Child Passenger Safety Knowledge Lacking in ED

April 2010

By Kerri Wachter
Elsevier Global Medical News

WASHINGTON -- Relatively few pediatric emergency physicians could correctly answer all questions regarding the American Academy of Pediatrics' child passenger safety recommendations, and these instructions are frequently not included in discharge instructions to parents, according to a survey of 274 physicians.

Among all respondents, 36% correctly answered all questions about AAP child passenger safety recommendations, and 41% correctly answered all questions about indications to replace car seats after motor vehicle crashes, Dr. Mark R. Zonfrillo reported at the annual meeting of the American Academy of Pediatrics.

The researchers used an anonymous, cross-sectional survey of the 1,088 emergency medicine physician members of the AAP Section of Emergency Medicine (SOEM). Participants were eligible if they were attending physicians who routinely treated children involved in motor vehicle crashes.

A total of 274 eligible physicians completed the surveys (25% of the sample). Of these, 90% were board-eligible or board-certified in pediatric emergency medicine.

For all survey participants, physician knowledge of AAP child passenger safety recommendations, characteristics of physicians and institutions, and opinion of topics to be included in a "gold standard" for pediatric motor vehicle safety discharge information were queried. In particular, survey questions addressed knowledge of age- and size-appropriate restraints, and indications to replace a car seat after a motor vehicle crash.

Although relatively few survey respondents could answer all three questions on the AAP recommendations, 85% of the respondents affirmed that child passenger safety information should be included in a gold standard instructions sheet following a crash. In addition, 74% affirmed that indications to replace car seats after motor vehicle crashes should be included.

There were no differences in child passenger safety knowledge based on gender, residency program, or years as an attending.

Division/department chiefs were specifically identified in the survey for questions about whether their emergency department provided child passenger safety information in its discharge materials. A total of 54 physicians identified themselves as division/department chiefs. Regarding ED practices, 80% of chiefs reported using template-based discharge instructions. Two-thirds (67%) reported using computer-based discharge instructions. In addition, 84% reported that it was possible to customize the computer-based discharge instructions.

However, when the division/department chiefs were asked specifically about motor vehicle safety, 43% reported that they provided no specific motor vehicle safety guidance, 22% provided motor vehicle safety instructions that were not pediatric specific, and 29% provided specific pediatric vehicle safety guidance.

"However, there were a few interesting subanalyses," said Dr. Zonfrillo, who is a senior fellow in pediatric emergency medicine at the Children's Hospital of Philadelphia. Respondents were more likely to know when forward-facing car seats were appropriate if they had a child. They were more likely to know when a child could safely sit in the front seat if they had a child older than 8 years. About three-quarters of the sample had at least one child.

Respondents also were given the chance to specify additional information that they thought should be included in the child passenger safety information. Five major themes emerged: statistics on effectiveness, resources for subsidized/free car seats, resources for non-English speakers, common errors in child passenger safety, and state passenger laws.

These results underscore the need for pediatric emergency physicians to maintain current knowledge about child passenger safety and to provide this information to families after the ED evaluation for motor vehicle crashes, Dr. Zonfrillo said.

AAP publications on child passenger safety can be found at The Web page includes links to resources for families, communities, and health care professionals, and also features a guide for families, a parent-teen driving agreement and fact sheet (for sale in pads of 100), and AAP policy statements on school transportation and teen drivers.

Dr. Zonfrillo reported that he has no relevant financial relationships.

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