Long-term outcomes for child occupants involved in crashes

Although child occupant fatalities have decreased dramatically since 1975, ~2 children die in crashes each day and ~60k more are treated each year in emergency departments (EDs) for crash injuries. The bulk of research to date examining factors that contribute to crash outcomes, including results from my K99 period, are focused on the time period before and during a crash. Very little research has examined post-crash factors and their influence on children’s long-term health. The high burden and costs of crashes among children ($530M annually [CDC 2019]) underscore the critical need to improve child occupant safety across the crash-injury continuum. Enhancing child occupant safety would prevent thousands of childhood disabilities and deaths annually, while ameliorating the financial, physical, and psychological burden of crashes experienced by children, their families, and society. This R00 is utilizing a breadth-to-depth approach that integrates knowledge obtained from population- (breadth) and individual-level (depth) analyses to improve children’s long-term health outcomes following a crash. The K99 phase of this work leveraged novel, state-level data to identify factors present pre- and during- a crash that contribute to child restraint system use and children’s injury risk. The R00 phase of this work seeks to expand these findings, specifically by conducting mixed-methods studies at two pediatric hospitals to characterize and understand factors that contribute to post-crash outcomes for children. Aim 1 of the R00 is to examine potential variations across hospitals in diagnostic, treatment, and discharge approaches for crash-involved children. To achieve this aim, we will interview physicians and other health care providers who make decisions about children’s treatment needs/options following a crash. We will also conduct a large, retrospective review of health records across study sites. Aim 2 is to characterize post-crash quality of life and health outcomes for a large cohort of crash-involved children and their families. We will use longitudinal surveys and semi-structured interviews completed by caregivers to characterize post-crash outcomes (e.g., physical and mental health, family dynamics). The knowledge gained by this project will ultimately reduce overall rates of pediatric crash injury and death by bolstering postcrash treatment strategies for children.