Editorial. Bicycle injuries and injury prevention

In 1989, long before this journal added injuries to its title, it published two papers on childhood injuries and I was asked to write an editorial for this occasion. I chose the title "Challenges for Injury Prevention: Two Neglected Aspects" because I thought the papers neglected to mention the inadequacy of injury statistics (at the time there were no emergency department data) and also failed to emphasize the public health importance of childhood injuries. It is instructive, therefore, to compare this issue's offerings with how matters stood nearly 25 years ago and see what progress we've made. Papers in this and the previous issue of this journal discuss bicycle safety in general and helmet use in particular. Although this is a somewhat narrow focus, it serves as one indicator of how the field has evolved and what remains to be done to improve both the science and policy in this domain.

Impact of a celebrity death on children's injury-related emergency room visits

OBJECTIVES

To determine whether a sharp increase in Emergency Room (ER) visits at the Montreal Children's Hospital (MCH) during the week following the death of Natasha Richardson from a skiing-related head injury was a) statistically significant and b) related to media coverage of the event. We postulated that there would be less coverage in the French media and in centres west of Quebec.

METHODS

We compared the number of visits to the MCH ER for 10 weeks beginning March 5 and recorded the number for head-related injuries. These data were also compared with averages for the MCH for the same weeks in the previous 16 years; with visit figures from Hôpital Ste-Justine (HSJ); and with those from 3 other pediatric hospitals in provinces west of Quebec for the same period.

RESULTS

We found a 60% increase in injury visits to the MCH ER compared to the baseline week (p < 0.001) and a 66% difference when compared with the 16-year average. HSJ also recorded a sharp increase during the study week but the rise did not persist. Smaller increases were recorded in the more western children's hospitals. At the MCH nearly half of the visits were for head injuries, but there was no change in the number judged to be severe.

CONCLUSIONS

These data suggest that the media coverage of this celebrity death may have generated anxiety among parents, prompting those who might not otherwise have sought medical care to bring their children to the ER.

Research Consortium on Children with Chronic Conditions (RCCCC): a vehicle for interdisciplinary collaborative research

To describe the evolution, accomplishments, and limitations of a research consortium after 25 years of existence. A narrative historical account supplemented by data documenting citations to all group papers. In 1980 the Research Consortium on Children with Chronic Conditions was established. Since then, we have met 2-3 times a year to discuss issues related to research and policies for children with special health care needs. We describe the origin of the Consortium, its operation, and some of its accomplishments, as well as the difficulties it encountered. Our interactions helped promote and sustain research on an emerging topic and did so in an interdisciplinary manner. We include a citation analysis suggesting that group papers published by Consortium members are reasonably well cited by others. We believe our work has been of value in developing influencing research, clinical practice, and policy. This paper is intended to serve as a guide for others who believe that this type of interaction can do much to promote an emerging field. However, it also highlights some of the difficulties in forging and maintaining a productive, research-focused relationship over an extended period of time. The most important lesson learned is that a small group of committed individuals able to meet on a regular basis can accelerate movement in a new field. However, unless stable funding can be secured, maintaining a consortium is truly challenging.

Long term effects of a home visit to prevent childhood injury: three year follow up of a randomized trial

OBJECTIVE

To assess the long term effect of a home safety visit on the rate of home injury.

DESIGN

Telephone survey conducted 36 months after participation in a randomized controlled trial of a home safety intervention. A structured interview assessed participant knowledge, beliefs, or practices around injury prevention and the number of injuries requiring medical attention.

SETTING

Five pediatric teaching hospitals in four Canadian urban centres.

PARTICIPANTS

Children less than 8 years of age presenting to an emergency department with a targeted home injury (fall, scald, burn, poisoning or ingestion, choking, or head injury while riding a bicycle), a non-targeted injury, or a medical illness.

RESULTS

We contacted 774 (66%) of the 1172 original participants. A higher proportion of participants in the intervention group (63%) reported that home visits changed their knowledge, beliefs, or practices around the prevention of home injuries compared with those in the non-intervention group (43%; p<0.001). Over the 36 month follow up period the rate of injury visits to the doctor was significantly less for the intervention group (rate ratio = 0.74; 95% CI 0.63 to 0.87), consistent with the original (12 month) study results (rate ratio = 0.69; 95% CI 0.54 to 0.88). However, the effectiveness of the intervention appears to be diminishing with time (rate ratio for the 12-36 month study interval = 0.80; 95% CI 0.64 to 1.00).

CONCLUSIONS

A home safety visit was able to demonstrate sustained, but modest, effectiveness of an intervention aimed at improving home safety and reducing injury. This study reinforces the need of home safety programs to focus on passive intervention and a simple well defined message.

Quality of information on risk factors reported by ski patrols

OBJECTIVE

To determine the reliability of reporting of information on risk factors from a standard accident report form used by ski patrols and a follow up mail questionnaire or telephone interview among injured skiers and snowboarders.

SETTING

19 ski areas in the Canadian province of Quebec between November 2001 and April 2002.

PARTICIPANTS

4377 injured skiers and snowboarders seen by the ski patrol, who completed a follow up mail questionnaire or telephone interview.

MAIN OUTCOME MEASURES

Kappa and weighted kappa statistics were used to measure the chance corrected agreement for self reported ability, age, skiing time on day of injury, lessons, type of practice, use of helmet at time of injury, and hill difficulty.

RESULTS

The kappa value for helmet use at the time of injury was 0.88 (95% confidence interval 0.87 to 0.90) and for other risk factors ranged from 0.45 (skiing time on day of injury) to 0.98 (age). Few differences were seen in reporting by body region of injury. Reporting consistency was lower for respondents who completed telephone interviews compared with those who completed mail questionnaires and those who responded more than four months after the injury.

CONCLUSIONS

Moderate to almost perfect agreement, depending on the risk factor, exists between ski patrols' accident report forms and follow up information. Ski patrol reports can be a reliable and readily available source of information on risk factors for skiing and snowboarding.

The effectiveness of a home visit to prevent childhood injury

OBJECTIVE

To examine the effectiveness of a home visit program to improve home safety and decrease the frequency of injury in children. We examined the effects of the program on 1) parental injury awareness and knowledge; 2) the extent that families used home safety measures; 3) the rate of injury; and 4) the cost effectiveness of the intervention.

DESIGN

A randomized, controlled trial.

SETTING

A multicenter trial conducted at 5 hospitals in 4 Canadian urban centers.

PARTICIPANTS

Children <8 years old, initially enrolled in an injury case-control study, were eligible to participate. Intervention. Subsequent to a home inspection conducted to determine baseline hazard rates for both groups, participants in the intervention group received a single home visit that included the provision of an information package, discount coupons, and specific instruction regarding home safety measures.

MAIN RESULTS

The median age was 2 years, with males comprising ~60% of participants. The experimental groups were comparable at outset in terms of case-control status, age, gender, and socioeconomic status. Parental injury awareness and knowledge was high; 73% correctly identified injury as the leading cause of death in children, and an intervention effect was not demonstrated. The adjusted odds ratios (ORs) for the home inspection items indicated that significant safety modifications only occurred in the number of homes having hot water not exceeding 54 degrees C (OR: 1.31, 95% confidence interval [CI]: 1.14, 1.50) or the presence of a smoke detector (OR: 1.45, 95% CI: 0.94, 2.22). However, the intervention group reported home safety modifications of 62% at 4 months and significantly less injury visits to the doctor compared with the nonintervention group (rate ratio: 0.75; 95% CI: 0.58, 0.96). The total costs of care for injuries were significantly lower in the intervention group compared with the nonintervention group with a cost of $372 per injury prevented.

CONCLUSIONS

An intervention using a single home visit to improve the extent to which families use safety measures was found to be insufficient to influence the long-term adoption of home safety measures, but was effective to decrease the overall occurrence of injuries. Future programs should target a few, well-focused, evidence-based areas including the evaluation of high-risk groups and the effect of repeated visits on outcome.

Effectiveness of a head injury program for children: a preliminary investigation

OBJECTIVE

The purpose of this study was to investigate whether a more coordinated, comprehensive head injury rehabilitation program provided at a children's trauma center yielded better outcomes than a less coordinated, less comprehensive program.

DESIGN

Using a quasi-experimental design, 64 children with head injury admitted to the center and who received rehabilitation services in either 1995 or 1993 were evaluated by using the Functional Independence Measure for children (WeeFIM)/The Functional Independence Measure (FIM) (e.g., primary outcome measure). Secondary outcomes included "psychosocial adjustment," "return to regular school," and "current problems related to the head injury."

RESULTS

No statistically significant differences were found between the groups with respect to mean WeeFIM/FIM scores after controlling for age and injury severity. The 1993 group had poorer scores on the withdrawal subscale of the psychosocial measure (P = 0.02), yet a smaller proportion of these children were enrolled in a special education class (P = 0.02).

CONCLUSIONS

This study serves as a model for a larger, definitive study of the effectiveness of rehabilitation for children with head injury. The trends suggest that more comprehensive care may lead to better outcomes.