PEDIATRICS Vol. 99 No. 5 May 1997, pp. 704-710 (doi:10.1542/peds.99.5.704)
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PEDIATRICS Vol. 99 No. 5 May 1997, pp. 704-710

Pediatric Injury Prevention Counseling Priorities

Received Feb 6, 1996; accepted Jul 29, 1996.

Lisa R. Cohen*, Dagger , Carol W. Runyan*, Dagger , Stephen M. Downs*, §, and J. Michael Bowling*, Dagger

From the * University of North Carolina Injury Prevention Research Center, the Dagger  Department of Health Behavior and Health Education, School of Public Health, and the § Department of Pediatrics, Chapel Hill, North Carolina.

Objective.  Child health care providers have a unique opportunity to conduct injury prevention counseling but limited empirical evidence for choosing prevention strategies. Efficient use of time requires that prevention strategies of higher priority be discussed before lower priority strategies. Our aim was to assess consensus among experts about the prioritization of prevention strategies for office based injury prevention counseling for parents of children under age two.

Design.  We used a modified Delphi technique with 23 childhood injury prevention experts nationwide. Participants were blinded to the identities of each other.

Measures.  The first questionnaire, distributed via facsimile transmission, consisted of open ended questions about prevention strategies participants believe should be included and their prioritization methods. The second questionnaire was closed ended and based on the results of the first.

Results.  Seventeen injury problems and 21 prevention strategies were suggested for counseling. Participants emphasized environmental strategies over more active, educational ones. Motor vehicle occupant injuries and car seats were given high priority scores by all participants. Smoke detectors, lowering the hot water heater temperature, and pool fencing also received high priority ratings. Participants based their decisions on the severity of the injury, the frequency with which the injury occured, and the availability of environmental strategies. However, they disagreed about the relative importance of these factors. Time constraints and parents' inability to absorb information led them to suggest limiting, to fewer than four, the number of prevention strategies addressed at any one visit.

Conclusions.  This study illustrates areas of consensus as well as unresolved dilemmas about pediatric injury prevention counseling. A rational decision making approach to prioritizing elements of clinical counseling is needed. Meanwhile, clinicians can use the findings of this study to derive their own judgments.

Key words: accidents, home, accident prevention, anticipatory guidance, clinical decision making, infants, safety.




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