Kevin Borrup

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

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.

Using Trauma Registry Data to Guide Injury Prevention Program Activities

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.

A prospective, multi-institutional study of pediatric all-terrain vehicle crashes

BACKGROUND Pediatric all-terrain vehicle (ATV) injuries have been increasing annually for more than a decade. The purpose of this study was to prospectively evaluate crash circumstances and clinical outcomes resulting from pediatric ATV crashes. METHODS Three pediatric trauma centers prospectively collected data from patients during their hospitalization for injuries sustained in ATV crashes from July 2007 through June 2012. Patients completed a 35-item questionnaire describing the crash circumstances (ATV engine size, safety equipment use, and training/experience). Clinical data (injuries, surgical procedures, etc.) were collected for each patient. RESULTS Eighty-four patients were enrolled, with a mean (SD) age of 13.0 (3.1) years, and were predominantly male (n = 55, 65%). Injuries were musculoskeletal (42%), central nervous system (39%), abdominal (20%), thoracic (16%), and genitourinary (4%). Multisystem injuries were prevalent (27%), and two patients died. Thirty-three patients (43%) required operative intervention. Most children were riding for recreation (96%) and ignored ATV manufacturers’ recommendation that children younger than 16 years ride ATVs with smaller (⩽90 cc) engines (71%). Dangerous riding practices were widespread: no helmet (70%), no adult supervision (56%), double riding (50%), riding on paved roads (23%), and nighttime riding (16%). Lack of helmet use was significantly associated with head injury (53% vs. 25%, p = 0.03). Rollover crashes were most common (44%), followed by collision with a stationary object (25%) or another vehicle (12%). Half (51%) of children said that they would ride an ATV again. CONCLUSION These data demonstrate a relationship between dangerous ATV riding behaviors and severe injuries in children who crash. Children younger than 16 years should not operate ATVs, and legislation that effectively restricts ATV use in children is urgently needed. LEVEL OF EVIDENCE Epidemiologic study, level III.

Impact of Connecticut's graduated driver licensing system on teenage motor vehicle crash rates

BACKGROUND In response to high rates of teen motor vehicle crashes (MVCs) many states have enacted graduated driver licensing (GDL) systems. GDL delays full licensure and allows beginners to obtain experience under lower risk conditions. The purpose of this study is to evaluate the impact over the past 10 years to determine its effect on teen MVCs. METHODS Connecticut MVC data from 1999 to 2008 were analyzed. Percent change (1999 vs. 2008) in MVC rates per 10,000 registered drivers was calculated by age, gender, during the night restriction (11:00 pm and 5:00 am), and MVCs with passengers. Linear regression analysis estimated the decrease of MVC rates each year. RESULTS The MVC rate decreased by 40% for 16-year-old and 30% for 17-year-old drivers. In comparison, rates among 18-year-old, 19-year-old, 25- to 29-year-old, and 30- to 59-year-old drivers were reduced by 16%, 7%, 8%, and 11%, respectively. The MVC rate for 20- to 24-year-old drivers increased by 1%. During nighttime restricted driving times, MVC rates decreased by 54% among 16-year-old and 49% among 17-year-old drivers. The MVC rate with passengers decreased by 65% for 16-year-old and 53% for 17-year-old drivers. In comparison, rates of nighttime and with passenger MVCs among older drivers were significantly less. CONCLUSIONS Implementation of Connecticuts GDL system has resulted in significant reductions in MVC rates among novice drivers. This analysis provides a method for other states to examine the impact of their GDL system.

Pediatrician attitudes, knowledge, and practice behavior regarding teen driving safety

PROBLEM Each year about 4,000 teens ages 16-19 die on U.S. roads. Injury prevention counseling is recommended as a valuable and cost-effective part of routine health supervision. This study describes pediatrician knowledge and practice regarding teen driving safety. METHODS A 31-item self-administered survey was mailed to pediatricians. RESULTS 160 of 392 pediatricians (41%) completed the survey. During a health supervision visit 93% of pediatricians reported discussing seat belt use, 89% impaired driving, 54% teen licensing laws, and 16% parent teen contract. Half reported having a teen in their practice killed in a crash. CONCLUSIONS A majority surveyed report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduated driver licensing laws or related issues. IMPACT ON INDUSTRY Broadly adopted, this inexpensive counseling approach, could lead to reductions in teen motorvehicle crash injuries.

Correlates of drug use and driving among undergraduate college students.

Objective: Drug use by drivers is a significant and growing highway safety problem. College students are an important population to understand drugged driving. The objective of this study was to examine correlates of drugged driving among undergraduate college students. Methods: We conducted an anonymous, confidential, 24-question survey at a large New England public university during the 2010–2011 academic year among undergraduates in courses that met a graduation requirement. Data include demographics; academics; housing status; lifestyle; personal values; high school/college drug use; and driving following alcohol use, drug use, or both; and as a passenger with a driver who used alcohol, drugs, or both. Descriptive statistics were calculated. Chi-square tests compared driver alcohol use, drug use, or both with demographic, academic, and lifestyle variables. Logistic regression analyses were performed with drugged driving as the dependent variable. Odds ratios and corresponding 95 percent confidence intervals were calculated for each of the potential explanatory variables in relation to the outcome. Results: Four hundred forty-four of 675 students completed surveys (66% participation rate). Participants were representative of the student body with a mean age of 19.4 (±1.3 years), 51 percent male, 75 percent white, and 10 percent Hispanic. Seventy-eight percent lived on campus, 93 percent had a drivers license, and 37 percent had access to a car. Students disagreed that cannabinoids impair driving (18%) compared to other drugs (17%), stimulants (13%), depressants (11%), hallucinogens (8%), and alcohol (7%). Twenty-three percent drove after alcohol use and 22 percent drove after drug use. Forty-one percent reported having been a passenger with a driver who had been drinking and 37 percent with a driver using drugs. Drugged driving was more likely among males vs. females (30% vs. 14%, P < .01), those living off campus (34% vs. 19%, P < .01), those reporting that parties are important (33% vs. 14%, P < .01), those reporting that community service is not important (28% vs. 18%, P < .05), those reporting that religion is not important (28% vs. 14%, P < .01), and those reporting personal drug use in high school (75% vs. 14%, P < .01) and well as that their best friends used drugs in high school (42% vs. 12%, P < .01) and college (50% vs. 8%, P < .01). Those factors most associated with drugged driving included using drugs in high school (odds ratio [OR] = 9.5, 95% confidence interval [CI]: 4.6–19.6) and best friends in college used drugs regularly (OR = 6.2, 95% CI: 3.4–11.6). Conclusion: Self-reported drugged driving and riding as a passenger with a drugged driver is common among subgroups of college students. The identification of undergraduate subgroups at risk for drugged driving will guide the design and implementation of traffic safety activities.

Does Knowledge of Teen Driving Risks and Awareness of Current Law Translate into Support for Stronger GDL Provisions? Lessons Learned from One State

Objective: Many states are considering strengthening their graduated driving licensing (GDL) systems for teenage drivers but most do not know the level of public support for proposed upgrades. This study provides a method for states to identify specific demographic groups that may differ with regard to their awareness of teen driving risks, knowledge of current GDL law, and support for GDL upgrades. Methods: A 28-item questionnaire was administered to Connecticut adults by phone survey during January 2008. We collected demographic information and whether respondents understood driving risks, were aware of the current GDL system, and whether they would support GDL upgrades. The states motor vehicle crash file (1999–2006) was used to calculate motor vehicle crash rate among 16- and 17-year-old drivers by town and correlate that with support for GDL upgrades. Results: Eight hundred seven people were interviewed. More women than men (92% vs. 86%, p < .05) and more parents than other adults (96% vs. 84%, p < .01) were aware of the current learners permit law. Female respondents (55% vs. 43%, p < .01) and adults who were not parents (54% vs. 45%, p < .05) were more likely to support increasing the minimum driving age. Parents were more aware than other adults (91% vs. 73%, p < .01) of the supervised driving provision. Women were more supportive of a supervised driving upgrade (83% vs. 69, p < .01). There was more support for a night restriction upgrade among other adults than parents (59% vs. 51%, p < .05), and the lowest support was in affluent towns (38%). Two thirds supported a passenger restriction upgrade with no differences based upon sex or geographic location. There was less support for an increased penalties in Fairfield County when compared to all other counties (55% vs. 63%, p < .05) and more support in Hartford County versus all other counties (70% vs. 58%, p < .05). Conclusions: Parents of Connecticut teens were more knowledgeable of current law but less supportive of GDL upgrades compared to other adults. Women were more apt to favor GDL upgrades than men. This study identifies subgroups that can be targeted for prevention activities and illustrates a useful method to assess public support for GDL upgrades.

Intervention improves physician counseling on teen driving safety

BACKGROUND As part of a statewide campaign, we surveyed physician attitudes and practice regarding teen driving safety before and after a brief intervention designed to facilitate in office counseling. METHODS A 31-item self-administered survey was mailed to Connecticut physicians, and this was followed by a mailing of teen driving safety materials to physician practices in the state. A postintervention survey was mailed 8 months after the presurvey. RESULTS A total of 102 physicians completed both the pre and postsurveys. Thirty-nine percent (39%) reported having had a teen in their practice die in a motor vehicle crash in the presurvey, compared with 49% in the postsurvey. Physician counseling increased significantly for a number of issues: driving while impaired from 86% to 94%; restrictions on teen driving from 53% to 64%; teen driving laws from 53% to 63%; safe vehicle from 32% to 42%; parents model safe driving from 29% to 44%; and teen-parent written contract from 15% to 37%. CONCLUSIONS At baseline, the majority of physicians who provide care to teenagers in Connecticut report discussing and counseling teens on first wave teen driver safety issues (seat belts, alcohol use), but most do not discuss graduate driver licensing laws or related issues. After a brief intervention, there was a significant increase in physician counseling of teens on teen driving laws and on the use of teen-parent contracts. Additional interventions targeting physician practices can improve physician counseling to teens and their parents on issues of teen driving safety.

Restricting youth suicide: behavioral health patients in an urban pediatric emergency department

BACKGROUND Suicide is the third leading cause of death among individuals age 10 years to 19 years in the United States. Adolescents with suicidal behaviors are often cared for in emergency departments (EDs)/trauma centers and are at an increased risk for subsequent suicide. Many institutions do not have standard procedures to prevent future self-harm. Lethal means restriction (LMR) counseling is an evidence-based suicide prevention strategy that informs families to restrict access to potentially fatal items and has demonstrated efficacy in preventing suicide. The objectives of this study were to examine suicidal behavior among behavioral health patients in a pediatric ED and to assess the use of LMR by hospital staff. METHODS A sample of 298 pediatric patients was randomly selected from the population of behavioral health patients treated at the ED from January 1 through December 31, 2012 (n = 2,294). Descriptive data include demographics (age, sex, race/ethnicity, etc,), chief complaint, current and past psychiatric history, primary diagnosis, disposition, alcohol/drug abuse, and documentation of any LMR counseling provided in the ED. RESULTS Of the 298 patients, 52% were female, 47% were white, and 76% were in the custody of their parents. Behavior/out of control was the most common chief complaint (43%). The most common diagnoses were mood disorder (25%) and depression (20%). Thirty-four percent of the patients had suicidal ideation, 22% had a suicide plan, 32% had documented suicidal behavior, and 25% of the patients reported having access to lethal means. However, only 4% of the total patient population received any LMR counseling, and only 15% of those with access to lethal means had received LMR counseling. CONCLUSION Providing a safe environment for adolescents at risk for suicidal behaviors should be a priority for all families/caretakers and should be encouraged by health care providers. The ED is a key point of entry into services for suicidal youth and presents an opportunity to implement effective secondary prevention strategies. The low rate of LMR counseling found in this study suggests a need for improved LMR counseling for all at-risk youth. LEVEL OF EVIDENCE Epidemiologic study, level III.

Practical applications of injury surveillance: a brief 25-year history of the Connecticut Injury Prevention Center

Background: The mission of the Connecticut Injury Prevention Center (CIPC), jointly housed in Connecticut Childrens Medical Center and Hartford Hospital, is to reduce unintentional injury and violence among Connecticut residents, with a special focus on translating research into injury prevention programmes and policy. The CIPC engages in four core activities: research, education and training, community outreach programmes and public policy. As surveillance is an essential element of injury prevention, the CIPC has developed a robust statewide fatal and non-fatal injury surveillance system that has guided our prior work and continues to inform our current projects. Objective: The purpose of this article is to review the projects, programmes, and collaborative relationships that have made the CIPC successful in reducing unintentional injury and violence in Connecticut throughout the course of its 25 years history. Design, setting, participants: Retrospective review of the application of injury surveillance. Results/Conclusions: We believe that the application of our surveillance system can serve as a model for others who wish to engage in collaborative, community-based, data-driven injury prevention programmes in their own communities.