Structured Abstract
Please note: In 2003, the CTF updated its Grades of
Recommendations to include an "I Recommendation" for situations where
insufficient evidence exists to allow a recommendation to be made.
(Formerly, these situations were captured under a "C
Recommendation".) This change is not retroactive, and all
"C Recommendations" made prior to 2003 have not been
reevaluated in light of the new "I" recommendation grade. For a
discussion of these recommendation grades, please link to the 2003 article in
the Canadian Medical Association Journal here.
Prevention of Household and Recreational Injuries in Children (<15 years
of age)
Prepared by R. Wayne Elford, MD, CCFP, FCFP, Department of Family Medicine,
University of Calgary
These recommendations were finalized by the Task Force in November
1992
Contents
Objective
To make recommendations for the prevention of household and recreational
injuries of Canadian children < 15 years of age. This is an update of
the 1979 Canadian Task Force recommendations.
Burden
of Suffering
For Canadians aged 1 to 24, intentional and unintentional injury accounts
for 63% of all deaths. The leading cause of death in Canadian children
is motor vehicle accidents, followed by drowning, burns, choking and falls.
For every fatal childhood injury, another 45 injuries will require hospital
treatment; about 1,300 more will require a visit to an emergency department
and an unknown number will result in a visit to a physician or clinic.
Some of the more common causes of injury include falls (there were 2,100
deaths due to falls 1981), drowning (429 Canadians drowned in 1987), burns,
scalds and fire-related deaths (accounting for 402 deaths among Canadians
in 1988), poisoning, (resulting in 424 fatal poisonings in Canada in 1987,
2 were under age 15), suffocation (accounting for 415 Canadian deaths in
1987, 36% were under age 15), bicycle and other sports-related injuries
(there were 139 fatal bicycle injuries in Canada in 1987), and fire-arm
related (resulting in 60 deaths in Canada in 1988).
Options
Interventions involve public health education, legislation, and individual
counselling.
Outcomes
Mortality and related morbidity.
Evidence
MEDLINE was searched from 1981 to November 1991 using the term accidents
with the subheadings diagnosis, economics, epidemiology, legislation and jurisprudence, mortality, prevention and control, standards, and trends;
aviation, occupational, and traffic accidents were excluded. Contact was
also made with other resource centres and reports.
Recommendations were graded as:
|
A
|
Good evidence to support the recommendation that the condition
be specifically considered in a PHE. |
|
B
|
Fair evidence to support the recommendation that the condition
be specifically considered in a PHE. |
|
C
|
Poor evidence regarding inclusion or exclusion of the condition
in a PHE, but recommendations may be made on other grounds. |
|
D
|
Fair evidence to support the recommendation that the condition
be specifically excluded from consideration in a PHE. |
|
E
|
Good evidence to support the recommendation that the condition
be specifically excluded from consideration in a PHE. |
Quality of evidence was rated according to 5 levels:
|
I
|
Evidence from at least 1 properly randomized controlled
trial (RCT). |
|
II-1
|
Evidence from well-designed controlled trials without randomization. |
|
II-2
|
Evidence from well-designed cohort or case-control analytic
studies, preferably from more than 1 centre or research group. |
|
II-3
|
Evidence from comparisons between times or places with
or without the intervention. Dramatic results in uncontrolled experiments
could also be included here. |
|
III
|
Opinions of respected authorities, based on clinical experience,
descriptive studies or reports of expert committees. |
Values
The 13-member Task Force of experts in family medicine, geriatric medicine,
pediatrics, psychiatry and epidemiology used an evidence-based method for
evaluating the effectiveness of preventive health care interventions. Recommendations
were not based on cost-effectiveness of options. Patient preferences were
not discussed.
Background papers providing critical appraisal of the evidence and tentative
recommendations prepared by the chapter author were pre-circulated to the
members. Evidence for this topic was presented and deliberated upon in
1- to 2-day meetings, 2 to 3 times per year from January 1993 to June 1993.
Consensus was reached on final recommendations.
Benefits,
Harms, and Costs
The incidences of falls and related accidents have been shown in descriptive
studies to be reduced up to 96% by use of legislation for window guards,
safety features such as car restraints, and stair guards. Counselling of
parents about safety features in the home has not been shown to be effective.
Before and after studies have been shown to reduce drowning and pool
submersions by the use of legislation (fencing and self-closing gates).
Expert opinion supports swimming lessons to reduce drowning. A cohort study
has shown the association between drowning and young children being left
alone in the bathtub.
Before and after studies have show reduced incidence of burns after
legislation on smoke detectors, noninflammable sleepwear, and hot water
temperature regulation. An RCT supports the use of lower hot water heater
temperature to reduce related injuries.
Before after studies have show a reduction in poisoning after legislation
on child-proof medicine containers. Education, although useful for increasing
the number of families who have and understand the use of ipecac for poisoning,
has generally failed to decrease the incidence of poisoning.
Bicycle helmet use is associated with a decrease in the severity of
head injuries. This is discussed in a separate guideline.
Recommendations
Recommendation grade [A, B, C, D, E] and level of evidence
[I, II-1, II-2, II-3, III] are indicated after each recommendation. Citations
in support of individual recommendations are identified in the guideline
text.
-
There is fair evidence to implement legislation for the use of window and
stairway guards [B, II-2].
-
There is fair evidence to include individual counselling on window and
stairway guards in the PHE of parents with young children [B,II-2].
-
There is fair evidence to implement public health education and legislation
to require swimming pools to conform to safety standards to reduce drowning
[B, II-2].
-
There is insufficient evidence to include or exclude individual counselling
on the teaching of water safety in the PHE of parents with young children
[C, III].
-
There is fair evidence to include public health education on the dangers
of leaving young children (< 36 months of age) alone in the bathtub
[B, II-2].
-
There is insufficient evidence to include or exclude individual counselling
on the dangers of leaving young children (< 36 months of age) alone
in the bathtub [C, III].
-
There is fair evidence to implement public health legislation on the use
of safety devices (smoke detectors, nonflammable sleepwear, and hot water
thermometers) [B, II-1].
-
There is fair evidence to include individual counselling on the use of
safety devices in the PHE of parents with young children [B,
I].
-
There is good evidence to implement public health education and legislation
on the use of ipecac and Regional Poison Centre Awareness programs [A,
I].
-
There is fair evidence to include individual counselling on the use of
ipecac and Regional Poison Centre Awareness programs in the PHE of parents
with young children [B,
I].
-
There is fair evidence to implement public health education and legislation
for the use of helmets when riding bicycles [B,
II-2].
-
There is insufficient evidence to include individual counselling on the
use of helmets when riding bicycles in the PHE of parents with young children
[C, I].
Validation
This report was externally peer reviewed. The 1989 U.S. Preventive
Services Task Force recommended counselling for parents regarding household
and environmental injuries. The American Academy of Pediatrics recommend
physicians counsel on the use of car restraints, smoke detectors, how water
temperature regulation, window and stairway guards, and the use of ipecac.
Sponsors
The Canadian Task Force on Preventive Health Care
developed this guideline with funding from Health Canada.
Selected
References
Source Document
Link to Full Text of this
review
Link to Summary Table of Recommendations of this review
Link to Selected References list of this review
Link to 1994 chapter: Prevention
of Household and Recreational Injuries in Adults
Link to 1994 chapter: Prevention
of Household and Recreational Injuries in the Elderly
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