Salam Rehana A, Arshad Ahmed, Das Jai K, Khan Marium Naveed, Mahmood Wajeeha, Freedman Stephen B, Bhutta Zulfiqar A
Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
Ziauddin University, Karachi, Pakistan.
J Adolesc Health. 2016 Oct;59(4S):S76-S87. doi: 10.1016/j.jadohealth.2016.07.024.
Globally, every day, ∼2,300 children and adolescents succumb to unintentional injuries sustained from motor vehicle collisions, drowning, poisoning, falls, burns, and violence. The rate of deaths due to motor vehicle injuries in adolescents is 10.2 per 100,000 adolescents. We systematically reviewed published evidence to identify interventions to prevent unintentional injuries among adolescents aged 11-19 years. We defined unintentional injuries as a subset of injuries for which there was no evidence of predetermined intent, and the definition included motor vehicle injuries, suffocation, drowning, poisoning, burns, falls, and sports and recreation. Thirty-five studies met study eligibility criteria. The included studies focused on interventions to prevent motor vehicle injuries and sports-related injuries. Results suggest that possession of a graduated driver license (GDL) significantly reduced road accidents by 19% (relative risk [RR]: .81; 95% confidence interval [CI]: .75-.88; n = 5). There was no impact of GDL programs on incidence of injuries (RR: .78; 95% CI: .57-1.06; n = 2), helmet use (RR: 1.0; 95% CI: .98-1.02; n = 3), and seat belt use (RR: .99; 95% CI: .97-1.0; n = 3). Sports-related injury prevention interventions led to reductions in the incidence of injuries (RR: .66; 95% CI: .53-.82; n = 15), incidence of injury per hour of exposure (RR: .63; 95% CI: .47-.86; n = 5), and injuries per number of exposures (RR: .79; 95% CI: .70-.88; n = 4). Subgroup analysis according to the type of interventions suggests that training ± education and the use of safety equipment had significant impacts on reducing the incidence of injuries. We did not find any study focusing on interventions to prevent suffocation, drowning, poisoning, burns, and falls in the adolescent age group. The existing evidence is mostly from high-income countries, limiting the generalizability of these findings for low- and middle-income countries. Studies evaluating these interventions need to be replicated in a low- and middle-income country-context to evaluate effectiveness with standardized outcome measures.
在全球范围内,每天约有2300名儿童和青少年死于机动车碰撞、溺水、中毒、跌倒、烧伤和暴力等意外伤害。青少年因机动车伤害导致的死亡率为每10万名青少年中有10.2人死亡。我们系统地回顾了已发表的证据,以确定预防11至19岁青少年意外伤害的干预措施。我们将意外伤害定义为没有预定意图证据的伤害子集,该定义包括机动车伤害、窒息、溺水、中毒、烧伤、跌倒以及运动和娱乐相关伤害。35项研究符合研究纳入标准。纳入的研究主要关注预防机动车伤害和运动相关伤害的干预措施。结果表明,持有分级驾照(GDL)可使道路事故显著减少19%(相对风险[RR]:0.81;95%置信区间[CI]:0.75 - 0.88;n = 5)。GDL计划对伤害发生率(RR:0.78;95% CI:0.57 - 1.06;n = 2)、头盔使用(RR:1.0;95% CI:0.98 - 1.02;n = 3)和安全带使用(RR:0.99;95% CI:0.97 - 1.0;n = 3)没有影响。运动相关伤害预防干预措施可降低伤害发生率(RR:0.66;95% CI:0.53 - 0.82;n = 15)、每暴露小时的伤害发生率(RR:0.63;95% CI:0.47 - 0.86;n = 5)以及每次暴露的伤害数(RR:0.79;95% CI:0.70 - 0.88;n = 4)。根据干预类型进行的亚组分析表明,培训±教育以及安全设备的使用对降低伤害发生率有显著影响。我们没有发现任何针对预防青少年窒息、溺水、中毒、烧伤和跌倒的干预措施的研究。现有证据大多来自高收入国家,限制了这些研究结果在低收入和中等收入国家的普遍性。需要在低收入和中等收入国家背景下重复评估这些干预措施的研究,以使用标准化结局指标评估其有效性。