INJURY PREVENTION

Health Evidence Bulletins - Wales
Team Leader: Dr. Ronan Lyons

Date of Completion: 2.4.98

1:Childhood injuries

This document is a supplement to, not a substitute for, professional skills and experience. Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation
The Statements The Evidence
1a. There is some evidence that Accident Prevention Committees in high risk deprived populations have reduced injuries. Participative rather than didactic approaches appear to have more success i.
(Health Gain Notation - 2 "likely to be beneficial")
i.Preventing unintentional injuries in children and young adolescents. Effective Health Care Bulletin. Vol. 2 No. 5. University of York: NHS Centre for Reviews and Dissemination, 1996. http://www.york.ac.uk/inst/crd/ehc25.htm
(Type III evidence - well designed non randomised trials)
1b. Targeted home visiting programmes may reduce injuries. A randomised controlled trial targeting poor, unmarried or teenage mothers of pre-school children in the United States showed an association between nurse home visiting and a reduction in home hazards i.
(Health Gain Notation - 2 "likely to be beneficial")
Home based social support has the potential to significantly reduce rates of child injury. A systematic review of eight trials of the effect of home visiting by professionals and non-professionals showed reduced child injury rates ii.
(Health Gain Notation- 1 "beneficial")
Targeting educational childhood initiatives at high risk households to reduce injuries appears to be more effective, especially when supported by home safety equipment loans or subsidised equipment schemes (e.g. stair gates)iii,iv,v.
(Health Gain Notation - 2 "likely to be beneficial")
i. Olds DL,Henderson CR, Kitzman H.Does prenatal and infancy nurse home visitation have enduring effects on quality of parental care giving and child health of 25-50 months of life? Paediatrics 1994; 93: 89-98.
(Type II evidence - randomised controlled trial)
ii.Hodnett ED, Roberts I. Home based social support for socially disadvantased mothers. Cochrane Database of Systematic Reviews, 1998, issue 2. http://www.update-software.com/
ccweb/cochrane/revabstr/ab000107.htm

(Type 1 evidence- systematic review)
iii. Health Education Authority. Health promotion in childhood and young adolescence for the prevention of unintentional injuries. Health Promotion Effectiveness Reviews Bulletin 2. London: HMSO,1996.
(Type III evidence- non randomised studies)
iv. Health Promotion Research Programme. Health visitor prevention of child home accidents. Bristol Univerisity: Department of Social Science, 1996.
(Type III evidence- non randomised studies);
v. Preventing unintentional injuries in children and young adolescents. Effective Health Care Bulletin Vol.2 No. 5. University of York: NHS Centre for Reviews and Dissemination, 1996. http://www.york.ac.uk/inst/crd/ehc25.htm
(Type III evidence - well designed non randomised trials)
1c. General Practioner advice, coupled with access to low cost equipment for low income families, increases the use of safety equipment and safe practices in the home.
(Health Gain Notation-2 "likely to be beneficial")
A randomised controlled trial of advice from G.P.’s on child safety, supplemented with low cost equipment for poorer families resulted in significant improvements in the use of safety equipment and safe practices with numbers needed to treat ranging from 2 to 16 i.
(Health Gain Notation-2 "likely to be beneficial")
i. Clamp M, Kendrick D. A randomised controlled trial of general practitioner safety advice for families with children under 5 years. British Medical Journal 1998; 316: 1576-9.
http://www.bmj.com/cgi/content/full/316/7144/1576
(Type II evidence - randomised controlled trial)

 

 

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1d. Drowning in the bath: educational programmes need to continue to raise awareness of how little water is needed to drown a child. Young children are at high risk of drowning in the bath. There would appear to be no formal evaluations of educational programmes i.
(Health Gain Notation - 4 "unknown")
i. Health promotion in childhood and young adolescence for the prevention of unintentional injuries. Health Promotion Effectiveness Review - Summary Bulletin 2. Health Education Authority, 1996.
(Type V evidence - expert opinion)

 

1e. Rubber or bark surfacing is associated with a low rate of childhood injury and should be used in public playgrounds. Reducing the height of monkey bars would also reduce injuryi.
(Health Gain Notation - 2 " likely to be beneficial")
i. Mott M, Rolfe K, James R et al. Safety of surfaces and equipment for children in playgrounds. Lancet 1997; 349: 1874-1876.
(Type IV evidence - observational studies)
1f. Child resistant containers have been very effective in reducing childhood deaths from poisoning. After the introduction of child resistant containers in Britain and the United States, fatal poisoning episodes in children fell by about 85% i,ii,iii.
(Health Gain Notation - 1 " beneficial")
i. Lawson GR. Changing patterns of poisonings in children in Newcastle 1974-1981. British Medical Journal 1983; 285: 15-17.
(Type III evidence - non randomised trials)
ii. Walter WW. An evaluation of the Poisoning Prevention Act. Paediatrics 1982; 69: 363-370.
(Type III evidence - non randomised trials)
iii. Sibert JR, Craft AW, Jackson RH. Child resistant packaging and accidental child poisoning. Lancet 1977; 2: 289-90.
(Type III evidence- non randomised trials)
1g.Window bars reduce childhood injuries and deaths from fallsi.
(Health Gain Notation- 1 "beneficial")
Note: effective preventative measures which reduce morbidity or mortality for all age groups (e.g. smoke alarms, seat belts ,etc) are covered in the general and road accident sections.
i. Spiegel CN,Lindaman FC. Children can’t fly: a programme to prevent childhood mortality from window falls. Injury Prevention 1995; 1(3):194-8.
(Type IV evidence - observational studies )
1h. Preventing injuries to young people aged 15-24 years is possible.
(Health Gain Notation 1- "beneficial")
A systematic review of the effectiveness of interventions to reduce injuries in young people identified many interventions which are separately considered in this
reviewi.
i. Coleman P, Munro J, Nicholl J, Harper R, Kent G, Wild D. The effectiveness of interventions to prevent accidental injury to young persons aged 15-24 years: a review of the evidence. University of Sheffield: Medical Care Research Unit, 1996.
(Type I evidence- systematic review).

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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk