Watson Michael, Kendrick Denise, Coupland Carol, Woods Amanda, Futers Deb, Robinson Jean
Faculty of Medicine and Health Sciences, School of Nursing, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2HA.
BMJ. 2005 Jan 22;330(7484):178. doi: 10.1136/bmj.38309.664444.8F. Epub 2004 Dec 16.
To assess the effectiveness of safety advice and safety equipment in reducing unintentional injuries for families with children aged under 5 years and living in deprived areas.
Randomised controlled trial.
47 general practices in Nottingham.
3428 families with children under 5.
A standardised safety consultation and provision of free and fitted stair gates, fire guards, smoke alarms, cupboard locks, and window locks.
Primary outcome measures were whether a child in the family had at least one injury that required medical attendance and rates of attendance in primary and secondary care and of hospital admission for injury over a two year period. Secondary outcome measures included possession of safety equipment and safety practices.
No significant difference was found in the proportion of families in which a child had a medically attended injury (odds ratio 1.14, 95% confidence interval 0.98 to 1.50) or in the rates of attendance in secondary care (incidence rate ratio 1.02, 0.90 to 1.13) or admission to hospital (1.02, 0.70 to 1.48). However, children in the intervention arm had a significantly higher attendance rate for injuries in primary care (1.37, 1.11 to 1.70, P = 0.003). At both one and two years' follow up, families in the intervention arm were significantly more likely to have a range of safety practices, but absolute differences in the percentages were relatively small.
The intervention resulted in significant improvements in safety practices for up to two years but did not reduce injuries that necessitated medical attendance. Although equipment was provided and fitted free of charge, the observed changes in safety practices may not have been large enough to affect injury rates.
评估安全建议和安全设备对居住在贫困地区的5岁以下儿童家庭减少意外伤害的有效性。
随机对照试验。
诺丁汉的47家普通诊所。
3428个有5岁以下儿童的家庭。
进行标准化的安全咨询,并提供免费安装的楼梯门、防火门、烟雾报警器、橱柜锁和窗户锁。
主要结局指标为家庭中的儿童是否至少有一次需要就医的伤害,以及两年内初级和二级医疗护理的就诊率和因伤害住院的比率。次要结局指标包括安全设备的拥有情况和安全措施。
在儿童有需就医伤害的家庭比例(优势比1.14,95%置信区间0.98至1.50)、二级医疗护理就诊率(发病率比1.02,0.90至1.13)或住院率(1.02,0.70至1.48)方面未发现显著差异。然而,干预组儿童在初级医疗护理中的伤害就诊率显著更高(1.37,1.11至1.70,P = 0.003)。在随访1年和2年时,干预组家庭采取一系列安全措施的可能性均显著更高,但百分比的绝对差异相对较小。
该干预措施在长达两年的时间里使安全措施有显著改善,但并未减少需要就医的伤害。尽管免费提供并安装了设备,但观察到的安全措施变化可能还不够大,不足以影响伤害发生率。