Biomedical subjects
Publications and source records attributed to P Agran.
Lawn mower-related injuries to children are relatively common and can result in severe injury or death. Many amputations during childhood are caused by power mowers. Pediatricians have an important role as advocates and educators to promote the prevention of these injuries.
Pickup trucks have become increasingly popular in the United States, accounting for about one in five vehicles involved in fatal motor-vehicle crashes. A critical factor in these deaths is the practice of carrying passengers in truck cargo areas, which are not designed for this purpose. Each year approximately 200 deaths occur to occupants riding in the back of pickup trucks. Over half the states have laws dealing with preventable injury problem, but these laws vary widely and most are too limited to be effective. We have reviewed existing laws, as well as crash injury data, and we have developed and recommend a model bill. The bill focuses on intended use, restricting passengers to only those portions of a vehicle designed for human transport. We have also conducted and report on a survey of legislative sponsors of pickup truck legislation.
We compared the fatality risk for occupants of rear passenger seats in extended cab and crew cab pickup trucks to the fatality risk for front seat occupants of the same vehicles using the (US) Fatality Analysis Reporting System (FARS) for 1982-1997. A 10-digit truncated vehicle identification number was used to classify the pickup trucks. The data were analyzed with an estimating equation for data having few observations per stratum. We identified 549 extended cab pickup trucks with one or more occupants of rear passenger seats and one or more occupant deaths. Occupants of rear passenger seats had a fatality risk 43% lower than front seat occupants (95% confidence interval 32% to 52%), controlling for age, sex, and restraint use. Occupants of rear seats of extended cabs in compact pickup trucks did not experience any higher fatality risk (relative to front-seat occupants of the same vehicles) than rear seat occupants of extended cabs in full-size pickup trucks and large 4-door crew cabs.
Proper record-keeping of emergency department visits and hospitalizations of injured children is vital for appropriate patient management. Determination and documentation of the circumstances surrounding the injury event are essential. This information not only is the basis for preventive counseling, but also provides clues about how similar injuries in other youth can be avoided. The hospital records have an important secondary purpose; namely, if sufficient information about the cause and mechanism of injury is documented, it can be subsequently coded, electronically compiled, and retrieved later to provide an epidemiologic profile of the injury, the first step in prevention at the population level. To be of greatest use, hospital records should indicate the "who, what, when, where, why, and how" of the injury occurrence and whether protective equipment (eg, a seat belt) was used. The pediatrician has two important roles in this area: to document fully the injury event and to advocate the use of standardized external cause-of-injury codes, which allow such data to be compiled and analyzed.
All hospitals should set policies that require the discharge of every newborn in a car safety seat that is appropriate for the infant's maturity and medical condition. Discharge policies for newborns should include a parent education component, regular review of educational materials, and periodic in-service education for responsible staff. Appropriate child restraint systems should become a benefit of coverage by Medicaid, managed care organizations, and other third-party insurers.
Children with special health care needs should have access to proper resources for safe transportation. This statement reviews important considerations for transporting children with special health care needs and provides current guidelines for the protection of children with specific health care needs, including those with a tracheostomy, a spica cast, challenging behaviors, or muscle tone abnormalities as well as those transported in wheelchairs.
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Transporting passengers in the cargo area of pickup trucks is a public health safety issue in the United States. Our study compared crashes involving passengers in the cargo area with those involving passengers in the cab. We obtained data for all injury events of pickup occupants for 1990 from the California Highway Patrol. A total of 702 traffic reports coded as having passengers riding in pickup truck beds involved 1,685 passengers in the cargo area and 865 in the cab. Significantly more events involving passengers in the cargo area occurred in summer in rural areas and were noncollisions than did events with only cab passengers. Crashes with passengers in the cargo area resulted in death in 5% of passengers. Of the drivers, 81% were male and 22% were younger than 20 years. Among the 1,685 passengers in the cargo area, 65% were male, 36% were younger than 15 years, and 30% were ages 15 to 19 years. Passengers in the cargo area were more frequently ejected and more seriously injured than their counterparts in the cab. Legislation to restrict travel in truck beds and the design of restraints for this area are some measures that may reduce the risk of injury.
In this study, a series of instances of children injured by a motor vehicle set in motion by an unsupervised child are reviewed. During a 24-month period, nine such children were identified through a multihospital and coroner's office monitoring system in a single urban county. Injuries ranged from multiple abrasions and contusions to serious leg and head injuries. Three children died. The typical circumstance involved a child releasing the brake or placing the vehicle in gear in a private driveway which resulted in the vehicle striking or rolling over the victim. In four of the nine cases, the child who set the vehicle in motion fell or jumped from the vehicle and then became the injured victim. The extent of these unusual motor vehicle-related injuries is unknown because they are unlikely to be reported in official police statistics. According to the study findings, there is a need to educate the public and health professionals about the risks associated with leaving a child unattended in a motor vehicle and the hazardous environment of the private driveway. Preventive measures would include not leaving a child unattended in a vehicle, locking unattended vehicles to prevent access, and redesigning of private driveways.
Motor vehicle occupant trauma is the major cause of mortality among the pediatric population. The mortality rate for adolescents is approximately 10 times that of the younger age groups. Despite enactment of child passenger safety laws in all states and mandatory seat belt use laws in two thirds of the states, mortality rates have not decreased to the extent expected. Additional interventions targeted at the adolescent driver, substance use and driving, and improved occupant protection for all children will be required to further decrease occupant trauma. Lack of comprehensive trauma data is a major roadblock to the calculation of morbidity and disability rates.
Four-to-9-year-old children are a special group with respect to motor vehicle occupant restraints. Having outgrown child safety seats, they are often placed in adult seat belts. This study was undertaken to examine patterns of injury among restrained 4- to 9-year-old by seat location and crash impact site. The data were obtained from an ongoing hospital-based monitoring system. Seventy percent of the sample sustained a head or face injury. Upper-torso and extremity injuries were infrequent. Lower torso injuries occurred primarily in frontal impacts in both the back and front seats. Frontal impacts resulted in a greater proportion of serious injuries than rear impacts. The most serious injuries, however, occurred to children seated on the side of impact in lateral collisions. Questions must be raised regarding the appropriateness of the present restraint system for young children. Recommendations, given current seat belt systems, are provided. However, technological improvements in vehicle design and belt systems are needed to improve protection, particularly in lateral impacts.
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