Biomedical subjects

F K Winston

Publications and source records attributed to F K Winston.

At least 19 recordsLinked to original sources

PubMed2006

Emergency department screening for risk for post-traumatic stress disorder among injured children.

OBJECTIVE: To discuss the successes and challenges associated with the implementation of a post-traumatic stress disorder (PTSD) screening tool in two pediatric emergency departments (ED). METHODS: The STEPP screening tool has been developed previously on an inpatient population of motor vehicle trauma patients. It was applied here to the general ED population at two different pediatric trauma centers. Nurse screeners were trained and a convenience sample of patients with unintentional injuries who met study criteria were screened in the ED. Feedback from nurse screeners was obtained. RESULTS: The process of implementing a screening tool to identify patients and their families significantly at risk for PTSD symptomatology presented some barriers, but overall acceptability of the process was high for both the emergency department staff and the patient. Recommendations for others considering implementation of screening programs in the ED are offered. CONCLUSIONS: Future research using screening protocols in the ED should, in their design, attempt to capitalize on the successes identified in the current protocol and circumvent barriers also encountered.

Accidents, Traffic↗

PubMed2006

Competent independent driving as an archetypal task of adolescence.

Supplement Editor, Dr Flaura K Winston, and Co-Editor, Dr Teresa Senserrick, introduce 10 papers covering the current science of safe driving among adolescents from the varied viewpoints of an international panel of experts. This Expert Panel, convened by the Center for Injury Research and Prevention (formerly TraumaLink) at the Children's Hospital of Philadelphia and State Farm Insurance Companies(R), working jointly on the Youthful Driver Research Initiative, represents a wide range of expertise, thereby providing a broad understanding of driving, adolescence, and adolescent driving.

Adolescent↗

PubMed2005

Trip characteristics of vehicle crashes involving child passengers.

OBJECTIVES: To describe the trip characteristics of vehicle crashes involving children, and to examine the effect of situational factors on front row seating or inappropriate restraint for young children. METHODS: A cross sectional study was conducted on children <16 years in crashes of insured vehicles in 15 US states, with data collected using insurance claims records and a telephone interview. A descriptive analysis of the characteristics of vehicle crashes involving children was performed. Multivariate Poisson regression was used to identify situational factors associated with inappropriate restraint or front row seating. RESULTS: These data suggest that children were traveling in vehicles involved in crashes that occurred under usual driving circumstances-that is, closer to home (60%), on a local road (56%), during normal daytime hours (71%), within areas with relatively lower posted speed limits (76%). Compared with children involved in morning crashes, those in daytime crashes (RR = 1.65, 95% CI 1.13 to 2.49) or in night-time crashes (RR = 1.63, 95% CI 1.09 to 2.67) were more likely to be sitting in the front seat. Children involved in night-time crashes were more likely to be inappropriately restrained (RR = 1.12, 95% CI 1.01 to 1.22) than those in daytime crashes. Children riding with two or more additional passengers were more likely to be inappropriately restrained (RR = 1.12, 95% CI 1.02 to 1.27) than those with no other passengers. CONCLUSIONS: Educational initiatives should aim to increase the perception that parents have about the potential crash risk of everyday trips. Some situational characteristics of trips were associated with inappropriate restraint and front row seating behaviors for young children.

Accidents, Traffic↗

PubMed2005

Teen drivers and the risk of injury to child passengers in motor vehicle crashes.

OBJECTIVES: The first aim was to examine the relationship between driver's age (novice teens, older teens, and adults) and child passenger's restraint status, front row seating, and injury risk. The second aim was to explore whether there was an excess injury risk to child passengers in teen crashes compared to those in adult crashes by examining the contributing factors. METHODS: A cross sectional study involving telephone interviews with insured drivers in a probability sample of 12 163 crashes involving 19 111 children was conducted. Sequential logistic regressions were employed. RESULTS: Among child passengers aged 4-8, appropriate restraint was <1% for novice teens, 4.5% for older teens, and 23.6% for adults. Front row seating for children <13 years was more common in the novice teen group (26.8%) than in the other two groups. Compared with children riding with adults, those with both teen groups experienced excess injury risk. After adjusting for crash severity, there was a 43% reduction in the odds ratio (OR) for novice teens (OR 1.58, 95% confidence interval (CI) 1.14 to 2.19) and a 24% reduction for older teens (OR 2.15, 95% CI 1.42 to 3.26). After adjusting for vehicle type, child's restraint status and front row seating, there was a further 19% reduction in the OR for novice teens (OR 1.37, 95% CI 1.00 to 1.88) and a further 13% reduction for older teens (OR 1.74, 95% CI 1.14 to 2.66). CONCLUSION: These findings suggest ways in which graduated driver licensing laws may be further enhanced to better protect child passengers from the excess injury risk associated with teen crashes.

Accidents, Traffic↗

PubMed2002

Child bicyclist injuries: are we obtaining enough information in the emergency department chart?

OBJECTIVE: The purpose of this study was to assess the range of information relevant to bicyclist injury research that is available on routinely completed emergency department medical records. METHODS: A retrospective chart review of emergency department medical records was conducted on children who were injured as bicyclists and treated at an urban level I pediatric trauma center. A range of variables relevant to bicyclist injury research and prevention was developed and organized according to the Haddon matrix. Routinely completed free text emergency department medical records were assessed for the presence of each of the targeted elements. In addition, medical records of seriously injured patients (for whom a more structured medical record is routinely used) were compared to free form records of less seriously injured patients to identify differences in documentation that may be related to the structure of the medical record. RESULTS: Information related to previous medical history (96% of records), diagnosis (89%), documentation of pre-hospital care (82%), and child traumatic contact points (81%) were documented in the majority of medical records. Information relevant to prevention efforts was less commonly documented: identification of motor vehicle/object involved in crash (58%), the precipitating event (24%), the location of the crash (23%), and documentation of helmet use (23%). Records of seriously injured patients demonstrated significantly higher documentation rates for pre-hospital care and child traumatic contact points, and significantly lower documentation rates for previous medical history, child kinematics, main body parts impacted, and location of injury event. CONCLUSIONS: Routinely completed free text emergency department medical records contain limited information that could be used by injury researchers in effective surveillance. In particular information relating to the circumstances of the crash event that might be used to design or target prevention efforts is typically lacking. Routine use of more structured medical records has the potential to improve documentation of key information.

Adolescent↗

PubMed2002

Exposure to traffic among urban children injured as pedestrians.

OBJECTIVES: To explore the immediate pre-crash activities and the routine traffic exposure (street crossing and play) in a sample of urban children struck by automobiles. In particular, the traffic exposure of children who were struck while playing was compared with that of those struck while crossing streets. DESIGN: Cross sectional survey. SETTING: Urban pediatric emergency department. PATIENTS: A total of 139 children ages 4-15 years evaluated for acute injuries resulting from pedestrian-motor vehicle collisions during a 14 month period. MAIN OUTCOME MEASURES: Sites of outdoor play, daily time in outdoor play, weekly number of street crossings, pre-crash circumstance (play v walking). RESULTS: Altogether 39% of the children routinely used the street and 64% routinely used the sidewalks as play areas. The median number of street crossings per week per child was 27. There were no differences in exposures for the 29% who were hit while playing compared with the 71% who were hit while walking. Although 84% of the children walked to or from school at least one day per week, only 15% of the children were struck while on the school walking trip. The remainder were injured either while playing outdoors or while walking to other places. CONCLUSIONS: Urban children who are victims of pedestrian crashes have a high level of traffic exposure from a variety of circumstances related to their routine outdoor playing and street crossing activities. The distributions of traffic exposures were similar across the sample, indicating that the sample as a whole had high traffic exposure, regardless of the children's activity preceding the crash. Future pedestrian injury programs should address the pervasive nature of children's exposure to traffic during their routine outdoor activities.

Accidents, Traffic↗

PubMed2001

Partners for child passenger safety: a unique child-specific crash surveillance system.

Insurance claims data were combined with telephone survey and on-site crash investigation data to create the first large scale, child-focused motor vehicle crash surveillance system in the US. Novel data management and transfer techniques were used to create a nearly real-time data collection system. In the first year of this on-going project, known as Partners for Child Passenger Safety, over 1200 children < or = 15 years of age per week were identified in crashes reported to State Farm Insurance Co. from 15 states and Washington, D.C. Partners for Child Passenger Safety is similar in its design and overall objectives to National Automotive Sampling System (NASS), the only other population-based crash surveillance system currently operating in the US.

Accidents, Traffic↗

PubMed2001

Protecting the child's abdomen: a retractable bicycle handlebar.

A surveillance system in the Emergency Department of a level 1 pediatric trauma center previously identified minor bicycle crashes as a cause of serious child abdominal injury. A discordancy exists between the apparently minor circumstances and serious injuries sustained by child bicyclists who impact bicycle handlebars. The objective of this work was to redesign the bicycle handlebar to reduce the forces transmitted to the child's abdomen during an impact with the handlebars. A retractable handlebar consisting of a spring-mass-damper system was designed to retract and absorb the majority of energy at impact (Patent pending). Because the child remains in contact with the bar after impact, the retracting system also includes a mechanism to damp the outward motion of the handlebar. This prototype will reduce the forces at impact by approximately 50% in a collision similar to those discussed above. A unique methodology of translating research findings into product design produced a novel handlebar that absorbs significant energy that otherwise would be transferred to the child's abdomen when impacting the handlebar.

Abdominal Injuries↗

PubMed2001

Factors influencing pediatric injury in side impact collisions.

BACKGROUND: Side impact collisions pose a great risk to children in crashes, but information about the injury mechanisms is limited. METHODS: This study involves a case series of children in side impact collisions who were identified through Partners for Child Passenger Safety, a large, child-focused crash surveillance system. The aim of the current study was to use in-depth crash investigations to identify injury mechanisms to children in side impact collisions. RESULTS: Ninety-three children in 55 side impact crashes were studied. Twenty-three percent (n = 22) of the children received an Abbreviated Injury Scale (AIS) score > or = 2 (clinically significant) injury. In these 22 children, head (40%), extremity (23%), and abdominal injuries (21%) were the most common significant injuries. Cases that illustrate body region-specific injury mechanisms are discussed. CONCLUSION: The cases revealed that serious injuries, particularly head injuries, occur even in minor crashes, and efforts should be made to make the interiors of vehicles more child occupant friendly. Lower extremity and abdominal injuries occurred because of contact with the intruding door. Design of vehicles to minimize crush should mitigate the occurrence and severity of these injuries.

Abbreviated Injury Scale↗

PubMed2001

Trends in booster seat use among young children in crashes.

INTRODUCTION: Booster seat use in the United States is extremely low among 4- to 8-year-old children, the group targeted for their use. However, more recent attention has been paid to the role of booster seats for children who have outgrown their forward-facing child safety seat. In particular, several states are currently considering upgrades to their child restraint laws to include the use of booster seats for children over 4 years of age. OBJECTIVE: To examine recent trends in booster seat use among children involved in automobile crashes in 3 large regions of the United States. DESIGN: This study was performed as part of the Partners for Child Passenger Safety project, an ongoing, child-specific crash surveillance system that links insurance claims data to telephone survey and crash investigation data. All crashes occurring between December 1, 1998, and November 30, 2000, involving a child occupant between 2 to 8 years of age riding in a model year 1990 or newer vehicle reported to State Farm Insurance Companies from 15 states and Washington, DC, were eligible for this study. A probability sample of eligible crashes was selected for a telephone survey with the driver of the vehicle using a previously validated instrument. The study sample was weighted according to each subject's probability of selection, with analyses conducted on the weighted sample. RESULTS: The weighted study sample consisted of 53 834 children between 2 to 8 years old, 11.5% of whom were using a booster seat at the time of the crash. Booster seat use peaked at age 3 and dropped dramatically after age 4. Over the period of study, booster seat use among 4- to 8-year-olds increased from 4% to 13%. Among 4-year-olds specifically, booster use increased from 14% to 34%. Among children using booster seats, approximately half used shield boosters and half used belt-positioning boosters. CONCLUSIONS: Although overall booster seat use among the targeted population of 4- to 8-year-old children remains low, significant increases have been noted among specific age groups of children over the past 2 years. These data may be useful to pediatricians, legislators, and educators in efforts to target interventions designed to increase appropriate booster seat use in these children.

Accidents, Traffic↗

PubMed2001

Rear seating and risk of injury to child occupants by vehicle type.

The safety of rear-seated child passengers was evaluated across vehicle types. 113,887 children under age 16 in crashes were enrolled as part of an on-going crash surveillance system which links insurance claims data to telephone survey and crash investigation data. Children in the second row suffered less significant injuries than those in the front in all vehicle types except compact extended cab pickup trucks in which the risk for children in the rear was 13% as compared to 2.8% for front-seated occupants. Further research is needed to identify the child and vehicle characteristics which might explain this increased injury risk.

Abbreviated Injury Scale↗

PubMed2001

The effect of seating position on risk of injury for children in side impact collisions.

The objective of this study was to evaluate the effect of seating position on risk of injury to children in side impact crashes. 5,632 children under age 16 in side impact crashes were enrolled as part of an on-going crash surveillance system which links insurance claims data to telephone survey and crash investigation data. Children seated in the front seat were at higher risk of significant injury than children seated in the rear (OR = 2.2 95% CI (1.2-3.8)). After adjusting for age, restraint use, and vehicle damage, children in the front seat were more likely to be injured (OR 2.6 95% CI (1.1-6.2)) than children seated in the rear when the child was sitting near the side of the impact. These results highlight the importance of evaluating the safety performance of both vehicles and restraint systems for children in side impact crashes.

Accidents, Traffic↗

PubMed2000

Actions without consequences: injury-related messages in children's programs.

OBJECTIVE: To characterize children's television programs in terms of their unintentional injury-related messages. DESIGN: Content analysis. Episodes representing a total of 216 unique television programs were coded for the presence of imitable unsafe behaviors without consequences. SETTING: A census of all children's programming airing in a northeastern city during the first week of December 1996. RESULTS: Exactly 47.0% of children's programming depicted at least 1 instance of unsafe, imitable behavior without consequences; one third had more than 3 instances. Exactly 51.0% of the programs targeted to school-age children and 33.4% of the programs targeted to preschoolers contained these unsafe behaviors. The majority (56.8%) of children's programs on basic cable television depicted unsafe behavior as compared with 23.1% of programs shown on public television. Cartoon programs depicted the most unsafe behaviors (60.3%), as compared with live-action programs (33.4%) and other genres (23.3%). CONCLUSIONS: Children's television programs depict too many unsafe behaviors without consequences. Future work should explore the role of these programs in the development of unsafe behaviors in children.

Adolescent↗

PubMed2000

The learning classifier system: an evolutionary computation approach to knowledge discovery in epidemiologic surveillance.

The learning classifier system (LCS) integrates a rule-based system with reinforcement learning and genetic algorithm-based rule discovery. This investigation reports on the design, implementation, and evaluation of EpiCS, a LCS adapted for knowledge discovery in epidemiologic surveillance. Using data from a large, national child automobile passenger protection program, EpiCS was compared with C4. 5 and logistic regression to evaluate its ability to induce rules from data that could be used to classify cases and to derive estimates of outcome risk, respectively. The rules induced by EpiCS were less parsimonious than those induced by C4.5, but were potentially more useful to investigators in hypothesis generation. Classification performance of C4.5 was superior to that of EpiCS (P<0.05). However, risk estimates derived by EpiCS were significantly more accurate than those derived by logistic regression (P<0.05).

Algorithms↗

PubMed2000

Assessing child restraint misuse by parental survey.

OBJECTIVE: To determine the extent to which child restraint system (CRS) misuse can be evaluated by parental survey. METHODS: A cross sectional survey was conducted at eight CRS clinics from May to October, 1998. Before CRS inspection, parents were administered a structured interview to identify distinct characteristics of restraint use and misuse. After the interview, a certified child passenger safety technician team independently evaluated the restraint system and identified specific modes of misuse. Parent descriptions of CRS use were compared with observations of the technician and the degree of agreement between the two was assessed for several specific attributes of use. RESULTS: A total of 100 children restrained in convertible CRSs were included in the study. Parents were able to accurately report several aspects of child restraint use-in particular, the attachment and fit of the CRS, the use of the harness clip, and the CRS incline. Parents were less accurate in their characterization of the fit of the child in the CRS. For nearly every item assessed, parents were more accurate in their description of correct compared with incorrect use. CONCLUSIONS: Interview tools can be developed that enable parents to describe aspects of CRS use and that screen for correct CRS use. These tools could be administered by telephone to obtain a more representative estimate of the prevalence of CRS misuse or to screen for CRS misuse. This screening would assist in targeting time consuming and costly CRS clinics to those parents who need them the most.

Cross-Sectional Studies↗

PubMed2000

Misuse of booster seats.

OBJECTIVE: To describe several aspects of booster seat use and misuse in a sample of children attending child safety seat clinics. METHODS: Booster seat practices were assessed at 76 child safety seat clinics held between April 1997 and January 1999 in Pennsylvania and southern New Jersey. At each assessment, a child passenger safety team evaluated the booster seat and identified modes of misuse. RESULTS: Altogether 227 booster seats were observed. Sixty eight per cent (68%) of shield boosters and 20% of belt positioning boosters were misused. Thirty two per cent of the children using a shield booster weighed more than 40 lb (18.1 kg); 68% of children in shield boosters and 63% in belt positioning boosters weighed less than 40 lb. CONCLUSION: This study identified a relatively high rate of booster seat misuse. Shield boosters were more likely to be misused than belt positioning booster seats. Significant numbers of children weighing more than 40 lb were using possibly dangerous shield boosters. The majority of children in this study were less than 40 lb. In this weight range, a convertible child restraint system provides better protection than a booster seat. Booster seat use should only be initiated once the child has completely outgrown their convertible child restraint system.

Humans↗

PubMed2000

The danger of premature graduation to seat belts for young children.

OBJECTIVE: To determine the risk of significant injury associated with premature graduation of young (2- to 5-year-old) children to seat belts from child restraint systems (CRS). BACKGROUND: Advocates recommend use of child safety seats for children younger than age 4 and booster seats for children age 4 and older. Despite these recommendations, many children are prematurely taken out of these child restraints and placed in seat belts. Although data exist to support the use of child restraints over nonrestraint, no real-world data exist to evaluate the risk of significant injury associated with premature use of seat belts. DESIGN/METHODS: Partners for Child Passenger Safety includes a child-focused crash surveillance system based on a representative sample of children ages 0 to 15 years in crashes involving 1990 and newer vehicles reported to State Farm Insurance Companies in 15 states and the District of Columbia. Driver reports of crash circumstances and parent reports of child occupant injury were collected via telephone interview using validated surveys. Results were weighted based on sampling frequencies to represent the entire population. RESULTS: Between December 1, 1998, and November 30, 1999, 2077 children aged 2 to 5 years were included and were weighted to represent 13 853 children. Among these young children, 98% were restrained, but nearly 40% of these children were restrained in seat belts. Compared with children in CRS, children in seat belts were more likely to suffer a significant injury (relative risk: 3.5; 95% confidence interval: [2. 4, 5.2]). Children in seat belts were at particular risk of significant head injuries (relative risk: 4.2; 95% confidence interval: [2.6, 6.7]) when compared with children in CRS. CONCLUSIONS: Premature graduation of young children from CRS to seat belts puts them at greatly increased risk of injury in crashes. A major benefit of CRS is a reduction in head injuries, potentially attributable to a reduction in the amount of head excursion in a crash.

Accidents, Traffic↗

PubMed2000

Discovery of predictive models in an injury surveillance database: an application of data mining in clinical research.

A new, evolutionary computation-based approach to discovering prediction models in surveillance data was developed and evaluated. This approach was operationalized in EpiCS, a type of learning classifier system specially adapted to model clinical data. In applying EpiCS to a large, prospective injury surveillance database, EpiCS was found to create accurate predictive models quickly that were highly robust, being able to classify > 99% of cases early during training. After training, EpiCS classified novel data more accurately (p < 0.001) than either logistic regression or decision tree induction (C4.5), two traditional methods for discovering or building predictive models.

Artificial Intelligence↗