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Peter J. Keefe, BS
Tommy Kim, BA
Jeremy Aidlen, MD
Kaitlyn Wong, MD, PhD, MPH
Jonathan Green, MD, MSCI
Michael Hirsh, MD
Muriel Cleary, MD, MHS

In this study, we evaluated the incidence of helmet use in pediatric patients that presented to a Level I trauma center following a bicycle, motorcycle (MC), all terrain vehicle (ATV), or skating accident. We analyzed the rates of intracranial injury in patients with helmets compared to patients without helmets. The objective of this study was to better understand the local community's injury prevention needs.

IRB approval was obtained to query a Level I Trauma Registry Database. All trauma activations between January 1st, 2017, and December 31st, 2021 for patients aged 0 to 18 years were analyzed. We specifically looked at the cumulative incidence of trauma activations caused by bicycle, motorcycle, or skating accidents and calculated helmet rates within each type of accident. In addition, patients were categorized into age groups of 1-4, 5-9, 10-14, 15-18. The primary outcome was to examine intracranial injury, defined by ICD10 Diagnosis codes. Chi-squared analysis was used to determine statistically significant differences between patient cohorts.

The 5-year number of bicycle related trauma activations was 108, motorcycle was 66, ATV was 26, and skating was 13. The rates of patients who were not wearing helmets were 68% for bicycle-related traumas, 20% for motorcycle traumas, 54% for ATV traumas, and 85% for skating traumas. The rate of patients not wearing helmets in bicycle related traumas decreased as age increased (age group 1-4: n=3, 0%; group 5-9: n=22, 59.1%; group 10-14: n=63, 71.4%; group 15-18: n=20, 75%).

For bicycle-related traumas, there were fewer intracranial injuries in children who wore helmets (helmet: 12 (34.3%), no helmet: 44 (60.3%); p=0.011). The rates of intracranial injuries were lower in children who wore helmets for MC traumas (helmet: 22 (41.5%), no helmet: 8 (61.5%)), ATV traumas (helmet: 3 (25%), no helmet: 8 (57.1%)), and skate traumas (helmet: 1 (50%), no helmet: 8 (72.7%)); however, these were not statistically significant differences.

The rates of helmet use are uniformly low amongst pediatric non-MC trauma patients, with an inverse relationship between helmet use and age among bicycle specific trauma. These results underscore the importance of bicycle helmet use in the pediatric population. Furthermore, the data highlights a need for improved helmet use in the local community. Future efforts are needed to evaluate why helmet use within this patient population is unsatisfactory and identify potential interventions, which may include increased education or access to safety gear.

1. Although national data is important, evaluation of local community data could help better guide injury prevention efforts.
2. Despite knowing the importance of using helmets, use among children in our community is suboptimal.
3. Proper helmet usage in children is critically important to decrease rates of intracranial injury.

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Thomas Menk, MD
E. Melinda Mahabee-Gittens, MD, PhD
Wendy J. Pomerantz, MD, MS

Shortly after the onset of the COVID Pandemic, when many schools and outside activities were suspended, dog adoption rates increased. It is unknown if increased dog adoption rates along with stay-at-home orders resulted in increases in the prevalence of dog bites in children. The objective of this study was to examine the incidence and characteristics of dog bites in 0-18-year-old children seen in a pediatric emergency department (PED) during the COVID-19 pandemic compared to before the pandemic.

A retrospective review of electronic medical records of children evaluated in the PED of a level 1 pediatric trauma center and its satellite PED from March 1, 2018 through February 28, 2022 who had a discharge diagnosis of dog bite (ICD-10 W54.0XXA) was conducted. Subsequent patient visits for the same diagnosis were excluded. Pre-pandemic cases, March 1, 2018 through February 29, 2020, were compared to those that occurred during the pandemic, March 1, 2020 through February 28, 2022. Incidence rates, demographics, patient dispositions, and injury characteristics were analyzed using chi-square analysis and student’s t-tests.

Of the 65,204 total injury-related patients seen in the PED during the study months, 2,222 (3.4%) were for dog bites. Compared to pre-pandemic cases, there were 114 more cases during the pandemic, and the incidence for the first year of the pandemic was 1.5 times higher than the 2 pre-pandemic years (Figure 1); the incidence returned closer to the pre-pandemic rate during the second year of the pandemic. There were no demographic differences between the pre-pandemic and during pandemic groups regarding age, sex, race, or ethnicity. However, more patients had private insurance during the pandemic compared to pre-pandemic (60.2% vs. 49.8%, p<0.001; see Table 1). More patients were admitted during the pandemic compared to pre-pandemic (6.1% vs 3.7%, p < 0.05). More patients required operative management during the pandemic compared to before (4.9% vs 3%, p<0.05). Facial injuries and injuries to multiple body parts occurred more frequently during the pandemic than pre-pandemic (face 35.9% vs 33.5%, respectively and multiple 18.5% vs. 15.6%, respectively, p<0.05). Total cases per age group did not vary between the pre-pandemic and during pandemic groups. For both groups, children ages 5 to 9 years were most commonly affected (33.6% pre-pandemic; 35.2% during).

There was a higher incidence of PED visits, higher admission rates, and an increase in multiple body part and facial injuries in children with dog bite injuries during the COVID pandemic compared to pre-pandemic. Pediatric providers should emphasize safe dog interactions with anticipatory guidance.

1) Dog bites in pediatric patients increased during the initial period of COVID-19 pandemic
2) As social restrictions relaxed, dog bite incidence rates returned back to pre-pandemic rates.
3) Higher admission rates, higher OR rates, and increases in facial and multi-part injuries suggest that dog bite injuries were more severe during the pandemic

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

Snowmobiles are a common recreational activity in rural areas in northern climes. Head injuries are a common cause of deaths and injuries while snowmobiling, and helmet use can significantly decrease the risk. Our objective was to determine rural adolescents’ attitudes regarding helmets, the frequency of their use while riding snowmobiles and associated demographic factors.

An anonymous survey was given to a convenience sample of attendees of the 2022 Iowa FFA (formerly Future Farmers of America) Leadership Conference at the University of Iowa Stead Family Children’s Hospital injury prevention booth. Descriptive, bivariate (Chi-square, Fisher’s exact test), and multivariable logistic regression analyses were performed after data compilation and importation into Stata 15.1 (StataCorp, College Station, TX).

1,331 adolescents between 13-18 years completed the survey with 50% living on farms, 21% in the country but not on a farm and 28% from towns. One-fourth (26%) lived in a household that owned a snowmobile with those from farms having the highest ownership proportion (31%), p<0.001. Overall, 35% had ridden a snowmobile in the past year. Snowmobile owners, males, non-Hispanic Whites, and farm residents all had higher proportions having ridden a snowmobile in the past year (all p<0.01). Snowmobile owners and older adolescents also had higher percentages of riding more frequently (weekly/daily), p<0.001 and p=0.025, respectively. Helmet use was: 53% always, 14% mostly, 11% sometimes, 6% rarely, 15% never. Helmet use importance (from 1-10) while riding snowmobiles was rated relatively high (median 9, mean 8.2), significantly higher than that for all-terrain vehicles (6, 6.1). Owners, females, and at least weekly riders had greater proportions that wore a helmet all or most of the time as compared to peers (p=0.018, p<0.001 and p<0.01, respectively), and they also rated the importance of wearing a helmet higher. Those whose families owned snowmobiles were 3.1 times more likely to always or almost always wear a helmet than those who did not own one. Overall, 59% stated there should be a law requiring snowmobile helmets.

Study adolescents rated wearing a helmet while snowmobiling very important and the majority supported laws mandating their use. Almost half who rode snowmobiles reported not always wearing a helmet. Our study identified demographics for which interventions regarding helmet use could be targeted. More rural adolescents always wearing a helmet while riding snowmobiles would likely decrease the number of deaths and serious injuries associated with these vehicles.

1. List at least three youth demographic factors associated with higher proportions having ridden a snowmobile in the past year.
2. Describe rural adolescent’s use of helmets and the importance they ascribe to helmet use while riding snowmobiles.
3. State which youth might be at greater risk for not wearing a helmet while riding snowmobiles.

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Shelby Crespi, MPH, CPST
Salvador Vargas, CPST-I
Melissa Burke, MPH

Unintentional injuries are the leading cause of death for children ages 1-19. Falls and motor vehicle crashes are among the top mechanisms of injury observed in the Lucile Packard Children’s Hospital Stanford Pediatric Emergency Department. To prevent these injuries, the Childhood Injury Prevention Program uses a partnership approach to reach underserved families throughout the Bay Area.

The Childhood Injury Prevention Program at Lucile Packard Children’s Hospital Stanford has partnered with the San Mateo County Nurse Family Partnership (NFP) Program for seven years to reach underserved families with important safety information and supplies. The NFP Program is an evidence-based, national, nurse home-visiting program. First-time expecting parents are paired with a Public Health Nurse who provides case management from pregnancy through the child’s second birthday. Families enrolled in the program are from historically underserved populations: low income, English Language Learners, racial/ethnic minorities, single parents, young or teen parents, or are experiencing substantial hardship. Safety workshops are taught by LPCHS Childhood Injury Prevention Program Staff (certified Child Passenger Safety Technicians) and cover: child passenger safety, falls prevention (furniture tip overs, stair falls, falls from furniture, trips/slips, and window falls), home safety (water safety, burns and scalds prevention, poison prevention, choking prevention). Each family takes a 2-hour safety workshop three times while enrolled in the NFP Program – while expecting, when their child is 12 months, and at 24 months before families graduate from the program. At each stage, parents are provided with safety information specific to their child’s current age and development as well as what to expect later. Families are also provided with safety supplies at no cost including an appropriate car seat, pack n plays, sleep sacks, 46-piece home safety kits, and window locks. Classes are hosted in English and Spanish by Child Passenger Safety Technicians. The class is facilitated in other languages, such as Thai, Ukrainian, and Portuguese, using translators. Knowledge change is assessed through pre and post surveys. Public Health Nurses reinforce injury prevention education while conducting in-home visits and make suggestions to modifications to child’s environment to promote safety.

In 2022, 80 families were provided with education and safety supplies. Families demonstrated increases in knowledge around confidence in installing car seats, understanding the safest place for a child to ride in a car, attitudes around bedsharing with infants, and other safety topics. Families taking safety classes three times, as well as in-home reinforcement of injury prevention knowledge by Public Health Nurses, results in program participants selecting the appropriate safety measure or behavior 90%-100% of the time by the end of the program.

Injury prevention messaging is best retained and results in positive behavior change using multiple touchpoints and education modalities. Consistent, age-appropriate injury prevention education coupled with in-home reinforcement and free safety supplies leads to families reporting prioritizing safety. Moreover, reaching families during pregnancy and in their child’s/children’s early years helps to establish a culture of safety in which parents and caregivers prioritize injury prevention and can proactively adapt to their children’s safety needs as they grow.

1. Understanding how to establish a partnership with community-based organizations and home-visit nursing programs
2. Assess impact of comprehensive, accessible injury prevention education and safety supplies in underserved communities using health equity approach
3. How to establish trust and conduct follow up to maintain attendance over several sessions

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Alicia Webb, M.D
Michele Nichols, M.D
Jennifer McCain, M.D.
Elizabeth Rocker, MSW, LICSW, PIP
Kathy Monroe, MD, MSQI
Anna Paige Wilson, B.S.

Safe storage practices have been shown to decrease incidence of medication ingestion and firearm related injuries in pediatric patients. This abstract describes successful approaches using different personnel in a busy pediatric emergency department setting to improve safe storage among parents.

Various educators (public health student, medical student, full time social service providers) were used in the emergency department to assess feasibility of ED as site for intervention and education, sustainability of various educators and impact of education and equipment on parental behaviors.

The initial stage of this project used a public health student as educator and resulted in 98% enrollment with 363 families receiving education and 843 total children impacted and increased reported correct storage for meds (9% to 85%) and firearms (45% to 67%). The second stage used a medical student as educator and resulted in 93% enrollment with 106 families receiving education and 199 children impacted. Both students were time limited when they returned to classwork. The study was refined to utilize medical social workers who are employed within the hospital with follow-up calls by a medical student. This has resulted in 78 families educated (271 children impacted) to date and began in July 2022. Follow up phone calls for those educated by social services (68% follow up rate) resulted in 24% of families utilizing the firearm lock and 72% using the medication box.

The emergency department is an effective location to provide families with education about safe storage of medication and firearms regardless of educator utilized. The project was effective when using students as educators but found this to be unsustainable due to scheduling conflicts and time restraints. The implementation of full-time hospital employees as educators provided a more sustainable model.

1. Understand the importance of safe storage practices in prevention of ingestion and firearm-related injuries.
2. Describe the materials and education provided to families in this study.
3. Illustrate differences in outcomes when utilizing various educators in the emergency department.

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Stephanie Ruest, MD, MPH
William Rudman MSc
Carsten Eickhoff, PhD
Susan Duffy, MD, MPH

Childhood fractures affect an estimated 20% of children, with approximately 12-20% of fractures caused by abuse. While the literature has described fracture patterns that should prompt a child abuse evaluation, little is known about the characteristics of the emergency department (ED) encounters themselves (e.g., time of day, day of week) and associated patient demographics among children for whom a child abuse pediatrician (CAP) consult is obtained. The objective of this study was to describe ED encounter arrival and disposition characteristics and demographics of children ages 0-5 years presenting to a tertiary pediatric ED with fractures who did and did not have a CAP consult.

This study was part of a larger retrospective observational study of 2,991 patients aged 0-5 with an ED discharge diagnosis including fracture who were seen in a regional tertiary pediatric ED in New England between January 2014 and December 2021.This institutional dataset includes all ED-encounter full-text clinician notes, radiology reports, and discrete variables (e.g., demographics, ICD-9/10 codes, triage acuity). Descriptive analyses of ED encounter arrival and disposition characteristics, patient demographics, and presence of a CAP consultation were completed.

There were 2,991 unique patient encounters for fractures during the study period, of which 193 (6.5%) had a completed CAP consult. Compared to children without a CAP consult, children who had a CAP consult had proportionately fewer weekend presentations (21.7% versus 31.9%) and more Monday presentations (21.8% versus 14.3%), a higher proportion of visits between 11p-7a (17.1% versus 8.7%), and a higher proportion of more acute triage ESI designations (68.9% ESI 2 versus 35.0% ESI 2). 86% of ED encounters with a CAP consult resulted in an admission, versus 9.9% of visits without a consult. Children with a CAP consult had a lower median age (0.5 years, IQR 1.2 versus 3.3 years, IQR 2.8), with a higher proportion of children identified as Black race (11.4% vs 8.5%) and with government insurance (45.0% vs 35.9%).

We found distinct ED encounter arrival temporal patterns for children with fractures who had a CAP consult, namely an increased proportion of visits on Mondays and decreased proportion of weekend visits, as well as an increased proportion of visits overnight. There was a higher proportion of more acute triage ESI designations and a higher proportion of admissions compared to children without a consult. Patient demographic trends were similar to prior publications about abusive injuries. These ED temporal patterns should be further studied to understand why they occur and may inform the development of child abuse prediction models.

1. Fractures are a common childhood injury and up to 20% may be due to abuse.
2. Children who had a child abuse pediatrics consultation had a lower mean age and a higher proportion of more acute emergency severity index triage designations.
3. A higher proportion of children with fractures who had a child abuse pediatrics consultation were seen on Mondays and on the overnight shift compared to those without a consultation.

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Lorrie Lynn, MA, CPSTI

Young children are particularly vulnerable to unintentional injury and death. The unintentional death of infants from suffocation or sudden infant death syndrome continues to be the leading cause of injury and death for infants under one-year of age. According to the County of San Diego - Health and Human Services Agency, nine infant deaths due to suffocation were recorded between 2017 to 2019. From 2017-2020 Emergency Room data from Rady Children’s Hospital -San Diego recorded suffocation as a mechanism of injury for eight infants. For children ages 1 to 4 years old, drowning is the leading cause of injury and death. The majority occur in swimming pools. During the pandemic, when families were in lockdown, most children who experienced a drowning incident were in backyard swimming pools. Falls are the leading cause of hospitalizations for children in this age group. During the pandemic lockdown, window falls increased dramatically to 55 in 11 months. Typically, Rady Children’s Hospital trauma department sees three fall victims a month. Thirty-eight percent of all trauma cases were falls with 42% of the total victims being children 1-3 years old. In 2022, the trauma department received seventy-nine victims of second story falls.

To address home safety for children we created the First Responder Outreach Program. Based on the Cribs for Kids National Public Safety Initiative, we created the First Responder Outreach Project. To develop and evaluate the feasibility we partnered with Chula Vista Fire Department (CHFD). Chula Vista is a rapidly changing city in the San Diego region. This city is our first responder participants will be culturally competent to address these culturally diverse, economically disadvantaged communities. Our First Responder Outreach project trains Emergency Personnel to target areas of concern, using simple messages and providing access to needed safety resources. These resources (Safe Sleep Survival Kits, water safety Books, window locks, home safety strategy flyers, information about car seat inspections, etc.) are made available at local sites or delivered to the family to ensure quick solutions to identified safe sleep environmental education and needs. Our project targeted four of the leading causes of unintentional injury for children 5 years and younger. Working with the CVFD and EMS we developed and implemented a train-the-trainer model, with resources provided by a grant, and a tracking system.

Held the first train-the-trainer meeting in January 2023. Developed a tracking system for materials to be shared with families. Trained 160 first responders using the method designed in collaboration with the Chula Vista Fires Department Educators. Families have received a selection of the available materials, with one family receiving all safety resources. The First responder Outreach program also led to a Child Passenger Technician training. This has increased the number of car seats inspections, twice each month.

Injuries and deaths occurring in the home are preventable. Through the first responder partnership with Chula Vista, we will be able to assess the effectiveness of this approach and reduce the number of families at risk for child injury.

1. Plan and implement a sustainable home safety assessment project
2. Build a collaboration with first responders
3. Institute a train-the-trainer model and tracking system to evaluate program effectiveness

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Heather Hirsch, MD, MPH
Melissa Adams, MD
Vidya Menon, MD
Brooke Evans, MD
Kaitlin Hannan, MD
Christine Kaba, MD

Unintentional injuries are the leading cause of deaths for all people from ages 1-44 years old. For infants (children under 1 year of age), unintentional injuries are the 5th leading cause of death. Unintentional injuries have been shown to be decreased via injury prevention counseling. One way to provide such counseling is via safety baby showers which are educational events that are feasible and helpful in improving expectant parent knowledge and comfortability with infant-related injury prevention topics. We also know that pediatric resident physicians can be great sources of information and influence for families of infants but do not always incorporate injury prevention discussions into their visits with families. In one study, less than half of pediatric residents mentioned injury prevention in their well-child visits, and when an injury prevention topic was introduced, only approximately 1 minute was devoted to the topic.

The goal of our program is to implement a sustainable safety baby shower curriculum into an existing group prenatal care setting for low-income mothers. Our curriculum includes multiple injury prevention topics ranging from infant safe sleep to poison prevention. We will provide a safety baby shower guide for families to reference, we will have individual stations on different injury prevention topics, and we plan to provide safety devices like hot water monitors, safe sleep sacks, baby proofing devices, etc. to incentivize parents to continue practicing infant injury prevention after their baby is born. We plan to evaluate the attendants’ knowledge, attitude, and beliefs related to infant injury prevention topics via surveys at the showers along with a one-month follow-up phone call (after their baby is born) to gauge retention of safety topics and family’s current practice. Additionally, we would like to gather baseline data of Emory pediatric residents’ knowledge of, barriers to discussing, and comfortability with discussing injury prevention topics. We also plan to have some pediatric residents participate in the showers so we can assess the efficacy of the showers’ ability to increase pediatric resident’s knowledge of and comfortability with discussing injury prevention with families.

We expect our intervention to improve expectant parents’ knowledge of and comfortability with infant injury prevention topics. We hope by providing some infant safety devices parents will endorse adherence to infant safety practices. Additionally, we expect pediatric residents’ knowledge and comfortability with discussing injury prevention topics to be on the lower side at baseline since they do not receive much training on these topics at present. We hope the residents that attend the showers will have improved knowledge and comfortability with infant safety topics as opposed to their colleagues who did not attend.

Infant safety is a wide array of topics that can be overwhelming for both parents and healthcare providers. We believe that safety baby showers will improve both parents’ knowledge and comfortability in practicing infant injury prevention along with improving pediatric resident knowledge and comfortability discussing these topics with parents.

1. Key components of safety baby showers
2. Safety baby showers can be implemented into existing programs
3. Areas pediatric residents may improve in their knowledge of infant safety

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Sarah Beth Abbott, BS, EMT-LP

Firearm injury is a leading and preventable cause of death for adolescence in the United States. Our region, which encompasses several large metropolitan areas, is particularly concerning for injuries and fatalities caused by firearms. In response to the crossing of the lines of the Center for Disease Controls and Prevention mortality data, validation of local TraumaBase© Registry System data, and increased prevalence of school shootings, our President and Chief Executive Officer, of one of the largest not-for-profit health systems, publicly pledged to provide thousands of firearm safety kits to individuals and families in our community. The Level I Pediatric Trauma Center Injury Prevention and Outreach Education Coordinator was then delegated by leadership to develop a program that is committed to reducing injuries and death from firearms by increasing awareness and education of protective measures and risk factors.

The Injury Prevention Coordinator utilized a systematic approach in developing a firearm safety kit distribution program that would be ideal for the 11-hospital system in the large metropolitan area. The coordinator used the five core components of Model Level I and Level II Trauma Center injury and violence prevention programs: Leadership, Resources, Data, Effective Interventions and Partnerships. Literature review and Logic Model development were significant early in the process. Recruitment of key champions, content experts, system communications/public relations, material management and marketing for the project occurred during 7/2022-12/2022 with kit distribution during 1/2023-4/2023. Evaluation design included mixed-methods approach with data collected from champions after the 22 specific interventions for quantitative and qualitative data.

In a mere 94 calendar days, the injury prevention champions vested into this firearm safety kit project, disseminated 10,000 kits into the metropolitan community at 22 unique locations during outreach events. Outreach events included internal (hospital locations) and external (community partners, art/health fairs, major sporting events, standing hemorrhage control courses and health clinics). Firearm safety kit contents included: Master Lock Cable Lock, Babysitter Information Tear Pad (asking if there is an unlocked gun in the home?), 988 Suicide and Crisis Lifeline Flyer and Fact Sheet: Firearm Injury Prevention Education for Parents (English/Spanish).

With using injury prevention core components, thorough program planning, having transparent conversations and keen diligence of all stakeholders led to a plan that can be replicated in large metropolitan areas when top-down decisions arise. The project also resulted in establishing the foundation and support of a more robust firearm safety program within the large not-for-profit health system in the future.

1. Discuss the five core components of Model Level I and Level II Trauma center injury and violence prevention program.
2. Understand the importance of logic model development in a firearm safety kit distribution program.
3. Recognize the significance of collaboration and community resources in relation to firearm safety.

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Tanya Charyk Stewart, MSc
Kevin McClafferty, BESc
Moheem Halari, MBBS
Allison Pellar, MEng
Pascal Verville, PEng
Michael Pickup, MD
Douglas Fraser, MD
Jason Gilliland, PhD
Mike Shkrum, MD

Pediatric pedestrians are a particularly vulnerable road user group, comprising an increasing proportion of road traffic injuries and deaths. The objective of this study was to review the epidemiology of child and adolescent pedestrian fatalities to identify risk factors to target via a safe system approach.

Fatal pedestrian collision and injury data were collected from the Office of the Chief Coroner (2013-19), with selected crash investigations. Descriptive analyses were undertaken. Child (< 14 years) and adolescent (15-19 years) pedestrian crashes were compared with Pearson chi square and Mann Whitney U tests. Multivariate logistic regression modeling was performed with risky behavior as the outcome, followed by an assessment of model fit and predictive accuracy.

There were 59 pediatric fatalities, 25 (42%) children and 34 (58%) adolescents, with median (IQR) age=17.0 (7.0-19.0) and ISS=75 (33-75). The head was the most frequent (90%), and severely injured body region, followed by the thorax (88%). Thirty-six pedestrians (61%) engaged in risky behavior. Logistic regression modeling found being male (OR=5.883), in an urban environment (OR=7.209), at nighttime (OR=13.562) significantly associated with pedestrian risky behavior. Significantly more children were involved in collisions during the daytime (6:00-1800) (83% vs. 30%; p<0.001), in crosswalks (42% vs. 10%; p=0.007) and intersections (45% vs. 20%; p=0.042), while crossing with the right of way (42% vs. 7%; p=0.003). Adolescents had higher impairment (36% vs. 0%; p=0.001), dark conditions (80% vs. 12%; p<0.001) and high-speed collisions (77% vs. 46%; p=0.017). There were 6 intentional adolescent pedestrian deaths (20% vs. 0%; p=0.027). Two-thirds (4/6) of these intentional injuries were death by suicide.

Pediatric pedestrians engage in risky behaviors. Being male, in an urban environment, at night increased the odds of risky behaviors. A safe system approach recognizes that people are vulnerable and inevitably make mistakes. Incorporating multiple countermeasures can help provide a safe and equitable transportation system that mitigates crash risk and protects all road users. Increased mental health and substance use services, higher rated vehicle headlight performance and reducing speeds were identified as prevention strategies to target adolescents. For children, implementing crossovers, safe routes to school programs and increased use of collision avoidance vehicle safety features, which are effective at low speeds, in lighted areas, could be effective strategies to mitigate pedestrian crash risk.

1. By the end of this presentation, participants will be able to identify risk factors for child (age < 14 years) pedestrian crash fatalities, including low speed, daytime collisions in crosswalks and intersections, that can be used to target prevention strategies to mitigate child pedestrian crash risk.
2. Participants will be able to identify adolescent (age 15-19 years) pedestrian unintentional and intentional fatality risk factors, including high speed collisions at night, often involving impairment, that can be used to target prevention strategies to mitigate adolescent pedestrian crash risk.
3. Participants will learn the key principles of a safe system approach to be able to proactively identify risks in the transportation system and develop multiple countermeasures to help provide a safe and equitable transportation system for all road users.

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Mandy Che, BS
Gina Lowell, MD, MPH
Kyran Quinlan, MD, MPH

Sudden Unexpected Infant Death (SUID) kills ~3600 infants each year in the US. While SUID is associated with many upstream structural root causes of poor health, there is strong evidence that consistently providing a safe sleep environment for infants may prevent SUID. Safe sleep education provided during the prenatal period is less often implemented or tested for feasibility, acceptability, or efficacy.

Funded by a Pacesetter grant from the Injury Free Coalition for Kids, we created 120 gift bags with safe sleep educational materials and products for distribution to expectant parents in the prenatal OBGYN clinic during their third trimester “Baby Friendly” visit. Clinic nurses distributed these bags and encouraged participation in REDCap surveys assessing safe sleep planning and intent. Data analysis included both quantitative analyses of the parent surveys as well as qualitative feedback from nurses.

Gift bags were distributed between October 2021 and February 2022. Parent surveys were completed by 22/120 (18.3%) parents. All survey respondents stated they planned to put their baby to sleep in a crib or bassinet, and 13 (59.1%) participants had already purchased items for their infant’s sleep environment. Ten (45.6%) parents demonstrated either worry or were unsure about keeping their infant safe while sleeping. All respondents had a better understanding of how to keep their babies safe and planned to do so based on AAP guidelines. Nurse's feedback indicated that this initiative was feasible and well-received by parents and staff members.

Prenatal education is a feasible and acceptable approach to promoting infant safe sleep. Our study showed that though all parents intended for their infant to use a safe sleep space, many parents were worried or uncertain about keeping their baby safe during sleep. A substantial number of parents had not yet purchased items for safe sleep, indicating that the 3rd trimester may be an important time to influence parents to plan for safe sleep and avoid unsafe products. Further evaluation of the delivery of safe sleep education and/or maternal perceptions, anxiety, and receptivity around safe sleep, can serve to develop a longitudinal approach to preventing SUID.

1. Safe sleep education in the prenatal setting has not been widely implemented or tested for feasibility, acceptability or efficacy, though it might be a better time to intervene.
2. We promoted infant safe sleep education in the prenatal OBGYN clinic and found that it was well received by clinic staff and parents. Our results suggest that the prenatal period may be a more appropriate time to address parental anxieties regarding infant sleep safety and help parents plan early and avoid purchasing unsafe products.
3. Further evaluation of the delivery of safe sleep education and/or maternal perceptions, anxiety, and receptivity around safe sleep can serve to develop a longitudinal approach to preventing sudden unexpected infant death.