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Cochrane Database of Systematic Reviews

Programas educativos escolares para la prevención de lesiones no intencionales en niños y jóvenes

Información

DOI:
https://doi.org/10.1002/14651858.CD010246.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 27 diciembre 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Lesiones

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Elizabeth Orton

    Correspondencia a: Division of Primary Care, University of Nottingham, Nottingham, UK

    [email protected]

  • Jessica Whitehead

    Division of Primary Care, University of Nottingham, Nottingham, UK

  • Jacqueline Mhizha‐Murira

    Division of Primary Care, University of Nottingham, Nottingham, UK

  • Mandy Clarkson

    Division of Primary Care, University of Nottingham, Nottingham, UK

  • Michael C Watson

    School of Health Sciences, The University of Nottingham, Nottingham, UK

  • Caroline A Mulvaney

    Lancaster Health Hub, Lancaster University, Lancaster, UK

    Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK

  • Joy UL Staniforth

    Division of Primary Care, University of Nottingham, Nottingham, UK

  • Munish Bhuchar

    Division of Primary Care, University of Nottingham, Nottingham, UK

  • Denise Kendrick

    Division of Primary Care, School of Medicine, The University of Nottingham, Nottingham, UK

Contributions of authors

EO is the guarantor and co‐ordinator of the review.

EO, MW, CM and DK wrote the protocol for the review.

JMM, MC, JW and MB ran the searches for the review.

JMM, EO, JW, MW, CM, MB and JS selected articles for inclusion.

EO, JMM, JW, MB, CM, MC, MW, DK and JS extracted data and undertook quality assessment.

EO, DK and JW undertook analyses.

EO, JW and JMM wrote the report.

All review authors commented on the draft.

Sources of support

Internal sources

  • Elizabeth Orton, UK.

    Salary paid by the University of Nottingham and the East Midlands NHS Healthcare Workforce Deanery

  • Denise Kendrick, UK.

    Salary paid by the University of Nottingham

  • Michael Watson, UK.

    Salary paid by the University of Nottingham

  • Caroline Mulvaney, UK.

    Salary paid by the University of Nottingham

External sources

  • Nottingham City PCT, UK.

    Financial support of GBP17,771

  • National Institute for Health Research (NIHR), UK.

    This project was supported by the UK National Institute for Health Research, through Cochrane Infrastructure funding to the Cochrane Injuries Group. The views and opinions expressed are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service or the Department of Health.

Declarations of interest

At the time that the review started, Elizabeth Orton was the public health representative from National Health Service (NHS) Nottingham City on the steering group for the Nottingham Injury Minimisation Programme (IMPs) that is delivered in part in the school setting. However, there were no financial incentives related to this work and her future employment is not dependent upon the continued funding of the IMPs programme by NHS Nottingham City.

Denise Kendrick: author on some studies included in the review. To avoid risk of bias of including these studies in the review, all articles retrieved from the literature searches were screened independently by Jacqueline Mhizha‐Murira or Jessica Whitehead and then a second author from the team. If the screening assessments differed a third author adjudicated the decision.

Caroline Mulvaney: author on some studies included in the review. To avoid risk of bias of including these studies in the review, all articles retrieved from the literature searches were screened independently by Jacqueline Mhizha‐Murira or Jessica Whitehead and then a second author from the team. If the screening assessments differed a third author adjudicated the decision.

Michael Watson: author on some studies included in the review. To avoid risk of bias of including these studies in the review, all articles retrieved from the literature searches were screened independently by Jacqueline Mhizha‐Murira or Jessica Whitehead and then a second author from the team. If the screening assessments differed a third author adjudicated the decision.

Jessica Whitehead: none known.

Jacqueline Mhizha‐Murira: none known.

Munish Bhuchar: none known.

Joy Staniforth: none known.

Acknowledgements

We thank the following people who helped with this review in many capacities.

Dr Lu Ban and Dr Yana Vinogradova for translating papers. Wendy Stanton for support with developing the search strategies. Dr Brian Bell for undertaking handsearches of Injury Prevention and conference abstracts, and the Cochrane Injuries group for assisting with database searches.

We would also like to thank the following people for responding to requests for additional information.

Name

Paper reference

Prof JA Morris

Hazinski 1995

Dr L Buckley

Buckley 2010

Dr G Floerchinger‐Franks

Floerchinger‐Franks 2000

Dr E Neuwelt

Greene 2002

Professor L Mori

Mori 1986

Professor FP Rivara

Wright 1995

Professor D Kendrick

Kendrick 2007

Professor JS Richards

Richards 1991

Dr D Moher

Morag 2002.

Version history

Published

Title

Stage

Authors

Version

2016 Dec 27

School‐based education programmes for the prevention of unintentional injuries in children and young people

Review

Elizabeth Orton, Jessica Whitehead, Jacqueline Mhizha‐Murira, Mandy Clarkson, Michael C Watson, Caroline A Mulvaney, Joy UL Staniforth, Munish Bhuchar, Denise Kendrick

https://doi.org/10.1002/14651858.CD010246.pub2

2012 Nov 14

School based education programmes for the prevention of unintentional injuries in children and young people

Protocol

Elizabeth Orton, Michael C Watson, Caroline Mulvaney, Denise Kendrick

https://doi.org/10.1002/14651858.CD010246

Differences between protocol and review

We clarified that included studies needed to be aimed at a preventing a range of injury mechanisms. We did this by changing the wording of the types of interventions from "Primary and secondary injury prevention education aimed at reducing a range of unintentional injuries..." to "...primary and secondary injury prevention interventions aimed at reducing a range of unintentional injury mechanisms..."

The searches were first run in 2013, and were rerun up to 2 July 2015. Between the first and second searches, three of the databases had changed hosts: PsycINFO and Index to Theses became hosted by Proquest and BEI became hosted by EBSCO and some changes to the search terms were required because of this. The final MEDLINE search strategy and the search strategies adapted for each of the databases are reported in full in Appendix 1 and Appendix 2.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adolescent; Child; Child, Preschool; Female; Humans; Male;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Logic model, based on Langford 2014
Figuras y tablas -
Figure 1

Logic model, based on Langford 2014

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PRISMA flow chart detailing the process of study selection for all studies included in the review. CBA: controlled before‐and‐after study; RCT: randomised controlled trial.
Figuras y tablas -
Figure 2

PRISMA flow chart detailing the process of study selection for all studies included in the review. CBA: controlled before‐and‐after study; RCT: randomised controlled trial.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 4

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Forest plot of comparison: 1 Injury rates, outcome: 1.1 Injury rates at follow‐up.
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Injury rates, outcome: 1.1 Injury rates at follow‐up.

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Comparison 1 Medically attended or non‐medically attended injury rates, Outcome 1 Injury rates at follow‐up, adjusted for baseline injury rates in non‐randomised studies.
Figuras y tablas -
Analysis 1.1

Comparison 1 Medically attended or non‐medically attended injury rates, Outcome 1 Injury rates at follow‐up, adjusted for baseline injury rates in non‐randomised studies.

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Summary of findings for the main comparison. School injury prevention programmes compared to controls for the prevention of unintentional injuries in children and young people

School injury prevention programmes compared to controls for the prevention of unintentional injuries in children and young people

Patient or population: children and young people
Setting: schools
Intervention: school injury prevention programmes aimed at preventing multiple injury mechanisms
Comparison: control

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Injury rate, adjusted for clustering, with control

Injury rate, adjusted for clustering, with School injury prevention programmes

Self‐reported medically or non‐medically attended unintentional injuries or injuries with an unspecified intent (injury rates adjusted for clustering)
assessed with: self‐report
follow‐up: range 12 months to 24 months

367 per 1000 person‐years

243 per 1000 person‐years

Rate ratio 0.76
(0.49 to 1.17)

12,977

(2073 person‐years adjusted for clustering)
(2 RCTs, 1 CBA)

⊕⊕⊝⊝
Low 1

We excluded 4 studies from the meta‐analysis due to varied interventions (e.g. sports, agriculture or risk‐taking injury prevention). Their findings were consistent with the meta‐analysis studies.

Safety skills
assessed with: observations
follow‐up: range 4 months to 5 months

Both studies found an improvement in observed safety skills (Kendrick 2007 ‐ fire and burn prevention skills: odds ratio 8.93 (95% CI 1.67 to 47.78, P = 0.01); Frederick 2000 ‐ basic life support skills, P < 0.005 for assessment of danger, responsiveness and circulation).

‐

1751
(1 RCT, 1 CBA)

⊕⊕⊝⊝
Low 2

Interventions and safety skills observed were varied in these 2 studies.

Behaviour
assessed with: observations and self‐reported
follow‐up: range 2 weeks to 36 months

All 4 studies (5 articles) reported that observed safety behaviour showed evidence of improved practices and 13/19 studies describing self‐reported behaviour reported improved practices.

‐

52,950
(9 RCTs, 4 non‐RCTs, 6 CBA)

⊕⊝⊝⊝
Very low3

Behaviours included safety equipment wearing, road risk‐taking behaviour, agriculture and sports‐related injury behaviours.

Safety knowledge
assessed with: surveys and self‐completion tests
follow‐up: range 1 month to 36 months

Of the 21 studies assessing changes in safety knowledge, 19 reported an improvement in at least 1 question domain in the intervention compared to the control group.

‐

55,732

(9 RCTs, 5 non‐RCTs, 7 CBA)

⊕⊝⊝⊝
Very low4

Outcomes included a wide range of knowledge testing instruments and topics.

Cost‐effectiveness
assessed with: cost:benefit ratio
follow‐up: 1 years

For every 1 Chinese Yuan spent, 13.90 was saved (cost:benefit ratio 1:13.9)

‐

4639
(1 CBA)

⊕⊝⊝⊝
Very low5

Only 1 study reported economic outcomes and should, therefore, be interpreted with caution.

CI: confidence interval; CBA: controlled before‐and‐after study; RCT: randomised controlled trial; non‐RCT: non‐randomised controlled trial.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Downgraded twice because of inconsistency as the I2 = 63%, indicating substantial heterogeneity and because there was imprecision in the results (the rate ratio was 0.76 but the confidence intervals spanned 1). Two of the studies were RCTs with a low risk of bias.

2 Downgraded twice because of a serious risk of bias (one of the two studies was a CBA resulting in selection biases relating to which schools participated in studies) and inconsistency, which was rated as serious because the two studies had different intervention types with different outcome measures. Imprecision was serious as there were wide confidence intervals in one of the two included studies, as well as a paucity of data. However, the effect sizes were classed as large as there was a nearly nine times greater odds of fire and burn prevention skills in the Risk Watch programme (Kendrick 2007), and 33% greater skills assessment in the Injury Minimisation Programme for Schools (IMPS) relating to assessment of danger (Frederick 2000).

3 Downgraded three times because 10 studies were CBA or non‐RCT design with high risk of selection bias of included schools, there was serious inconsistency in methods of collecting data and intervention types, and this may have contributed to the wide range of effect sizes and directions seen (no effect or some effect), There was often wide confidence intervals in results presented.

4 Downgraded three times because 11 studies were CBA or non‐RCT design with high risk of selection bias of included schools; there was serious inconsistency in knowledge tested, questionnaire designs and methods of collecting data, a wide range of intervention types and pedagogical approaches and this may have contributed to the wide range of effect sizes and directions seen (no effect or some effect). Results were presented in a way that often made precision difficult to compare.

5 Downgraded three times because this was one study, limited in applicability with high or unclear risk of bias across multiple domains.

Figuras y tablas -
Summary of findings for the main comparison. School injury prevention programmes compared to controls for the prevention of unintentional injuries in children and young people
Ir a la tabla de la revisión
Table 1. Age ranges included in the studies

Study ID

Age (years)

4/5

5/6

6/7

7/8

8/9

9/10

10/11

11/12

12/13

13/14

14/15

15/16

16/17

17/18

Azeredo 2003

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Buckley 2010

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Campbell 2001

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Carmel 1991

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Chapman 2013

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Collard 2010

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Cook 2006

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Falavigna 2012

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Frederick 2000

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Grant 1992

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Greene 2002

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Gresham 2001

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Kendrick 2007

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Lee 2004

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Lu 2000

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Martinez 1996

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Morrongiello 1998

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Reed 2001

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Richards 1991

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Sun 2004

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Terzidis 2007

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Twisk 2013

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Wang 2009

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Wesner 2003

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Wright 1995

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Zhao 2006

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Zirkle 2005

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‐

‐: not applicable; ●: age range covered.
Figuras y tablas -
Table 1. Age ranges included in the studies
Ir a la tabla de la revisión
Table 2. Injury mechanisms targeted for included studies

Study ID

Injury mechanism

Pedestrian

Cycle

Motorcycle

Vehicle (non‐specific)

Falls

Swimming/ drowning/ diving

Smoke/ fire/ flames

Heat and hot surfaces

Sport/ physical activity

Sun

Household safety

Agricultural injuries

Poisoning

Azeredo 2003

‐

●

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●

‐

●

●

‐

‐

‐

‐

‐

‐

Buckley 2010

●

●

●

●

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Campbell 2001

‐

‐

‐

‐

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‐

●

●

●

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●

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●

Carmel 1991

‐

‐

‐

‐

‐

‐

●

●

‐

‐

‐

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‐

Chapman 2013

‐

●

●

●

‐

‐

‐

‐

‐

‐

‐

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‐

Collard 2010

‐

‐

‐

‐

‐

‐

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●

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Cook 2006

●

●

‐

●

‐

‐

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‐

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Falavigna 2012

‐

●

●

●

●

●

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‐

‐

‐

‐

‐

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Frederick 2000

●

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●

●

●

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‐

●

‐

●

Grant 1992

‐

‐

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Greene 2002

●

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Gresham 2001

‐

●

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Kendrick 2007

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Lee 2004

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Lu 2000

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Martinez 1996

●

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Morrongiello 1998

‐

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Reed 2001

‐

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Richards 1991

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Sun 2004

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Terzidis 2007

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Twisk 2013

●

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Wang 2009

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Wesner 2003

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Wright 1995

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Zhao 2006

●

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Zirkle 2005

●

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●

●

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐: outcome not measured; ●: outcome measured.
Figuras y tablas -
Table 2. Injury mechanisms targeted for included studies
Ir a la tabla de la revisión
Comparison 1. Medically attended or non‐medically attended injury rates

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Injury rates at follow‐up, adjusted for baseline injury rates in non‐randomised studies Show forest plot

3

2073

Rate Ratio (Random, 95% CI)

0.73 [0.49, 1.08]
Figuras y tablas -
Comparison 1. Medically attended or non‐medically attended injury rates
Ir a la tabla de la revisión