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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Preventing unintentional injuries to children in the home: a systematic review of the effectiveness of programmes supplying and/or installing home safety equipment

M Pearson, R Garside, T Moxham, and R Anderson.

Review published: 2011.

CRD summary

This review concluded that few injury prevention programmes reduced injury rates in children in the home and distribution of smoke alarms alone was insufficient for improving installation rates. Evidence was mixed for effectiveness on installation rates of other home safety equipment. Potential for publication and language biases and bias and errors in the review process mean that the authors' conclusions should be interpreted with caution.

Authors' objectives

To assess the effectiveness of programmes that supply and/or install home safety equipment for prevention of unintentional injuries in children in the home.

Searching

Sixteen databases were searched from 1990 to 2009 for studies in English. The databases included MEDLINE, PsycINFO, HMIC, CINAHL, ASSIA, DARE, The Cochrane Library, Web of Knowledge, Social Science Citation Index and Science Citation Index Expanded. Search terms were reported in a supplementary file. Reference lists of relevant publications were screened.

Study selection

Studies that evaluated programmes for decreasing injury rates in the home for children and increased the correct installation of smoke alarms and other home safety equipment in homes in which at least one child under 15 years lived were eligible for inclusion. Only programmes in which home safety equipment was supplied and/or installed or a home risk assessment was conducted were included. The review outcomes were rates of injury and correct installation of smoke alarms and other home safety equipment.

The included studies evaluated various programmes that supplied smoke alarms, other home safety equipment (such as window locks and fire guards) and those that supplied smoke alarms following a home risk assessment. Approximately 40% of included studies reported that participants had no ongoing contact with the programme team; some studies reported that participants continued to have routine care visits from community healthcare staff. Most studies included installation and/or a home risk assessment alongside supply of home equipment. Approximately one quarter of included studies included an education component in their programmes.

One reviewer assessed studies for inclusion. Uncertainties were resolved by discussion.

Assessment of study quality

Study quality was assessed using the GATE quality appraisal tool. Studies were rated "++" if all or most of the quality criteria were met, "+" if some quality criteria were met or "-" if few or none of the quality criteria were met.

The authors did not state how many reviewers assessed study quality.

Data extraction

Data were extracted on event rates to enable calculation of odds ratios (ORs) with 95% confidence intervals (CIs).

One reviewer extracted data. A random sample of 10% of the included studies were checked by a second reviewer.

Methods of synthesis

Studies were combined in a narrative synthesis supported by data tables.

Results of the review

Nineteen studies (22 reports) were included in the review: nine randomised controlled trials, three cluster randomised controlled trials, three controlled before-and-after studies and four uncontrolled before-and-after studies. Ten reports were judged "++", eight as "+" and four "-" for study quality. The total number of participants was not reported.

Injury rates: Two studies reported that programmes in which smoke alarms were supplied and installed led to no significant reduction in child injury rates. One study reported that one programme that supplied and installed other home safety equipment (such as window locks and fire guards) in addition to smoke alarms did not show a significant reduction in child injury rates. The evidence of the impact of programmes that conducted a home risk assessment and supplied home safety equipment was mixed. One study reported a significant reduction in child injury rates at six to nine months follow-up for a programme in which home safety equipment (thermostatic valves) were supplied and installed.

Smoke alarms: Seven intervention comparisons showed that programmes on installation and functioning of smoke alarms were associated with a significant benefit in the correct installation and functioning of smoke alarms compared with controls. Four intervention comparisons showed a non-significant difference in this outcome between the two groups.

Other home safety equipment: Five intervention comparisons showed that programmes on installation of other home equipment (such as locks, fireguards and stair gates) were associated with a significant increase in the rate of installation and use of these items compared with controls. Most intervention comparisons showed no significant difference between the two groups.

Authors' conclusions

Few programmes reduced injury rates in children in the home. Distribution of smoke alarms alone was insufficient for improving installation rates. Evidence of effectiveness on installation rates for other home safety equipment was mixed.

CRD commentary

This review's inclusion criteria were clear. Several relevant databases were searched. No attempts were made to find unpublished studies, which increased potential for publication bias. Only studies in English were included in the review, which increased the risk of language bias. No efforts were made to minimise biases and errors during study selection. Data extraction was conducted in duplicate for only a small proportion of included studies. It was unclear whether quality assessment was performed in duplicate. Appropriate criteria were used to assess study quality. Clinical heterogeneity between included studies was assessed and a narrative synthesis was appropriately employed.

Potential for publication and language biases and bias and errors in the review process mean that the authors' conclusions should be interpreted with caution.

Implications of the review for practice and research

Practice: The authors stated that in socio-economically deprived communities the offer of installation of home safety equipment such as stair gates may be important if the equipment was to remain installed in the long term.

Research: The authors stated that further qualitative research was required to provide more understandings of why (and in what contexts) programmes were effective in preventing unintentional injuries in children in the home.

Funding

Centre for Public Health Excellence, National Institute for Health and Clinical Excellence, UK.

Bibliographic details

Pearson M, Garside R, Moxham T, Anderson R. Preventing unintentional injuries to children in the home: a systematic review of the effectiveness of programmes supplying and/or installing home safety equipment. Health Promotion International 2011; 26(3): 376-392. [PubMed: 21131627]

Other publications of related interest

Smithson J, Garside R, Pearson M. Barriers to, and facilitators of, the prevention of unintentional injury in children in the home: a systematic review and synthesis of qualitative research. Injury Prevention 2011; 17(2): 119-126.

Indexing Status

Subject indexing assigned by NLM

MeSH

Accident Prevention /methods; Adolescent; Child; Child, Preschool; Equipment and Supplies; Health Promotion /methods; Humans; Infant; Infant, Newborn; Residence Characteristics; Risk Assessment; Risk Factors; Safety Management /methods; Wounds and Injuries /prevention & control

AccessionNumber

12011006447

Database entry date

28/05/2012

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 21131627

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