Injury prevention: is the pediatric emergency department the appropriate place?

Safe at home: prevention of pediatric unintentional injuries

BACKGROUND

Unintentional injuries are the leading cause of death in children in the United States. Studies have shown that parent adherence to safety guidelines is improved when education is provided in conjunction with safety equipment.

METHODS

This study surveyed parents about specific injury prevention behaviors regarding medication and firearm storage and provided education and safety equipment for safe practice of these behaviors. The project took place in a pediatric emergency department (PED) and partnered with the hospital foundation and the school of medicine. Inclusion criteria were families visiting a freestanding PED in a tertiary care center. Participants completed a survey conducted by a medical student approximately 5 min in length. The student then provided each family with a medication lock box (if children ≤ 5 years old lived in the home), firearm cable lock, and education for safe storage of medications and firearms in the home.

RESULTS

The medical student researcher spent a total of 20 h in the PED from June to August 2021. 106 families were approached to participate in the study, of which 99 agreed to participate (93.4%). A total of 199 children were reached with ages ranging from less than 1 year old to 18 years old. A total of 73 medication lockboxes and 95 firearm locks were distributed. The majority (79.8%) of survey participants were the mother of the patient and 97.0% of participants lived with the patient > 50% of the time. For medication storage, 12.1% of families store medications locked and 71.7% reported never receiving medication storage education from a healthcare professional. Regarding firearms, 65.2% of participants who reported having at least 1 firearm in the home stored firearms locked and unloaded with various methods of storage. 77.8% of firearm owners reported storing ammunition in a separate location from the firearm. Of all participants surveyed, 82.8% reported never receiving firearm storage education from a healthcare professional.

CONCLUSIONS

The pediatric ED is an excellent setting for injury prevention and education. Many families are not storing medications and firearms safely, demonstrating a clear opportunity to increase knowledge in families with young children.

A Comprehensive Report on All-Terrain Vehicles and Youth: Continuing Challenges for Injury Prevention

All-terrain vehicles (ATVs) represent a serious and ongoing public health and safety concern for children and adolescents. Survey studies indicate that high proportions of youth ride ATVs in both rural and nonrural populations. The significant human and economic costs of pediatric ATV-related deaths and injuries result from a number of major risk factors that are highly common in pediatric ATV crashes: operating adult-size vehicles, riding with or as passengers, lack of protective equipment, and riding on public roads. Other less well-studied but potentially significant risk factors are speed, riding at night, alcohol use among older teenagers, and lack of training and supervision. Although potentially safer than adult ATVs, youth models present a number of safety concerns that have not been addressed with rigorous study. The most common ATV crash mechanism is a noncollision event-for example, a rollover. Common injury mechanisms include ejection from the vehicle, resulting in extremity and head injuries, and being pinned or crushed by the vehicle with resulting multiorgan trauma and/or compression asphyxia. Traumatic brain injury and multisystem trauma are the 2 most common causes of death and disabling injury. Taken together, a large multidecade body of evidence is the basis for the American Academy of Pediatrics policy statement recommendation that no child younger than 16 years of age ride on an ATV. Because children continue to be allowed to ride these vehicles, however, efforts to prevent pediatric ATV-related deaths and injuries require multipronged strategies, including education of both youth and parents, safety-based engineering, and enforcement of evidence-based safety laws.

Self-Reported Usage of Safety Equipment Provided Through a Community Partnership Approach to Injury Prevention in the Pediatric Emergency Department

OBJECTIVES

Previous studies have shown that educational programs in conjunction with provision of free or low-cost safety equipment increases the likelihood of parents changing behaviors at home. This project surveyed caregivers in the pediatric emergency department (ED) about safety behaviors before and after provision of education and safety equipment related to medication storage, firearm storage, and drowning.

METHODS

A convenience sample of families presenting to the ED for any complaint with a child of any age were approached for participation in this feasibility study. Exclusion criteria included patients presenting for a high acuity problem (Emergency Severity Index 1 or 2) and non-English-speaking caregivers. Enrollment, surveys, and educational intervention were performed by the graduate student investigator from the School of Public Health. Participants were surveyed regarding presence of firearms and medications within the home and their storage practices. Additional questions included relationship to the patient, number and age of children younger than 18 years in the home, and zip code of residence. Educational handouts were reviewed, and participants were provided with a medication lock box, trigger lock, toilet lock, and/or pool watcher tag as indicated by answers given to the survey questions. Process measures were collected for number of products given out, number of children potentially affected by the intervention, and time spent by the investigator. Follow-up calls assessed use of the products provided.

RESULTS

The student investigator spent a total of 180 hours and enrolled 357 caregivers accounting for 843 children. Fifty-seven percent of the participants answered the follow-up phone call. Only 9% initially reported that they stored medications in a locked or latched place. Medication lock boxes were given to 316 participants. On follow-up, 88% of those who received a lock box reported using it to store medications and 86% reported satisfaction with the lock box and how it worked. Of the 161 participants who admitted to gun ownership, 45% reported storing their guns locked and unloaded. Of those who reported unsafe manners of gun storage, 96% also reported unsafe manners of medication storage. Although only 161 participants endorsed gun ownership, 236 participants took a gun lock when offered. At follow-up, 66% of participants had used the gun lock and 67% of participants who took the gun lock reported satisfaction with the device. For water safety, 195 toilet latches and 275 drowning prevention lanyards were provided. On follow-up, 48% of those who had received a toilet latch were using it and 62% reported satisfaction with the device. Data were not collected on use of or satisfaction with the drowning prevention lanyards.

CONCLUSIONS

Families often report unsafe home storage of medications and firearms, which together account for a large amount of morbidity and mortality in pediatrics. Drowning risk for young children is ubiquitous in the home setting, and low rates of use of home safety devices indicates need for further education and outreach on making the home environment safe. Despite relying on self-reported behaviors and the risk of reporting bias skewing the data, the behaviors reported in the preintervention survey were still very unsafe, suggesting that children may have a much higher risk of injury in the actual home environments. The ED is traditionally thought of as a place to receive care when injuries happen, but any encounter with families should be seen as an opportunity for injury prevention messaging. Partnering with a local school of public health and other community resources can result in the establishment of a low-cost, consistent, and effective injury prevention program in the pediatric ED that reaches a large number of individuals without the added burden of additional tasks that take time away from already busy ED providers and staff.

Effect of parental supervision of infants at age 4 to 6 months on injuries at age 4 to 12 months

This study analyzed the effect of parental supervision of infants at age 4 to 6 months on injuries at age 4 to 12 months. Among all Korean children born during 2008-2009, 464,326 (50.6%) infant had parents who responded to a questionnaire that surveyed their safety and supervision when infant were 4 to 6 months-old. Based on questionnaire score, infant were divided into "safe" or "unsafe" group. 1:1 propensity score matching was used to balance the groups, and injury diagnosis and treatments were analyzed. After matching, we examined the records of 405,862 infant. The unsafe group had significantly increased risk ratios (RRs) for injury of head/neck (RR: 1.06), trunk/abdominopelvic region (RR: 1.12), upper extremities (RR: 1.04), and from burn and frostbite (RR: 1.10). The risks of a wound and fracture and foreign body injury were significantly greater in infant whose parents sometimes left them alone (RR: 1.15 and 1.06, respectively), and whose parents did not always keep their eyes on them (RR: 1.04 and 1.13, respectively). Infant whose parents had a hot drink when carrying them had an increased risk of burn injuries (RR: 1.21). Injuries were less common in infant whose parents provided more supervision.

Cell Phone and Computer Use Among Parents Visiting an Urban Pediatric Emergency Department

OBJECTIVES

The objectives of this study were to estimate the prevalence of cell phone and computer use among urban families bringing their children to an emergency department and to determine which technologies parents prefer to use to receive health information.

METHODS

We visited 2 pediatric emergency departments in Baltimore, Md, and Little Rock, Ark. A convenience sample of parents of children 8 years old or younger completed a self-administered survey in the waiting area.

RESULTS

Two hundred thirty-eight surveys were completed. Respondents were primarily female (83%), less than 35 years old (74%), and had at least a high school diploma or General Educational Development (94%). Forty-three percent were employed full time. A majority (95%) of respondents reported owning a cell phone, with most (88%) owning a smartphone and 96% reported having some internet access. Of cell phone owners, 91% reported daily text messaging activity. Over half (63%) of respondents reported having computer internet access at home; 31% reported having internet access at work. Patterns of behavior and preferences emerged for both cell phone and computer use. Respondents were more likely to check their email (75% vs 50%, P < 0.0001) and access the internet (78% vs 67%, P = 0.002) with a smartphone rather than their computer.

CONCLUSIONS

Both cell phones and computers are prevalent and used among urban families seen in pediatric emergency departments, offering new ways to deliver health information to these often underserved populations. Providers aiming to deliver health information should consider smartphone applications, text message-based programs, and email to communicate with their patients.

Grill-Related Injuries in Children Treated in US Emergency Departments, 1990-2009

OBJECTIVE

The aim of the study was to describe grill-related injuries in pediatric patients seeking emergency treatment.

METHODS

Data from the National Electronic Injury Surveillance System from 1990 through 2009 were investigated. Sample weights were used to calculate national estimates. United States Census Bureau data were used to calculate injury rates per 100,000 individuals. Linear regression and computation of relative risks (RRs) with 95% confidence intervals (CIs) were performed.

RESULTS

An estimated 308,560 children were treated in US emergency departments for grill-related injuries during the study period, with an average of 15,428 cases per year. The rate of injuries increased by 32.3% during the study period. Males (62.8%) and children aged 11 to 18 years (55.8%) sustained the largest number of injuries. Children younger than 5 years were more likely to injure the head and neck (RR, 1.26 [95% CI, 1.21-1.33]), be injured by impact with a grill (RR, 1.97 [95% CI, 1.88-2.07]), and sustain burns (RR, 1.39 [95% CI, 1.35-1.45]) when compared with other age groups. Children aged 11 to 18 years were more likely to experience a fracture or dislocation (RR, 2.07 [95% CI, 1.58-2.72]) and more likely to sustain a grill-related injury while the grill was not in use (RR, 7.95 [95% CI, 6.25-10.12]).

CONCLUSIONS

The rate of grill-related injuries among children is increasing, which underscores the need for increased prevention efforts. Prevention strategies should address measures such as lighting a grill and grill location in addition to burn prevention.

Self-harm, Assault, and Undetermined Intent Injuries Among Pediatric Emergency Department Visits

OBJECTIVES

Although injuries are a known cause of morbidity and mortality among children and adolescents, little is known about the epidemiology of injury-related emergency department (ED) visits in the United States by injury intent. The objective of this analysis was to examine ED outcomes, defined as death in the ED, inpatient admission, and visit cost, among ED visits stratified by injury intent (i.e., self-harm, assault, and injury with undetermined intent, as compared with unintentional injuries).

METHODS

All injury-related ED visits in the United States for children and adolescents, ages 8 to 17 years, were identified using the 2008 Nationwide Emergency Department Sample. Multivariate survey weighted logistic and linear regression analyses were then used to estimate the likelihood of death on ED visit, inpatient admission, and cost across the 4 injury types.

RESULTS

In 2008, with the use of weighted estimates, there were 66,895 self-harm, 176,125 assault, 24,144 undetermined injury, and 4,244,589 unintentional injury ED visits among children 8 to 17 years. Visits due to self-harm, assault and undetermined injuries were more likely to result in death during the ED visit compared with visits due to unintentional injuries. Self-harm and undetermined intent were also associated with greater odds of inpatient admission as well as 90% and 60% higher ED visit costs, respectively.

CONCLUSIONS

Data from this nationwide sample of pediatric ED visits highlight the resource burden of self-harm, undetermined intent, and assault injury visits. Pediatric EDs may provide a window of opportunity for better case identification and intervention with children experiencing violence and injury.

Throw rug-related injuries treated in US EDs: are children the same as adults?

BACKGROUND

Various characteristics of floors and floor coverings are well established as injury hazards. Loose carpeting, such as rugs, is often cited as a hazard leading to injury.

PURPOSE

To describe the epidemiology and patterns of rug, mat, and runner-related injuries in patients seeking emergency treatment.

METHODS

Data from the National Electronic Injury Surveillance System from 1990 through 2009 were investigated. Sample weights were used to calculate national estimates. US Census Bureau data were used to calculate injury rates per 100 000 individuals. Linear regression and computation of relative risks (RRs) with 95% confidence intervals (CIs) were performed.

RESULTS

An estimated 245 605 patients were treated in US emergency departments for rug-related injuries during the study period, with an average of 12 280 cases per year. Females (72.3%) and individuals older than 64 years (47.1%) sustained the largest number of injuries. Patients younger than 6 years were more likely to injure the head or neck region (RR, 3.52 [95% CI, 3.26-3.81]) compared with all other groups. Patients older than 18 years were more likely to experience a fracture or dislocation (RR, 2.52 [95% CI, 2.13-2.88]) and sustain an injury as a result of tripping or slipping on a rug (RR, 1.36 [95% CI, 1.26-1.41] compared with other age groups. Increasing age was associated with increased risk of hospitalization in this study. Patients who sustained an injury from a rubber or plastic mat/rug were significantly less likely to be admitted (RR, 0.67 [95% CI, 0.55-0.83]). Injuries occurring in kitchens or bathrooms resulted in significantly higher admission rates (RR, 1.45 [95% CI, 1.34-1.54]).

CONCLUSIONS

Rug-related injuries are an important source of injury for individuals of all ages.

Using a safe taxi service to transport newborn babies home from hospital

AIM

To evaluate an intervention to enhance parents' use of car safety seats (CSSs) for their newborn baby's first journey home from the hospital in a population not usually exposed to television, internet and mainstream printed media.

METHODS

Parents of newborn babies who did not bring a CSS to the hospital before their baby was discharged were lent a CSS to use in a 'safe taxi' service. All taxi drivers were trained to install the CSS safely. The intervention was evaluated using preprogramme questionnaires and follow-up interviews 4-8 weeks after discharge.

RESULTS

Twelve parents participated in the intervention during the study period (January to April 2011) and in the evaluation process. Eleven couples were Jewish and one was Muslim. Most (75%) reported that they had not previously used CSS routinely and the reason was not financial. Following the 'safe taxi' intervention, 83% reported the use of CSS when travelling in all vehicles (excluding buses). On follow-up, most participants reported that the intervention increased their awareness and the use of CSS.

CONCLUSION

The intervention, targeted at this specific population, was well received by the parents, increased awareness, changed practices and assured that more newborns travelled home safely in a CSS.

Feasibility and acceptability of a pediatric emergency department alcohol prevention intervention for young adolescents

OBJECTIVE

The objective of this study was to determine feasibility and acceptability of a brief pediatric emergency department (PED) prevention intervention to delay/prevent initiation of alcohol use in 12-to 14-year-olds.

METHODS

Medically stable 12- to 14-year-olds presenting to the PED who were accompanied by a parent and who had not initiated alcohol use were eligible. Adolescent-parent dyads completed a computerized assessment and were randomized to either brief targeted prevention intervention (BPI) or enhanced standard care (ESC). Families randomized to BPI participated in a PED-based motivational interviewing and skill building-based session with a trained counselor. Parents randomized to BPI had telephone boosters at 1 and 3 months. Families randomized to ESC received standard care and adolescent substance use pamphlets. All dyads completed 6-month follow-up assessments to assess alcohol use-related outcomes.

RESULTS

Two hundred twenty-eight families were approached: 122 were eligible and 104 were enrolled (85%). Mean youth age was 13 (SD, 0.83) years, 51% were female, and 90% of parents were females. Of the 104 enrolled, 5 withdrew; 99 (94%) completed the assessment battery in the PED in less than 30 minutes. All BPI dyads completed the counseling session in the PED. However, only 53% of BPI parents completed the booster telephone sessions. Brief targeted prevention intervention acceptability items were rated favorably (82%-100%) by both parents and adolescents. There were no differences between BPI and ESC on substance-related outcomes, although the study was not adequately powered for this purpose because it was designed as a feasibility study.

CONCLUSIONS

A BPI in the PED is both feasible and acceptable, but phone boosters proved less feasible. Larger samples and further study are needed to identify efficacy of the BPI in delaying onset of alcohol use in teens.

Injury prevention: opportunities in the emergency department

Because injury is the leading cause of morbidity and mortality in young patients, emergency departments have a significant opportunity to provide injury-prevention interventions at a teachable moment. The emergency department has the ability to survey injuries in the community, use the hospital setting to screen patients, provide products, offer resources to assist families within this setting to change their risky behaviors, and connect families to community resources. With a thoughtful, collaborative approach, emergency departments are an excellent setting within which to promote injury prevention among patients and families.

Emergency physicians' knowledge and provision of child passenger safety information

OBJECTIVES

While physicians provide discharge instructions to patients and families following emergency department (ED) visits, injury prevention information may not be routinely included in these instructions. This study assessed emergency physicians' knowledge and provision of child passenger safety (CPS) information to patients following motor vehicle crashes (MVCs).

METHODS

This study was both a survey of emergency physician knowledge and provision of CPS information and an examination of frequency of CPS information in discharge instructions at a single institution. Members of the American Academy of Pediatrics (AAP) Section on Emergency Medicine were invited to participate in the survey. Respondents were asked about their provision of CPS information to patients and knowledge of national AAP CPS recommendations. The institutional ED medical record chart review assessed the frequency of written CPS information for patients of MVC-related visits who were discharged home.

RESULTS

There were 317 survey respondents from 1,024 eligible physicians, of whom 43 began but did not complete the survey. The data analyzed are from the 274 who completed the survey. While 85% (95% confidence interval [CI] = 81% to 89%) of physicians believed that CPS information should be included in discharge instructions, only 36% (95% CI = 31% to 42%) correctly answered all knowledge questions. Of the 51 self-identified division/department chiefs, 15 (29.4%; 95% CI = 16.9% to 41.9%) reported that their EDs routinely provide CPS information in discharge instructions for pediatric passengers in MVCs. For the medical record review, of the 152 randomly selected MVC visits, 13 (8.6%; 95% CI = 4.1% to 13.0%) had documented CPS information in the discharge instructions. Patients with documented CPS information were younger, but there were no significant differences in race, sex, or maximum abbreviated injury scale score between patients with versus without CPS information.

CONCLUSIONS

While emergency physicians value the use of CPS information in discharge instructions following MVCs, they do not have adequate knowledge of, nor do they regularly disseminate, this information.

Hazardous use of car seats outside the car in the United States, 2003-2007

PURPOSE

Car seats should be used to prevent injury or death in children during motor vehicle crashes. When used improperly or for unintended purposes, car seats can place children at risk for injury or death. The objective of this article is to describe patterns of hazardous use of car seats outside the car for infants (<1-year-olds) in the United States from 2003 to 2007.

METHODS

The National Electronic Injury Surveillance System of the US Consumer Product Safety Commission database was accessed to obtain information regarding car seat-related injuries treated in emergency departments from 2003 to 2007. Injuries sustained during motor vehicle crashes were excluded. Demographic data, type of injury, body location, disposition, injury circumstances, and other pertinent information were extracted and analyzed.

RESULTS

An estimated 43 562 car seat-related injuries were treated in emergency departments from 2003 to 2007. This national estimate was based on a weighted sample of 1898 infants. The average age of these infants was 4.07 +/- 2.73 months, 62.4% of the injuries occurred in infants younger than 4 months, and 54.4% occurred in boys. Of these injuries, 49.1% occurred at home, 8.4% of the infants had to be hospitalized, and 84.3% of the infants suffered a head injury. The most common mechanisms of injury were infants falling from car seats, car seats falling from elevated surfaces, and car seats overturning on soft surfaces.

CONCLUSIONS

Injury-prevention efforts should be focused on eliminating hazardous use of car seats outside the car. Caregivers should be cautioned against the placement of car seats on elevated or soft surfaces.

Comparison of on-reserve road versus off-reserve road motor vehicle crashes in Saskatchewan, Canada: a case control study

BACKGROUND

There is an overwhelmingly high incidence of severe injuries caused by motor vehicle crashes (MVCs) among Aboriginal Canadians as compared with the general population.

METHODS

The authors obtained MVC data for a 3-year period, 2003-2005, from Saskatchewan Government Insurance (SGI) for collisions occurring on on-reserve roads (n = 1270) together with a randomly selected sample of MVCs from off-reserve roads (n = 1270) in Saskatchewan. They compared the collision characteristics using bivariate and multiple logistic regressions.

RESULTS

On-reserve MVCs were more likely to include multiple collisions and result in severe injuries than the off-reserve sample. A number of factors were significantly related to the increased risk of on-reserve collisions as compared with the reference group for each variable.

INTERPRETATION

Factors from all 3 levels (human, environmental, and vehicle factors) are associated with on-reserve MVCs.

Alcohol-related visits to the emergency department by injured adolescents: a national perspective

PURPOSE

Alcohol use is a risk factor for injury in adolescents. Many injured adolescents require treatment in emergency departments (EDs). The present study was intended to explore this association between adolescent alcohol use and injury-related ED visits using the National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative probability sample of visits to EDs.

METHODS

This was a retrospective, cross-sectional study using data from NHAMCS for 2001 through 2004. ED visits by injured adolescents aged 13-20 years whose visits were determined by NHAMCS coders to be related to alcohol were compared with visits by those whose visits were determined not related to alcohol. Specific variables of interest included demographic and medical characteristics of visits.

RESULTS

Our analyses indicated that there were several visit-related characteristics that were associated with alcohol-related ED visits, including time of visit, type of health insurance, and geographic location of the ED. Similarly, there were a number of patient-related characteristics that were also associated with alcohol-related visits to the ED, including patient acuity and injury intentionality.

CONCLUSIONS

Our findings suggest that injured adolescents are more likely to present to the ED with an alcohol-related visit during the early hours of the morning, that the injury is more likely to be assault related and of higher acuity than non-alcohol-related visits. These findings suggest the ED as a potential site for alcohol prevention interventions with younger adolescents. However, these interventions will need to take into account when such adolescents will present to the ED and will need also to recognize that factors such as violence and aggression, in addition to alcohol use, may be important issues to address in the intervention.

Use of a safety resource center in a pediatric emergency department

OBJECTIVE

To describe the use of a safety resource center (SRC) within a pediatric emergency department (ED) about injury prevention (IP) counseling, sales, costs, and parental responses to the services.

METHODS

The SRC was established in June 2005 in the waiting area of an urban pediatric ED caring for approximately 96,000 patients annually. Safety resource center staff sells products of proven efficacy (eg, car seats, smoke alarms, and bike helmets) and offers safety education materials to patients and families. Activities including sales, educational content provided, types of inquiries from families, and overall satisfaction with the service were logged into a Microsoft Access database. Follow-up phone calls are made to all families 3 weeks after they purchase a product.

RESULTS

Between June 20, 2005 and July 1, 2007, the SRC served approximately 13,000 families. Seven hundred eighty-six families purchased 816 products, generating $14,859. An additional 473 products were given away, totaling 1289 product items provided to families. The most commonly purchased items were car safety seats and bicycle helmets. Roughly 7000 IP-related brochures were distributed to ED families, and 120 car seats were fitted. Of the 786 families who made a purchase, 383 (49%) were reached for follow-up. Ninety-seven percent reported to still be using the purchased product, and 28% made a different change in the home to practice safer behaviors. Ninety-five percent were grateful that the SRC was located in the ED.

CONCLUSIONS

The SRC can provide IP product, encourage families to practice safer behaviors, and is well-received within a large, urban pediatric ED.

Infant injuries from child restraint safety seat misuse at British Columbia Children's Hospital

BACKGROUND

Child restraint safety seats (CRS) are used to prevent injuries or deaths among child passengers involved in a motor vehicle crash. When used outside of a motor vehicle, CRS use could potentially place an infant at risk of injury. The objective of the current study was to describe the proportion of CRS misuse injuries among infants <12 months old and associated factors presenting to the British Columbia (BC) Children's Hospital Emergency Department over 5 years (1997-2002).

METHODS

The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) was the source for the emergency department injury surveillance data used in the present study. BC Children's Hospital is the participating CHIRPP site in British Columbia. A search of individual level patient records was conducted to capture all injuries from CRS misuse taking place during the study period using a predetermined code for 'child car seat-related injuries'. A retrospective analysis of 87 infants <12 months old, who presented at BC Children's Hospital for CRS-related injuries between January 1997 and December 2002 was performed in order to describe the epidemiologic and background factors related to injury occurrence.

RESULTS

Infants aged 0-4 months accounted for approximately 59.7% of cases (52/87). Among all infants, falls were a common mechanism of injury resulting from CRS misuse (98.8%, 86/87). Falls from elevated surfaces (e.g. chairs, tables, counters) were also common among infants presenting to the emergency departments and accounted for 43% of all falls (37/86).

CONCLUSIONS

Injury prevention efforts should be focused on reducing CRS outside the motor vehicle setting and preventing placement of the CRS at an elevated surface. Educating caregivers on the dangers of falls resulting from CRS misuse in a variety of care settings is also recommended.

Injury prevention in the emergency department: a caregiver's perspective

BACKGROUND

Emergency medicine physicians and their staff care for high-risk injured patients, making the emergency department (ED) an appropriate place to discuss injury prevention (IP).

OBJECTIVE

To determine family receptiveness to and short-term effectiveness of IP information delivery during an ED visit.

METHODS

A cross-sectional survey was conducted in an urban pediatric ED. Caregivers of children younger than 15 years, with any chief complaint, were approached to participate. The survey consisted of caregiver's background, IP information received by their primary care pediatrician, and their wishes for receiving IP information in the ED. At survey completion, participants were given an age-appropriate IP handout. Follow-up phone surveys were made at 2 weeks to determine caregiver satisfaction and any self-reported IP changes made.

RESULTS

Two hundred fifty-one caregivers were approached. Two hundred forty-six (98%) were interested in receiving IP information in the ED, and 217 (86%) consented to participate. Ninety-three percent felt that the ED should provide IP information; 83% believed it should be offered even if it prolonged their ED visit. There was no significant difference among participants with regard to who should provide the information or how it should be provided. One hundred thirty (60%) of 217 completed the follow-up survey. Ninety-seven percent felt that the IP information was useful, and 63% kept the handout in a retrievable place. Twenty-eight percent of caregivers who completed the follow-up survey reported to change their safety behavior as a result of their ED encounter.

CONCLUSIONS

Many families surveyed in an urban pediatric ED wished for IP information in the ED setting. A simple IP intervention in an ED setting may encourage families to practice safer behaviors for their children.

Survey of current injury prevention practices by registered nurses in the emergency department

INTRODUCTION

It has been shown that a vast majority of injured patients who seek treatment in emergency departments are seen and released. The events resulting in the individuals seeking treatment may have been preventable and some of the time spent in an emergency department could be used for injury prevention (IP) education. This study sought to determine current IP practices of registered nurses working in an emergency department, to discover whether or not they believed IP was important, and to identify perceived obstacles for incorporating IP education into clinical practice.

METHODS

A convenience sample of 150 registered nurses working in the emergency departments of an adult level 1 trauma centre in Ontario, Canada was used. A descriptive survey composed of 10 questions was used. Data analysis was completed using SPSS Version 11.0.

RESULTS

Findings suggest current IP strategies are varied, and implemented inconsistently. Evidence indicates educating patients about IP is an important part of the emergency nurse role. However, time, education, and resources were recognized obstacles to implementation.

DISCUSSION

A better understanding of registered nurses' current IP practices will guide the development and implementation of a future adult focused injury prevention program for ED patients.