Installation of home safety devices reduces incidence of preventable injury in young children
Article Outline
- Question
- Design
- Setting
- Participants
- Intervention
- Outcomes
- Main Results
- Conclusions
- Commentary
- References
- Copyright
Phelan KJ, Khoury J, Xu Y, Liddy S, Hornung R, Lanphear BP. A randomized controlled trial of home injury hazard reduction: the HOME injury study. Arch Pediatr Adolesc Med 2011;165:339-45.
Question
Does the installation of safety devices in the homes of young children reduce the rate of injuries, compared with provision of handouts alone?
Design
A nested, prospective, randomized controlled trial.
Setting
Households in the Cincinnati, Ohio regional area.
Participants
355 mothers and their children from birth to 3 years old (mean age 6.3 months) participating in the Home Observation and Measures of the Environment study.
Intervention
Installation of multiple passive measures (eg, stair gates, cabinet locks, and smoke detectors) to reduce exposure to injury hazards. Injury hazards were assessed at home visits by teams of trained research assistants using a validated survey. Both intervention and control groups received American Academy of Pediatrics' “The Injury Prevention Program” information sheets on developmentally appropriate injury risks and control measures.
Outcomes
Modifiable and medically attended injury (ie, telephone calls, office visits, and emergency visits for injury).
Main Results
Injury hazards were reduced in the intervention homes but not in the control homes at 1 and 2 years (P < .004). There was no difference in the rate for all medically attended injuries in intervention children compared with controls: 14.3 injuries (95% CI, 9.7-21.1 injuries) vs 20.8 injuries (95% CI, 14.4-29.9 injuries) per 100 child-years (P = .17); but there was a significant reduction in the rate of modifiable medically attended injuries in intervention children compared with controls: 2.3 injuries (95% CI, 1.0-5.5 injuries) vs 7.7 injuries (95% CI, 4.2-14.2 injuries) per 100 child-years (P = .03).
Conclusions
An intervention to reduce exposure to hazards in homes led to a 70% reduction in the rate of modifiable medically attended injury.
Commentary
Injuries in the home are a major public health concern, and a leading cause of death in children under the age of 5 years.1 Although it is logical to deduce that hazards in the home environment contribute to a sequence of events culminating in an injury, our recent Cochrane Review found insufficient evidence to suggest that amelioration of such hazards reduced injuries.2 This study by Phelan et al demonstrates an intervention that reduces hazards in the home, and significantly reduces the rate of modifiable medically attended injuries in intervention children. It is also successfully installed and maintained home safety devices in all intervention homes. One limitation of the study is its generalizability. Mothers were excluded from the trial if they were: younger than 18 years, could not speak fluent English, living in public/shelter housing, or living in a property built after 1978. These criteria excluded a high percentage of households, which have been shown to be at increased risk of injury and less likely to engage in safety practices.3, 4 Additionally, the main outcome was based on a relatively small number of modifiable medically attended injuries (intervention group, n = 5; control group, n = 16). Nevertheless, this well-conducted trial is a significant advance on previous work, and provides encouraging results for the reduction of home injuries. It demonstrates the importance of actively installing home safety devices to ameliorate hazards, rather than relying solely on safety advice as in other studies. Before strong policy recommendations can be made, the successful home safety intervention described in this trial should be replicated with larger sample sizes, and across different populations and settings.
References
- In: Peden M, Oyebite K, Ozanne-Smith J, Hyder AA, Branche C, Rahman FAKM, Rivara F, Bartolomeos K editor. World report on child injury prevention. Geneva: World Health Organization Press; 2008;
- Modification of the home environment for the reduction of injuries. Cochrane Database Syst Rev. 2011;2:CD003600
- . Relationships between child, family and neighbourhood characteristics and childhood injury: a cohort study. Soc Sci Med. 2005;61:1905–1915
- . Children's safety in the home: parents' possession and perceptions of the importance of safety equipment. Public Health. 1994;108:21–25
PII: S0022-3476(11)00697-4
doi:10.1016/j.jpeds.2011.07.003
© 2011 Mosby, Inc. All rights reserved.
