Pediatric Patients Still Ride in Front of Air Bags
Pediatric Patients Still Ride in Front of Air Bags
abstract & commentary
Source: Wittenberg E, et al. The effect of passenger air bags on child seating behavior in motor vehicles. Pediatrics 1999; 104:1247-1250.
A massive educational campaign has been carried out by the U.S. Department of Transportation, via warning labels in vehicles and a widespread media blitz, warning parents not to seat their children in front of an air bag. Wittenberg and colleagues studied the effect of this effort through an observational study employing driver interviews in 1998. Data were collected from vehicles at highway service stations, information areas, and non-highway fast food restaurants in Connecticut, Maine, Massachusetts, New Hampshire, and Vermont. All vehicles contained at least one person less than 13 years of age. Seating position, vehicle information, and driver characteristics, including educational level, income, and demographics, were studied. Analyses were performed to identify the odds of a child being seated in the front passenger seat in front of an air bag based on driver characteristics as well as driver perception of air bags, seats per vehicle, and the mix of occupants in the vehicle.
From a total of 711 passenger cars and light trucks observed to have a child in the vehicle, 509 drivers agreed to participate in the interview and 202 refused. Drivers who refused were less likely to be wearing safety belts than those who agreed to participate, biasing the sample toward more safety-conscious individuals. Among vehicles with dual air bags, 17% carried a child in the right front seat, compared to 30% of vehicles without dual air bags. Of the vehicles with the child seated in the front, 91% had at least one available empty seat in the rear. The percentage of vehicles carrying a child in the front seat was 51% if there were no other adult or teenage passengers in the vehicles. Driver seat belt use also made a difference, in that 20% of the vehicles in which the driver was belted had a child seated in the front compared with 36% of vehicles in which the driver was not belted.
Although a lower percentage of children were seated in the front passenger compartment in vehicles with dual air bags than those without, at least one in six New England drivers still seats children younger than 12 years of age in front of an air bag.
Comment by Jeffrey W. Runge, MD, FACEP
Yesterday in the emergency department, I saw an 18-month-old child with severe brain injury who was correctly seated in a child passenger safety seat. Unfortunately, the safety seat was not correctly attached to the vehicle, and the baby and the seat became a missile in a frontal-impact collision. A few months ago, we tried to resuscitate a school-age girl seated in the front passenger seat next to her mom. Unfortunately, the air bag deployed in the low-velocity frontal impact, resulting in an atlanto-occipital dissociation and transection of the cord at C1.
In both of these cases, these children had recently been seen by a physician. In the former case, the pediatrician had reviewed the child’s immunization history to make sure this child would not succumb to infectious disease. However, the leading cause of death for children older than 1 year of age in this country is not infectious disease, but motor vehicle crash. There are perfectly safe and effective "immunizations" for motor vehicle crash that physicians rarely discuss, namely placing the child in the correct seating position in an age-appropriate restraint system.
In my final commentary for Emergency Medicine Alert as a member of the editorial board, I want to get in one last plug for incorporating a very simple strategy into the practice of emergency medicine. The most common chief complaint in our emergency department is fever, and the patients most likely to have a complaint of fever are children younger than 12 years of age. If you are an emergency physician and you do not discuss the most likely cause of injury and death in this age group with the parents, you are missing a golden opportunity for simple and quick primary prevention. The same physicians who would not dream of discharging a patient with a tetanus-prone wound without a tetanus shot in order to prevent a rare infectious disease are the ones who would discharge a child without "immunizing" him or her against a much more likely disease. When you are looking in a child’s ears, it is a perfect chance to talk to mom or dad about where they seat their child in the vehicle and whether or not they own an age-appropriate restraint. That is a far more fruitful use of breath than the useless baby talk we use to try to convince the kid we are harmless.
Motor vehicle crash injury to children in this country is a public health emergency, and it can be mitigated through simple primary prevention. The good news is that the word seems to be getting through to some people, as evidenced by this study. The bad news is that this study, which over-sampled safety-conscious affluent white people, revealed that even in the face of all public education efforts, at least one in six children still are seated in front of a 200 mph explosion designed to protect people greater than 55 inches in height. While we have these devices in the vehicle fleet, the only solution is proper seating position in the back seat and age-appropriate restraints. For physicians not to immunize our children against this disease is a travesty.
The study by Wittenberg et al found the incidence of children younger than 12 years of age seated in front of an air bag to be:
a. one in six.
b. one in 10.
c. one in 12.
d. one in 20.
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