Child restraint device use in patients leaving a children's hospital
W. T. Zempsky, D. J. Isaacman, K. M. Sullivan and N. Sipp
Department of Pediatrics, University of Pittsburgh School of Medicine, Pa, USA.
OBJECTIVE: To determine the frequency of and factors associated with the
use of child restraint devices (CRDs) in patients leaving an urban
children's hospital. DESIGN: Verbally administered survey, followed by
observation of CRD use. SETTING: Main parking area at an urban children's
hospital with mandated use of parking attendants. PARTICIPANTS: A
convenience sample of 295 parents or guardians who were leaving the
hospital and were accompanied by at least 1 child younger than 48 months.
RESULTS: Eighty percent of the respondents were female; 77% of the
respondents were white and 22% were African American. Two hundred
thirty-five (80%) used CRDs. Subjects who were at risk of CRD noncompliance
included nonwhite individuals (adjusted odds ratio [OR], 6.6; 95%
confidence interval [CI], 3.0-14.5), those whose primary source of medical
care was from a public clinic (OR, 2.4; 95% CI, 1.1-5.3) or from a
specialty clinic (OR, 2.4; 95% CI, 0.8-6.6), and those who were older than
24 months (OR, 8.7; 95% CI, 3.5-21.9). Parental education and income level
were not important predictors of CRD compliance controlling for race,
primary medical care source, and age. Study participants were observed for
incorrect CRD use; 30% (30/ 99 of infants younger than 12 months were
incorrectly placed in the forward-facing position, and 23% (54/ 235 of all
CRD users did not use its harness. CONCLUSIONS: Patients who use public
clinics or pediatric subspecialists as their primary source of medical
care, especially those who are African Americans, are at risk of CRD
noncompliance. Children's hospitals should take an active role in improving
CRD use in these patients.
