Preventable Pediatric Trauma From Child Restraint Non-Use in Latin America: A Multilevel Study

Tuesday, March 24, 2026

8:45 AM - 9:45 AM Central Time

Location: Connections Central - RST 16

Paula Caporal, MD, MPH (she/her/hers)

Johns Hopkins University - Bloomberg School of Public Health, District of Columbia

Disclosure(s): No relevant financial relationship(s) to disclose.
DG

Devis Nicolás Guzmán-Tordecilla, PhD

Post Doc
Johns Hopkins Bloomberg School of Public Health

Disclosure information not submitted.
AV

Andrés Ignacio Vecino Ortiz, MD, ME, PhD

Associate Research Professor
Johns Hopkins Bloomberg School of Public Health

Disclosure information not submitted.
AL

Angélica López Hernandez, MD, MPH, PhD

Senior Program Officer
World Bank, Global Financing Facility

Disclosure information not submitted.
BL

Bisi Lauren, MPH

PhD Student
Johns Hopkins Bloomberg School of Public Health

Disclosure information not submitted.
RL

Ruben Ledesma, PhD

Researcher
National University of Mar del Plata- National Scientific and Technical Research Council IPSIBAT (UNMDP-CONICET), Institute of Basic and Applied Psychology and Development of Psychological Technology, Mar del Plata, Argentina

Disclosure information not submitted.
FP

Fernando Poó, PhD

Researcher
National University of Mar del Plata- National Scientific and Technical Research Council IPSIBAT (UNMDP-CONICET), Institute of Basic and Applied Psychology and Development of Psychological Technology, Mar del Plata, Argentina

Disclosure information not submitted.
LG

Luis Angel Guzmán García, N/A

Researcher
Universidad de los Andes, Bogotá, Colombia

Disclosure information not submitted.
VG

Vanessa Guzmán Mesa, N/A

Project Manager
Universidad de los Andes, Bogotá, Colombia

Disclosure information not submitted.
RP

Raúl Francisco Pérez-Tasigchana, MD, MSc, PhD

Researcher
Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC) Universidad UTE, Quito, Ecuador

Disclosure information not submitted.
DM

Daniele Mayumi Sinagawa, N/A

Researcher
University of São Paulo, São Paulo, Brazil

Disclosure information not submitted.
CT

Carlos Roberto Tasigchana Paredes, N/A

Researcher
Universidad de los Andes, Bogotá, Colombia

Disclosure information not submitted.
EH

Elisa del Carmen Hidalgo-Solorzano, MD

Researcher
Centre for Health Systems Research, National Institute of Public Health, México

Disclosure information not submitted.
FC

Flávio José Cunto, PhD

Associate Professor
Brazilian National Council for Scientific and Technological Development Department of Transportation Engineering Universidade Federal do Ceará, Brasil

Disclosure information not submitted.
MM

Manoel Mendonça De Castro Neto, N/A

Associate Professor
Federal University of Ceara, Fortaleza, Brazil

Disclosure information not submitted.
HS

Henrique Silva Bombana, PhD

Researcher
University of São Paulo, São Paulo, Brazil

Disclosure information not submitted.
LG

Ligia Góes Endo, N/A

PhD Student
University of São Paulo, São Paulo, Brazil

Disclosure information not submitted.
AB

Abdulgafoor M. Bachani, PhD, MHS

Associate Professor- Director of International Injury Research Unit
Johns Hopkins Bloomberg School of Public Health

Disclosure information not submitted.

Introduction: Road traffic injuries (RTI) are the leading cause of death among children and adolescents aged 5–29 globally, with Latin America (LATAM) showing mortality rates nearly double the global average. While child restraint systems (CRS) reduce injury and death, their use remains critically low. Prevalence data are limited, and behavioral and contextual drivers of CRS use in LATAM are poorly understood.
We aimed to estimate CRS use among children aged 0–11 in LATAM cities; identify factors associated with its use; and explore city-level variation.

Methods: We conducted a multicenter cross-sectional study using direct roadside observations of motor vehicle occupants in 11 LATAM cities between 2020-2023, as part of phase III of the Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS). A total of 395,303 occupants were observed daily from 7 a.m. to 7 p.m.
The outcome was CRS use among children aged 0-11. We used multilevel logistic regression with city-level random intercepts to identify individual and contextual factors. Models were adjusted for child and driver demographics, vehicle and road characteristics, weather, and time. Intraclass correlation coefficients (ICCs) quantified variance attributable to differences between cities.

Results: We observed 8,984 children riding in vehicles. 20% were using a CRS; 37% in children under 5 and 12% in those aged 5–11. Younger children were significantly more likely to be restrained than older ones (OR: 0.45; p< 0.001).
CRS use was associated with driver seatbelt use (OR: 4.50; 95% CI: 3.48–5.81) and was less likely with male drivers (OR: 0.66; p< 0.001) or more passengers (OR: 0.58; p=0.002). Use was higher in fog (OR: 22.68; p=0.010).
The ICC showed that 7.9% of the variance in CRS use was explained by within-city clustering, suggesting structural or contextual city-level influences.

Conclusions: CRS use remains critically low across LATAM cities, especially among older children and in vehicles with unbelted drivers. These preventable gaps contribute to the high burden of pediatric trauma, a leading cause of intensive care unit (ICU) admission. Pediatric intensivists play a key role in advocating for policies that promote CRS use. Strengthening child passenger safety can reduce ICU admissions and improve outcomes