Looking Back and Ahead: 25 Years of Preventing and Researching Childhood Injuries

The Center for Injury Research and Prevention is looking ahead with a new leadership team that includes (from left to right) Strategy Director Suzanne Hill; Associate Director Rachel Myers, PhD; Scientific Director Kristy Arbogast, PhD; and Business and Administrative Director Ronni Kessler, MS.

By Lauren Ingeno

The world was mostly designed for adults back in 1996, and finding ways to prevent injury with evidence-based research that was specific to children was not commonplace.

"There was a sense that accidents were just a normal part of childhood," said Kristy Arbogast, PhD, recently named Scientific Director at CHOP's Center for Injury Research and Prevention (CIRP).

Two CHOP physicians disagreed with that sentiment, after identifying the first child who died of an airbag injury in a motor vehicle crash. Pediatrician, engineer and public health researcher Flaura K. Winston, MD, PhD, and pediatric emergency medicine physician Dennis Durbin, MD, MSCE (now at Nationwide Children's Hospital) wanted to bring together a team of scientists and clinicians who could raise the rigor of the research applied to the field of injury science. They went on to create CIRP as the first Center of Emphasis at CHOP Research Institute, which Dr. Arbogast joined as a bioengineer in 1997.

One of their landmark research projects partnered with State Farm Insurance and collected information on 173,000 crashes involving more than 260,000 children that fueled efforts by the National Highway Traffic Safety Administration, industry, and other stakeholders to advance motor vehicle safety for children, create federal policies and regulations, inform state child restraint laws, and educate families.

More than two decades later, fatalities to children in motor vehicle crashes have been cut in half. More work remains, however, as unintentional injury (including motor vehicle crashes), suicide, and homicide remain the three leading causes of death for people under age 25, together claiming nearly 33,000 lives in 2020, according to the Centers for Disease Control and Prevention.

Evolving CIRP Research to Meet the Need

To meet the challenges of the next decade and beyond, CIRP has evolved into an ambitious and multidisciplinary research center with a broad range of focus areas: young driver safety, violence prevention, road traffic protection, injury and rehabilitation biomechanics and engineering, concussion and brain health, traumatic stress, and transportation equity.

"Twenty years ago, CIRP's research portfolio was virtually exclusively road traffic protection," Dr. Arbogast said. "In 2024, our research additionally contributes important findings and recommendations to the science of young driver safety, concussion diagnosis, recovery and prevention, as well as addressing critical antecedents to future exposure to violence."

Through its partnership with Center for Violence Prevention, CIRP researchers are developing evidence-based programming for children and youth around relational aggression in schools, firearm safety in the home, and emotional recovery from non-familial assault-related injuries.

CIRP's road traffic protection research has evolved as vehicles and driving behaviors have changed. Early road traffic protection research at CIRP helped update pediatric crash test dummies, provided data to update nearly every state law to include child restraints and rear seating to higher ages, and improve graduated driver's licensing laws for teen drivers.

Today, CIRP scientists partner with industry to study how children move in vehicles, including a research project funded by Toyota to measure the movement of motor vehicle passengers of different ages during crash avoidance maneuvers. In addition, CIRP investigators apply novel methods to link state-level databases to examine the pre-injury period to the post-injury period, creating unique data sources to answer important questions related to injury prevention. New challenges are emerging.

"Everyone's talking a lot about autonomous vehicles, for example — well, where is the child in that scenario? Could they travel alone? How old would they need to be?" Dr. Arbogast said. "Our role at CIRP is always to represent the voice of the child."

CIRP's lab-based biomechanical tools developed for road protection research are being adapted to other injury scenarios such as falls or other populations such as those with disabilities, always with an eye toward creating and advancing technological solutions.

A validated Virtual Driving Assessment (VDA), software originally developed as research tool for CIRP's young driver research, is now a standard clinical tool provided to adolescents in CHOP Primary Care practices to measure a person's ability to drive safely and avoid crashes. The VDA is also being developed at CIRP as a novel behavioral probe of neural and cognitive function and development in various clinical populations.

CIRP is the research home to CHOP Minds Matter Concussion Frontier Program, which developed a visio-vestibular exam that was recently endorsed as best practice for the Child Sports Concussion Office Assessment Tool (Child SCOAT6) by an international consensus group. Concussion research efforts extend to engineering approaches where CIRP scientists led an effort to develop best practices for the collection, analysis, and reporting of head acceleration measurement data in sport.

New Roles in CIRP Leadership, Same Passion for Translational Research

Among the changes afoot as CIRP looks ahead to the next 25 years, there is a new leadership team. Dr. Arbogast will lead CIRP with Associate Director Rachel Myers, PhD, MS, guided by a new strategic plan that supports the vision of a future where all young people live to their full potential, unencumbered by consequences of physical and emotional injury. Dr. Winston remains engaged as the founder and former director of CIRP, dedicated to advising the new leadership team, managing a robust research portfolio, and directing CHOP's Innovation Ecosystem.

CIRP's new strategic priorities focus on:

• Conducting high-impact research to mitigate the burden of violence and injury
• Retaining and recruiting outstanding injury scientists
• Strengthening outreach and engagement with CIRP external stakeholders
• Training the next generation of injury scientists and practitioners

CIRP's strength lies in its multidisciplinary fabric, as well as the center's longstanding connections to internal and external stakeholders who are able to drive breakthroughs in technology, clinical care, policy and education, according to Dr. Arbogast. Researchers engage with industry, government, and national, regional, and local community-facing partners throughout their research to make sure they generate solutions with real-world utility and impact.

"That intersection of clinical medicine, public health/epidemiology, and engineering can really only happen here at CHOP. It makes CIRP unique in the field of injury science," Dr. Arbogast said.

Dr. Myers, who joined CIRP in 2009, is a public health researcher whose primary work focuses on community violence and trauma recovery support. She has collaborated with Health Alliance for Violence Intervention (The HAVI) member programs to establish the feasibility of cross-site data sharing among hospital-based violence intervention programs and co-leads several projects with clinical and community partners to conduct trauma-informed and community-engaged research to address youth violence.

Additionally, Dr. Myers collaborates with other CIRP investigators to conduct a study examining the use of child restraints and injury outcomes in motor vehicle crashes in New Jersey, as well as leading work to build capacity to demonstrate the impact of youth violence prevention programs on improving the well-being, health, and safety of young people and families.

"What stands out to me about the work at CIRP — and what we want to continue to do as we look forward — is respecting and incorporating diversity in our research, so that we can make sure we're asking the right questions and partnering with the right people, both within our teams and with our external partners to bridge academic, clinical, and community expertise in understanding urgent problems and developing feasible solutions in pediatric injury prevention," Dr. Myers said.

Thinking forward, Dr. Arbogast and Dr. Myers said that CIRP's new strategic plan lays the infrastructure for the research team to solve new injury-related challenges, which are constantly evolving.

"Our goal is to have all children — from our local Philadelphia neighborhoods to communities across the country and around the world — experience safe schools, safe neighborhoods, safe homes, safe play spaces and equitable mobility," Dr. Myers said. "Given that injury and violence remain the leading causes of death and acquired disability for children and youth, it only makes sense that this work happens here at CHOP."

Learn more about how CIRP has helped to solve important problems in pediatric health as a Center of Emphasis in a Bench to Bedside podcast with CHOP Research Institute Chief Scientific Officer Susan Furth, MD, PhD, and Dr. Winston.