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Injury prevention programmes in primary care: a high risk group or a whole population approach?
1Department of General Practice, University of Nottingham Medical School, UK.
Insights
Identifying children at high risk for unintentional injury is challenging. Current risk factors, like previous injury, are not effective enough for targeted prevention programs in primary care.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Childhood unintentional injuries represent a significant public health concern.
- Effective injury prevention strategies are crucial for reducing morbidity and mortality in children.
- Identifying children at high risk is essential for targeted and resource-efficient interventions.
Purpose of the Study:
- To investigate the association between risk factors and childhood unintentional injury outcomes.
- To evaluate the feasibility of using identified risk factors to pinpoint children at elevated risk for injury.
- To inform the development of targeted primary care-based injury prevention programs.
Main Methods:
- A postal questionnaire survey was administered to parents of 771 children registered at a general practice in Nottingham, UK.
- Data collected included risk factors and sociodemographic information.
- Children were followed for one year to record medically attended injuries.
Main Results:
- The overall injury rate was 246 per 1000 children.
- Previous medically attended injury was a significant predictor across all injury outcomes (OR 2.33-2.58).
- Male sex was associated with accident and emergency attendances (OR 2.13), and risk factor predictive values were generally low.
Conclusions:
- Targeting primary care-based injury prevention programs at children identified as 'high risk' is currently not supported by the evidence.
- A broader population-based approach may be more effective for injury prevention.
- Further research with larger, diverse populations is needed to refine risk identification and prevention strategies.
Objective:
To examine the relationship between risk factors for childhood unintentional injury and injury outcome and to assess the feasibility of using risk factors to identify children at high risk of injury.
Setting:
One general practice in Nottingham, UK.
Method:
A postal questionnaire survey to all parents of children registered with the practice (n = 771) to obtain data on risk and sociodemographic factors. All children still registered with the practice one year later were followed up for occurrence of a medically attended injury.
Results:
The response rate was 78%. The injury rate over the follow up year was 246 injuries per 1000 children. Previous medically attended injury was associated with each of the injury outcomes (odds ratio (confidence interval) for all attendances, 2.33 (1.37 to 4.05); for accident and emergency attendances, 2.27 (1.15 to 4.4); and for primary health care team attendances, 2.58 (1.33 to 5.0)). Male sex was associated only with accident and emergency department attendance (odds ratio 2.13 (1.06 to 4.2)). Maternal age and previous injury were associated with a higher number of injuries in the subsequent year on univariate and multivariate analyses. The sensitivity and positive predictive value of the risk factors were low, except for previous injury and male sex. The number of children needing an injury prevention intervention to prevent one injury as identified by the risk factors was not significantly different from that required if a whole population approach were to be used.
Conclusion:
Primary care based injury prevention programmes, at present, should not be targeted at children identified as being at 'high risk' of injury. Nevertheless, a larger study using a wider cross section of the population is needed to address this issue further.