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Sheryl Williams, BSN, RN, CCM
Adrienne Gallardo, BSW, MAOM, CPST-I

One hospital is revolutionizing adaptive car seat assessments and funding. The most vulnerable members of our population were overlooked during the pandemic due to limiting community contact. During this time, DME providers took over the adaptive car seat demands which led to incorrect use and compatibility concerns both with the vehicle and child fit. After multiple incompatibilities were found, we connected with the DME providers and began establishing relationships. This program is now the program that medical providers, therapist, and DMEs are referring all adaptive car seat requests to.

Prior to establishing the Adaptive Needs Fitting Station, the assessments were a team effort by all special needs trained technicians. A family would work with a Child Passenger Safety Technician (CPST), find an appropriate car seat, and the CPST would provide a letter of medical necessity for the family to share with their case manager to pursue funding. This resulted in adaptive car seats not being funded.

To solve this issue for these valuable members, we streamlined the process to one CPST. To fund the position, we tracked the number of families being seen, how many hours spent from start to finish with one family, and proved the increase in funding from 0% to 66% to leadership.

Due to the established fitting station, successful funding, and relationships being built with key stakeholders, we are the point-team for all adaptive car seat request and have limited misuse, incompatibilities, and increased funding and most importantly a safe way for children with disabilities to travel in their vehicle.

Throughout 2020-2021 we began seeing most of the adaptive seating needs in a large city, and in 2021 we helped 81 families with adaptive car seats and closed 35 with a funding rate of 43%. In 2022 we established a .5 FTE position to allow one person to establish relationships with DME and insurance plans and oversee the adaptive car seat assessments. Averaging 12 – 20 hours a week, this one person helped 101 children with special healthcare needs in Oregon, Washington, and Idaho with a funding rate of 66%. To date in 2023, 34 assessments have been conducted and have competed 19 with a funding rate of 56%

We are establishing relationships with Medicaid and funding sources and leveraging key stakeholders to change how adaptive car seats are obtained. Through our trials, errors, and successes, we want to share what we have learned and set a pathway for other agencies and states to find the same success.

1. How to meet community adaptive seating demands and the costs to main program
2. How to leverage key stakeholders and establish relationships with DME providers
3. Tips and tricks navigating Medicaid and private insurance plans

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Jennifer E. McCain, MD
Ashley E. Bridgmon, MPH, MBA
William D. King, DrPH
Michele Nichols, MD
Kathy Monroe, MD, MSQI

Golf carts have become a popular mode of transportation and many cities allow operation of these by children as young as 14 years old. Unfortunately, children can be seriously injured from activities surrounding the use of golf carts. Our study aims to identify the descriptive epidemiology of golf cart-related injuries in our institution in order to develop prevention measures for this injury type.

Golf cart-related injury visits were identified using an injury surveillance system in the emergency department (ED) of a pediatric tertiary hospital. All children 18 years and younger evaluated in the ED and given an ICD10 code range within V86, V87 and V09 external cause of injury code in 2022 were included. Confirmatory searches of the History of Present Illness (HPI) section of provider notes containing “golf” were performed. Basic descriptive statistics, frequency tables, and T-test of means were performed using Epi Info Version 7.2.4.0 (CDC).

In 2022, 44 children ranging in age from 2 -16 years old (mean 10.5, median 11.0) were treated for golf cart-related injuries. Males (n=29, 65.9%) accounted for the majority of these injuries. The majority of these patients had private insurance (n=31, 70.4%). Trauma code criteria were met by six patients (13.6%) while 12 patients (27.3%) were admitted to the hospital (13.5% of all injury visits result in admission). Patient mean age did not differ significantly between admitted and discharged patients (mean age 11.7 yrs vs 9.9 yrs, respectively) (t=1.2, p=0.23). Among those admitted, 5 patients (41.7%) had a one day admission while 7 patients (58.3%) had stays from two to 21 days (median 2 days).

Injuries sustained included: lacerations/abrasions (33), skull fractures (8), extremity fractures (7), intracranial hemorrhages (3), concussions (3), pulmonary contusions (2), pneumothorax (1), vertebral fracture (1), orbital injury (1), and degloving of foot (1). Mechanisms for those more severely injured included ejection from cart (6), golf cart rollover (4), hit by vehicle while riding cart (1), and pedestrian hit by cart (1).

Children playing in and around golf carts can result in significant injuries- many of which require hospital admission. Golf cart laws vary from state to state and even community to community and it is important that these laws are enforced. Golf cart owners should be aware of the age a child can legally drive a golf cart in their area. Injury prevention efforts should highlight behaviors increasing the risk for rollover while using these vehicles. All golf cart operators should understand the risk of serious injury when riding on uneven ground, when riding near motor vehicles, and when children are unrestrained.

1. Children can be seriously injured when playing in and around golf carts.
2. The most frequent mechanisms for serious golf cart-related injuries are rollovers and ejections.
3. Existing laws should be enforced and pediatricians should advocate for more stringent laws.

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Sehansa Karunatilaka
Brianna Iverson, BS
Devin Spolsdoff, MS
Pam Hoogerwerf, BA
Kristel Wetjen, RN, MSN
Shannon Landers, BS
Charles Jennissen, MD

All-terrain vehicles (ATVs) are work and recreational vehicles common in rural areas and mishaps associated with them frequently cause death and serious injury. Head injuries are the most common cause of death in ATV-related events, and helmet use can significantly decrease the risk. Our objective was to determine rural adolescents’ attitudes regarding helmets while riding ATVs, motorcycles and dirt bikes, the frequency of helmet use on these vehicles, and how demographic factors may be associated.

A convenience sample of attendees of the 2022 Iowa FFA (formerly Future Farmers of America) Leadership Conference completed an anonymous survey at the University of Iowa Stead Family Children’s Hospital injury prevention booth. After compilation, data were imported into Stata 15.1 (StataCorp, College Station, TX). Descriptive and statistical analyses including bivariate (Chi-square, Fisher’s exact test) were performed.

A convenience sample of 1,331 adolescents between 13-18 years old participated in the study. One half lived on a farm, 21% lived in the country but not on a farm and 28% were from towns. Nearly two-thirds (65%) of subjects owned an ATV with 77% of all having ridden an ATV in the past year. Farm residents had the highest ATV ownership (78%) and having ridden (80%) proportions, both p<0.001. Overall, ownership and ridership for motorcycles (22% and 30%, respectively) and dirt bikes (29% and 39%, respectively) was significantly less than ATVs, all p<0.001. Of ATV riders, those living on farms or in the country but not on a farm rode them more frequently than those from towns, p<0.001. Higher percentages always/almost always wore helmets while riding dirt bikes (51%) and motorcycles (57%) than ATVs (21%), p<0.0001. Those from farms had significantly lower proportions wearing helmets as compared to those living elsewhere for all vehicles. Helmet use importance ratings (from 1-10, 10 high) were not different for motorcycles (mean 8.59) and dirt bikes (mean 8.30), but much lower for ATVs (mean 6.13). Females, non-owners, less frequent riders, and those supporting helmet laws all had higher helmet use importance ratings. Males, older adolescents, those from farms, and owners of the vehicle had lower proportions that supported helmet laws for ATVs, motorcycles and dirt bikes. Support for helmet laws was significantly lower for ATVs (30.7%) than dirt bikes (56.3%) or motorcycles (72.3%), both p<0.001.

ATV ownership and use by rural adolescents in the study was extremely common, especially those from farms. Study adolescents rated wearing a helmet while riding motorcycles and dirt bikes as being very important but much lower for ATVs. Farm youth had lower proportions wearing helmets for all vehicles and less support for laws mandating helmet use. Our study indicates that the safety culture surrounding helmet use is poor among rural adolescents and deserves targeted interventions. Increased helmet use would likely decrease the number of deaths and serious injuries associated with these motorized vehicles.

1. List at least three youth demographic factors associated with higher proportions having ridden ATVs, motorcycles and dirt bikes.
2. Describe rural youth’s attitudes related to helmet use and how it differs among motorized vehicles.
3. State which rural adolescents might be at greater risk for lack of helmet use on motorized vehicles including ATVs.

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Shannon Kelleher, MPH
Maura Powell, MPH, MBA
Uchenna Nwokeji, MS
Nicole Koepke, MSN, CRNP
Jamillah Millner, MPH
Joshua C. Fischer, BS
Alexander K Gonzalez, MS, MBA
Shukai Cheng, MS
Elizabeth A. Walshe, PhD
Colleen Schlotter, BS
Flaura Winston, MD, PhD
Alex Fiks, MD, MSCE

Motor vehicle crashes are a leading cause of death for youth, and most crashes are due to driver error. Our study objective was to implement a Virtual Driving Assessment (VDA) into adolescent well visits at a large pediatric primary care network to assess driving skills and provide customized feedback to help teenagers avoid common driving errors. Funding was provided by a gift from NJM Insurance.

Between May 2021- December 2022, we conducted a single arm implementation study utilizing the IHI Innovation Methodology, an iterative testing and refinement process. The VDA is a validated 15 minute self-guided virtual driving test. 18 urban, suburban, and semi-rural primary care sites integrated the VDA into the adolescent well-visit for teens 15 years of age and older. A multi-disciplinary stakeholder group, including clinical champions, driving experts, innovation specialists, administrative leaders, parents and teen advisors, provided input to implement strategies addressing key barriers to expanded VDA use. We measured the proportion of eligible teens by site who completed a VDA at their well-visit monthly and overall and collected user satisfaction feedback.

In total, 16,736 eligible patients had a well visit during the implementation period. Among these adolescents, 2,161 completed a VDA with an overall median network completion rate of 11% (IQR: 5-17%, Figure 1), with some sites achieving up to 31% completion rate across the study period. There were notable rate changes over the study period around COVID and winter viral surges (Figure 1). Those completing the VDA were more likely to be 16 or 17 years old compared to 15 years of age (p-value < 0.001); and the majority had not yet received a license or permit. Key implementation barriers identified by stakeholders included workflow variability by site and additional time needed to complete the VDA. To address stakeholder feedback, we implemented in-office interventions such as distributing weekly eligible patient reports posted in staff areas. A text messaging strategy was created to alert families that the VDA would be available at well-visits.

76% of teens completing the satisfaction survey both agreed or strongly agreed that they would recommend the VDA to their friends and that they would take the VDA again.

Implementing a novel virtual driving assessment into the adolescent well visit in a busy primary care setting is feasible and desired by teens, although barriers remain. This project provides a model for integrating innovative technologies into primary care to address salient health risks.

1. Why the VDA is an important tool
2. How the VDA can be implemented into a primary care network
3. Potential barriers for implementation of the VDA