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

Identifying Health-Related Social and Unintentional Injury Risks Among Patients Presenting to a Pediatric Urgent Care

OBJECTIVE

Many families seek medical care at pediatric urgent care centers. The objective of this study was to determine social and unintentional injury risks reported by these families.

METHODS

This cross-sectional study surveyed a convenience sample of guardians of patients 1 to 5 years of age presenting to our pediatric urgent care, 9/10/21 to 2/25/22. Outcomes were the number of reported social and unintentional injury risks. Predictors and covariates included child and parent demographic characteristics and a neighborhood socioeconomic deprivation index. Chi-square, Student's t test, Pearson's correlation tests, and multinominal regression were used.

RESULTS

A total of 273 guardians (and children) were included; 245 of guardians (89.7%) were female; 137 (50.2%) of included children identified as Black. Approximately 60% reported ≥1 social risk; 31.5% reported ≥3. Approximately 90% reported ≥1 unintentional injury risk; 57.9% reported ≥3. There were significant associations between social risk presence and Black race, public/no insurance, and neighborhood deprivation (all P < .05). There were no significant associations between unintentional injury risks and assessed predictors. Black guardians were more likely than those of other races to report a greater number of social risks (adjusted odds ratio [AOR] 2.90, 95% confidence interval [CI] 1.50, 5.58 for ≥3 vs 0 risk). Children with public/no insurance compared to private insurance were more likely to experience a greater number of social risks (AOR 3.34, 95% CI 1.42, 7.84 for ≥3 vs 0 risks).

CONCLUSIONS

Many presenting to pediatric urgent cares experience social and unintentional injury risks. Risk identification may guide equitable responses.

Emergent Mental Health Visits to a Pediatric Hospital: Impact on Firearm Storage Practices

OBJECTIVE

The aims of this study were to describe firearm storage practices in homes of patients evaluated for mental health (MH) complaints at a tertiary care children's hospital and to describe storage practice changes after treatment.

METHODS

We surveyed families of children with MH complaints presenting to the emergency department or psychiatry unit who stored firearms in their homes between February 12, 2016, and January 14, 2017. Patients and families received standard care, including routine counseling on limiting access to methods of suicide. Participants completed surveys at baseline, 7, and 30 days after discharge. The primary outcome was triple safe firearm storage-storage of firearms unloaded, locked, and with ammunition stored and locked separately.

RESULTS

Ninety-one household members of MH patients who stated they had firearms were enrolled at baseline. Seventy-seven (85%) completed at least 1 follow-up survey, and 63 (69%) completed both. At baseline, 21% (19/91) of participants reported engaging in triple safe firearm storage, 26% had an unlocked firearm, 23% had a loaded firearm, and 65% stored ammunition either unlocked or with their firearm. Triple safe storage rates increased to 31% at both 7 days and 30 days. Ten (17%) of 59 (P < 0.01) participants who did not report triple safe storage at baseline and completed a follow-up survey changed to reporting triple safe storage on follow-up.

CONCLUSIONS

The majority of firearm-storing family members of children with MH complaints do not follow triple safe storage practices. Storage practices modestly improved after an emergent MH visit, but over two thirds of participants reported unsecured or partially secured firearms 7 and 30 days later.

Pediatric Health Care Provider Perspectives on Injury Prevention Counseling in Acute and Primary Care Settings

The objective of this study was to characterize how pediatric primary care and emergency medicine health care providers and trainees engage in injury prevention counseling and assess perceptions toward injury prevention resources. We surveyed physicians, advanced practice providers, and trainees in the Emergency Department, Primary Care Network, and Pediatric Residency Program at Children's Hospital of Philadelphia from September to November 2019. Of the 578 eligible participants, 208 (36.0%) completed the survey. When asked to rank the suitability of alternative personnel for providing counseling, 63.0% of the participants selected an injury prevention specialist as best suited. Seventy-six percent of the providers considered a tablet or mobile device used before a patient encounter to be a helpful resource. Variability existed in provider comfort, knowledge, and frequency of counseling by injury topic. Free-text responses cited time as a barrier to counseling. Opportunities exist to improve the provision of injury education through the utilization of novel resources and personnel.

Injury Prevention Education in the Waiting Room of an Underserved Pediatric Primary Care Clinic

Unintentional injuries are the leading cause of childhood mortality in the United States. Study aims included educating families about injury prevention and improving satisfaction with the waiting room experience. Two hundred caregivers with young children in the waiting room of an underserved pediatric primary care clinic participated in brief individual education sessions and received a toolkit containing small safety items and content highlighting age-appropriate safety topics. Participants completed 2 follow-up surveys, and most caregivers (94%) reported learning new information about injury prevention and thought that the intervention resulted in a better waiting room experience (91%). Of those who completed the 2-week follow-up survey (84%), 93.5% made changes at home and 42.7% bought new safety equipment. Injury prevention education can be effectively provided in the waiting room of a pediatric primary care clinic by improving reported caregiver safety knowledge and behaviors as well as satisfaction with the waiting room experience.

Evaluating a smartphone application to improve child passenger safety and fire safety knowledge and behaviour

BACKGROUND

Although proven measures for reducing injury due to motor vehicle collision and residential fires exist, the number of families properly and consistently using child passenger restraints and smoke alarms remains low. This paper describes the design of the Safety In Seconds (SIS) 2.0 study, which aims to evaluate the impact of a smartphone app on parents' use of child restraints and smoke alarms.

METHODS

SIS is a multisite randomised controlled trial. Participants are parents of children aged 4-7 years who are visiting the Pediatric Emergency Department or Pediatric Trauma Service. Parents are randomised to receive tailored education about child passenger safety or about fire safety via the SIS smartphone app. A baseline and two follow-up surveys at 3 months and 6 months are conducted. Primary outcomes are: (1) having the correct child restraint for the child's age and size; (2) restraining the child in the back seat of the car; (3) buckling the child up for every ride; (4) having the restraint inspected by a child passenger safety technician; (5) having a working smoke alarm on every level of the home; (6) having hard-wired or lithium battery smoke alarms; (7) having and (8) practising a fire escape plan.

DISCUSSION

Finding ways to communicate with parents about child passenger and fire safety continues to be a research priority. This study will contribute to the evidence about how to promote benefits of proper and consistent child restraint and smoke alarm use.

TRIAL REGISTRATION NUMBER

NCT02345941; Pre-results.

A comprehensive approach to pediatric injury prevention in the emergency department

Injury is the leading cause of pediatric mortality and long-term disability. Although the primary care setting has traditionally been considered as the main venue to address injury anticipatory guidance, an emergency department (ED) visit may serve as a "teachable moment" because most injured children are cared for in this setting and the experience may elicit a greater chance of behavior change. However, EDs can also provide additional information and services beyond counseling to prevent injuries. These adjunct efforts and activities focus on primary injury prevention (screening for and promoting safe behaviors and collecting data to survey high-risk community locations), secondary prevention (use of safety products to mitigate injury), and tertiary prevention (maximizing injury care and minimizing injury sequelae). This review will describe several ways an ED can help to mitigate the epidemic of pediatric injuries through surveillance, screening, education, product disbursement, community engagement, and quality improvement efforts.

An evaluation of a dog bite prevention intervention in the pediatric emergency department

BACKGROUND

This study aimed to determine the efficacy of a video-based dog bite prevention intervention at increasing child knowledge and describe any associated factors and to assess the acceptability of providing this intervention in a pediatric emergency department (PED).

METHODS

This cross-sectional, quasi-experimental study enrolled a convenience sample of 5-year-old to 9-year-old patients and their parents, presenting to a PED with nonurgent complaints or dog bites. Children completed a 14-point simulated scenario test used to measure knowledge about safe dog interactions before and after a video intervention. Based on previous research, a passing score (≥ 11/14) was defined a priori. Parents completed surveys regarding sociodemographics, dog-related experiential history, and the intervention.

RESULTS

There were 120 child-parent pairs. Mean (SD) child age was 7 (1) years, and 55% were male. Of the parents, 70% were white, two thirds had higher than high school education, and half had incomes less than $40,000. Current dog ownership was 77%; only 6% of children had received previous dog bite prevention education. Test pass rate was 58% before the intervention and 90% after the intervention. Knowledge score increased in 83% of children; greatest increases were in questions involving stray dogs or dogs that were fenced or eating. Younger child age was the only predictor of failing the posttest (p < 0.001). Nearly all parents found the intervention informative; 93% supported providing the intervention in the PED.

CONCLUSION

Child knowledge of dog bite prevention is poor. The video-based intervention we tested seems efficacious at increasing short-term knowledge in 5-year-old to 9-year-old children and is acceptable to parents. Parents strongly supported providing this education.

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.

Changes in eye protection behavior following an occupational eye injury

This study investigated whether workers modify eye protection behavior following an occupational eye injury. Workers treated for work-related eye injuries were questioned regarding the use of protective eyewear for the work-month prior to their eye injuries and again 6 to 12 months later. Workers reported an increase in the proportion of work-time they used eye protection (from a median of 20% to 100%; p < .0001). The effect appeared to be driven by whether eye protection was used at the time of the injury. Most respondents (66%) indicated they were more likely to use eye protection since their injuries. Workers not using eye protection at the time of injury were more likely to use eye protection in the future. A variety of employer and employee factors may influence this change. Although many workers' behaviors changed, health care providers should embrace the teachable moment when treating occupational eye injuries to encourage continued use or more appropriate forms of eye protection.

Changes in eye protection behavior following an occupational eye injury

This study investigated whether workers modify eye protection behavior following an occupational eye injury. Workers treated for work-related eye injuries were questioned regarding the use of protective eyewear for the work-month prior to their eye injuries and again 6 to 12 months later. Workers reported an increase in the proportion of work-time they used eye protection (from a median of 20% to 100%; p < .0001). The effect appeared to be driven by whether eye protection was used at the time of the injury. Most respondents (66%) indicated they were more likely to use eye protection since their injuries. Workers not using eye protection at the time of injury were more likely to use eye protection in the future. A variety of employer and employee factors may influence this change. Although many workers' behaviors changed, health care providers should embrace the teachable moment when treating occupational eye injuries to encourage continued use or more appropriate forms of eye protection.

Dog bite prevention: an assessment of child knowledge

OBJECTIVES

To determine what children know about preventing dog bites and to identify parental desires for dog bite prevention education.

STUDY DESIGN

This cross-sectional study sampled 5- to 15-year-olds and their parents/guardians presenting to a pediatric emergency department with nonurgent complaints or dog bites. The parent/guardian-child pairs completed surveys and knowledge-based simulated scenario tests developed on the basis of American Academy of Pediatrics and Centers for Disease Control and Prevention dog bite prevention recommendations. Regression analyses modeled knowledge test scores and probability of passing; a passing score was ≥11 of 14 questions.

RESULTS

Of 300 parent/guardian-child pairs, 43% of children failed the knowledge test. Older children had higher odds of passing the knowledge test than younger children, as did children with white parents vs those with nonwhite parents. No associations were found between knowledge scores and other sociodemographic or experiential factors. More than 70% of children had never received dog bite prevention education, although 88% of parents desired it.

CONCLUSIONS

Dog bites are preventable injures that disproportionately affect children. Dog bite prevention knowledge in our sample was poor, particularly among younger children and children with nonwhite parents. Formal dog bite prevention education is warranted and welcomed by a majority of parents.

Unintentional injury among low-income 5-year-olds with chronic health conditions

BACKGROUND

Growing numbers of children suffer from chronic health conditions, and initial evidence suggests chronic illness may be associated with increased child injury risk. We examined injury risk among 5-year-olds with and without chronic health conditions.

METHODS

Data from a diverse US sample of 7954 low-income 5-year-olds participating in the National Head Start/Public School Early Childhood Transition Demonstration Study were analysed. Mothers reported demographics, presence/absence of eight chronic health conditions, and whether children had experienced injuries requiring professional medical attention in the past year. Primary analyses used ordinal logistic regression.

RESULTS

Asthma, bronchitis, recurrent ear infections, hay fever/allergies and speech problems associated with increased injury risk (OR range = 1.20-1.49 in bivariate ordinal logistic regression, ps < 0.01). Children with cerebral palsy had reduced injury risk (OR = 0.37, 95% CI = 0.15-0.91, p < 0.05). Most findings held after including demographic covariates in multivariate models.

CONCLUSION

Because a range of chronic health conditions associated with increased injury risk, the causal mechanism behind relations between chronic illness and injury risk may not be disease-specific. Instead, factors related to having chronic medical conditions-not any particular condition-might contribute. Possible mediators include impaired family functioning, impaired peer relations, and familiarity with the health system/health-seeking behaviours.

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.

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.