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Mark R. Zonfrillo, MD, MSCE
Caroline T. Goodwin, BA
Michael J. Mello, MD, MPH
Lindsay M. Orchowski, PhD

The Injury Control Center for Biomedical Research Excellence (COBRE) at Rhode Island Hospital is the first and only NIH-funded COBRE research center to focus solely on injury control, and supports the research activities of injury control researchers to ensure their transition to independently funded scientists. The Research to Practice and Policy (RPP) Core equips COBRE-affiliated investigators with tools to tailor their study methodologies and dissemination strategies for impact on clinical practice and policy. Our primary objective was to design a Data Warehouse with comprehensive archiving of training and seminars related to the Injury Control COBRE, as well as creation of a clearinghouse of publicly available data sources that can be used to study injury.

Identification of open-access datasets and other metadata for public use were identified through internet searches and snowball sampling of researchers in various injury networks. Once databases were identified and collated, PubMed and Google Scholar searches were conducted to identify publications and authors who had used each database. These authors were contacted and asked to contribute by completing slides based on a standardized template describing the database in depth. They were also asked to add a brief description of exemplar publications they co-authored using the same database. A brief (5-7 minute) video was created using the slides and narrated by the respective authors, who were compensated for their time from the COBRE grant.

To date, 51 databases have been identified and 24 supplemental videos have been created. They are publicly available on our Injury Control COBRE website. https://injurycontrolcobre.org/cores/research-to-practice-and-policy-core/research-to-practice-and-policy-database/

Creation of a novel Data Warehouse can be used by our Injury Control COBRE grant awardees (research project leads and pilot program researchers), and are publicly available as a centralized resource for a broad group of injury researchers.

1. How to access and utilize a curated warehouse of injury-related public datasets
2. Innovative methods for enhancing data usability and dissemination
3. Ways this resource bridges research to policy and practice

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Savannah Olsen, MSW, APSW
Maria Beyer, MPH
Rada Drca, MA, LPC
Daysi Garcia, MBA
Michael N Levas, MD, MS

Project Ujima, a hospital-based violence intervention program affiliated with Children’s Wisconsin, provides comprehensive trauma-informed services to youth impacted by community violence. As part of a federally funded initiative to expand gender-responsive, trauma-focused interventions, Project Ujima integrated two evidence-based programs (EBPs)—Voices: A Program of Self-Discovery and Empowerment for Girls and A Young Man’s Guide to Self-Mastery (AYMG)—into its existing service framework. While theoretically aligned with the program’s trauma-informed mission, implementation revealed tensions related to system readiness, staff engagement, and curriculum fit. This study explores facilitators and barriers to EBP implementation, with the goal of informing sustainable, context-responsive practice.

A qualitative narrative design was used to explore staff experiences with implementation. Eight EBP training sessions were delivered in early 2022 to 50 participants, including five Project Ujima staff. Four of these staff later participated in semi-structured interviews, alongside two leadership team members. Interview topics included perceptions of the EBPs’ purpose, alignment with existing program culture, training experiences, and implementation processes. Interviews were recorded, transcribed, and thematically analyzed using a hybrid inductive-deductive coding approach. Triangulation was conducted by evaluators from Children’s Wisconsin and Wraparound Milwaukee.

Staff expressed differing levels of clarity regarding the rationale for integrating Voices and AYMG. While leadership articulated alignment with trauma-informed care, frontline staff reported confusion stemming from limited communication and historical resistance to structured programming perceived as “research-based." Implementation was challenged by a lack of shared decision-making and unclear role expectations during group facilitation. Shifts in responsibilities and limited onboarding for new staff contributed to inconsistency in group structure and delivery. Initial training sessions were viewed as informative but overwhelming, with limited opportunities for practical application. Staff valued informal supports but noted the absence of systematic refreshers or guidance for new facilitators. Despite this, staff demonstrated adaptability by modifying delivery to engage youth, balance curricular demands with group dynamics, and remain responsive to trauma-related needs. Despite these constraints, Project Ujima staff delivered a total of 244 hours of curriculum instruction to 47 youth, with groups held twice yearly. Sessions were co-facilitated by Crime Victim Advocates and Mental Health Professionals, with adjustments made for inclusive delivery across genders. Project Ujima also provided transportation and meals to support participation and safety.

Integrating structured EBPs into established, flexible trauma-informed systems like Project Ujima requires careful attention to alignment, communication, and workforce readiness. While gender-responsive curricula offer important enhancements, successful implementation hinges on engaging frontline staff early, reinforcing training through ongoing support, and adapting content without compromising core principles. Findings underscore the need for transparent leadership, shared ownership of program goals, and cross-agency collaboration to ensure that EBPs are both effective and sustainable in complex, community-based service environments.

1. Identify key facilitators and barriers to implementing trauma-informed, evidence-based practices within an established youth violence intervention program.

2. Describe strategies for aligning structured curricula with existing program culture, staff capacity, and youth needs in community-based settings.

3. Apply lessons learned from implementation to inform future efforts in sustaining gender-responsive, trauma-informed interventions in multidisciplinary systems

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Marc Doobay, MPAS PA-C
Nicholas Stange, MD MPH
Pam Hoogerwerf, BA
Cassidy Branch, MA
Victor Soupene, PhD MS
Charles Jennissen, MD

Suicides and unintentional death rates due to firearms are greater in rural areas as compared to those more urban, and the rates are increasing. The presence of firearms in the home increases the risk of firearm-related deaths and injuries, and rural households, especially farms, are more likely to have firearms. Safe firearm storage is a major factor in preventing these tragedies. However, a study of nearly 1400 adolescent Iowa FFA members found over four-fifths had at least one firearm stored unlocked or loaded at least some of the time in their home. Our study objective was to evaluate the attitudes held by farming parents in Iowa regarding home storage of firearms.

Rural parents participated in focus group sessions conducted in person or on-line in 2024. Participants were recruited through several methods: Iowa FFA (formerly Future Farmers of Amerca) club advisors were contacted by e-mail to inform member parents, a mass email was sent to University of Iowa faculty/staff, and invitations were distributed to 2024 Farm Progress Show attendees. Inclusion criteria were: (1) Must live on and actively farm/ranch in Iowa, (2) Must have at least one child between 10-19 years, and (3) Must have at least one firearm in the home. Dedoose, a qualitative analysis software package, was used for transcript content analysis. Further coding was performed by three team members. Major themes and subthemes emerged. Coding discrepancies were discussed by the team until consensus was achieved.

Thirty-two participated. A few felt safe storage best kept children safe, and that unsafe storage was dangerous. However, some felt it was important more so to prevent theft and maintain gun condition, and to appease others. The majority had views that unsafe storage was acceptable or even not required. In many cases, subjects felt safe storage was incompatible with their use including personal protection and protecting/euthanizing livestock (i.e., they use it as a tool and store it that way). Many felt unsafe storage was safe such as hiding firearms and educating children “not to touch” when younger and how to use properly when older. Some didn’t feel they needed to meet best practices to have safe storage including not having ammunition locked or locked separately, having firearms unlocked but not loaded, and having “most” locked or just temporarily not locked and/or unloaded.

Our study found that the majority of farming parent participants were comfortable with firearm storage that did not meet safe storage criteria (i.e., firearms unloaded and locked with ammunition locked and stored separately) for a variety of reasons. Healthcare providers and other stakeholders will need to address these attitudes/barriers and find compromises that would improve but not necessarily meet best firearm storage practices.

Learning Objectives:
Attendees will be able to:
1. State at least three reasons why safe storage is important as provided by some rural farm parents at focus group sessions.
2. Identify at least three reasons why safe storage is not required and is unnecessary as provided by some rural farm parents at focus group sessions.
3. Discuss how attitudes held by rural parents might be addressed by healthcare providers and other stakeholders to improve firearm storage.

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Iris Garcia, MPH, CHES, CPSTI

Motor vehicle crashes continue to be a leading cause of death among children in the United States. According to the Centers for Disease Control and Prevention (CDC), in 2022 there were more than 1,100 children ages 12 and younger who died in motor vehicle crashes. The National Highway Traffic Safety Administration (NHTSA) reports child occupant traffic fatalities accounted for 80 percent of child traffic fatalities in 2021, a 3 percent increase from 2020. In California, the Department of Public Health (CDPH) reports that motor vehicle occupant injuries are among the top five causes of both death and hospitalization among children under age 16. NHTSA reports that California has the second highest number of children fatalities in vehicle crashes. Our program created partnerships to expand child passenger safety efforts.

Our program is hospital-based and community-driven. This intervention supports families with motor vehicle collision traumas, in birthing centers, and within school regions with high occurrence of injuries and fatalities. Classes are offered in person at the hospital and virtually to allow for varied methods of participation. Caregivers challenged by technology were eager to return to in-person education while other families appreciated the continued opportunity to learn remotely. Partnerships with outside birthing hospitals, schools, and social welfare organizations expanded outreach efforts to increase modality options and attendance rates.

The effectiveness of the program was determined by the analyzed data gathered at each session. Data collected includes attendance rates, pre- and post-test surveys, and evaluations upon completion of the educational sessions. 2023 data of child passenger safety classes shows a 52% increase in knowledge of car seat use and state laws. Evaluations captured self-reported positive behavior change confirming increased safety in transport children. Partnering with local hospitals and agencies increases outreach efforts to be able to plan and implement this program.

Limitations include barriers in technology, internet access, and language. Our classes are offered in English and Spanish only. Los Angeles County in California includes a vast melting pot of cultures and languages. If a participant did not have a family member that could be on the class with them, unfortunately we could not provide interpretation services.

Fostering relationships with prenatal programs in outside birthing hospitals, school administrators and police, and social welfare organizations are key components of a successful program. Education was designed as a PowerPoint presentation to include state laws, best practices, and tailored to the targeted audience at schools. Classes and presentations were led by Injury Prevention Program staff and school police officers who are nationally certified Child Passenger Safety Technicians and Instructors. Vehicle seat simulators, different size dolls, and varied car seat types were utilized to demonstrate proper harnessing and installation techniques. Data including pre-tests, post-tests, and evaluations were collected via an online collection tool. These processes can be applied to other jurisdictions across the country by connecting with local agencies and partnering to gather resources within the community.

1. Session attendees will learn how to replicate successful partnership models to
enhance outreach and education in the community.

2. Session attendees will identify strategies for implementing child passenger safety
educations programs.

3. Session attendees will gain insight into measuring program impact through data
collection methods.

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Kelly White, BS
Amy Watkins, MPH
Mark Lee, MD
Kevin Borrup, DrPH, JD, MPA
Jennifer Tabak, RN, MSN
Evan Fusaro, MSPAS, PA-C
Brendan Campbell, MD, MPH, FACS

Femur fractures are among the most common injuries requiring hospitalization in young children. Spica cast immobilization, a standard treatment for pediatric femur fractures, creates a significant challenge for safe vehicle transport at discharge. National guidelines recommend specialized car seats for these patients, yet many families face cost, availability, and care coordination barriers. Safe Kids Connecticut, a community program affiliated with a Level 1 pediatric trauma center, operates a Child Passenger Safety Program that loans adaptive car seats and provides caregiver education. This program evaluation examines the program’s reach, effectiveness, and sustainability.

From September 2021 through December 2024, data was collected on all patients under 6 years old who were treated at a Level 1 pediatric trauma center for femur fracture with spica cast stabilization. The Injury Prevention Center was notified when a patient needed a specialized car seat, and Child Passenger Safety Technicians (CPSTs) fit the child with an appropriate seat and instructed caregivers on proper use. Program reach is assessed by comparing operating room case data to CPST seat distribution records. Outcome measures include the number of seats distributed, completion of caregiver education, return rates, and average loan duration.

Thirty children received spica cast stabilization during the evaluation period. Of these, 80% (n=24) were discharged with a specialized car seat and received in-person education from a trained CPST. The program achieved an 86% return rate (n=26), with an average loan duration of 3.75 months (range: 2–6.5 months). One family kept their seat due to ongoing medical need, while three families have not returned their seats. The primary challenge to program sustainability is the high cost of medical-grade car seats, which range from $300 to over $2,000 and require periodic replacement due to expiration, damage, or loss.

A hospital-based loaner program that provides adaptive car seats and caregiver education addresses a critical gap in discharge safety for pediatric patients with spica casts. The program effectively reduces financial and logistical barriers for families, supports safer transitions home, and promotes injury prevention. Prompt communication between healthcare providers and CPSTs is important to ensure timely seat provision and prevent discharge delays. Sustained funding is essential to maintain seat inventory and ensure long-term program impact.

1. Describe the transportation safety needs of pediatric patients discharged in spica casts.

2. Identify key components of a sustainable hospital-based child passenger safety program.

3. Discuss challenges and strategies for overcoming financial and logistical barriers in car seat access.

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Emma Sartin, PhD, MPH
Ashley Downs, MPH
William King, DrPH
Kathy Monroe, MD, MSQI
Jennifer McCain, MD

The Children’s Injury Database (CID) is an injury surveillance system developed to collect data from injury-related visits to our tertiary care pediatric emergency department (ED). The purpose of this study was to examine updated injury trends from ED visits that occurred in 2023 and 2024 vs. those reported in 2021 (Mccain et al., 2023).

Demographic and injury data on children 0-16 years old identified as having an injury-related ED visit in 2023 and 2024 were descriptively analyzed and compared to trends documented in 2021.

A total of 28,745 injury visits from 2023-2024 were analyzed. Demographic trends remained consistent from 2021, with 56% of the cases identified as males and 53% identified as White in 2023-2024. A total of 3,991 injury visits (13.8%) resulted in hospital admission, consistent with 2021 trends (13.5%). Compared with 2021 data, in 2023-2024 there were notably fewer cases of poisonings (13.2% vs. 8.9% of all injuries, respectively), motor vehicle crashes (7.9% vs. 4.3%), dog bites (2.0% vs. 1.6%), and assault (2.1% vs. 1.6%). Conversely, there were more cases of injuries because of ATVs (1.1% vs. 2.9%) and insect bites (<1% vs. 2.8%). Cases injuries due to falls, burns, intentional self-harm, pedestrian, and bicycle-related events were consistent. Drownings (45.2%, poisonings (41.7%), chokings (38.0%), ATVs (34.0%), and burns (33.0%) had the highest rates of admissions.

There were notable differences in injury trends from 2021 to 2023-2024. This underscores the importance of injury surveillance systems, which can assist with reporting new injury patterns while also acting as a stimulus for new research ideas, planning interventions targeting the most at-risk populations, and evaluating the effectiveness of injury prevention interventions.

1. Injury trends in an emergency department post-COVID era.
2. Ways injury surveillance systems can assist with research and real-world practice.
3. Primary injury mechanisms across demographic factors.

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Sara Beth Rowell, BS
Michele Nichols, MD
Charli Cohen, MD
William King, MPH, RPh, DrPH
Jennifer McCain, MD
Kathy Monroe, MD, MSQI

Dog bites are a common cause of injury, with the CDC estimating that 4.5 million occur annually. Children are particularly susceptible to this injury, with one study finding that 46.1% of school aged children report being bitten in their lifetime. Families experience long term consequences following this injury, as 50% of children develop PTSD symptoms for more than one month. According to WISQARS the total cost of nonfatal emergency department pediatric dog bite visits including medical expenses, work loss and quality of life loss in 2023 was $859.36 million. It is estimated that 45.5% of U.S. households own a dog, making the emphasis of safe ownership practices among families with small children essential in preventing this injury.

A retrospective ICD 10 query over five years was performed to identify canine related bites (W54.OXXA) presenting to a Children’s Hospital in the Southeast. Data was exported to a standardized review sheet and demographic data was categorized. Injuries due to falls or scratches were excluded. Data analysis was performed using Epi Info 7 (CDC), Version 7.2.4.0.

Between 2019-2023, our emergency department saw 1,403 dog bite related visits. There were 1,252 initial visits and 151 return visits for follow-up care related to the same injury. The most common reason for a return visit was rabies prophylaxis (n=114). Despite experiencing an overall reduction of ED visits in 2020, there was a significant change in dog bite related visits per 1000 emergency department visits, increasing 70% from the previous year. Nearly 12% of patients required admission. Injuries occurred to the head/neck/face (64%, n=805), extremities (38%, n=471) and torso/pelvis/buttocks (9%, n=99). Frequently consulted specialties include OMFS (n = 170), ENT (n=90), plastic surgery (n=86), ophthalmology (n=82), and surgery (n=59). The most common procedure performed was wound closure (63%, n=784), and severe injuries required interventions such as facial nerve repair, fracture reduction and subdural drain placement. Males (57%, n=711) were more likely to be affected than females (43%, n=541). Injuries occurred most often in the patient’s own home (38%, n=480). Age groups involved include less than 2 (n=155), 2 to 5 (n=431), 6 to 12 (n=538), and older than 12 (n=138). Dog breeds were identified in 596 cases, and the most frequently involved were Pit Bulls (41%, n=243), German Shepherds (11%, n=67) and Labrador Retrievers (10%, n=60).

Dog bite injuries are a common reason for emergency department visits. Our institution experienced a significant increase in the proportion of dog bite related visits in 2020. This may be due to the increase in dog adoptions that occurred during the COVID-19 pandemic and stay-at-home ordinances causing children to spend more time in the household. Pediatricians have a crucial role in reducing this type of injury by educating families on ways to make the home safer for both children and dogs.

1. The prevalence of dog bite related injuries among the pediatric population.
2. Epidemiologic characteristics of patients who have been bitten by dogs.
3. The role of pediatricians in educating families about strategies they can implement to reduce this type of injury.

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Alise Haddad, BS
Matthew Denenberg, MD
Richard Kennedy, PhD
Ethan Dimock, BS
Sue Townsel, MS
Sarah Rauner, NP
Jacob Kelley, MS

Mild to moderate head injuries are common in pediatric patients, yet follow-up care is often inconsistent. The Visio-Vestibular Exam (VVE) System was implemented in two Corewell Health Emergency Centers (Troy and Royal Oak) to enhance concussion assessment and potentially improve follow-up compliance.

As part of a quality improvement initiative, we retrospectively analyzed data from pediatric patients treated for mild to moderate head injuries between October 2023 and October 2024. Variables assessed included injury severity markers (loss of consciousness, vomiting, CT use), race, age, insurance status, and whether a VVE was performed in the ED.

Out of 509 eligible patients, 43.4% attended their follow-up appointment. No statistically significant differences in follow-up rates were found based on age, race, insurance status, or injury severity. Unexpectedly, patients who received a VVE during their ED visit were significantly less likely to follow up than those who did not (30.7% vs. 47.6%, p = 0.00023).

Demographic and clinical factors traditionally believed to influence follow-up adherence did not significantly predict outcomes in this cohort. Notably, completion of a VVE was associated with lower follow-up rates, suggesting that families may perceive the exam as sufficient care. These findings underscore the importance of improving discharge communication to emphasize the necessity of post-injury follow-up, regardless of initial ED findings.

1. To evaluate follow-up rates after pediatric head injuries
2. To understand how factors such as injury severity, race, age, insurance type, and completion of a VVE influenced the likelihood of attending a scheduled follow-up appointment

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Laurel Barker
Jaycelyn Holland, MD
Jennifer McCain, MD
William King, DrPH
Kathy Monroe, MD, MSQI

Injuries are the number one cause of death in children and cause significant morbidity. Common scenarios for injury involve wheeled recreational devices (WRDs) as they allow children to be mobile and independent. This study compares injury patterns and mechanisms between dirtbikes (motorized, often used in organized events) and bicycles (primarily used for recreation and transportation) to evaluate common injuries and outcomes.

Following IRB approval, the Children’s Injury Database (CID) of our emergency department (ED) at a tertiary care children’s hospital was queried to identify all patients with an injury related to a dirtbike or bicycle during a two year period (2023 and 2024). Demographic information along with injury specific data (dirtbike versus bicycle, helmet use and admission rates) were collected and analyzed.

A total of 282 patients met criteria for inclusion with 123 dirtbike riders and 159 bicycle riders. Ages of patients ranged from 2 to 16 years for dirtbikes and 1 to 16 years for bicycles. The mean age was significantly higher for dirtbikes as compared to bicycles (11.1 versus 8.8 years; t=5.4, p< 0.0001). The majority of patients were Caucasian (81% for dirtbikes, 66% for bicycles), which is in contrast to our overall ED population, which is only 42% Caucasian. The majority of patients were male (88.62% for dirtbikes, 69.18% for bicycles).

Helmet documentation was done in 173 charts (61%) with usage rates being 65% for dirtbikes versus 16% for bicycles among documented cases. Non-documentation was higher for bicycles (53%) than dirtbikes (20%). Patients with injuries from dirtbike mechanisms were at a significantly higher likelihood of requiring admission as compared to bicycle-related injuries (34% versus 13%, p<0.00001) and also as compared to the general admission rate for all injuries (13.4%, p<0.00001).

This study reveals distinct injury differences between motorized dirtbike riders and bicycle riders in pediatric population. While demographic differences were minimal, dirtbike riders were found to be significantly older. Despite higher helmet documentation and usage rates among dirtbike riders, they required hospitalization at nearly three times the rate of bicycle riders, indicating likely more severe injuries in this group. These findings highlight the importance of age-appropriate safety measures and protective equipment for all WRD users.

1. Participants will identify key differences in dirtbike and bicycle injuries and severity
2. Participants will compare differences in hospital admission rates and helmet usage between the two mechanisms
3. Participants will describe epidemiological characteristics of pediatric WRB injuries presenting to emergency departments

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Kendall Snellgrove, MD
Lauren Bozarth, BS
Claire Johnson, MD
Zain Hashmi, MD
Megan Schultz, MD
Jennifer McCain, MD

In 2020, firearm injuries became the leading cause of death among U.S. children and adolescents. For Black youth, this has been true since 2006. While 14–25% of pediatric survivors of firearm injuries develop new mental health conditions, little is known about their use of emergency departments (EDs) for mental health care post-injury. This study aims to describe the epidemiology of pediatric firearm injuries in one region and investigate the prevalence of mental health-related ED visits within one year after injury.

This retrospective cohort study includes all firearm-injured pediatric patients (ages 0–18) presenting to a Level 1 Pediatric Emergency Department (PED) and a Level 1 Adult Trauma Center in the same city January 2018 - December 2023. Comprehensive chart reviews across both hospital systems are conducted to capture all patients and visits without omission.

Data collected includes: (1) demographics (age, sex, race, ZIP code, insurance), (2) firearm details (type, shooter, location, intent), (3) injury characteristics (injured body area, Abbreviated Injury Score [AIS], disposition, length of stay, diagnoses), (4) mental health history (pre-existing conditions, prior PED crisis visits, new mental health diagnoses, new crisis visits post-injury), and (5) somatic health comparisons (non-mental health PED visits post-injury).

Descriptive statistics will characterize the cohort. Chi-square and Mann-Whitney U tests will compare key variables. Kaplan-Meier curves will estimate time from injury to new mental health diagnosis or crisis event.

Chart review is ongoing. Preliminary analysis of 2023 patients seen at the PED show most were male (80.8%), Black (92.3%), and publicly insured (80.8%), with a mean age of 11.7 years. The largest subgroup was ages 13–16 (53.8%). Injuries involved extremities (46.2%), trunk (30.8%), and head (23.1%). About one-third had an AIS of 2 (34.6%).

Shooters were unknown in 50.9% of cases. Assault was the most common intent (37.3%), followed by unknown (35.3%) and unintentional (27.5%). Shooting locations included street (35.3%), home (35.3%), community (13.7%), vehicle (5.9%), or unknown (9.8%). Most patients (73.1%) were admitted.

Pre-existing mental health conditions were present in 23.1%. No new mental health diagnoses requiring a PED visit were identified within one year post-injury. However, 11.5% presented for somatic complaints.

Preliminary findings show a disproportionate burden of firearm injury among Black, male, and publicly insured youth. Despite notable pre-existing mental health needs, no new mental health-related PED visits were recorded within one year, suggesting potential gaps in recognition, access, or care utilization. These results highlight the urgent need for improved mental health screening, structured follow-up protocols, and community-level support to address the full impact of firearm trauma in youth.

1. Describe the demographics of pediatric firearm injuries.
2. Identify the prevalence of pre-existing and new mental health conditions within one year post-injury.
3. Discuss gaps in post-injury mental health care utilization and implications for ED/community interventions.