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Knowledge and evidence in child injury prevention: ten years between clinical ideals and public health practices
  1. H M Alvesson*,
  2. L Laflamme
  1. Correspondence Department of Public Health Sciences, Karolinska Institutet, Nobels vg 9, Solna Campus, Stockholm 171 77, Sweden

Abstract

After more than 10 years of systematic evaluation of injury preventive strategies by the Cochrane Collaborations review group Cochrane Injuries Group, the list of evidence-based strategies remains limited in length and scope. The first review was posted on the website in 1998 and reviews are continuously added. A literature search carried out on the Cochrane Injuries Groups website identified a total of 96 references on systematic reviews. These titles were examined and the reviews that indicated they were evaluating interventions targeting the prevention of unintentional injuries among children were selected which left us with 29 reviews. Of these, only twelve reviews were evaluated as evidence-based by the systematic review authors themselves. The strategies considered evidence-based does not well reflect the injury mortality or morbidity burden on children. With the exception of the traffic environment and for very young children also the home environment, the reviews present few findings on effective preventive strategies. The question is what this list reflects the actual status of the field, the interventions that entails measurable behavioural changes, or the preventive mechanisms that can be captured in randomised controlled trials. A discussion of the benefits as well as the potentially adverse effects of the evidence-based preferences for the randomised controlled trial, includes the trade-offs between rigorous clinical study designs and the ability to capture performances as well as the implementation processes through which injuries can be prevented in both high and low-income settings.

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