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Mikayla Gibson, BS
Briah Drewry, BS
Maia Bibbs, Undergraduate
Treyton Krupp, MD
Pam Hoogerwerf, PhD
Charles Jennissen, MD

Riding lawnmowers are the most frequent cause of major limb amputation in young U.S. children, and in the majority of these events the child is a bystander. Pediatric lawn mower injury research has been minimal. Our objective was to investigate the circumstances of pediatric bystander riding lawn mower injuries and identify behaviors that may precipitate these events.

Followers/members of both a public and a private lawn mower injury support and prevention Facebook page who had or were aware of children who had suffered a lawn mower-related injury were invited to complete an electronic survey on Qualtrics which included open-ended questions regarding supervision and circumstances of the event. Injuries involving push mowers and duplicate cases were removed. Qualitative analysis of responses was independently performed by three research team members, and differences in coding were resolved through an iterative process. Descriptive analyses of responses were performed.

Of the 140 injured children identified, 97 were bystanders. Major themes identified that contributed to the injury event included: Supervision Issues (40%), Child Not Perceiving Danger (40%), Child Allowed to be in Vicinity of Mower (23%), Mowing in Reverse (51%), and Other Mower-Related Issues (15%). Sub-themes for Supervision Issues included: Distracted Supervisor (34%)--which was sub-categorized into attending other children, doing another task, visiting/talking with other adults, and supervisor was mower operator, and Child Not Supervised (7%)—which was sub-categorized into miscommunication, supervisor could not see child, and no designated supervisor. Sub-themes for Child Not Perceiving Danger included Lawn Mower Rides (17%)—which was sub-categorized as child running up to mower wanting a ride, and child had received a mower ride day of injury, and Child Approached Mower (24%)—which was sub-categorized as child approached mower for a specific reason, child approached mower with no specified motive, and child engaging in play activities with lawn mower or mower operator. Sub-themes for Child Allowed to be in Vicinity of the Mower included Child Playing Near Mower (17%) and Child Doing Another Activity/Not Playing Near Mower (5%). Other Mower-Related Issues included the sub-themes: Ability to Mow in Reverse (7%), Mower Guard/Chute Issue (4%) and Blind Spots (4%).

Contributing risk factors for child bystander lawn mower injuries were identified and reinforce many safety directives including close supervision of children by someone other than the operator, and not allowing children outside when mowing is being performed. Many injured child bystanders were, or may have been, approaching the mower to get rides. Mower rides likely desensitize children to the inherent dangers and lead them to seek rides when the mower is being used. Mower design preventing blade operation when traveling in reverse and not giving children rides on lawn mowers may be critical in decreasing lawn mower-related injuries.

Attendees will be able to:
1. Describe factors that put children at risk for bystander riding lawnmower-related injuries and why careful supervision is so important.
2. Discuss why giving rides to children on lawnmowers increases their risk for lawn-mower-related injury as bystanders.
3. State why mowing in reverse is a problem related to child bystander lawnmower-related injuries and how engineering changes might decrease the risk.

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Maura Powell, MPH, MBA
Gabrielle DiFiore, MPH
Stephanie Mayne, PhD
Hannah Martin, BS
Nicole Koepke, MSN, CRNP
Elizabeth Walshe, PhD
Anthony Luberti, MD
Brian Jenssen, MD, MSCE
Angela M. Rapposelli, BA
Flaura Winston, MD, PhD
Alexander Fiks, MD, MSCE

Low-income teens are more likely to delay driver licensing to 18 or older. It is not known whether this delay reflects disparities in intentions to drive or barriers to licensure. The Childhood Opportunity Index (COI) is a multi-dimensional indicator of neighborhood opportunity conducive to healthy child development that may be associated with driving intention and licensure. Little is known on the intersection of COI and these outcomes.

We conducted a cross-sectional analysis of electronic health data for adolescents aged 15-18 years seen within a large 31-site Primary Care Network from February 2022-October 2023. Adolescents were included if they completed their annual Adolescent Health Questionnaire (AHQ). The AHQ assesses health risks, including self-reported driving intention and licensure status. Neighborhood opportunity was measured using score quintiles of the Childhood Opportunity Index (COI) based on adolescents’ addresses. Mixed effects logistic regression separately estimated the association between neighborhood COI and driving intention for 15-year-olds and licensure status of 17-18-year-olds. Regression models were adjusted for adolescent sex, race/ethnicity, health insurance payor, and urbanicity.

Adolescents (n=17,622) were 51% Non-Hispanic White, 70% privately insured, and 65% lived in neighborhoods with “high” or “very high” COI. 77% of 15-year-olds from “low” or “very low” COI neighborhoods planned to learn to drive within the next year, compared to 83% from “high” or “very high” COI neighborhoods. 38% of 17-18-year-olds from “low” or “very low” COI neighborhoods reported having a permit or license, compared to 84% in “high” or “very high” COI neighborhoods. In adjusted models, being in the lowest two vs the highest two COI quintile neighborhoods was not significantly associated with intention to start driving in 15-year-olds (OR: 0.85, 95% CI: 0.62, 1.16), but was associated with 58% lower odds of 17-18-year-olds having their permit or license (OR: 0.42, 95% CI: 0.34, 0.51).

Although driving intentions are similar in 15-year-olds from neighborhoods with lower vs higher COI, our findings indicate a large disparity in licensure at age 17-18. Future studies should examine barriers that limit progress from driving intention to licensure in order to develop approaches to address this disparity.

1. Describe the disparity in self-reported driving intentions among adolescents by neighborhood opportunity
2. Describe the disparity in self-reported licensure status among adolescents by neighborhood opportunity
3. Demonstrate a method for collecting adolescent driving intention and licensure status in a preventive care visit workflow

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Ariel Carpenter, MD
Kelsey Schoenmeyer, BS
Cassi Smola, MD
Meghan Hofto, MD, MPH
Kirsten Bechtel, MD
Sandra McKay, MD
Kathy Monroe, MD

Firearms are the number one cause of death in children in the United States. The presence of a firearm in a home represents an independent risk factor for increased risk of unintentional firearm injury, death and suicide in children. Despite this risk, many gun owners choose to keep their firearms loaded and accessible leading to increased risk of accidental or nonaccidental trauma in children of all ages. Safe storage devices, such as gun locks, trigger locks, gun safes or lock boxes, have been shown to decrease the risk of unintentional injury and suicide and are important tools in decreasing firearm injury and death in children. However, access and resources can be a barrier to obtaining these devices. In an effort to protect children, institutions have begun to provide these devices to children and families. Despite literature documenting this practice and evidence to support effectiveness, there is limited data on the national prevalence of this practice. Together with the Injury Free Coalition for Kids firearm injury prevention subcommittee , we aim to glean a better understanding of this practice and provide much needed data that could expand provision of safety devices to families and guide future advocacy and policy efforts.

We conducted a multi-center cross-sectional mixed methods study of injury-free coalition representatives at IFCK sites nationwide. We sent a survey to the PI and PC at each IFCK site. The survey consisted of 16 questions including both quantitative and qualitative data to characterize the prevalence and details of physician or hospital provided safe storage devices. Analysis included demographic data, descriptive statistics and analysis of common themes derived from qualitative questions.

Survey responses were collected from 40 IFCK representatives across the U.S. Among the 40, 38 stated their site is allowed to work on firearm injury prevention. Results include how many IFCK sites currently provide safe storage devices, which devices are provided, how many devices are provided each year, how this is funded, who receives devices, and barriers to providing devices.

IFCK efforts to decrease firearm injuries in children include education and provision of safety equipment such as safes and trigger locks. This study describes the various efforts, common barriers and sources of funding used by IFCK sites.

1. Firearm injury is the number one cause of death in children in the United States.
2. Safe storage of firearms is a proven effective method of preventing firearm injury in children.
3. Survey results indicate widespread provision of firearm safety devices at centers across the United States and support expansion of these efforts.

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Eliot England, MPH
Sumihiro Suzuki, PhD
Kyran Quinlan, MD, MPH
Felicia Scott, MD
Gina Lowell, MD, MPH

In the first year of life, Sudden Unexpected Infant Death (SUID) is the leading cause of death from 1-month to 1-year-old in the United States, claiming ~3500 lives each year. In 2019, Cook County joined the Center for Disease Control and Prevention’s national SUID surveillance system in efforts to expand knowledge and improve prevention strategies. Nearly all SUID in Cook County have been found to occur in unsafe sleep environments. Non-Hispanic Black (NHB) and Hispanic infants from high hardship communities die more often than their White counterparts. Families from high hardship communities in Cook County experience housing instability and crowded housing. We aim to describe the characteristic differences between SUID that occurred in temporary living situations compared to those that occurred in an infant’s usual home to identify actionable prevention approaches.

Data from the Cook County IL SUID Case Registry between 2019 and 2022 were analyzed to compare SUID that occurred in the infant’s usual home with those that occurred when an infant was not in their usual home, or “temporary stay” SUID. SUID were analyzed for statistically significant differences between groups using chi-squared tests for infant age, sex, and combined race/ethnicity; maternal age and supervisor age and relationship; sleep position, bedsharing, bed-sharers and whether a crib was available for use. SUID narratives were reviewed to further identify patterns and themes to supplement the descriptive analysis between groups.

Of 181 SUID in Cook County from 2019-2022, 173 were sleep-related. Of these sleep-related SUID, 143 (83%) occurred in the infant’s usual home and 30 (17%) occurred during a temporary stay. Peak age for usual home SUID was 1-2-months and peak age for temporary stay SUID was 4-months. Ninety-eight (68.5%) usual home SUID and 30 (100%) temporary stay SUID were NHB infants (p<0.05). Thirty-one (22%) usual home SUID and 12 (40%) temporary stay SUID were bedsharing with both adults and children (p<0.05). Supervisors were non-parental relatives for 2 (1%) usual home SUID and 10 (33%) temporary stay SUID (p<0.05). Twenty-five (18%) usual home SUID and 10 (33%) temporary stay SUID had no crib available for use (p<0.05). Narrative review of temporary stay SUID revealed a pattern of young parents (<25 years-old) whose parents were also young when parenting them as infants.

Nearly 1 in 5 SUID in Cook County involve a temporary living situation. SUID during temporary stays were older, less likely to have a crib available for sleep, more likely to be bedsharing with both adults and children, more often supervised by a relative and more often non-Hispanic Black infants. Practicing safe sleep may be especially challenged in temporary stay situations. Housing instability plays a role in putting infants at risk of SUID. These findings have implications for providing contextual safe sleep counseling as parents want or need their infants to temporarily stay with others. Exploring the environmental and social reasons for temporary stays may improve relevant guidance for families facing similar circumstances.

1. Describe characteristics of SUID that occur during temporary living situations
2. Recognize situational circumstances that inhibit safe sleep practices
3. Consider changes to safe sleep counseling for families requiring alternate living or caregiving situations

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Rachel Eisenhauer, BS
Harman Sawhney, MD
Kevin Rix, PhD, MPH
Michelle Ruda, MD
Irma Ugalde, MD
Bibek Bista, MBBS, MPH

Level 1 Pediatric trauma requires multidisciplinary care including our community partners. However, there is a paucity of literature regarding categorizing incidence of multidisciplinary care during the hospitalization and follow up of patients with serious pediatric trauma. This is valuable information for communication between health care organizations and community partners. Our study aims to categorize these referral patterns for serious pediatric trauma at a Level 1 Trauma Center with comparison of unintentional and intentional trauma with mortality and survival.

The subjects were identified from a Level 1 Trauma center’s trauma registry between January 2019 to December 2020 among patients aged 0-18 years with serious pediatric trauma. Serious pediatric trauma was defined as trauma that either led to death or admission to the Intensive Care Unit (ICU). A retrospective chart review was performed from hospital Electronic Medical Record, and pertinent data was obtained from the Medical Examiner’s office and Texas Department of Family Protective Services (DFPS)/Child Protective Services (CPS). Statistical analysis was done using t-tests and Chi-square tests.

There were 263 subjects identified as having serious pediatric trauma during the study period. Among them, 224/263 (85%) experienced non-intentional trauma and 39/263 (15%) experienced intentional trauma. Most frequent mechanism of injury among non-intentional trauma subjects was Motor Vehicle Collision (MVC) (92/224, 41%) and among non-intentional trauma was Gun Shot Wound (GSW) (23/39, 59%). Intentional trauma patients were more likely to have mortality compared to non-intentional trauma (13% vs 41%, 28/224 vs 16/39, p =< 0.001). The Child Abuse Pediatric (CAP) team was statistically more likely to see intentional trauma compared to non-intentional trauma (26% vs.12%, p = 0.01). In GSW non-intentional trauma, social work was consulted in 79% and CAP team in 3% of cases. In subjects where CAP was consulted, social work was consulted in 100% of those cases. For the intentional trauma subjects admitted to the PICU, social work was consulted 100% of the time, while the CAP team was only consulted for 43%. Of the 44/263 mortality cases, social work was consulted in 71%, CAP team in 11%, and DFPS/ CPS reporting was done in 30% of cases.

Findings from this study help to evaluate the pattern of referral and reporting in Level 1 pediatric trauma. There were missed opportunities for involving social work, CAP team, and reporting to DFPS for specific types of serious pediatric trauma and potential suboptimal care. Findings from this study help to implement processes to have timely consults and reporting to our in-hospital services and community partners.

1. Describe the nature, mechanism of injury and associated mortality among serious Pediatric Trauma in a Level 1 Trauma Center.
2. Describe the types of trauma and patterns of referrals made at a Level 1 Trauma center.
3. Discuss the missed opportunities for involvement of social work, the CAP team, and CPS.

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Joyce Pressley, PhD, MPH
Zarah Aziz, MS
Barbara Barlow, MD
Riya Virani, BS

The U.S. experienced a significant increase in all age motor vehicle mortality during the Covid-19 pandemic that has not returned to pre-Covid-19 levels. A better scientific understanding of the Covid-19 impact on motor vehicle mortality in the pediatric population could aid in designing and conducting more effective prevention efforts.

A census database of all U.S. roadway deaths, the Fatality Analysis Reporting System (FARS), was employed to investigate pandemic changes in motor vehicle mortality in the U.S. pediatric population aged 0-19 years. The pre-pandemic era was defined from 04/01/2017 to 12/31/2019 (n=9,566) and the Covid-19 era from 04/01/2020 to 12/31/2022 (n=10,692). FARS variables were mapped to the Safe System five pillar framework and compared across the two timeframes for: 1) road users; 2) roadways; 3) vehicles; 4) speeds; and 5) post-crash care. To control for seasonal differences, the two time periods were exact matched by month and length of study time. Deaths occurring during a buffer period from 01/01/2020 to 03/31/2020 were excluded. In this ongoing study, statistical analyses will include Chi Sq for bivariate analyses and multivariable logistic regression for unadjusted and adjusted odds with 95% CI.

The pandemic period was associated with more than 1,100 excess pediatric motor vehicle deaths compared to an identical length period in the pre-Covid timeframe. Mortality increased by 11.8% in ages 0-19 years during the pandemic, but this varied significantly by age. Percent increase in mortality was highest in ages 10-14 (18.1%) and second highest in 15-19 years (13.8%) than other age groups (p=0.005). Mortality increased by approximately 10% in drivers with a full or a GDL license, but by 52.5% in drivers without a driver’s license (p<0.0001). There was a 40.5% increase in failure to use safety equipment (p<0.0001) and a 37.8% increase in underaged alcohol-impaired drivers (p=0.002). Urban roadway mortality increased more than rural roadways (21.2% vs. 2.4%, p<0.0001). Mortality decreased during inclement weather, but increased significantly in clear conditions (p<0.0001) and at night (p=0.0001). Mortality increased by approximately 11.8 to 14.8% for trucks, cars, and SUVs, but by 20.3% for motorized 2 and 3 wheelers and 43.2% for nearly 1,000 “other” vehicle types (p<0.001). Vehicle ejections were up by 27.5% p<0.0001). Speed related crashes increased by 32.2% (p<0.0001). Post crash care had a 17.9% increase in died on the scene and not transported for emergency care during the Covid era (p=0.004).

The U.S. pediatric population experienced an increase in pandemic mortality despite stay-at-home orders, entertainment shuttering, and school closures. Use of the five pillar Safe System framework was valuable in identifying pandemic-associated road user behavior, roadway, vehicle, speed, and post-crash factors contributing to the pediatric pandemic mortality increase.

Attendees of this session will be able to:
1) Explain concepts of the safe system approach and cite an example of its use to expand our scientific knowledge of pediatric motor vehicle fatal injury pre-Covid-19 and in the Covid-19 era;
2) Identify emerging issues and trends in the pediatric population experiencing fatal roadway injury;
3) Discuss how these scientific findings can be used to focus and inform prevention efforts.

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Asia Simpson, BS, CPSTI
Dominick Dunbar, BS, CPST
Jonathan Green, MD, MSCI

Unintentional injuries are the leading cause of death in children. These injuries represent a significant public health concern globally, often resulting in devastating consequences for children and their families. These injuries encompass a broad spectrum, including falls, burns, drowning, poisoning, bites, and motor vehicle collisions. Despite advancements in safety measures and injury prevention strategies, children continue to be vulnerable to these incidents due to their natural curiosity, and lack of awareness about potential hazards.

Our hospital partnered with a local insurance agency to create Safety Quest, a large RV with several games about safety including interactive media games geared toward 4th-5th grade students. This program emphasizes how children can be safe and responsible for themselves and others. Safety Quest comprises 4 games, each focusing on different aspects of safety. Home Hazard Hunt, Street Smarts, Fire Escape and Charades. Home Hazard Hunt walks the children through a home and playground and identifies the hazards that might be found throughout these environments. Street Smarts focuses on paying attention to surroundings while walking or biking in public and on sidewalks. Fire Escape teaches the students what to do in a fire emergency in their homes and simulates escaping a fire emergency in a home. Charades is an acting game all about safety. Students will engage in discussion about why certain everyday items may be important for them to learn more about. Participants are given pre and post surveys to evaluate comprehension, as well as improve the content.

In the 2023- 2024 school year, Safety Quest has visited approximately 40 schools and about 2,000 5th grade students have participated.

Unintentional injuries are the leading cause of death in children. Safety Quest brings awareness and education to 4th and 5th grade students about fire safety, pedestrian safety, bicycle safety, water safety, poison safety, home safety, and playground safety. Future directions are to analyze the pre and post survey responses in order to improve the content, as well as evaluate the comprehension of the participants.

1. Developing partnerships with insurance agencies
2. Methods of game development for injury prevention
3. The importance of collaboration with school systems

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Isabell Sakamoto, MS, CHES
Gloria Vidal, MPH
Christina Delgado, DNP, RN, SANE-A
Chris Buresh, MD
Thomas Agostini, MD
Adriana Herrera, MD

Drug overdose is now a leading cause of injury death among children and young adults in the program region: from 2019 to 2022 the rate of deaths involving opioids nearly doubled among children and young adults. In this region, deaths from drug overdose in people ages 0 to 24 now outpace the number of deaths caused by firearms and motor vehicles - the two leading causes of injury death nationally for this age group. As access to fentanyl increases, harm reduction programming tailored to young people should be implemented to reduce overdose fatalities.

The hospital’s Community Health team developed a strategic program plan with the goal to deliver education and services that appropriately respond to the opioid overdose crisis among young people, reduce stigma around substance use disorder, support access to resources for safe medicine storage and disposal, and ultimately reduce morbidity and mortality. Primary audiences include youth, families, and clinicians. We’ve used the socioecological model to frame delivery of education and services to parents, caregivers, and adults who care for children and teens in the program region.

We’ve piloted an opioid overdose recognition and response education model to deliver to community. Between March and May 2024, approximately 150 community members received education on opioid overdose, and 100 naloxone kits were distributed in the program region through an event. All the people who received naloxone at the event and completed a survey reported that they were at least somewhat likely to carry naloxone within the next month, and 94% reported increased confidence to use naloxone after attending the event.

We’ve also developed and implemented an educational presentation for pediatric medical residents to highlight the urgency of this issue in the pediatric population and to illuminate existing clinical resources and medication treatment options. To date, approximately 31 medical residents have received training to support adolescent opioid awareness and harm reduction, with initial pilot results suggesting increased confidence in providing patient counseling on overdose recognition and naloxone administration.

Currently, this program pilot is funded by the hospital and a limited supply of naloxone was provided by the state department of health.

Program education has been well received by community members and medical residents in the program region. There is momentum to expand the program’s reach through collaboration with clinicians, community health team members, school-based health centers, and community organizations. We plan to use the transtheoretical model and health belief model to further develop program interventions for clinicians and youth audiences.

1. Understand opioid overdose prevention and harm reduction program goals, objectives, and evaluation design for a pediatric hospital.
2. Identify avenues to increase community access to naloxone.
3. Demonstrate ways to collaborate cross-departmentally and with community organizations to develop and implement opioid overdose prevention and harm reduction initiatives.

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Michael Chappell, CPST-I

The State is the smallest State in the country, but has a very robust Child Passenger Safety program. There are currently 157 Child Passenger Safety Technicians (CPST's) certified in the State. Sixty five percent of these CPSTs, which equates to 102, are law enforcement. The remaining 35% of the CPSTs are spread out among The Injury Prevention Center, the State's only Children's Hospital. community partners, and volunteer fire departments. The State's Department of Transportation (DOT), is the sole funding source for all Child Passenger Safety (CPS) activities for law enforcement, IPC, and community partners. In the past, law enforcement agencies were given a set amount of money to purchase car seats. Those car seats had to last the entire grant year since there was no additional funding. High performing agencies would run out of seats, and be left with no car seats to distribute to caregivers who were in need. Based on this issue, a pilot program was created for a single car seat repository for all agencies and community partners who receive grant money from DOT.

The car seat distribution program is coordinated out of the Injury Prevention Center. DOT has supplied a single funding source where car seats can be purchased by the IPC. The car seats are stored in an off site storage unit. In conjunction with DOT, it was determined that each police department and community partner would receive a set amount of car seats to start with. Three convertible seats, one high back booster, and one no back booster would be given to each agency. The time frame was from 10/1/23 - 9/30/24. The IPC delivered to a total of 36 agencies (31 municipal police departments, 4 State Police barracks, and 1 Community partner). A total of 108 convertible seats, 36 high back booster seats, and 36 no back booster seats were delivered. Agencies would sign a "contract" at the time of delivery of the seats indicating they understood the terms of the program. This "contract" is filled out each time an agency receives additional car seats. Once an agency distributed a car seat, they send my office a form indicating the why, and what type of seat was distributed. To acquire more car seats, the CPST will email me to set up a time to come to the IPC.

The results have been positive. As previously stated, 36 agencies have participated in the program. No agency has run out of car seats, which equates to a 100% success rate as caregivers have not been turned away which occurred in the past. A total of 22 seats as of 5/30/24 have been distributed by 7 agencies. All data is maintained by the Project Coordinator. At this time, we have not had any challenges.

For the first year of the program, we have seen success with the statewide car seat distribution program. The intent is to fund this program again for FY 25.

1. Understand the structure and purpose of the statewide car seat distribution program
2. Identify the key stakeholders and their roles in the initiative
3. Evaluate the effectiveness of the pilot car seat distribution model