Johns Hopkins pediatrician Eliana Perrin discusses her recent research on the effectiveness of the Injury Prevention Program (TIPP). Developed by the American Academy of Pediatrics in 1983, TIPP is designed to guide pediatricians in giving developmentally tailored injury prevention advice to parents during appointments.
For young Children, unintentional injuries are common and a leading cause of death. National guidelines recommend that pediatricians counsel parents about preventing injuries during well child checkups. From prior research, we know that injury prevention programs can help parents gain knowledge and even adopt safety practices. But few show they work to reduce injury. We also don't know very much about minor injuries at home when Children don't come in for medical care. The injury prevention program or Tip for short was developed by the American Academy of Pediatrics in 1983 it was designed to guide pediatricians to give developmentally tailored injury prevention advice to parents at each well child visit. So for example, the tip program uses materials like these to remind providers to suggest that parents put in stair gates before Children learn to move in order to prevent falls. But as far as we know, there haven't been any experimental studies to test whether the tip program is effective for preventing injuries in young Children to test tips effectiveness. We conducted a trial at four academic medical centers. Two of the four centers trained their pediatric residents to use tip screening and counseling materials at all. Well, child checks from age 2 to 24 months, two centers were control centers not trained in tip that implemented a different unrelated intervention. We then enrolled two month old Children and their parents at the four centers at each well child visit. A research assistant asked the parent in English or Spanish to report how many times if any the child had been injured since the prior visit for each injury. The parent was asked also to report the type of injury and whether any of the injuries required medical attention. Our study results include 781. Parent infant dies. More than half of parents were Hispanic. More than a quarter were non-hispanic black. Over 85% were insured by Medicaid reported injuries increased over time at 26, 1218 and 24 months. Parents reported at least one injury in 39, 2531 and 40% of Children respectively at 24 months. 22% of parents reported at least two injuries. The most common type of injury was a fall which was reported over 600 times in a distant second place for injury type was other which varied in parent description from plant, fell on my child to my child was scratched by another child. Burns were reported 31 times. Thankfully in the whole study, serious injuries like choking poisoning, motor vehicle crashes and near drowning were reported very few times. Injuries requiring medical attention increased over the first two years of life. But overall, fewer than one in five injuries or 16% required medical attention. Overall, we found that the tip intervention worked to prevent injury in young Children, families at tip sites reported significantly fewer injuries throughout their children's first two years. From the statistical models, we estimated that the risk of reporting injury across all scheduled. Well, child checkups averaged from four months to 24 months was 30% in the control group and only 14% in the tip group. Our study did have limitations. The biggest was that this was a cluster randomized trial with only four clusters. We tried to control for differences in the sites but residual confounding may exist. Further research is needed to increase injury, counseling factors such as lack of time are likely at play. But our cluster randomized trial shows that overcoming barriers and implementing the A AP tip program could prevent many injuries for America's young Children.
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