Abstract
BackgroundInjuries in childhood are largely preventable yet an estimated 2,400 children die every day because of injury and violence. Despite this, the factors that contribute to injury occurrence have not been quantified at the population scale using primary care data. We used The Health Improvement Network (THIN) database to identify risk factors for thermal injury, fractures and poisoning in pre-school children in order to inform the optimal delivery of preventative strategies.MethodsWe used a matched, nested case-control study design. Cases were children under 5 with a first medically recorded injury, comprising 3,649 thermal injury cases, 4,050 fracture cases and 2,193 poisoning cases, matched on general practice to 94,620 control children.ResultsYounger maternal age and higher birth order increased the odds of all injuries. Children’s age of highest injury risk varied by injury type; compared with children under 1 year, thermal injuries were highest in those age 1-2 (OR = 2.43, 95%CI 2.23–2.65), poisonings in those age 2-3 (OR = 7.32, 95%CI 6.26–8.58) and fractures in those age 3-5 (OR = 3.80, 95%CI 3.42–4.23). Increasing deprivation was an important modifiable risk factor for poisonings and thermal injuries (tests for trend p≤0.001) as were hazardous/harmful alcohol consumption by a household adult (OR = 1.73, 95%CI 1.26–2.38 and OR = 1.39, 95%CI 1.07–1.81 respectively) and maternal diagnosis of depression (OR = 1.45, 95%CI 1.24–1.70 and OR = 1.16, 95%CI 1.02–1.32 respectively). Fracture was not associated with these factors, however, not living in single-adult household reduced the odds of fracture (OR = 0.88, 95%CI 0.82–0.95).ConclusionsMaternal depression, hazardous/harmful adult alcohol consumption and socioeconomic deprivation represent important modifiable risk factors for thermal injury and poisoning but not fractures in preschool children. Since these risk factors can be ascertained from routine primary care records, pre-school children’s frequent visits to primary care present an opportunity to reduce injury risk by implementing effective preventative interventions from existing national guidelines.
Highlights
Childhood injury is largely preventable [1] yet continues to be a significant public health issue
National Institute for Health and Clinical Excellence (NICE) suggest that GPs along with other primary care practitioners such as Health Visitors should refer families that would benefit from these interventions and that GPs and other primary care practitioners should provide home safety advice when visiting the home of vulnerable families, even if this is not related to a safety or injury issue
Thermal Injuries Multivariable analysis of thermal injuries showed that male sex and increasing birth order were both associated with increased odds of injury and there was an n-shaped relationship with child age, with the highest odds of injury occurring at age 1-2 years (OR, 2.43 95% confidence intervals (CI) 2.23–2.65) compared with children under 1 year (Table 3)
Summary
Childhood injury is largely preventable [1] yet continues to be a significant public health issue. Recent guidance in the UK from the National Institute for Health and Clinical Excellence (NICE) recommends identifying those children at greatest risk of injury in order to target the provision of home safety interventions [8]. For the implementation of preventative measures to be effective, we require both a comprehensive understanding of the common factors that put children at risk of avoidable injury and methods for identifying these children in order to have impact at a population level, both of these are currently lacking. Injuries in childhood are largely preventable yet an estimated 2,400 children die every day because of injury and violence. We used The Health Improvement Network (THIN) database to identify risk factors for thermal injury, fractures and poisoning in pre-school children in order to inform the optimal delivery of preventative strategies
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