Injuries are often preventable yet remain the most common cause of
death in children ages 1 to 19 in North America and most of other
countries in the world. As such, the American Academy of Pediatrics and
national injury experts cite injury prevention as a priority area for
counseling during routine health maintenance visits for young children.
(1, 2)
A recent Randomized Controlled Trial (RCT) (3) demonstrates that the
emergency department can be a venue for behavior change counseling if the
right resources are available. Counseling was provided to teens following
an accident that led to an emergency room visit. While at the emergency
room, young people 12 to 20 were provided with a brief counseling session
intended to change risky behavior. One behavior addressed within the
counseling session was safety belt use, and the researchers found that the
counseling was effective in increasing self-reported safety belt use later
on. This is an effective strategy as children and adolescents continue to
rely heavily on emergency services for their primary care needs. (4)
However, injury prevention counseling is associated with reported
preventive safety practices among US children, but a relatively small
proportion of households with young children report receiving such
counseling. (3) Physicians may not receive adequate training in injury
prevention during their medical education, and continuing education
opportunities may be limited for physicians outside of urban centers.
Accessible and relevant continuing medical education in novel formats is
needed to address the gap between ideal and actual practice in injury
prevention.
There is evidence to suggest that time constraints and other
competing demands limit physicians’ abilities to deliver injury prevention
counseling during routine health maintenance visits. (5, 6, 7) Priorities
need to be defined so that the most important injury prevention topics and
strategies are discussed effectively in the limited time available. In
addition the frequency and impact of pediatric counseling can be further
enhanced by experiential training that targets specific injury hazards
(3).
Recent review by Gittelman and Durbin (8) has suggested that an
emergency department visit for an injury represents a "teachable moment"
for the patient and their family, which may make the injured more
receptive to educational information.
REFERENCES:
(1). Cohen L.R., Runyan C.V., Downs S.M., Bowling J.M. Pediatric
injury prevention counseling priorities. Pediatrics.1997; 99 :704 –710
(2).Committee on Injury and Poison Prevention. Office-based
counseling for injury prevention. Pediatrics.1994; 94 :566 –567
(3). Johnston B.D., Rivara F.P., Droesch R.M., Dunn C., Copass M.K.
Behavior change counseling in the emergency department to reduce injury
risk: a randomized, controlled trial. Pediatrics. 2002; 110:267 -274
(4). Lehmann C.U., Barr J., Kelly P.J. Emergency department
utilization by adolescents. J Adolesc Health. 1994; 15 :485 -490
(5). Yarnall K.S.H., Pollak K.I., Ostbye T. Krause K.M., Michener
J.L. Primary care: is there enough time for prevention? Am J Public
Health.2003; 93 :635 –641
(6).Quinlan K.P., Sacks J.J. Kresnow M. Exposure to and compliance
with pediatric injury prevention counseling–United States, 1994.
Pediatrics.1998; 102(5) . Available at:
pediatrics.aappublications.org/cgi/content/full/102/5/e55
(7). Cohen L.R., Runyan C.W. Barriers to pediatric injury prevention
counseling. Inj Prev.1995; 5 :36 –40
(8). Gittelman, M.A., Durbin, D. Injury prevention: Is pediatric
Emergency Department the appropriate place? Pediatric Emergency Care
2005;27 (7) 460-467
Conflict of Interest:
None declared
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