Williams Selvi B, Whitlock Evelyn P, Edgerton Elizabeth A, Smith Paula R, Beil Tracy L
Oregon Evidence-based Practice Center and Kaiser Permanente Center for Health Research, Portland, Oregon 97227, USA.
Ann Intern Med. 2007 Aug 7;147(3):194-206. doi: 10.7326/0003-4819-147-3-200708070-00009.
Motor vehicle-related injuries are the leading cause of death among children, adolescents, and young adults.
To systematically review evidence of the effectiveness of counseling people of any age in primary care settings about occupant restraints or alcohol-related driving to prevent injuries.
MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, CINAHL, and Traffic Research Information Service; published systematic evidence reviews; experts; and bibliographies of selected trials.
Randomized, controlled trials (RCTs); controlled clinical trials (CCTs); or comparative observational research studies that evaluated behavioral counseling interventions feasible to conduct in primary care or referral from primary care.
Investigators abstracted data on study design, setting, patients, interventions, outcomes, and quality-related study details.
Trials report that counseling to increase the use of child safety seats leads to increased short-term restraint use (7 CCTs, 6 RCTs). Interventions that included a demonstration of correct use or distribution of a free or reduced-cost child safety seat reported larger effects. Few trials described the effect of counseling children 4 to 8 years of age to use booster seats (1 RCT); counseling older children, adolescents, or adults to use seat belts (1 CCT, 2 RCTs); or counseling unselected primary care patients to reduce alcohol-related driving behaviors (no trials).
Most of the relevant trials were published before the widespread enactment of child safety seat legislation and had methodological flaws.
The incremental effect of primary care counseling to increase the correct use of child safety seats in the current regulatory environment is not established. The effectiveness of primary care counseling to reduce alcohol-related driving has not been tested. Studies are needed.
在儿童、青少年和青年中，与机动车相关的伤害是主要死因。
系统评价在初级保健机构为各年龄段人群提供关于乘车约束装置或与酒精相关驾驶的咨询以预防伤害的有效性证据。
医学期刊数据库（MEDLINE）、考克兰对照试验中心注册库、考克兰系统评价数据库、心理学文摘数据库（PsycINFO）、护理学与健康领域数据库（CINAHL）以及交通研究信息服务；已发表的系统证据评价；专家；以及所选试验的参考文献目录。
随机对照试验（RCT）；对照临床试验（CCT）；或比较观察性研究，这些研究评估了在初级保健机构可行的行为咨询干预措施或从初级保健机构转诊的情况。
研究人员提取了关于研究设计、环境、患者、干预措施、结局以及与质量相关的研究细节的数据。
试验报告称，关于增加儿童安全座椅使用的咨询可导致短期内约束装置使用增加（7项CCT，6项RCT）。包括演示正确使用或分发免费或低成本儿童安全座椅的干预措施效果更显著。很少有试验描述对4至8岁儿童使用增高座椅进行咨询的效果（1项RCT）；对年龄较大的儿童、青少年或成年人使用安全带进行咨询的效果（1项CCT，2项RCT）；或对未选定的初级保健患者减少与酒精相关驾驶行为进行咨询的效果（无试验）。
大多数相关试验是在儿童安全座椅立法广泛颁布之前发表的，并且存在方法学缺陷。
在当前监管环境下，初级保健咨询对增加儿童安全座椅正确使用的增量效果尚未明确。初级保健咨询对减少与酒精相关驾驶的有效性尚未得到检验。需要开展研究。
