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Maneesha Agarwal, MD
Kristyn Melchiors, MD
Morgan Cantor, MD
Jacqueline Gluck, BS
Zoe Fischman, BS
Wendy Pomerantz, MD, MS

Preventable injuries are the leading cause of pediatric death. Most healthcare organizations and the general public engage in social media (SoMe) to disseminate and consume health-related information. However, it is unclear how frequently pediatric hospitals leverage their SoMe platforms to educate the general public on injury prevention (IP) topics. Thus, we sought to better characterize SoMe messaging and IP content by children’s hospitals.

This was a retrospective cross-sectional study of US children’s hospitals’ primary SoMe Facebook (FB), Twitter/X (X), and Instagram (IG) accounts. Included hospitals were associated with the Injury Free Coalition for Kids (IFCK), a current or past Centers for Disease Control and Prevention Injury Control and Research Center (CDC ICRC), a level 1 pediatric trauma center, or a pediatric surgery fellowship. Accounts established after 1/1/23 or covering adult health topics were excluded. Trained data abstractors reviewed all posts from 2023; posts were dichotomized into IP vs non-IP content, with further subcategorization based on injury mechanisms and other topics covered. Data abstraction is ongoing. Descriptive statistics and frequencies with ranges were calculated. Chi-squared analyses were used for comparisons between groups.

Of the 82 unique hospitals with eligible SoMe accounts, all used FB and 69 (84.1%) used all 3 SoMe platforms. FB accounts had the most followers (median=53,500; 25th%ile 25,750; 75th%ile 124,250) compared to IG (median 12,831; 25th%ile 6,512; 75th%ile 22,229) and X (median 10,125; 25th%ile 5,840; 75th%ile 23,572). IP affiliations included IFCK (N=40; 48.8%), level 1 pediatric trauma center (N=78; 95.1), pediatric surgery fellowship (N=50; 61.0%), and CDC ICRC (N=18; 22.0%). Only 10 hospitals (12.2%) had all four IP affiliations, while 27 (32.9%) had three, 20 (24.4%) had two, and 25 (30.5%) had only one.

Of 25,685 posts from 43 hospitals, 1,600 (6.2%) posts covered IP. Individual hospital SoMe accounts discussed IP in 0% to 12.4% of posts. Amongst IP posts, the most frequently covered specific topics were mental health/suicide (N=210; 0.8%), poisonings (N=161; 0.6%), and water safety (N=124; 0.5%). Most non-IP posts were focused on general publicity/goodwill (N=24,085; 46.5%); the most frequently covered medical categories were cardiac (N=1,110; 4.3%), cancer (N=984; 3.8%), and neonatal (N=804; 3.1%). Hospital affiliation with IFCK (??2 =10.72; p<.001), pediatric surgery fellowship (??2 =16.81; p<.001), and level 1 pediatric trauma center (??2 =6.65; p=.01) was associated with more IP content. More affiliations with IP oriented organizations were also associated with more IP content (??2 =35.05; p<.001).

Although children’s hospitals have large SoMe followings, IP is rarely discussed in SoMe content. While ties to IP oriented organizations improves coverage of IP content, this represents a critical missed opportunity to address the leading causes of pediatric deaths.

1. Although US children's hospitals have large social media followings, pediatric injury prevention is infrequently covered on social media channels.
2. Stronger connections to organizations that promote injury prevention improves the frequency of injury prevention content on social media channels.
3. Content covered on US children's hospitals' social media channels do not reflect the epidemiology of pediatric injuries or pediatric morbidity & mortality.

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Caroline Chivily, MD, MPH
Katharina Goebel
Meghan Norred, CPNP
Timothy Moran, PhD
Maneesha Agarwal, MD
Kiesha Fraser Doh, MD
Claudia Morris, MD
Nathan Call, PhD
Sofia Chaudhary, MD

Unintentional injury is the leading cause of death for children and teens ages 0-19 years old. Children with Autism Spectrum Disorder (ASD) can exhibit high-risk behaviors, placing them at increased injury risk due to accessing improperly secured dangerous items, elopement, and drowning. The primary objective is to examine the feasibility of injury prevention counseling in a pediatric ASD outpatient clinic. The secondary objective is to evaluate caregiver injury prevention practice changes related to firearm safety, elopement, and water safety.

This was a prospective interventional study of caregivers of youth with ASD of varying severity presenting for new patient appointments to an outpatient pediatric ASD clinic in a large metropolitan area between July 2024 and January 2025. Advanced practice providers, specifically nurse practitioners, assessed caregiver injury risk awareness utilizing standardized questionnaires and provided verbal anticipatory guidance and written injury prevention resources. Caregivers were invited to participate in one-month follow-up phone surveys, which assessed the feasibility of injury prevention counseling and caregiver injury prevention practice changes. The primary analysis included feasibility measures such as caregiver attrition and intervention acceptability. Likert-scale responses were tabulated manually and dichotomized to strongly agree/agree (affirmative) vs. neutral/disagree/strongly disagree. Secondary analysis evaluated injury prevention practice changes related to elopement, water safety, and firearm safety via mixed-effects logistic regressions.

In total, 68% of approached caregivers completed a follow-up interview (n=21). Of these, 100% determined the clinic to be an appropriate setting to discuss elopement and water safety and 94% for firearm safety. Caregivers were most knowledgeable regarding elopement injury risk (76%). Enrollment in swimming lessons had the highest relative increase (153%) of all assessed water safety practice changes (pre: 19%, post: 48%). Among firearm owning families (n=6), there was a 24% relative increase in those “always” utilizing safe storage devices (pre: 67%, post: 83%) and a 66% relative increase in those storing firearms separately from ammunition (pre: 50%, post: 83%). There were significantly more self-reported preventive measures post-intervention compared to pre-intervention for both elopement (OR=2.22, 95% CI [1.45, 3.40], p=0.0002) and water safety (OR=1.60, 95% CI [1.18, 2.16], p=0.002).

The outpatient subspecialty clinic setting offers a unique opportunity for injury prevention counseling for children with ASD. Our study demonstrates that these subspecialty outpatient clinics are an appropriate place for these conversations and that caregivers respond to the injury prevention education with tangible practice changes.

1. Determine if outpatient clinics are an appropriate setting for injury prevention counseling for caregivers of children with ASD.
2. Illustrate perception of injury risk in caregivers of children with ASD.
3. Examine caregiver injury prevention strategies relating to elopement, water safety, and firearm safety.

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Ashley Blanchard, MD, MS
Carolyn DiGuiseppi, MD, PhD
Caleb Ing, MD, MS
Guohua Li, DrPH

People with autism spectrum disorder (ASD) are at heightened risk of injury-related death and specific injuries, such as drowning and self-injury. As ASD prevalence rises, epidemiologic data describing specific injuries, such as suffocation, are essential for prevention efforts. We aimed to describe the excess risk of suffocation associated with ASD and common co-occurring diagnoses among people treated in United States (US) emergency departments (EDs).

Using a repeated cross-sectional study design, we analyzed data from the 2016-2020 Nationwide Emergency Department Sample (NEDS), the largest US all-payer ED visit claims database. Children ? 1 years and adults diagnosed with ASD and treated in EDs were identified using ICD-10-CM code F84.0. Intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), and Alzheimer's disease and related dementia (ADRD) were similarly identified using relevant ICD-10-CM codes. ED visits for suffocation were identified using the ICD–10–CM external cause-of-injury matrix. Weighted multivariable logistic regression models were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of suffocation-related ED visits in persons with and without ASD, ID, ADHD, and ADRD. Each model was adjusted for the other conditions, age, sex, urbanicity, and payor.

The 2016-2021 NEDS recorded a weighted total of 803,777,608 ED visits, of which 1,012,210 (0.13%) were related to suffocation. Suffocation accounted for 0.35% of ED visits in patients with ASD, 0.67% of ED visits in patients with a diagnosis of ID, 0.07% of ED visits in patients with a diagnosis of ADHD, and 0.34% of ED visits in patients with a diagnosis of ADRD. Patients with ASD had a 75% increased odds of suffocation (aOR = 1.75; 95% CI: 1.65, 1.86), patients with ID a more than six-fold increased odds of suffocation (aOR = 6.56; 95% CI: 6.2, 6.94), patients with ADHD a 44% increased odds of suffocation (aOR = 1.44; 95% CI: 1.35, 1.53), and patients with ADRD a 106% increased odds of suffocation (aOR = 2.06; 95% CI: 2.01, 2.12). Across the lifespan suffocation accounted for a larger proportion of ED visits among patients with ASD than those without ASD.

Children and adults with ASD have an increased odds of ED-treated suffocation. ID, ADHD, and ADRD common co-occurring diagnoses with ASD across the lifespan, are also associated with increased odds of ED-treated suffocation. Further understanding of environmental circumstances and unique factors that may increase risk of suffocation in people with ASD is needed.

Learning objectives
1) Children and adults with autism have an increased odd of ED-treated suffocation.
2) Review the risk of suffocation in children with autism among various age groups.
3) Understand risk factors that may predispose children with autism to suffocation.

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Enjuli Chhaniara, MD, PGY-2
Hailey Nelson, MD, FAAP, IBCLC

Unintentional injuries remain the leading cause of death for children ages 1–21. In 2023 alone, a regional children’s hospital reported over 700 trauma admissions, excluding numerous additional injuries managed in the emergency department. The majority of the hospital’s pediatric patients are from underserved backgrounds, with high proportions of racial/ethnic minorities and families living below the federal poverty line. While the pediatric residency program includes some advocacy-focused education, a gap in training exists during the second and third years. Additionally, current curricula lack emphasis on media literacy and strategic communication—key tools for modern advocacy. This project aims to develop a longitudinal curriculum for senior residents during “Y weeks” that equips pediatric residents with both injury prevention knowledge and communication skills to effectively engage communities.

This program will span July 2025 to March 2026. Twenty-seven senior residents will be divided into five large cohorts (5-6 residents each), with each cohort assigned one of five high-priority injury topics: drowning prevention, poison prevention, safe sleep, burn prevention, or motor vehicle safety. Each cohort will be further divided by age focus (0–10 and 11–18 years). In partnership with Safe Kids California, each cohort will be paired with a content expert mentor and participate in a series of structured learning modules, including:

Written-to-verbal translation of research articles

Simulated advocacy conversations with families

Health policy workshops

Field trips to relevant community organizations

Residents will then design and implement a health campaign for their injury topic, including bilingual (English/Spanish) materials such as blog posts, infographics, and short videos. Campaigns will be presented during an Interprofessional Injury Prevention Day to residency faculty, hospital staff, AAP Chapter members, and Safe Kids Coalition partners.

By March 2026, we anticipate ten distinct health campaigns (one per sub-cohort), each consisting of a minimum of two educational deliverables. This will yield at least 20 bilingual materials to be used in community outreach. Qualitative evaluation will include grading rubrics used by stakeholders during the capstone showcase to assess content accuracy, public engagement, and creativity. Residents will complete pre- and post-tests to assess their knowledge of injury prevention and advocacy, alongside self-assessment surveys to measure growth in confidence and skill.

This novel curriculum fills a critical training gap by integrating injury prevention and advocacy skills into a longitudinal format. With structured mentorship and community partnerships, residents gain real-world communication experience while producing valuable educational resources. The model is scalable and replicable for other institutions aiming to enhance resident advocacy and community impact.

1. Describe the structure of a longitudinal injury prevention and advocacy curriculum integrated into pediatric residency training.
2. Identify effective strategies for teaching communication skills to residents using injury prevention topics.
3. Demonstrate how to leverage community partnerships to guide resident-led health campaigns and evaluate outcomes.

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Kendall Snellgrove, MD
Isabella Masler, MD
Andrew Donahue, MD
Heather Austin, PhD
Nicole Jones, MD
Mark Baker, MD

Pediatric trauma can lead to serious mental health issues, but identifying at-risk patients is challenging. To address this, a Pediatric Emergency Department (PED) at a level 1 pediatric trauma center launched the PsySTART Pilot Project in June 2024. PsySTART is a validated triage tool that screens trauma patients for mental health risks and helps connect individuals at high risk to a 12-week trauma-focused cognitive behavioral therapy (TF-CBT) program. The tool satisfies the 2022 American College of Surgeons Trauma Center performance measure for a mental health screening on all trauma patients. However, following implementation, only 46% of triage forms were completed in the first five months, highlighting system inefficiencies. Incomplete screening may lead to missed follow-up care, raising concerns about equitable mental health support for all pediatric trauma patients.

This program aims to raise PsySTART triage form completion for pediatric trauma activations in a level 1 PED from 52% to 70% over 12 months. Using the Plan-Do-Study-Act (PDSA) quality improvement method, a multidisciplinary team identified key interventions, including a Just-in-Time training video and an electronic health record (EHR) reminder. Training completion and PsySTART form completion rates will be tracked, and an annotated run chart will track each intervention’s impact.

After the first PDSA cycle (Just-in-Time training video), completion rate dropped to 42%. Only 30% of eligible staff completed the training. After the second PDSA cycle (EHR reminder), completion rate increased to 71%. Overall completion rate is now 50% since PsySTART implementation. Prior to the first PDSA cycle, the percentage of patients referred to a mental health provider per trauma activation was 13%. This increased to 17% and 24% during the first and second PDSA cycle, respectively. 2 patients (1%) were referred to TF-CBT prior to the first PDSA cycle. 2 patients (4%) and 3 patients (5%) were referred to TF-CBT during the first and second PDSA cycle, respectively. 2 patients have completed TF-CBT and 2 are currently enrolled.

Implementing the PsySTART triage system revealed the importance and challenges of identifying pediatric trauma patients at risk for developing mental health complications. Despite low initial completion and training rates, targeted interventions—especially EHR reminders—led to improved PsySTART use and more referrals to specialized mental health care. Although training uptake remained low, the increase in PsySTART completion and subsequent referrals to mental health and TF-CBT providers suggests early progress toward more equitable and effective post-trauma care. Continued refinement is needed to sustain improvements and ensure timely access to appropriate post trauma mental health care.

1. Describe the purpose and function of the PsySTART triage tool in identifying high-risk pediatric patients and facilitating mental health referrals.
2. Evaluate the effectiveness in specific quality improvement interventions on PsySTART completion and subsequent referrals to mental health and TF-CBT services.
3. Compare the effectiveness of an educational intervention to a behavioral prompt during program implementation.