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What new technologies are available that might cut death rates for road traffic injury and what evidence is available as to their effectiveness? One of the four new reviews from the Cochrane Injuries Group has examined the use of alcohol ignition interlock devices in programmes intended to reduce recidivism among convicted drink-drivers.1
Convicted drink-drivers are sometimes offered the choice of a standard punishment, or for an alcohol ignition interlock to be fitted to their car for a fixed period. To operate a vehicle equipped with an interlock, the driver must first give a breath specimen. If the breath alcohol concentration of the specimen is too high, the vehicle will not start. Our reviewers found 14 studies meeting their inclusion criteria that had been conducted to see whether the interlock stopped drink-drivers from offending again. They included one randomised controlled trial. However, most of the studies were not of high quality. The interlock seems to reduce reoffending, in both first time and repeat offenders, as long as it is still fitted to the vehicle. Sadly, there seems to be no long term benefit after it has been removed. More studies of good quality are needed to confirm these findings. One problem that has emerged is the low percentage of offenders who choose to have an interlock fitted; this makes it difficult to reach firm conclusions about their effectiveness.
Some high tech interventions turn out to be useful in some parts of the world but they may be too expensive to use in those countries that bear the greatest burden of road traffic injury—the developing world. One of the challenges faced by our group is to try to ensure that the majority of our reviews are relevant to the needs of decision makers working with limited resources. The authors of systematic reviews also need to take note of where their included studies took place—usually in high income countries—and consider whether the interventions in question are robust enough to retain their effectiveness in other environments.
We will be more likely to meet these challenges if we involve more people from developing countries in the writing of our reviews. It is, therefore, very encouraging to be able to report that one of our projects now in the pipeline deals with a major cause of injury in developing countries, drowning, and will be written by two Vietnamese reviewers.2 They point out that an estimated 97% of drownings occur in the developing world. The diverse circumstances in which drowning occurs contributes to the challenge of developing effective and appropriate prevention programmes. This review is unusually broad in its scope as the reviewers want to examine all possible ways of reducing the loss of life.
There are of course other systematic reviews on injury prevention also on the way. We have recently published protocols for the following projects: “Home safety education and provision of safety equipment for injury prevention”, and “Child-resistant containers in the prevention of childhood poisoning”.