Unintentional home injury in preschool-aged children: looking for the key—an exploration of the inter-relationship and relative importance of potential risk factors
Introduction
Injury is the leading cause of morbidity and mortality in children aged 1–14 years,1 with home accidents a particular problem in the preschool-age group. Accidents account for significant health service utilization,2 presenting an enormous social and economic burden.3 It has been estimated that one in every five children will attend an accident and emergency (A&E) department in any year with an injury.4 Injury prevention thus deserves greater priority from those responsible for improving child health. Recent government policy documents have re-instated the need for both general action to improve the health of our children, and accident prevention in particular as national priorities.5., 6.
There is increasing pressure on healthcare workers' skills and time, with demands for improved efficiency and evidence-based practice to maximize health gain. To this end, formalizing a method for identification of children at increased risk of home injury would be useful to facilitate targeted prevention activity.7 This information would be of particular value to health visitors, who can bridge the gap between researchers and families, both for the purposes of gathering study data and for subsequent implementation of recommendations.
Previous studies have identified a wide range of factors which appear to be associated with increased childhood injury risk, including socio-economic status, family type, previous injury, stress and home physical hazards.8., 9., 10., 11., 12., 13., 14., 15., 16., 17., 18., 19., 20. These studies considered discrete aspects of injury risk, but we could not find studies addressing their interaction, relative importance or whether a key explanatory factor exists. Children live in family units of disparate nature, and it would seem likely that the physical, social and psychological environment in which they exist are intertwined, influencing injury risk to varying degrees. Our study therefore, simultaneously considered a wide range of aspects of the child and their family in an attempt to untangle the complex inter-relationships and identify the most significant risks.
Section snippets
Design and data collection
A prospective case–control study carried out over a 1-year period during 1998–1999.
Study population
Cases were 0–4-year-old children resident in East and Midlothian who presented to the A&E Department, Royal Hospital for Sick Children, Edinburgh with one of four injury categories (falls over 1 m; poisonings; burns/scalds; fingertip injuries) as a result of an accident occurring at home. Two controls, who had not attended A&E in the past 6 months, were identified for each case using the Scottish Immunization
Results
A total of 264 eligible children were enrolled in the study of which 207 responded, giving a response rate of 78.4%. There were no statistically significant differences between responders and non-responders in terms of gender, age, deprivation category of residence26., 27. or injury type. Among the responders, cases (n=79) and controls (n=128) were well matched for gender, mean age and deprivation category, with no statistical differences in any of these variables.
Discussion
The 78% response rate was high, given the questionnaire length and the sensitivity of some questions. In general, the attitude towards the study amongst both health visitors and parents was very positive, reflecting the importance of the issue to these people.
Some of the significant results in this study may have occurred by chance as a result of multiple testing, but we believe that most are genuine findings that deserve comment and explanation. This applies especially to those that remain
Conclusions
Our study uncovered few significant differences between the families of children who had and had not attended the A&E department due to a home injury. Our main findings were that the main carer's educational attainment and socket cover utilization were lower in case families.
Acknowledging the time and resource constraints health visitors face, enquiry about these two risk factors could facilitate identification of families with most potential for gain from targeted input. In line with previous
Key messages
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The main carers of cases had a lower educational attainment.
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Case households used socket covers less often.
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Control carers dealt with more injuries by themselves.
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These risk factors could be used to target injury-prevention activity, including first-aid training.
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Initiatives to improve the educational status of the general population could reduce childhood injuries.
Acknowledgements
The authors would like to thank the parents, health visitors, A&E nursing staff and SIRS staff for their invaluable contributions to the study. Thanks also to Peter Heron, Lecturer in Psychology, Napier University for his advice on measurement of life events and to Dr D. Ruta, Department of Epidemiology and Public Health, University of Dundee for his help with the SF-12 health survey instrument. The research was funded by a mini-project grant from the Chief Scientist Office, Scottish Office
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