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Original research
Randomised feasibility trial of a virtual intervention to address infant car seat misuse
  1. Sadiqa Kendi1,2,
  2. Michael F Taylor1,
  3. Bobbe Thomas3,
  4. Uma D Khemraj2,
  5. Mohamed A. Mohamed4,
  6. Michelle L. Macy5,
  7. James M. Chamberlain3
  1. 1 Emergency Medicine, Children's National Health System, Washington, District of Columbia, USA
  2. 2 Pediatric Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
  3. 3 Emergency Medicine, Children's National Medical Center, Washington, District of Columbia, USA
  4. 4 Neonatology, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5 Emergency Medicine, Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Sadiqa Kendi, Children's National Health System, Washington, DC 20010, USA; sadiqa.kendi{at}gmail.com

Abstract

Background Serious car seat installation errors occur at high rates in infants and children. These errors significantly increase the risk of child injury in a motor vehicle crash, and few interventions have addressed the challenge longitudinally.

Methods This was a pilot randomised controlled feasibility trial of virtual car seat safety checks for caregivers of newborns recruited from an urban newborn nursery. The control (enhanced usual care (EUC)) group received an in-person car seat check as a newborn and virtual check at 9 months. The intervention group received two additional virtual checks at 3 and 6 months. Installation and infant positioning errors were documented and corrected by a child passenger safety technician (CPST). We measured feasibility and acceptability by tracking caregiver and CPST challenges, and caregiver retention. Group differences were tested for statistical significance using χ2 or Fisher’s exact test for categorical variables, and two sample t-tests for continuous variables.

Results 33 caregivers were randomised to the EUC and 28 to the intervention group. Virtual checks were feasible, with variable participation levels at each quarter. Wi-Fi and app challenges noted in 30%. There was satisfaction with the virtual car seat checks. At baseline, car seat installation and infant positioning errors occurred at equal frequency, and at 9 months the intervention group had a significantly lower mean proportion than the EUC group in all categories of errors. In summary, virtual seat checks are feasible and the optimal timing of repeat checks requires additional study. A larger study is needed to further evaluate the effect of longitudinal virtual checks on errors.

  • Injury Diagnosis
  • Education
  • Restraints
  • Motor vehicle � Occupant

Data availability statement

Data are available on reasonable request. Deidentified patient data and results are available on request from the corresponding author at sadiqa.kendi@bmc.org.

https://doi.org/10.1136/ip-2022-044660

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    Data availability statement

    Data are available on reasonable request. Deidentified patient data and results are available on request from the corresponding author at sadiqa.kendi@bmc.org.

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    Footnotes

    • Contributors SK acted as guarantor, designed the project, acquired and analysed data, and wrote the manuscript. MFT acquired data, made critical revisions of the manuscript and approved the final product. BT acquired data, made critical revisions of the manuscript and approved the final product. UDK assisted with data analysis, drafted portions of the manuscript, made critical revisions of the manuscript and approved the final product. MM contributed to the design of the project, data analysis and critical revisions of the manuscript. JC contributed to the design of the project, data analysis and critical revisions of the manuscript.

    • Funding We would like to acknowledge the study team (T. Bobbe Thomas, Ryan Pearman, Alease Young, Julie Farmer, Leslie Brown), expertise of Dr David Schwebel, and clinical staff at the newborn nursery for their work on this research, our funding source (Award Numbers UL1TR001876 and KL2TR001877 from the NIH NCATS), and the families who participated in the study.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.