Published online April 1, 2005
PEDIATRICS Vol. 115 No. 4 April 2005, pp. e423-e427 (doi:10.1542/peds.2004-1556)
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ELECTRONIC ARTICLE

The Utility of Safety Counseling in a Pediatric Emergency Department

Ilene A. Claudius, MD and Alan L. Nager, MD, FAAP

From the Department of Pediatrics, Division of Emergency and Transport Medicine, Childrens Hospital Los Angeles, and the Keck School of Medicine of the University of Southern California, Los Angeles, California

Objective. Pediatric injuries have a significant impact on the medical system, costing lives and disabling many survivors. Although injury-prevention measures do exist, they are underutilized. A majority of families do not consistently receive counseling by a primary care provider (PCP). We attempted to demonstrate the efficacy of counseling families who presented to a pediatric emergency department with unrelated medical complaints.

Methods. A self-report questionnaire was administered to assess the home safety of patients 2 weeks to 12 years old presenting to the emergency department. Targeted counseling on areas noted to be unsafe was provided, and a 2-week follow-up telephone call was made to assess the effectiveness of the counseling. Information on previous counseling by a PCP was also collected and analyzed. Logistic regression was performed to determine significance and calculate odds ratios.

Results. Thirty-seven percent of caregivers recalled receiving any counseling at a PCP visit. Caregivers who had received prior counseling by a PCP were significantly more likely to have a safe home environment. Patients who were English speaking were significantly more likely to have received safety counseling than their Spanish-speaking counterparts. One hundred fifty families received counseling in the emergency department, and 117 were eligible for follow-up. Of these families, 39% made a positive change in the safety of their child's environment at the 2-week telephone follow-up.

Conclusions. Caregivers receiving counseling by a PCP are more likely to provide a safe home environment for their children. Spanish-speaking patients are at particularly high risk of not receiving counseling. Of caregivers reporting unsafe practices during an unrelated emergency-department encounter, targeted counseling made a positive impact on behavior after discharge.

Key Words: pediatric • prevention • safety counseling • injury

Abbreviations: PCP, primary care provider • TIPP, the Injury Prevention Program • CI, confidence interval

Accepted Nov 15, 2004.


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