2018-19 TOW #48: Injury prevention

Next up in TOW-land is reviewing injury prevention, a timely topic for summer months, which are known as “trauma season” to all those at Harborview. Please offer appreciation to your colleagues taking care of injured children this summer at HMC. We also offer gratitude to our injury prevention experts including Drs. Beth Ebel, Brian Johnston, and Fred Rivara, who dedicate their time to making kids safer across our nation/globe.

Materials for review:

Take-homes points:

  1. How big a problem are childhood injuries? About 1 in 4 children has an unintentional injury that requires medical care each year. Injury is the leading cause of death among children and adolescents > 1yr in the US. Injuries cause 42% of deaths in children ages 1-4 and 65% of deaths ages 4-18.  Injury peaks during the toddler years (ages 1 to 4) and again during adolescence and young adulthood (ages 15 to 24). The problem is even more profound in developing countries.
  2. Have childhood injury rates changed over time? Thankfully, injury rates have decreased due to multiple public health and health care efforts. Between 2000 to 2009, the unintentional injury death rate for US children <19 declined by 29%. This is attributed to seat belts and carseats, reduced drunk driving, increased use of child-resistant packaging, as well as better awareness and improved medical care. The highest deaths remain due to motor vehicle accidents, drownings, and firearms, so we cover those more in-depth in other topics.
  3. How do we best prevent Injuries? Mace and colleagues describe the “four E’s of injury prevention”-education, engineering (modifying environmental or product design), enforcement (mandating appropriate laws), and economics (creating financial incentives and disincentives). In general passive interventions that don’t require someone to act (like air bags, road design) work better than active ones that require users to choose them (like seatbelts, helmets), and certainly better than education alone (as Kat Bonsmith recently reviewed for us in her informative RCP on baby-proofing).
  4. What’s the pediatrician’s role in education (and advocacy)? In the primary care setting, education is the main way we provide anticipatory guidance, and the AAP recommends every well-child visit include age-appropriate injury prevention counseling. However, only approximately 50% of pediatric residents and practitioners provide injury prevention counseling at well-child visits. We have to be strategic because we can’t cover every topic every time. Bright Futures helps guide which injury prevention topics to cover at each age. Extending our role to advocacy addresses the even more important “E’s” that produce system improvements to protect thousands of children.
  5. Are there “teachable moments” after an injury? Due to the lack of data, there is some controversy that the “teachable moment” has an added effect after an injury, but its reasonable to ensure people have the information and tools they need to prevent future injuries. At Harborview, the peds team distributes injury-specific information and resources as often as possible, such as bicycle safety and helmets after an unhelmeted bicycle injury, a new carseat after an MVA, or window guards after a fall.

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