Garry Lapidus

Using a geographic information system to understand child pedestrian injury

Data from police accident reports involving pedestrians less than 20 years of age in Hartford, Conn, during 1988 through 1990 were abstracted and entered into a geographic information system. Two high-frequency collision areas were identified and compared. There were 374 child pedestrians involved in collisions (a rate of 28 per 10,000). Two high-occurrence areas accounted for 30% of collisions. Collisions in one of these areas were more likely to involve younger children (8.1 vs 10.2 years of age) and to occur in the late afternoon, and occurred closer to the childs residence, than collisions in the other area. The geographic information system is a useful tool in the study of child pedestrian collisions.

The Effects of City-Wide Implementation of “Second Step” on Elementary School Students’ Prosocial and Aggressive Behaviors

This study examined the impact of implementing Second Step, a violence prevention program, using a comprehensive, city-wide approach. The evaluation included 741 3rd–5th graders in six schools. Student surveys, behavioral observations, and discipline referrals were used to assess aggressive-antisocial and prosocial behaviors. We found significant improvements in positive approach-coping, caring-cooperative behavior, suppression of aggression, and consideration of others, but no changes in aggressive-antisocial behaviors. Behavioral observations and disciplinary referrals showed no significant changes. The program was implemented with high fidelity and engaged a wide range of participants from the community.Editors’ Strategic Implications: Key implementation issues are presented for a cross-site, city-wide evaluation on “Second Step.” School and community officials will benefit from these lessons, as well as the authors’ recommendations for further longitudinal study with appropriate comparison groups.

A population-based study of motorcycle injury and costs

STUDY OBJECTIVE To provide a population-based injury and cost profile for motorcycle injury in Connecticut. DESIGN Population-based retrospective epidemiologic review of Connecticut death certificates, hospital discharge data, and police accident reports. RESULTS Connecticut death certificates identified 112 deaths from motorcycle injuries for an annual death rate of 1.2 per 100,000 persons. Death rates were highest among 20- to 24-year-old men. Nonhelmeted motorcyclists were 3.4-fold more likely to die than were helmeted riders (P less than .05). An estimated 2,361 motorcycle-related hospital discharges resulted in an annual hospitalization rate of 24.7 per 100,000 persons. Head, neck, and spinal injuries accounted for 22% of all injuries. Total costs exceeded

Pediatric injury prevention

29 million; 29% of hospitalized patients were uninsured, and 42% of the cost was not reimbursed to the hospitals. CONCLUSION Motorcycle injuries contribute significantly to Connecticuts mortality, morbidity, and medical costs. Our study suggests that a uniform helmet law would save an estimated ten lives and prevent more than 90 nonfatal injuries in Connecticut each year at a cost savings to the state of

All-terrain vehicle riding among youth: how do they fair?

5.1 million. These data are crucial in advocating re-enactment of motorcycle helmet laws.

Using Trauma Registry Data to Guide Injury Prevention Program Activities

Pediatric injuries are the leading cause of childhood death and disability and are responsible for more childhood deaths than all other diseases combined. The panel summarized the principles of pediatric injury prevention and reviewed the incidence, epidemiology, and prevention of six common pediatric injuries.

Burn injuries among children in an urban emergency department

PURPOSE Pediatric all-terrain vehicle (ATV) injuries have been increasing annually for more than a decade. The objective of this study was to describe the riding behaviors, helmet use, and crash history of young ATV riders. METHODS A 38 question self-administered survey was distributed to a convenience sample of children at 4 agricultural fairs during 2007. A total of 228 surveys were reviewed. Collected data included demographic information, ATV characteristics, helmet use, driving habits, and crash history. RESULTS Survey respondents were predominantly male (71%) with an average age of 13.6 +/- 2.0 years. Riding began at a young age (9.2 +/- 3.2 years). Few children reported using age-appropriate sized engines (3% < 90 cm(3)), and 22% of children rode ATVs with engines more than 300 cm(3). Respondents rode primarily for recreation (94%), and more than a third reported riding without a helmet (40%). More than 70% of children reported riding with passengers, 60% without adult supervision, and nearly half (46%) rode after dark. Less than 5% of riders received any formal ATV riding/safety instruction. Of the respondents, 45% reported being involved in an ATV crash. Those children who reported a crash also rode more powerful ATVs, were more often self-taught, and overall reported higher rates of riding with passengers and without supervision, and riding after dark (P < .05). CONCLUSION Dangerous driving behavior among children who ride ATVs is widespread, and current safety recommendations are largely ignored. Renewed efforts are needed to improve safety programs and create policy measures that prevent pediatric ATV crash-related injuries.

Outdoor play: A survey of parent's perceptions of their child's safety

BACKGROUND Injury prevention programs should be based on objective injury data. This study demonstrates how local injury data can be used to help guide injury prevention programs. METHODS We reviewed trauma registry data (2004-2006) from a Level I pediatric trauma center. Data included demographic information, anatomic location of injury, mechanism of injury, safety device utilization, Injury Severity Score (ISS), and temporal and geographic variables. The Injury Prevention Priority Score for each mechanism of injury was calculated. RESULTS There were 1,874 trauma patients. Most admissions were among white males, aged 11 years to 15 years (mean, 7.9 years ± 5.2 years). Most admissions occurred during summertime and on weekend evenings. Blunt injuries (92%) and fractures (56%) predominated (mean ISS, 5.9). A severe ISS >15 was highest among 11 year to 15 year and lowest among patients older than 15 years (p < 0.01). Falls, cut, or pierce, ATV, and off-road motorcycle ranked highest in the Injury Prevention Priority Score. Of the 134 motor vehicle occupants, 52% (n = 70) were restrained in car seats/seat belts. Only 15% of bicyclists, 24% of motorcyclists, and 58% of ATV riders wore helmets. CONCLUSION A significant percentage of injured children and adolescents were not using proven effective injury prevention devices at the time of their injury. These data identified areas for further study and will help guide community injury prevention programs at our institution.

Misclassification of childhood homicide on death certificates.

To determine the profile of burn injury among an ambulatory population, we conducted a retrospective chart review over a one-year period of all first visits by patients under age 18 receiving burn care in our emergency department. Of the 109 visits, contact burns were most numerous (43.1%) followed by scalds (33.9%), flame/explosion (11.0%), cigarettes (5.5%) and electrical (2.8%). For children under 11 years of age, contact burns caused over half of all burns. Irons accounted for 44.7% of contact burns and 19.1% of all burns. The next most frequent causative agents were beverages (14.7%), food (nonbeverage) (7.3%), tap water/bath (7.3%), and cooking-related (6.4%). Contact burns were more likely to be smaller and more localized when compared with other burns. The cause and causative agents of burns differ in frequency and relative importance depending on the patient population studied and the level of medical care being provided. Specific burn prevention strategies should be directed toward particular patterns of injury within defined patient groups.

The safe teen work project: A study to reduce cutting injuries among young and inexperienced workers

BACKGROUND Anecdotal reports suggest that parents may be restricting outdoor play in response to a perceived lack of safety and fear of violence and crime in urban environments. The study objective was to determine whether parents who perceived their neighborhood as unsafe would be most likely to restrict their childs outdoor play and report the greatest worries related to neighborhood characteristics. METHODS A convenience sample of primary caregivers of children aged 5 years to 7 years were recruited from a pediatric primary care center based at an urban academic childrens hospital. Study participants completed a 23-question survey available in English and Spanish. RESULTS Two hundred fifty-four parents completed the survey. Most were English speakers (69%), female (89%), and aged between 21 years and 35 years (76%). Sixty-two percent let their child play outside often or sometimes; whereas 19% reported never allowing their child to play outside. Parents were less likely to allow outside play as their degree of worry increased about traffic (p < 0.0001), rundown parks (p < 0.003), crime (p < 0.0001), witnessing violence (p < 0.0001), being a victim of violence (p < 0.0009), drugs (p < 0.0001), gangs (p < 0.004), and weapons (p < 0.003). Frequency of outdoor play was not correlated with the sex or age of the child or number of children in the family. Spanish speakers were less likely to allow outside play (p < 0.008) but more likely to allow unsupervised play (p < 0.03). CONCLUSIONS Decreased frequency of outdoor play correlated with increased parental concerns about safety, however, many parents still report allowing outdoor play at least sometimes.