1406: PREVENTABLE PEDIATRIC TRAUMA FROM CHILD RESTRAINT NON-USE IN LATIN AMERICA: A MULTILEVEL STUDY

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