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The Screening Tool for Early Predictors of PTSD (STEPP) questionnaire can identify children who may develop post-traumatic stress disorder after an accidental injury, according to a study of 171 families whose child was injured in a traffic accident. The questionnaire consists of 12 questions that can be answered quickly by children and their parents in a primary care setting. The questionnaire is very accurate in detecting children who may develop PTSD in the future.

Parents can reduce the risk of injury to their young children by 59% by using belt-positioning booster seat for all children between four and seven years of age. This was the conclusion of a study of 4,243 children in this age group who were involved in a car crash. The booster seat also completely prevented injuries to the abdomen, neck, spine, and lower extremities.

Objective. Children who have outgrown child safety seats and been placed in adult seat belts are at increased risk for injury. Pediatricians and other advocates have been called on to encourage booster seat use in these children. The objective of this study was to identify barriers to booster seat use and strategies to increase their use. Methods. A qualitative study consisting of focus groups and follow-up in-depth discussions were conducted among parents and/or children to elicit barriers and strategies to appropriate/best practice child restraint system use. Phase I focus groups (parents and children) identified barriers to booster seat use along with children's self-reported likes and dislikes about booster seats. Phase II focus groups (parents only) identified additional barriers to booster seat use and suggestions for strategies to increase the use of booster seats. In-depth telephone discussions (parents only) were conducted after each phase of focus groups to identify new themes and to explore further previously emerged topics that were not conducive to probing in focus group settings. Results. This study demonstrated that although knowledge of the benefits and purpose of booster seats is an important issue in promoting booster seat use, it is not the only issue. In particular, differences in risk perception, awareness/knowledge, and parenting style were noted when comparing parents of children in booster seats with those whose children were in seat belts. Media campaigns, improved laws, parenting education, and extending the use of child restraints to older ages were among the strategies suggested by parents to increase booster seat use. Conclusions. Anticipatory guidance regarding booster seats may be new for many pediatricians. This article arms pediatricians with insights from parents about their perceptions regarding booster seats and how parents think that the booster seat message can be most effectively delivered. Furthermore, it gives insight into how parents make safety decisions for their children and the important role of children in this decision-making process. Pediatrics 2002;110:729-736; motor vehicle safety, child safety seat, seat belt, booster seat, qualitative research, focus groups., Motor vehicle crashes are the leading cause of death among children ages 4 to 14 years of age. (1) Booster seats have been demonstrated to be an effective injury prevention [...]

Children who sit in the back seat of a compact extended-cab pickup truck have a higher risk of injury than children who sit in other vehicles. These pickup trucks have a small back seat area, but it contains side-facing fold-down seats that are exempt from regulatory safety testing., Context An increasing number of compact pickup trucks can accommodate restrained rear occupants. Rear seats in these pickup trucks are exempt from regulatory safety testing though their relative safety has not been determined. Objectives To evaluate the risk of injury to children in compact extended-cab pickup trucks compared with children in other vehicles and to determine if any unique hazards exist. Design Cross-sectional study of children aged 15 years or younger in crashes of insured vehicles, with data collected via insurance claim records and a telephone survey. Setting and Participants Probability sample of 7192 multirow vehicles involved in crashes, with 11335 child occupants, in 3 large US regions from December 1, 1998, to November 30, 2000. Main Outcome Measure Relative risk of injury, defined as concussions and more serious brain injuries, spinal cord injuries, internal organ injuries, extremity fractures, and facial lacerations, estimated by odds ratios (ORs) adjusting for age, restraint use, point of impact, vehicle weight, and crash severity. Results Injuries were reported for 1356 children, representing 1.6% of the population. Children in compact extended-cab pickup trucks were at greater risk of injury than children in other vehicles (adjusted OR, 2.96; 95% confidence interval [Cl], 1.685.21). Children in the rear seats of compact pickup trucks were at substantially greater risk of injury than rear-seated children in other vehicles (adjusted OR, 4.75; 95% Cl, 2.39-9.43). Children seated in the front seat of compact extended-cab pickup trucks were at greater risk of injury than children in the front seats of other vehicles, but this risk was not statistically significant (adjusted OR, 1.70; 95% Cl, 0.78-3.69). Conclusions Children in compact extended-cab pickup trucks are not as safe as children in other vehicles, primarily due to the increased relative risk of injury in the back seat. For families with another choice of vehicle, clinicians should advise parents against transporting children in compact pickup trucks. The current exemption for regulatory testing for occupant protection in the rear seats of compact pickup trucks should be reconsidered.

Children could be seriously injured by bicycle handlebars. Of 107 bicycle-related injuries at one hospital, 17 were caused when the child fell onto the handlebars. In most cases, this occurred when the child lost control of the bike or had a minor crash. Although this may seem a minor accident, the injuries included lacerations of the spleen, liver, pancreas and kidneys. Most handlebar injuries were to the abdomen whereas most serious non-handlebar injuries involved the head and extremities. Bicycles could be redesigned to prevent such injuries., Objectives. To delineate the mechanism of serious bicycle handlebar-related injuries in children and make recommendations for preventive strategies. Methods. Prospective cross-sectional surveillance system of seriously injured child bicyclists supplemented by in-depth, on-site crash investigation to delineate specific injury mechanisms. Interdisciplinary analyses involved engineers, clinicians, epidemiologists, and biostatisticians. Setting. The emergency department and in-patient trauma service of an urban level one pediatric trauma center between October 1995 and September 1997. Participants. Patients under 18 years of age who were treated for serious bicycle-related injuries (Abbreviated Injury Scale scores of 2 or greater). Results. The surveillance system identified two distinct circumstances for serious child bicyclist injury: 1) handlebar-related injuries associated with minor incidents (falls from bicycles) and 2) nonhandlebar-related injuries associated with severe incidents (bicycle-motor vehicle crashes). Crash investigations explored the minor incidents that resulted in serious handlebar-associated injuries. In the typical mechanism, as the child lost control of the bicycle and began to fall, the front wheel rotated into a plane perpendicular to the child's body. The child then landed on the end of the handlebar resulting in serious truncal injuries. Conclusions. A discordancy exists between the apparently minor circumstances and serious injuries sustained by child bicyclists who impact bicycle handlebars. Recognition of the mechanism of handlebar-related injuries might aid the practitioner in early diagnosis of serious abdominal injuries in child bicyclists. This injury mechanism may be avoided through bicycle redesign that would involve both limiting rotation of the front wheel and modifying the ends of handlebars. An integrated approach involving a surveillance system to identify an injury hazard supplemented by in-depth, on-site crash investigations effectively provided the detailed mechanism of injury needed to develop interventions. Pediatrics 1998;102:596-601; bicycle, handlebars, children, abdominal trauma, injury prevention, injury mechanism., ABBREVIATIONS. ICE, Injury Circumstance Evaluation; EMS, Emergency Medical Services; AIS, Abbreviated Injury Scale; ISS, Injury Severity Score; MAIS, Maximal AIS. A primary goal of injury control research is to develop [...]