Abstract

OBJECTIVE: To assess the effectiveness of a new multidisciplinary method for reconstructing the causal sequences that lead to child pedestrian injuries. SETTING: Subjects were 5-12 year old residents of Chicago, Illinois, USA, presenting for care due to pedestrian injury at one pediatric trauma center. METHODS: The interactions of medical, child, psychosocial, and traffic factors contributing to the injury were analysed. For 142 cases, information about the victim, his/her family, the injury site, and the activities just before the injury, was used in a structured manner by a multidisciplinary team to produce injury scenarios. Each scenario comprised a list of contributing factors, an estimate of the importance of each, and a narrative description of the causal sequence leading to the injury event. Face validity was assessed by two outside teams that performed a structured review of a subsample of cases (n = 11). Reliability was evaluated by comparison of the results of parallel teams assessing the same cases (n = 14). Process consistency and bias were assessed by analysis of the correlations of factor-importance rating patterns between members and over time. RESULTS: The outside team's agreement scores were based on a 1-5 Likert scale; these showed a mean of 3.6 and median of 4.0. Parallel teams consistently showed agreement greater than 85% on global attributes of cases. Intraclass correlation coefficient scores showed fair or better agreement for all classes of contributors, and excellent agreement for more than one third. Rating pattern analyses showed strong agreement by team members. Agreement did not increase over the period of the study. CONCLUSIONS: This causal sequence reconstruction method has acceptable face validity, reliability, and internal consistency. Although labor intensive and thus costly, it can produce unique, rich information for understanding injury causation and for guiding the search for promising interventions.