By Marlene Cimons, National Science Foundation
In the summer of 1995, a 20-day-old infant was rushed to the emergency department at The Children’s Hospital of Philadelphia, the victim of a two-car crash. The baby was dead, but not from the crash itself. The infant, properly restrained in a rear-facing safety seat, had been killed by a deploying airbag. It was the first known case of a child airbag death.
“That was the beginning,” says pediatrician Flaura Koplin Winston, MD., Ph.D., professor of pediatrics at the University of Pennsylvania, who was on duty when the baby arrived. “It really galvanized the need to think comprehensively about injury prevention for children as its own science.”
Winston, also an engineer, began to see an increasing number of child airbag injuries and fatalities, and realized with growing horror that deploying airbags posed a significant danger to young children. She and others began working with industry to improve airbag design, with the goal of reducing the threat.
Ultimately, these efforts led to her founding the Center for Injury Research and Prevention at The Children’s Hospital of Philadelphia in 1997. Since 2005, the injury center has been the host organization for a National Science Foundation (NSF) Industry/University Cooperative Research Center called the Center for Childhood Injury Prevention Studies, or CChIPS. This designation refers to research centers that join with industry to study and draft solutions to important issues.
The CChIPS program, co-directed by Winston and Kristy Arbogast, Ph.D., a trained engineer and research associate professor of pediatrics at the University of Pennsylvania, is the only one in the NSF’s science/industry partnership program that focuses solely on child injury prevention.
NSF has funded the center with more than $900,000 since 2005. Twelve industry members also support the center with annual membership fees of $50,000 each. These have provided the center with an additional $540,000 in 2010 alone.
The need for such a center was clear from the outset. Injury is the leading cause of death and acquired disability for children ages one to 19. Among those ages five to 19, an estimated 68 percent of injury deaths result from motor vehicle crashes, according to the Centers for Disease Control and Prevention. Moreover, children are a population with injury risks unique to their physiology.
“Children aren’t just small adults,” Winston says. “We have to approach this from a child developmental perspective—from their biomechanical and physical development to their brain, social and psychological development. Who’s getting hurt - and why? We try to answer these questions in ways that will produce solutions.”
Through the NSF-sponsored Center for Childhood Injury Prevention Studies, scientists from The Children’s Hospital of Philadelphia and the University of Pennsylvania work with industry partners—including automobile and child car seat manufacturers, an insurance company, and a company specializing in driving simulation technology—to conduct research that ultimately will prove practical to industry, that is, in helping develop new product designs and other strategies aimed at improving child safety.
“It emerged out of the concept we had already applied for years within our injury research center. We’d been conducting translational research into child injury, in cooperation with federal agencies, non-profit organizations, industry for years,” Winston says. “Our purpose is to advance the safety of children, adolescents and young adults through research. We are, essentially, doing research to provide credible, practical information to our collaborators on how to make better products, educational programs and policies that can prevent crashes and injuries and save kids’ lives.”
While traffic injury prevention and treatment has been the primary focus of the center for more than a decade, researchers recently have begun to examine other areas, such as sports injuries, and hope to add new partners, such as sports teams and others. “Concussion occurs from many mechanisms, from crashes to sports, and across the age spectrum, but children are more at risk; so, we are starting to focus on it,” Winston says. “Emerging research is demonstrating the importance of prevention and early treatment when a concussion does occur.”
Not long after Winston and her colleagues founded the Center for Injury Research and Prevention at The Children’s Hospital, the center joined with State Farm Insurance Companies to establish Partners for Child Passenger Safety (CHOP), a motor vehicle crash surveillance system specific to crashes involving children. One of its initial findings showed that older children were less likely to the appropriate restraints for their age, increasing the threat of injury or death.
The center began a public campaign through the media, legislative efforts, and the public health community to increase booster seat awareness. By 2001, its research showed a rapid increase in booster seat use among children between the ages of four and eight. At the start of the study, only 51percent children enrolled were correctly restrained at the time of a crash. By the end of the study period, the percentage had risen to 78 percent. And by 2007, most U.S. children through the age of eight were using child safety restraints, according to the center.
As part of this work, CHOP’s injury center also has been involved in upgrading 48 state laws and two federal laws regarding booster seats and has created a website in English and Spanish, providing child traffic safety information.
Center researchers also have conducted research to find out why parents fail to use seat belt positioning booster seats, and developed a video based on what they learned to encourage booster seat use. “It’s not enough to improve the safety seat technology,” Winston says. “We have to understand how parents interact with technology to ensure that they also know how to use it, and will use it.”
The same video, originally developed for American parents, also was effective when dubbed in Mandarin and aired in China. Booster seat use among the study participants in Beijing increased from 15 percent to 85 percent. “The results were dramatic,” Winston says.
“It’s very important to remember that the vast majority of child injuries happen in countries with emerging economies that lack the wealth of evidence-based prevention strategies available in developed countries,” she adds. “We wanted to see if the same intervention, proven effective in the U.S., could be replicated in Beijing, where they are adding about 1,500 new cars every day. They had the same issues there as in the United States. Parents didn’t know the importance of booster seats or how to use booster seats, and didn’t have access to them. China is a major manufacturer of booster seats, but they are mostly exported to the U.S. and other countries. We can come up with all these high-tech solutions, but need to think how to make them affordable, accessible, and mainstream in other countries.”
The center uses a multidisciplinary approach, drawing upon a team of experts from epidemiology, biostatistics, engineering, behavioral sciences, outreach, public policy and public health.
The center’s biomechanical engineers, for example, conduct research to help the automotive industry develop more accurate pediatric test crash dummies based on more than a decade of research into real-world accidents using innovative research methods. In one study, engineers partnered with clinicians in CHOP’s pediatric intensive care unit, using sensors to study the forces applied to children’s chests during CPR, thus leading to a better understanding of how a child’s chest interacts with a seat belt or car seat harness when crash forces are applied.
The scientists concluded that children’s bone structure and soft tissue respond much differently to crash forces than those of an adult, and recommended design improvements that would better represent an actual child’s body mechanics, including the head and brain, the neck and spine, the abdomen and the chest and rib cage. These body areas account for the most serious and frequently seen injuries children suffer in car accidents.
Until now, child crash dummies have just been smaller sized versions of adult dummies,” Arbogast says. “But their body composition is much different from an adult’s. They are developing organisms, and this can make them much more vulnerable to certain injuries in a crash than an adult.”
CChIPS also has sponsored a number of studies related to teen driving safety, including research on distracted driving and the impact of attention deficit disorder medications, which apparently results in “a significant improvement in driving performance,” according to Winston.
More recently, scientists at The Children’s Hospital in collaboration with State Farm Insurance Companies, released a report examining the effects of teen driving accidents on society, showing that the impact reaches far beyond teen drivers’ families and friends. In 2008, for example, more than half a million people were nvolved in crashes where a teen driver was behind the wheel. More than 40,000 were injured, and nearly 30 percent of those who died in these crashes were not in the cars driven by teens, according to the study.
In addition to State Farm, and NSF, CHOP’s Center for Injury Research and Prevention receives financial support from the Association of Global Automakers, the CDC, National Institutes of Mental Health, and others.
The NSF-supported Center for Childhood Injury Prevention Studies is funded by its industry advisory board members, which include Britax Child Safety Inc., Dorel Juvenile Group Inc., Evenflo Company Inc., General Motors Holdings LLC, Honda R&D Americas Inc., the National Highway Traffic Safety Administration, Nissan Technical Center North America Inc., Realtime Technologies, Inc., State Farm Insurance Companies, TK Holdings Inc., Toyota Motor Manufacturing of North America Inc. and Volkswagen Group of America Inc.
“There are a lot of players out there who really care about child injury,” Winston says.
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