Zonfrillo Mark R, Gittelman Michael A, Quinlan Kyran P, Pomerantz Wendy J
Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, Rhode Island, USA.
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
BMJ Paediatr Open. 2018 Jun 18;2(1):e000300. doi: 10.1136/bmjpo-2018-000300. eCollection 2018.
Injury is the leading cause of death and acquired disability in children. Primary care providers routinely provide age-appropriate injury prevention (IP) counselling during healthcare visits. The objective was to review evaluations of the effectiveness of office-based paediatric IP counselling research.
This review identified studies from July 1991 to June 2016 of children <5 years and their caretakers to determine the effectiveness of office-based counselling on IP knowledge, behaviours and outcomes. Studies were included if they had: (1) an intervention for a family with a child <5 years of age; (2) an unintentional injury mechanism addressed during counselling; (3) one or more mechanisms recommended to be discussed for children <5 years in the 2007American Academy of Pediatrics Policy Statement; (4) counselling occurring in the office setting; (5) an assessment of an outcome (eg, change in knowledge, behaviour or injury occurrences); and (6) English-language publication. Study characteristics (whether the study was controlled, randomised and/or blinded), target safety behaviours, the sample size, outcomes assessed (injuries, behaviour changes and/or education changes) and demonstrated effects were summarised.
Sixteen articles met inclusion criteria. Twelve articles were randomised controlled trials, three were non-randomised trials and one was a pretest and post-test study. Fourteen articles measured a change in knowledge or reported behaviour, four included observed behaviour change and five measured change in injury outcomes. Thirteen of the 16 studies had positive effects demonstrated for certain outcomes, including for fall, poisoning, burn, fire, traffic injury and drowning prevention, while 10 showed no differences between study groups for other outcomes.
Published outcomes-based IP-related counselling research in the primary care setting for young children is infrequent, and additional research is necessary to further describe the effectiveness of these primary prevention efforts.
伤害是儿童死亡和后天残疾的主要原因。初级保健提供者在医疗就诊期间常规提供适合儿童年龄的伤害预防（IP）咨询。目的是回顾基于门诊的儿科IP咨询研究的有效性评估。
本综述确定了1991年7月至2016年6月针对5岁以下儿童及其照料者的研究，以确定基于门诊咨询对IP知识、行为和结果的有效性。符合以下条件的研究纳入其中：（1）对有5岁以下儿童的家庭进行干预；（2）咨询过程中涉及意外伤害机制；（3）2007年美国儿科学会政策声明中建议针对5岁以下儿童讨论的一种或多种机制；（4）在门诊环境中进行咨询；（5）对结果进行评估（如知识、行为或伤害发生情况的变化）；（6）英文出版物。总结了研究特征（研究是否为对照、随机和/或盲法）、目标安全行为、样本量、评估的结果（伤害、行为改变和/或教育改变）以及显示的效果。
16篇文章符合纳入标准。12篇文章为随机对照试验，3篇为非随机试验，1篇为前后测试研究。14篇文章测量了知识变化或报告的行为，4篇包括观察到的行为改变，5篇测量了伤害结果的变化。16项研究中的13项在某些结果上显示出积极效果，包括预防跌倒、中毒、烧伤、火灾、交通伤害和溺水，而10项研究在其他结果上显示研究组之间没有差异。
在初级保健环境中针对幼儿开展的基于结果的IP相关咨询研究较少，需要进一步开展研究以进一步描述这些一级预防措施的有效性。
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