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Sarah Gard Lazarus, DO
Timothy Moran
Sofia Chaudhary, MD
Kiesha Fraser Doh, MD
Terri Miller
Carlos Delgado
Chris Rees

Unintentional injuries are the leading cause of childhood death in the United States. Children living in neighborhoods with lower social vulnerability indices (SVI), originally used to evaluate communities at higher risk of complications following natural disasters, have greater overall injury risk. However, the overlap in injury-related mortality risk by SVI looking at multiple mechanisms has been less explored. Our objective is to evaluate the association of SVI with the incidence of the five most common causes of injury-related death among children and young adults (0-24y) in the state of Georgia.

We conducted a cross-sectional study utilizing Georgia Department of Vital Records death certificates from 2011-2021. We evaluated the association between incident deaths from drownings, firearms, motor vehicle collisions (MVCs), poisonings, and sleep-related death (SUID) with census-level SVI defined by the CDC (a composite SVI divided into quartiles). We evaluated incident deaths for each cause stratified by the four subcategories comprising the SVI (socioeconomic, household composition/disability, minority, housing type/transportation). To determine factors associated with incident injury-related causes of death, we modeled outcomes using negative binomial regression controlling for the cause of death and SVI.

10,643 deaths were included: 531 from drownings, 3,798 from firearms, 3,414 from MVCs, 1,163 from poisonings, and 1,737 from SUID. Most of the deaths were in males (7,845, 74%). Lower socioeconomic SVI and greater minority SVI had the strongest correlation with incident deaths overall. Firearm deaths were most disparate between the lowest and highest overall SVI quartiles (2.1 deaths per 100,000 in the wealthiest SVI vs. 5.8 deaths per 100,000 in the poorest SVI). Conversely, the incidence of deaths from poisonings was highest in the wealthiest SVI in all subcategories (socioeconomic, household composition/disability, minority, housing type/transportation). Incident deaths from drownings varied the least by SVI (0.42 deaths per 100,000 in the wealthiest SVI vs. 0.64 deaths per 100,000 in the poorest SVI).

More socially vulnerable children had a higher incidence of injury-related deaths for all causes except for poisonings. Disparities in incident deaths were greatest in those affected by firearm injury, indicating a pressing need to address this cause of death in socially vulnerable populations. Determining which SVIs were associated with each injury-related mechanism can inform targeted interventions to prevent these untimely deaths.

1. Evaluate the incidence of the 5 most common causes of pediatric injury death in Georgia
2. Compare the incidence of pediatric injuries throughout SVI quartiles

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Shannon Coleman, MD
Heather Hirsch, MD, MPH
Christine Kaba, MD
Melissa Adams, MD
Vidya Menon, MD
Kaitlin Hannan, MD
Brooke Evans, MD
Andrew Potter, DO
Timothy Moran, Ph.D

Unintentional injuries are the leading cause of death for people ages 1-44 and the fifth leading cause of death for infants. Injury prevention counseling has been shown to reduce unintentional injuries. Safety Baby Showers (SBS) are educational events that aim to improve expectant parent knowledge of infant safety. Pediatric resident physicians are resources for families, but don't always discuss injury prevention during patient encounters. In one study, less than half of pediatric residents mentioned injury prevention in well-child visits and only one minute was devoted to these topics if discussed. As a follow-up to previously presented work, we will discuss the evaluation of our SBS program aimed at improving pediatric resident and expectant parent infant safety knowledge and comfort.

We conducted SBS events in partnership with Centering Pregnancy, a group prenatal care model for low-income expectant mothers. Participants rotated through six safety stations covering infant-specific injury prevention topics. Participants received educational materials and an incentive gift bag with approximately $75 worth of safety items. Raffles were held for larger items such as car seats. Participants completed pre- and post-SBS surveys to assess effectiveness in improving parent knowledge and confidence. Follow-up surveys were sent out to participants 3-9 months after SBS attendance to determine long-term impact. We assessed baseline pediatric resident knowledge and comfort with infant injury prevention topics via survey in fall 2023. Residents who attended SBS events completed an additional survey to assess attitudes regarding SBS clinical impact.

We’ve hosted three SBS events with 76 participants; 40% identifying as first-time parents. Participants had significant improvement in knowledge of infant safe sleep positions, with 47% identifying the back as the safest position for sleep in pre-survey and 76% in post-survey. Participants had significant improvement in knowledge of car seat transitioning time, from 31% correct in pre-survey to 54% in post-survey. Participant confidence increased in multiple areas, including child passenger safety and choking management.

Approximately 55% of pediatric residents completed a baseline survey. Over half reported never previously receiving infant safety training. The most frequently reported safety topics residents discussed in patient encounters were safe sleep (93%), formula mixing (75%), and car seats (87%). Most residents reported discussing car seats with families, it was one of the most uncomfortable topics to review. Additionally, 75% of residents who volunteered at a SBS felt it was a very good/excellent educational activity, and two-thirds would use what they learned from the showers in clinical practice.

Infant safety can be overwhelming for parents and residents. Safety baby showers may be an effective way to improve pediatric resident knowledge and comfort in infant injury prevention counseling, and to share safety information with parents. We plan to continue our SBS program utilizing this feedback to improve their efficacy.

1. Potentional framework to establish a safety baby shower program.
2. Areas expectant parents need improvement in infant safety.
3. Areas pediatric residents need improvement in infant safety.

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Jordan Couceyro, MD
Sofia Chaudhary, MD
Timothy P. Moran, PhD
Maneesha Agarwal, MD

Pediatric traumatic brain injuries from activities where helmet use is recommended (AWHUR) can be mitigated by use of appropriately fitting helmets. However the rate of appropriate helmet use during AWHUR on dedicated pedestrian/bicycle paths may vary, and the efficacy of brief education regarding helmet fit is unknown. Our objectives were to evaluate helmet use of children participating in AWHUR on a dedicated bike/pedestrian path and to evaluate the effect of a brief educational intervention on helmet fit.

In this study’s observational arm, we observed children participating in AWHUR and recorded sex, race, estimated age group, type of AWHUR, and helmet use. In the interventional arm, guardian/child pairs were asked to complete a pre/post assessment. Participants completed a survey on demographics and helmet use. Educators assessed helmet fit after the caregiver put their child’s helmet on or supervised their child’s own helmet placement. Helmet fit was assessed based on chin strap and side strap placement, helmet brim height, and helmet movement greater than 1 inch in any direction. Helmet standards were also assessed for age, certification, and AWHUR suitability. Any single incorrect element resulted in a fail. Then, an educator demonstrated proper helmet fit. After loosening straps and removing the helmet, guardians fit it on their child a second time; this post-education assessment was recorded, with additional feedback if needed. The pre- and post-test values were compared using McNemar’s test and are reported with p-values.

Of the 287 children (61.3% male, 78% White) in the observational arm, most were engaged in bicycling (39.0%) or riding in a bike seat or caravan (40.4%). Overall helmet use was 72.8% with rates varying by activity. In the interventional arm, even though 80.8% of 78 guardian/child dyads endorsed helmet ownership, only 24.4% demonstrated appropriate helmet fit pre-intervention; this fell to 15.4% when accounting for helmet standards. Post-intervention, helmet fit improved to 89.7% (p< 0.001). The most common areas of poor fit pre-intervention included helmet brim (51.3%) and chin strap placement (29.5%); post-intervention this improved to 93.6% and 94.9% respectively (p< 0.001).

Even though pediatric helmet use during AWHUR on a dedicated pedestrian/bicycle path was high, appropriate helmet use and fit was suboptimal . A brief educational intervention significantly improved helmet fit immediately after education. Further study on whether improvements in helmet fit are retained over time is warranted.

1. Describe how helmet use in the pediatric is suboptimal, both in usage rates and helmet fit.
2. Understand how a simple intervention can improve caregiver understanding of appropriate helmet fit.
3. Discuss how helmet use rates vary across activity children engage in.

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

Cyclists are a particularly vulnerable road user group, with the number of preventable deaths increasing by 37% over the past decade. The objective of this study was to review the epidemiology of cyclist fatalities to identify risk factors to target via a safe system approach.

Fatal cyclist motor vehicle collision (CMVC) and injury data were collected from the Office of the Chief Coroner (2013-19), with selected crash investigations and expert review by a multidisciplinary team of engineers, coroners, physicians, geographers and epidemiologist. Descriptive analyses were undertaken. Urban and rural CMVC were compared with Pearson chi square and Mann-Whitney U tests.

There were 83 unintentional cyclist fatalities (81% male), 5(6%) children, 11(13%) youth, 57(69%) adults and 10(12%) seniors, with median (IQR) age=48.0 (27.0-48.0) and ISS=75 (45-75). Head was the most severely injured body region (median MAIS=5), except in children [median MAIS thorax=4.5 (3.75-5)]. Nearly 2/3 of cyclists were not wearing a helmet and 24% were impaired at the time of the crash. Expert review found 60% of child cyclists were runover, all <6 years, and this was the only age group to be struck by a car or pickup truck. Distraction from cell phone (n=1;1%) or headphones (n=7;8%) may have contributed to CMVC. There were 49 (59%) cyclists killed in an urban environment. Comparing urban with rural CMVC, all child cyclist deaths were in the urban group, which also had a significantly (p<0.001) higher proportion of collisions involving an intersection (57%; 6%), very low speed (?15kmh) collisions (33%; 0%), bike lane (29%; 0% with 8/14, 57%, struck by a heavy truck), cyclists stopped/slowed (33%; 3%), crossing the street (31%; 0%), involving heavy vehicles (31%; 6%; p=0.006), resulting in more runovers (49%; 9%). Rural collisions were associated with significantly (p<0.001) more high speeds (>50 kmh) (94%; 49%), darkness/nighttime (44%; 10%), cyclist going ahead (97%; 65%), riding on roadway with traffic (65%; 18%). No rural CMVC had cycling infrastructure, bike lane/path or sidewalk, available (0% vs 33%; 0% vs 84%; p<0.001).

Riding a pedal cycle in traffic puts cyclists at risk for severe injury and death, in both urban and rural environments. A safe system approach recognizes that people are vulnerable and make mistakes. Incorporating engineering countermeasures into the design of roadways to separate cyclists from vehicles, lighting in rural areas, and traffic calming measures to reduce speeds. Vehicle safety features include guard rails, mirrors and cameras on heavy vehicles, higher rated vehicle headlight performance, and advanced driver assistance technologies to detect cyclist or automated emergency braking can play important roles in the prevention of CMVC. Policy and legislative action can also improve the safety of the transportation system. To be equitable, these countermeasure must be implemented in all areas of a region to protect all road users.

1. The epidemiology and risk factors associated with urban and rural fatal cyclist motor vehicle collisions.
2. Principles of a safe system approach to road safety for cyclists.
3. Engineering countermeasures including road and vehicle design, to help mitigate crash risk.

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Owen S. Henry, MD
Alexandra S. Rooney, MPH
Megan V. Heflinger
Alicia G. Sykes, MD, MA
Claudio B. Ghetti, MD
Victor de Cos, BS
Karen M. Kling, MD
David A. Lazar, MD
Matthew J. Martin, MD
Vishal Bansal, MD
Romeo C. Ignacio, MD, MS, MPath, FACS, FAAP

There is a paucity of data to describe how neighborhood socioeconomic disadvantage (NSD) correlates with childhood injuries and outcomes. This study assesses the relationship of NSD to bicycle safety and trauma outcomes among pediatric bicycle versus automobile injuries.

Between 2008 and 2018, patients < 18 y old with bicycle versus automobile injuries from a Level I pediatric trauma center were evaluated. Area Deprivation Index (ADI) was used to measure NSD. Patient demographics, injury, clinical data characteristics, and bike safety were analyzed. Traffic scene data from the Statewide Integrated Traffic Records System were matched to clinical records. Multivariate logistic regression was used to assess demographic characteristics related to helmet usage.

Among 321 patients, 84% were male with a median age of 12 y [interquartile range 9-13], and 44% were of Hispanic ethnicity. Hispanic ethnicity was greater in the most disadvantaged ADI groups (P < 0.001). Mortality occurred in two patients, and most (96%) were discharged home. Of Statewide Integrated Traffic Records System matched traffic records, 81% were at locations without a bike lane. No differences were found in GCS, intensive care unit admission, or length of stay by ADI. Hispanic ethnicity and the highest deprivation group were independently associated with lower odds of wearing a helmet (AOR 0.35, 95% confidence interval 0.1-0.9, P = 0.03; AOR 0.33 95% confidence interval 0.17-0.62; P = 0.001), while patient age and sex were unrelated to helmet usage.Outcomes for bike versus auto trauma remains similar across ADI groups. However, bike helmet usage is significantly lower among Hispanic children and those from neighborhoods with greater socioeconomic disadvantage.

Outcomes for bike versus auto trauma remain similar across ADI groups. However, bike helmet usage is significantly lower among Hispanic children and those from neighborhoods with greater socioeconomic disadvantage.

1. Learn the definition of Area Deprivation Index (ADI).
2. Explore the association between Area Deprivation Index and bicycle helmet use.
3. Discover how Area Deprivation Index can be utilized to design and implement targeted injury prevention programs.

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

Head injuries are the most common cause of fatal injuries among cyclists. Helmet use can significantly decrease the risk. Our study objective was to evaluate the frequency of bicycle helmet use by rural adolescents, determine their attitudes with regards to helmets, and to identify associated demographic factors.

A convenience sample of 2022 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees completed an anonymous survey electronically by cell phone or by paper which was later entered into the Qualtrics database. Descriptive, contingency table and multivariable logistic regression analyses were performed.

1,331 rural adolescents 13-18 years of age participated. Almost three-fifths (58%) of respondents were female and 56% were 16-18 years. One-half lived on a farm, 21% lived in the country/not on a farm and 28% lived in town. Ninety percent of subject’s households had at least one bicycle. Overall, 78% had ridden a bicycle in the past year. Those who lived on farms had lower proportions that had ridden a bicycle in the past year (68%) then those that lived elsewhere (82%), p<0.001. Those from farms had lower proportions that rode at least weekly (21%) as compared to those from the country/not on a farm (35%) and from towns (31%), both p<0.001. Younger teens (13-15 years) were twice as likely as older teens (16-18 years) to ride at least weekly. Median importance (rated 1-10) of wearing a helmet on a bike was 4.7 with a median of 4. Females, younger teens, those who were not non-Hispanic White, and those who did not live on farms all ascribed higher bicycle helmet importance than their corresponding peers. Fifteen percent believed there should be a law requiring the use of a helmet while riding a bicycle. Three-quarters (74%) rarely or never wore a helmet; only 13% said they always or mostly wore a helmet. There was a direct relationship between helmet use and those who rode more frequently, as well as to those who ascribed a higher importance to helmet use. Only 12% of participants stated their parents had a strict “no helmet, no bike riding rule”. However, those who had such a rule had 18x greater odds of supporting a bicycle helmet law and had a higher median ascribed bicycle helmet importance (9) compared to those without such a rule (4). Moreover, those with the strict rule had 32x higher odds of wearing a bicycle helmet always or most of the time versus those who had no rule.

Bicycle helmet use is infrequent amongst rural adolescents. Youth whose parents had a strict “no helmet, no bike riding rule” had significantly greater helmet use, placed greater importance on helmet use and were more supportive of bicycle helmet laws.

Attendees will be able to:
1. State the frequency of rural adolescent’s use of bicycles and bicycle helmets.
2. Identify at least three rural adolescent demographic groups who ascribe lower importance to helmet use.
3. Discuss how a strict parental “no helmet, no bike riding rule” might influence bike helmet use and attitudes.

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Molly B. Johnson. M.AmSAT, PhD
Barbara Cosart, MLIS, MPH, CHES
Stewart R. Williams, MBA
Brent M.Troy MD, MPH
Karla A Lawson, PhD, MPH

In the US, more children 1-4 years old die from drowning than from any other cause. Additionally, drowning is a leading cause of death for children of all ages. Swimming pools are the most common drowning location for children 1-14 years old, but for infants under 1 year old, bathtubs are the most common drowning location. Additionally, older children may be at risk of drowning in a bathtub due to impaired development or disability, illness, or seizures. The aim of this study was to overview characteristics of patients treated for unintentional bathtub drownings at a large urban children’s hospital in the US.

A 10-year retrospective study was performed using medical records for all children treated for unintentional drowning at one large hospital serving central Texas, US. Descriptive data on the drowning context and outcome were assessed for the drownings that occurred in a bathtub setting.

Of the 457 children treated for drowning at the hospital, for 51 (11%), the setting of the drowning was a bathtub. Of all bathtub drowning admissions, 62.8% were female. The age of the patients ranged from 0.1 - 9.5 years. The majority of the children were <1 year old (54.9%). At the time of the incident, 94.1% were bathing during a planned bath time; the other 5.9% accessed water in a bathtub that had been filled for other reasons or filled the tub without permission. Of the 87.2% of adults intending to supervise the child around water during planned bath time, only 19.5% were supervising during the incident. In over one third of cases, the reason for a lapse in supervision was that the caregiver was performing bath-related chores, most often getting a towel. It is suspected that submersion was precipitated by a seizure in 11.8% of the children, including all children over 6 years old. Of the children who submerged in a bathtub, 45.1% were not breathing when removed from the water, 54.9% received a CPR-based rescue activity immediately after being removed from the water, and 13.7% received CPR from a medical professional. Additionally, 35.3% were discharged home from the Emergency Department following evaluation and/or treatment;13.7% of the incidents resulted in death or morbidity.

Bathing poses a drowning risk for children, particularly those under 1 year old and children with a history of seizures. Focused supervision is a critical layer of protection, yet lapses in supervision are common. Drowning prevention initiatives should emphasize the importance of gathering towels and clothing before starting water for a bath and avoiding distractions, including chores and other childcare when a young child is in the bath.

1) Overview common drowning scenarios for pediatric bathtub drowning incidents.
2) Highlight the importance of supervision for infants and toddlers while bathing.
3) Provide evidence to support bathtub water safety messaging emphasizing gathering towels and other bath supplies prior to starting water for a bath.