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Table 1 Overview about the studies’ objectives, impact conditions, methodologies of reviewed pediatric safety studies

From: Pediatric safety: review of the susceptibility of children with disabilities to injuries involving movement related events

Author Objective
& Population
Impact Conditions Methodology Results & Recommendations
Gaw,C. Abraham, V. M., Gaw, C. E., Chounthirath, T., & Smith, G. A. (Park & Yoo, 2009) Comprehensively investigate toy-related injuries among children N/A Patients were separated into 2 age categories, younger than 5 years, and 5 to 17 years of age.
Mechanism of injury was divided into categories such as falls, collisions and foreign body involvement.
Ride-on toys were 3.19 times more likely to be associated with a fracture or dislocation compared with other toy products.
Patients younger than 5 years were more likely to injure their head or neck and face than patients aged 5 to 17.
34.9% of toy-related injuries were associated with ride-on toys.
Sinclair, S. A., & Xiang, H. (Blankenburg et al., 2018) Verify reports from many researchers that report that disabled children are at a higher risk of injury than non-disabled children.
The epidemiology of injury among children with disabilities hasn’t been adequately studied.
N/A Data was pooled from the 1997–2005 National Health Interview Survey (NHIS)
The prevalence of injuries in children who had a single disability were compared to children without a disability by gender, age, parent’s education, poverty status, and family size.
An injury episode was defined as a traumatic event in which the person was injured 1 or more times from an external cause.
It was found that the risk of injury was significantly higher among children with a single disability than among non-disabled children. (3.8%; 95% CI = 3.4, 4.1 vs. 2.5%; 95% CI = 2.5, 2.6, respectively; P < 0.001). However, the risk of injury differs by type of disability.
The most frequent causes of injury episodes for both test groups were falls.
The disability with the greatest probability of injury was children who had a bone, joint, or muscle problem.
Zhu, H., Xiang, H., Xia, X., Yang, X., Li, D., Stallones, L., & Du, Y. Â (AlemdaroÄŸlu, 2017) Children with disabilities may have a reduced ability to handle environmental hazards because of physical limitations, impairments in mental processing, or in their ability to adjust to their environment. N/A The China Disabled Persons’ Federation was utilized to survey all registered, disabled children ages 1–14 years.
For every disabled child, a non-disabled child living in the same neighborhood and with the same gender and age was matched.
Disabilities were organized into categories of vision, hearing, speech, physical, and mental health disorders.
Children with multiple disabilities were also taken into consideration.
A scale of four varying levels of disabilities was used.
Socio demographic variables were also considered.
Rates of injuries among children with a single disability (9.6%) and multiple disabilities (11.2%) were significantly higher than that among children without disabilities (4.4%).
It was found that age of the child, children in single parent households; children whose parent’s highest education was middle school or less; children with less than 30% of time per day supervised by an adult; and children whose family income per month was less than 1000 RMB has little to no change on rate of injury.
Level 2 of disability was injured the most (11.5%), followed by level 3 (10.4%), then level 4 (10.3%), and lastly level 1 (8.1%).
Ha D. (Ginsburg, 2007) 6-year-old children with disabilities
3 pediatric manual wheelchairs
20 g/48 km/h front crash pulse
Wheelchair impact
Sled test using a seated Hybrid III 6-year-old ATD
Head acceleration, chest acceleration, pelvis acceleration, femur forces, chest deflection, neck forces, and moment were measured.
Test results were compared with kinematic limitation and injury criteria that listed in the ANSI/RESNA WC-19, FMVSS 213 and FMVSS 208 standards.
Klinich KD (Kleinberger et al., n.d.) 6-year-old and 10-year-old healthy children
Not using belt-positioning booster
Sled pulse delta velocity is 28.8 km/hr. Sled test using a seated Hybrid III 6-year-old and 10-year-old ATD
Vehicle seats
Cushion length of 450 mm
Cushion length of 350 mm
Belt Geometry
Lap belt angles tested: 23o (rear), 50o (mid),and 70o (forward)
Compared kinematic outcomes between long and short cushion length and increasing lap belt angles.
Park D (Zhu et al., 2014) Healthy 3-year-old children
Existing three-point belt-type child seat
50 km/h front crash pulse
Children car seat impact
Combined sled test and computer based simulations
a Standard crash test: velocity increased to 50 km/h then suddenly decelerated
Simulation:
Geometric modelling: LS-DYNA, CATIA
Preprocessor: FEMB, and postprocessor: LS-POST
Finite elements
Compared sled test and computer simulation results to validate data collected.
Developed an advanced new type of a child seat based on the results (six-point belt-type)
Isabelle S. (Sinclair & Xiang, 2008) Compare the kinematic response of children and child anthropomorphic test devices (ATDs) during emergency braking events in different restraint configurations in a passenger vehicle
16 healthy children aged 4 to 12
Q3, Hybrid III (HIII) 3-year-old, 6-year-old, and 10-year-old ATDs
2 braking events
Vehicle brakes as fast as possible to a full stop while traveling at a velocity of 70 km/h The maximum deceleration of all analyzed braking events was 1.2 g. The peak mean deceleration was 1.0 g with a standard deviation of 0.08 g and duration of 1.8 s
The duration of the entire deceleration period was 2.4 s
2 sharp turns to the right in each restraint system
Child volunteer and ATDs test
Short children (stature 107–123 cm) and the Q3, HIII 3-year-old, and 6-year-old were restrained on booster cushions as well as high-back booster seats.
Tall children (stature 135–150 cm) and HIII 10-year-old were restrained on booster cushions or restrained by 3-point belts directly on the car seat.
Restrained on the right rear seat of a modern passenger vehicle.
Four small video cameras (Monacor TVCCD-30, lens focal length 3.6 mm, Monacor International, Bremen, Germany) were affixed inside the vehicle providing a front view of the child, a perpendicular lateral view, and 2 oblique views of the children volunteer.
The recording rate was 12.5 frames per second.
Data collected included vehicle velocity, acceleration in longitudinal and lateral directions, and brake pressure.
MATLAB was used to analyze data.
40 trials were analyzed
Child volunteers had greater maximum forward displacement of the head and greater head rotation compared to the ATDs.
The average maximum displacement for children ranged from 165 to 210 mm and 155 to 195 mm for the forehead and ear target, respectively. Corresponding values for the ATDs were 55 to 165 mm and 50 to 160 mm.
The change in head angle was greater for short children than for tall children.
Shoulder belt force was within the same range for short children when restrained on booster cushions or high-back booster seats. For tall children, the shoulder belt force was greater when restrained on booster cushions compared to being restrained by seat belts directly on the car seat
Jingwen H. (Gaw et al., 2015) Analyses of crash injury data have shown that injury risk increases when children transition from belt-positioning boosters to the vehicle seat belt alone.
Investigate how to improve the restraint environment for these children.
Healthy children aged 6 to 12 years old
Frontal crash test Used a parametric child ATD MADYMO model
To scale the baseline child ATD model into different body sizes, custom software was developed by combining MADYMO Scaler and a program written by Scilab V5.2.2 (Scilab Enterprises, France)
An automated computer program was developed using a combination of MADYMO (TASS, The Netherlands), Scilab, and ModeFRONTIER (ESTECO, Italy) to integrate the parametric child ATD model, ATD positioning procedure, automatic belt fitting algorithm, and other crash conditions together.
A 200 N force was applied to the 3 belt anchorages
The maximum head and knee excursions in this parametric study were 639 and 833 mm, respectively. Both were below the limits defined in FMVSS No. 213, in which head excursion should be less than 720 mm and knee excursion should be less than 915 mm.
Lower and more rearward D-rings (upper belt anchorages), higher and more forward lap belt anchorages, and shorter, stiffer, and thinner seat cushions were associated with improved restraint performance.
Children with smaller body sizes require more-forward D-rings, inboard anchors, and outboard anchor locations to avoid submarining. However, these anchorage locations increase head excursions relative to more-rearward anchorages.
Florian F. (Logan et al., 2016) Case study: a serious accident involving two passenger cars took place in Austria in which three children seated in the rear were fatally injured in a frontal collision. The study was performed to gain a better understanding of rear occupants injury mechanisms and potential improvements to rear-seat restraint system
3 children: 5 years old, 8 years old and 10 years old
Frontal collision
EBS (equivalent barrier speed) and EES (energy equivalent speed) is 62 km/h
Approaching angle of 85â—¦
The approaching velocity of the VW was calculated to be 63 km/h
For the Nissan, a velocity of 69 km/h was determined
An HIII (hybrid III) six-year-old dummy (hereafter HIII 6yo) was used for simulating the youngest child, aged five, seated behind the driver. The eight-year-old child, who was seated in the middle, was simulated by a TNO P10 dummy (hereafter TNO P10)
For the eldest child, aged 10, an HIII 5th percentile dummy (hereafter HIII 5th) was used
An HIII 50th percentile dummy was seated in the driver’s seat.
An HIII 5th percentile dummy was situated on the front occupant’s seat to enable direct comparison of the restraining effect between the front and the rear compartments
A crash test was used for validating a numerical model of the rear compartment, programmed with the multi-body (MB) simulation code MADYMOR. The MADYMOR model was used for a set of parametric variations
Results:
The HIII 5th seated in the rear showed a considerable chest (52 mm chest deflection, 66 g chest acceleration) and head load (HIC [head injury criterion] = 1047 and acceleration exceeding during a cumulative time interval of 3 ms [cum3ms] = 96 g). The shoulder belt forces reached almost 9 kN
◦ The chest deflection in the HIII 6yo and HIII 5th only slightly exceeded the threshold values of 40 mm and 52 mm In contrast, the loads on the HIII 5th seated in the front seat were consistently lower compared with those on the rear-seated HIII: head acceleration was 25% lower, neck forces and torques were considerably lower (by 25–40%), chest deflection was 25% lower, shoulder-belt forces were 12% lower and chest acceleration was 15% lower. Furthermore, the shoulder belt in the front seat had a 50% greater pullout (100 mm)
Recommendations
Provision of mandatory seatbacks with side wings to protect against lateral impact.
Provision of a mandatory guide for shoulder belts.
Mandatory introduction of anti-rotation devices, e.g., top tether and outrigger.
Definition of maximum size of not-ISOFIX seat (geometry envelope).
Identification of CRS, including the weight, size and age of the child for which the specific model is designed.