Abstract
This study of pediatric emergency department medical records explores children’s unintentional home injuries and parents’ reports of the cause of the injury, what could have prevented it, and changes made in homes afterward.
Medical attention for an injury can increase parents’ perception of their child’s susceptibility to injury.1 Understanding subsequent parental actions to avert future injuries can inform prevention efforts. In this study, we describe the injured body part and parents’ reports of (1) the cause of the injury, (2) what could have prevented it, and (3) changes made afterward.
Methods
We reviewed medical records of pediatric emergency department patients who sought care for an unintentional home injury between January 1 and December 31, 2012, and contacted the parents for a home interview. The medical record review provided details about the injury and the child’s age and sex. The parental interview, which was audiorecorded and transcribed, provided parents’ responses to the following: (1) Please describe how your child got injured. (2) Do you think there is anything that could have prevented the injury? If so, what? (3) Have you done anything to change the area of the home where the child was injured? If so, what?
Home interviews were conducted on average 27 days (range, 5-57 days) after the pediatric emergency department visit. A codebook of parental responses was generated and analyzed to yield the following groups of codes: (1) body part injured (head/neck/face, leg, arm/hand, or other), (2) injury mechanism (fall, cut/pierce, burn, struck by/against, or carbon monoxide poisoning), (3) item(s) involved (toys, furnishings, house features, food/beverage, or other), (4) parents’ perception of preventability (child behavior, adult supervision, or safer environment), and (5) changes made (increased supervision, got rid of/replaced item, or safer environment (restricted access to dangerous item).
We tallied the code groups and arranged cross-tabulations of injury mechanisms and body parts. At recruitment, we obtained written parental informed consent per approval by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board.
Results
One hundred four children (42 female and 62 male) aged 6 months to 7 years (mean [SD] age, 2.9 [1.8] years) who were predominantly of black race/ethnicity (84 [80.8%]) experienced 123 injuries. One injury mechanism was associated with 109 of 123 injuries (88.6%), while 2 injury mechanisms were associated with 14 of 123 injuries (11.3%). The most common injury mechanism was a fall (57 of 123 [46.3%]), and the most common body part injured was the head/neck/face (76 of 123 [61.8%]) (Table 1). Most children (99 of 104 [95.2%]) had 1 injured body part, whereas 5 of 104 children (4.8%) had 2 injured body parts.
Table 1. Body Part and Injury Mechanism for 123 Injuries in 104 Children Injured in Their Homes.
| Injury Mechanism | Body Part | Total, No. (%) (N = 123)a | |||
|---|---|---|---|---|---|
| Head/Neck/Face (n = 76) | Leg (n = 17) | Arm/Hand (n = 23) | Other (n = 7) | ||
| Fall | 44 | 3 | 8 | 2 | 57 (46.3) |
| Cut/pierce | 13 | 6 | 7 | 0 | 26 (21.1) |
| Burn | 6 | 5 | 6 | 3 | 20 (16.3) |
| Struck by/against | 13 | 3 | 2 | 0 | 18 (14.6) |
| Carbon monoxide poisoning | 0 | 0 | 0 | 2 | 2 (1.6) |
Missing 3 participants, who contributed 5 injury mechanisms (3 falls and 2 cut/pierce).
In all but 2 cases, an item was identified as contributing to the injury: 42 of 120 (35.0%) involved house features, 40 of 120 (33.3%) involved furnishings, 13 of 120 (10.8%) involved food/beverage, and 10 of 120 (8.3%) involved toys (Table 2). Parents, who were mostly female (96 of 104 [92.3%]) and high school graduates (78 of 104 [78.8%]), identified at least 1 prevention strategy (86 of 104 [82.7%]). Of the 110 suggestions, 44 (40.0%) were to create a safer environment (eg, store hazardous products), 34 (3.9%) were to modify child behavior (eg, implement new rules), and 32 (29.1%) were to provide increased adult supervision. Fifty-nine of 104 parents (56.7%) reported making changes: 53 of 104 (50.9%) modified the environment, 22 of 104 (21.2%) got rid of/replaced items, and 8 of 104 (7.7%) increased supervision.
Table 2. Items and Prevention Suggestions for 120 Injuries in 104 Children Injured in Their Homes.
| Item and Injuries (n = 120) | Item(s) Involved (n = 122)a | Prevention Suggestions (n = 110)a,b | Changes Made (n = 83)a,c |
|---|---|---|---|
| Toys Total injuries: 10 (8.3%) |
Wheeled toys (n = 4) Baseball bat (n = 1) Toy gun (n = 1) Unspecified toy (n = 4) Total items: 10 |
Adult supervision (n = 3) Modify child behavior (n = 4) Safer environment (n = 3) Total suggestions: 10 |
Increased supervision (n = 0) Got rid of/replaced items (n = 3) Modified the environment (n = 6) Total changes: 9 |
| Furnishings Total injuries: 40 (33.3%) |
Tables (n = 8) Chairs/couch (n = 14) Bed (n = 12) Other (n = 8) Total items: 42 |
Adult supervision (n = 10) Modify child behavior (n = 17) Safer environment (n = 11) Total suggestions: 38 |
Increased supervision (n = 4) Got rid of/replaced items (n = 9) Modified the environment (n = 14) Total changes: 27 |
| House features Total injuries: 42 (35.0%) |
Floor (n = 16) Stairs (n = 8) Door (n = 4) Wall/ceiling (n = 4) Other (n = 10) Total items: 42 |
Adult supervision (n = 8) Modify child behavior (n = 10) Safer environment (n = 14) Total suggestions: 32 |
Increased supervision (n = 2) Got rid of/replaced items (n = 7) Modified the environment (n = 19) Total changes: 28 |
| Food/beverage Total injuries: 13 (10.8%) |
Hot water/coffee (n = 5) Hot soup (n = 6) Can (n = 2) Total items: 13 |
Adult supervision (n = 7) Modify child behavior (n = 2) Safer environment (n = 5) Total suggestions: 14 |
Increased supervision (n = 1) Got rid of/replaced items (n = 1) Modified the environment (n = 7) Total changes: 9 |
| Other Total injuries: 15 (12.5%) |
Beauty supply (n = 3) Iron (n = 2) Child item (n = 2) Other (n = 8) Total items: 15 |
Adult supervision (n = 4) Modify child behavior (n = 1) Safer environment (n = 11) Total suggestions: 16 |
Increased supervision (n = 1) Got rid of/replaced items (n = 2) Modified the environment (n = 7) Total changes: 10 |
Not mutually exclusive. The same individual could have mentioned more than 1 item or suggestion for prevention of a given injury.
Eighty-five parents provided 110 prevention suggestions.
Fifty-nine parents reported 83 changes made.
Discussion
This study explored how parents changed their homes after a medically attended unintentional injury to prevent reoccurrence. Most parents identified a prevention strategy, commonly an environmental one (eg, store hazardous products); however, only 59 of 104 (56.7%) made modifications. Parents’ endorsement of environmental modification (eg, passive strategies) is encouraging because this approach is a preferred injury prevention strategy.2 Increasing supervision (eg, active strategies) represented a smaller proportion (32 of 104 [29.1%]) of parents’ suggestions. Evidence suggests that supervision can reduce injuries to young children; however, research is required to address the many challenges parents face in these efforts.3,4
Limitations and Conclusions
Limitations of these findings include that parental self-report about the injury could have been influenced by the time that elapsed from the injury event to the home interview and by social desirability bias. Parents’ ideas regarding safety changes were generally consistent with best practices for injury prevention, although the low rate of actually implementing changes represents a gap that future prevention efforts should address.
References
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