Child passenger safety education in the emergency department: teen driving, car seats, booster seats, and more

Abstract

Background: The leading cause of death in children less than 19 years old is motor vehicle crashes (MVC). Non-use or improper use of motor vehicle car seats significantly adds to the morbidity and mortality. Emergency department (ED) encounters provide an opportunity for caregiver education. Our objective was to determine the effect of an educational intervention on knowledge and counseling behaviors of pediatric ED nurses regarding child passenger safety (CPS). Methods: A pre/post educational intervention study was conducted with nursing staff in an urban ED. Responses to CPS related knowledge and counseling behaviors were collected using surveys administered before and after the intervention. The ED nurse education intervention was a one-hour lecture based on the American Academy of Pediatrics (AAP) CPS guidelines and Alabama state law regarding ages for each car seat type and teen driving risky behaviors. Individual data from pre and post surveys were matched, and nominal variables in pre-post matched pairs were analyzed using McNemar's test. To compare categorical variables within pre or post test data, we used the Chi-square test. Results: Pretests were administered to 83/110 ED nurses; 64 nurses received the educational intervention and posttest. On the pretests, nurses reported "never" or "occasionally" counseling about CPS for the following: 56% car seats, 62% booster seat, 56% teen driving, 32% seat belts. When comparing the pretest CPS knowledge between nurses working 0-1 year vs. ≥ 2 years there was no statistically significant difference. Two CPS knowledge questions did not show significance due to a high correct baseline knowledge rate (> 98%), including baseline knowledge of MVC being the leading cause of death. Of the remaining 7 knowledge questions, 5 questions showed statistically significant improvement in knowledge: age when children can sit in front seat, state GDL law details, seat belt state law for back seat riders, age for booster seat, and rear facing car seat age. All four counseling behavior questions showed increases in intent to counsel families; however, only intent to counsel regarding teen driving reached statistical significance.

Impact of Child Passenger Safety Education for Pediatric Nurses

“…Ekundayo et al (2013) and Smola et al ( 2020) conducted similar studies using a pre-and posttest design with a CPS education intervention and showed increased nurse CPS knowledge and confidence level postintervention comparable with our study. Smola et al (2020) focused on overall pre-and postintervention knowledge, whereas Ekundayo et al (2013) also considered the demographics of the study participants and found no significant knowledge difference between age groups or ethnicities, similar to our study. Finally, one study targeted education for caregivers and showed similar outcomes to this study (Budziszewski et al, 2021).…”

“…Previous research describes the importance of educating clinicians on basic CPS (Ekundayo et al, 2013; Kuska & Zonfrillo, 2017; Smola et al, 2020). However, our research extends the current CPS training literature by addressing the gap of specifically targeting nurses assigned to the NICU, PICU, pediatric unit, and MBU.…”

“…Although CPS education is recommended prior to discharge of children from the hospital, many health care providers lack the appropriate basic knowledge to convey accurate information to caregivers (Ekundayo et al, 2013; Kuska & Zonfrillo, 2017; Smola et al, 2020). Nurses are often responsible for educating caregivers on CPS.…”

Using Crash Outcome Data Evaluation System (CODES) to examine injury in front vs. rear-seated infants and children involved in a motor vehicle crash in New York State

“…NYS child restraint laws have been shown to be an effective way at reducing MV injuries in children (Sun et al, 2010 ). Previous research comparing child restraints and seat belts alone for children aged 2–6 years has demonstrated that child restraint systems offer considerable safety advantage over seat belts (Macy et al, 2014 ; Smola et al, 2020 ). Child restraints are specially designed to help reduce the risk of ejection during a crash as well as to better distribute the force of the crash through stronger bones rather than soft tissues (Durbin et al, 2003 ; Elliott et al, 2006 ; Winston et al, 2007 ).…”

Standardizing Child Passenger Safety Screening in the Emergency Department: A Quality Improvement Study

“…Increased knowledge of CPS recommendations and practices is Standardizing Child Passenger Safety Screening in the Emergency Department: A Quality Improvement Study associated with improved confidence and frequency of providing anticipatory guidance to families (Zonfrillo et al, 2014). Morrissey et al (2016) and Smola et al (2020) reported that providers and registered nurses (RNs) who received CPS education significantly increased anticipatory guidance teaching to families and were more likely to counsel families in the areas of seat belts, front seat riders, back seat belts, graduated driver's license laws, booster seats, and MVCs.…”