Background The aim of this Cochrane systematic review was to evaluate the effectiveness and cost-effectiveness of school-based education programmes to prevent unintentional injuries in children and young people.

Methods A total of 28 electronic databases and websites were searched. We included randomised and non-randomised controlled trials and controlled before-and-after studies of primary and secondary prevention interventions, delivered in the school setting, aimed at a range of injury mechanisms. The primary outcome was self-reported or medically-attended unintentional (or unspecified) injuries and secondary outcomes were observed safety skills, observed behaviour, self-reported behaviour and safety practices, safety knowledge and health economic outcomes.

Results 27 studies reported in 29 articles were included. Interventions comprised information giving, peer education or were multi-component. 7 studies reported the primary outcome of injury occurrence and only 3 of these were similar enough to combine in a meta-analysis with a pooled incidence rate ratio of 0.76 (95% CI: 0.49, 1.17) and significant heterogeneity between effect sizes (Chi² = 10.38, df = 2, P = 0.006; I² = 81%). Safety skills reported in 2 studies showed significant improvement, as did all 4 studies reporting observed safety behaviours and 13 out of 19 studies describing self-reported behaviour. The 21 studies measuring changes in safety knowledge were varied in their focus, including water, burn, sport, brain and spinal cord, agricultural or mixed injury prevention programmes and most reported that safety knowledge improved. Only one study reported intervention costs but did not undertake a full economic evaluation.

Conclusions There is good evidence that school-based injury prevention programmes improve safety skills, behaviour and knowledge. We found insufficient economic studies to assess cost-effectiveness.