Study: ED providers could be doing more to prevent injuries, deaths related to improperly restrained child passengers

Experts say child safety seats are complicated and commonly misused

The Centers for Disease Control (CDC) in Atlanta, GA, reports that every year more than 130,000 children younger than the age of 13 are rushed to the ED for treatment following motor vehicle accidents on the nation’s roadways. As unfortunate as these incidents are, public health experts stress that they represent critical opportunities for emergency personnel to prevent future injuries by passing along information about the proper use of child restraints to parents.

However, research from the University of Michigan’s CS Mott Children’s Hospital in Ann Arbor, MI, suggests that too often ED providers are not taking the extra steps needed to prevent future collision-related injuries.1 “Both general and pediatric-trained emergency providers aren’t getting the information out to families on a consistent basis when they come to the ED for care,” explains Michelle Macy, MD, MS, the lead author of the study and a clinical lecturer in the Departments of Emergency Medicine and Pediatrics at the University of Michigan.

This information is based on a survey Macy and colleagues mailed to a random sample of 1200 emergency physicians across the country. Fewer than half of the responding physicians indicated that the parents of a 2-year-old being discharged from their ED following a motor vehicle crash would be supplied with discharge instructions that include advice about the proper use of car seats. Further, while half of the physicians working in a pediatric trauma center indicated that they always recommend replacement of a 3-year-old’s car seat after a roll-over motor vehicle crash, as recommended by the National Highway Traffic Safety Administration, only one-third of the physicians working in adult and non-trauma EDs said that they routinely make such a recommendation.

These are important omissions, says Macy, because child seats are complicated, and they are commonly misused. The study notes that 20% of 1 to 3-year-olds and about half of 4 to 7-year-olds are typically not restrained in the recommended restraint for their age. “Child passenger injuries in crashes are the leading cause of death for children who are older than age 3 years in the United States, and that persists up to the early driving years,” says Macy. “They are the second leading cause of death among children aged 1 to 4.”

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The researchers found that the parents of children who are seen in general EDs that do not specialize in pediatric cases are the least likely to receive information about child restraints, but these general EDs treat more than 85% of children requiring emergency care.

“We think if we could get higher use of restraints among the school-aged kids and older, we would be able to at least reduce deaths and injuries,” explains Macy. “We know from other research that when kids are buckled up properly, we can reduce their risk of injury and death by 50% to 75%. We also know that when we just give families information, and then also provide them with a proper car seat, they are going to increase their use of the safety device.”

While research has shown that recommendations from physicians carry a lot of weight with patients and parents, Macy stresses that the information does not necessarily have to come directly from emergency physicians. “We need to make it easy for clinicians, nursing staff, techs, and social workers to have the information at hand,” she says.

For example, Macy notes that local resources where parents can obtain information about child passenger safety can be automatically included in discharge instructions. “That can be pitched as a simple solution to at least increase awareness of this issue,” she says. “I don’t think providers need to necessarily all go through child passenger training and to know all the ins and outs of the issue.”

For starters, Macy would like to see every discharge instruction include the web address, a link that families can use to find local inspection stations and other resources on child passenger safety. The link could easily be included in electronic medical records as well as highlighted within the paper documents that families leave the hospital with when they are discharged. “Then it would fall back on the families to follow-up with those resources, but at least providers would be making some effort to impact the leading cause of death among children.”

Beyond the simple solutions, however, Macy stresses that the issue can really resonate with medical personnel who have seen the consequences of motor vehicle accidents on improperly restrained children. She points out that this type of experience can be shared with others. “Physicians, social workers, medics, and nurses in the ED have all seen a child or family that has been devastated by a car crash, and I think they can speak from that personal experience in a powerful way,” she says.


1. Macy M, Clark S, Cunningham R, et al. Availability of child passenger safety resources to emergency physicians practicing in emergency departments within pediatric, adult and nontrauma centers: A national survey. Pediatric Emergency Care 2013;29:324-330.


• Michelle Macy, MD, MS, Clinical Lecturer, Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI. E-mail: