessed in a time-to-event analysis, was the first serious fall injury, adjudicated with the use of participant report, electronic health records, and claims data. We hypothesized that the event rate would be lower by 20% in the intervention group than in the control group. RESULTS: The demographic and baseline characteristics of the participants were similar in the intervention group (2802 participants) and the control group (2649 participants); the mean age was 80 years, and 62.0% of the participants were women. The rate of a first adjudicated serious fall injury did not differ significantly between the groups, as assessed in a time-to-first-event analysis (events per 100 person-years of follow-up, 4.9 in the intervention group and 5.3 in the control group; hazard ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P = 0.25). The rate of a first participant-reported fall injury was 25.6 events per 100 person-years of follow-up in the intervention group and 28.6 events per 100 person-years of follow-up in the control group (hazard ratio, 0.90; 95% CI, 0.83 to 0.99; P = 0.004). The rates of hospitalization or death were similar in the two groups. CONCLUSIONS: A multifactorial intervention, administered by nurses, did not result in a significantly lower rate of a first adjudicated serious fall injury than enhanced usual care. (Funded by the Patient-Centered Outcomes Research Institute and others; STRIDE ClinicalTrials.gov number, NCT02475850.).

Analysis of risk factors contributing to road traffic accidents in a tertiary care hospital. A hospital based cross-sectional study.

PURPOSE: Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them. METHODS: During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward. RESULTS: In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motorcyclists (54.2%) followed by pedestrian (25.1%). CONCLUSION: There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.

Experts' perspectives on the application of public-private partnership policy in prevention of road traffic injuries.

PURPOSE: Successful application experiences on public-private partnership (PPP) in different countries, suggest that PPP could be an option in road traffic injury (RTI) prevention. The present study aims at investigating the applicability of PPP policy in RTI prevention in Iran based on the experts' perspectives. METHODS: This is a qualitative study with grounded theory approach which has been conducted in Tabriz University of Medical Sciences, Iran in 2018. The participants were 22 experts in the field of RTIs selected using purposive sampling method. Data were collected by semi-structured interviews and analyzed with content-analysis method. RESULTS: The results were classified under 5 main themes (applicability, scopes and services, challenges, advantages, and strategies) for applying PPP policy and 37 sub-themes. Due to the prevalence of RTIs, the present challenges in public sector, existence of qualified private sector, and successful experiences in other areas, there are opportunities for private sector partnership in prevention of RTIs. Private sector could participate in different scopes and services regarding RTI prevention, including road construction and maintenance, maintenance and provision of vehicles safety and public education. The main challenges including legislation issues, ambiguities in collaboration, political and organizational unsustainability, government's financial hardship and lack of experienced experts in the field of RTI. However, there are significant advantages including high efficiency in program implementation, covering the weaknesses of public sector, effective and efficient management on application of PPP in RTI prevention. The strategies include identifying and prioritizing the assignable activities, identifying the qualified private sector, developing PPP policies and legal frameworks, creating a common language between public and private parties, trying to meet the expectations of the private sector by public sector, developing a comprehensive and sound contract, and cultivating public culture to accept private sector in the field of RTI prevention. CONCLUSION: This study sought to determine whether PPP could be used as strategy to reduce the burden of RTIs in Iran. But it requires a lot of preliminary studies to provide the context and conditions for applying this policy.

Automatic Emergency Braking (AEB) System Impact on Fatality and Injury Reduction in China.

The automatic emergency braking (AEB) system is an effective intelligent vehicle active safety system for avoiding certain types of collisions. This study develops a national-level safety impact evaluation model for this intelligent vehicle function, including the potential maximum impact and realistic impact. The evaluation model was firstly applied in China to provide insights into Chinese policymaking. Road traffic fatality and severe injury trends, the proportion of different collision types, the effectiveness of collision avoidance, and the AEB market penetration rates are considered in the potential maximum impact scenario. Furthermore, the AEB activation rate and the technology's technical limitations, including its effectiveness in different weather, light, and speed conditions, are discussed in the realistic scenario. With a 100% market penetration rate, fatalities could be reduced by 13.2%, and injuries could be reduced by 9.1%. Based on China's policy, the market penetration rate of intelligent vehicles with AEB is predicted to be 34.0% in 2025 and 60.3% in 2030. With this large market penetration rate increase of AEB, the reductions in fatalities and severe injuries are 903-2309 and 2025-5055 in 2025; and 1483-3789 and 3895-7835 in 2030, respectively. Considering AEB's activation rate and its three main limitations, the adjusted realistic result is approximately 2/5 of the potential maximum result.

Parental Knowledge of Appropriate Placement of Child Restraint Systems Before and After Educational Intervention in a Pediatric Emergency Department.

OBJECTIVE: This study aimed to determine caregiver's knowledge of appropriate car restraint systems (CRSs) use and compare this with the actual use among children presenting to the pediatric emergency department (PED), and to determine the efficacy of PED-based intervention on improving knowledge. METHODS: We conducted a prospective, intervention study of children (<8 years old) during a 12-month period in the PED. Based on their height and weight, children were assigned to group 1 (rear facing), group 2 (forward facing), or group 3 (booster). Caregivers were surveyed in their baseline CRS knowledge. Certified child passenger safety technicians evaluated each CRS and gave caregivers one-on-one education. Participants were called back to answer a posttest to determine if the information given was retained. RESULTS: Of the 170 children enrolled, 64 (37.6%) were assigned to group 1, 68 (40%) to group 2, and 38 (22.3%) to group 3. Of these, 63% were not aware of the state law regarding CRS use. Among those without a CRS, 18% belonged to group 1, 36% to group 2, and 46% to group 3. Even among those who reportedly had CRS, 13% of children did not have one-on-on inspection. After inspection, 84% of group 1, 71% of group 2, and 70% of group 3 were in the appropriate one. Nearly 45% were not compliant with American Academy of Pediatrics guidelines of children riding in rear-facing CRS until 2 years of age. CONCLUSIONS: A significant proportion of children visiting the PED are not in appropriate CRS, and caretaker knowledge about correct CRS types and installation is poor. Future educational efforts should focus on rear-facing and booster seat age-group children.