Penn Student Participates in Undergraduate Research on Child Injury

Steven Scarfone is spending 10 weeks this summer investigating the mechanisms of pediatric traumatic injury as a participant in the University of Pennsylvania’s Injury Science Research Experiences for Undergraduates program.

Sponsored by the National Science Foundation, the research program is run by the Center for Injury Research and Prevention, or CIRP, at the Children’s Hospital of Philadelphia. It is the third year the program has been held at Penn.

Scarfone, a Penn junior from Voorhees, N.J., is one of nine participants paired with a mentor to work on a multidisciplinary project on injury science.

A biophysics major in the College of Arts and Sciences, Scarfone initially considered a career in medicine. After his arrival at Penn, he volunteered at the Hospital of the University of Pennsylvania and shadowed at nearby Children’s Hospital but decided towards the end of his sophomore year to see if injury research would be better suited to his interests.

“I have the mind of an engineer,” Scarfone explains. “I tend to think of things in their physical sense, but I am also fascinated by biology. Injury science fits the bill because it includes physics and engineering, but is still very much tied to anatomy.”

For his internship, Scarfone was matched with Mark Zonfrillo, a pediatric emergency physician, injury epidemiologist and head of the Child Passenger Safety research team at CIRP, and Catherine McDonald, a postdoctoral fellow in Penn’s School of Nursing and CIRP. 

“This research program is a unique and competitive opportunity,” Zonfrillo says. “It allows students like Steve to apply what they’ve learned during undergraduate studies but also get a comprehensive introduction into translational research.”

Scarfone is participating in two projects under the direction of Zonfrillo, the first of which involves a 2012 school bus crash in Florida. The bus, which was transporting 30 children, was hit on its side by a tractor-trailer, leading to one death and multiple injuries.

Scarfone explains that this accident is significant to CIRP’s research because four video cameras had been installed on the bus a few months prior to the incident.

Zonfrillo and his team helped the National Transportation Safety Board examine and evaluate the crash earlier this year and are hoping to further analyze the videos and crash information in order to identify areas for improvement and measures for injury prevention.

“The videos facilitate the work of injury researchers by allowing them to understand what was it about the safety mechanisms, the design of the bus and the nature of accident itself that led to the injuries,” Scarfone says.

During the supplementary evaluation, Scarfone has reviewed detailed descriptions of the accident supplied by the NTSB and searched for past studies into school bus accidents and pediatric traumatic head injuries.

“I’m seeing what’s already known about head injuries in school bus crashes and have realized there isn’t much that’s been published about that topic,” Scarfone says. “It’s a vast area where we could make some significant headway.”

Scarfone says that he and his fellow researchers will turn to computer simulations for in-depth injury analyses. He explains that children on school buses are protected by closely spaced seatbacks from longitudinal impacts but are more vulnerable in the event of a side impact, as was the case in the Florida incident.

Scarfone also notes that the Florida bus only provided lap belts. He intends to research the advantages of lap and shoulder belts in addition to other preventive side-impact measures.

“In the best case scenario, we’ll realize there’s some sort of pattern to the injuries that these children sustained,” Scarfone says. “If we can identify a pattern, then we can think of a solution.”

For his second project, Scarfone analyzed a database from the National Highway Traffic Safety Administration database, which combines crash-scene information and medical data. He queried the source for pediatric spinal injuries for properly restrained or almost properly restrained individuals. He found about 60 accidents that fit the criteria.  

He says that he and Zonfrillo, along with engineers from CIRP and the automobile industry, will now go through each accident and perform a case review of the collision and the sustained occupant injuries.

“We try to come up with an injury-causation scenario for each accident, and we start to think about what could have been done to prevent it,” Scarfone says. “We hope to come up with a singular solution that will knock out a percentage of the sustained spinal injuries with one safety upgrade.”

Zonfrillo notes that historically a good portion of the Center’s work was focused on the epidemiology and biomechanics of child passenger safety but that CIRP has also branched out to include areas like teen-driver safety, post-traumatic stress and violence prevention. Still, he says that all of the efforts at CIRP aim to promote child safety through injury prevention and post-injury care.

“The overall goal in the projects with Steve,” Zonfrillo says, “is to determine what led to the injuries in these crashes in order to try to reduce injuries and deaths in similar types of crashes and identify the best interventions.”

For his research with Nursing’s McDonald, Scarfone has been working with a driving simulator in place at CIRP. He is looking to develop a simulated driving assessment which, when administered to potential drivers, would accurately predict how well they would be able to drive in a real environment.  

For the upcoming academic year, Scarfone hopes to continue his work in the form of an independent research project.

“Working at a translational research center means being a part of something that has made and will continue to make an impact in the real world,” Scarfone says.

Scarfone will continue his duties as co-president of Penn Science Across Ages, a student group that teaches science to local elementary and high school students, and as a peer advisor in the College. He is considering a career in biomechanical engineering after graduation.

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