Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. e483-e496 (doi:10.1542/peds.2003-1038-L)
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ELECTRONIC ARTICLE

A Systematic Review of Interventions to Prevent Childhood Farm Injuries

Lisa Hartling, MSc*, Robert J. Brison, MD, MPH, FRCPC{ddagger}, Ellen T. Crumley, MLIS*, Terry P. Klassen, MD, MSc, FRCPC* and William Pickett, PhD{ddagger}

* Alberta Research Centre for Child Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
{ddagger} Departments of Emergency Medicine and Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada

Objective. The goal of the study was to systematically review the global body of evidence surrounding the effectiveness of interventions for the prevention of acute pediatric agricultural injuries. A specific focus was the effectiveness of the North American Guidelines for Children's Agricultural Tasks.

Methods. Two reviewers independently screened studies and applied inclusion criteria on the basis of searches of 17 bibliographic databases (eg, Medline and Embase). We also screened reference lists of relevant studies and contacted experts in the area. Studies were included if they represented primary research, a comparison group was used, the study population included children or the intervention was directly applicable to children, and objective outcomes were reported. Two reviewers independently assessed the methodologic quality of included studies with the Downs and Black checklist. A qualitative analysis was performed because of extensive heterogeneity among studies.

Results. We included 23 controlled studies, ie, 4 randomized, controlled trials, 5 controlled trials, and 14 quasiexperimental or observational studies. Only 8 of the relevant studies were published in peer-reviewed journals. School-based programs appeared to be effective at increasing short-term knowledge acquisition; outcomes were enhanced with active, hands-on participation, as opposed to passive activities. Safety day camps showed positive results for knowledge acquisition. Tractor training programs and community- and farm-based interventions showed mixed results. Studies examining the North American Guidelines for Children's Agricultural Tasks suggested that uptake improves if dissemination is accompanied by a farm visit from a safety specialist or if information about child development principles is provided in conjunction with the guidelines.

Conclusions. There is a lack of randomized, controlled trials and community-based trials in this area. Studies primarily examined intermediate outcomes, such as knowledge acquisition; few studies evaluated changes in injury rates. The interventions targeted at children and youths that were evaluated focused on educational interventions. There is both the need and potential for the development and evaluation of injury control interventions for children, particularly programs addressing lethal injuries to young/preschool-aged children.

Key Words: wounds and injuries • agriculture • systematic review

Abbreviations: NAGCAT, North American Guidelines for Children's Agricultural Tasks • ROPS, rollover protection structures • QI, quality index • RCT, randomized, controlled trial • IQR, interquartile range

Accepted May 6, 2004.




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