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Contributors to Injury Prevention frequently lament the inadequacy of the evidence base on interventions intended to prevent injury. The most recent reviews completed by the Cochrane Injuries Group (CIG) highlight the fact that some types of injury are better served by the evidence base, such as it is, than are others.
Injuries from falls are recognised as a major threat to elderly people. There are several measures that are known to be efficacious in reducing the risk of falling for old people individually, but how effective are prevention programmes conducted at community level in reducing the incidence of fall related injury? One of CIG’s latest systematic reviews has addressed this question—“Population-based interventions to prevent fall-related injury in older people”.1 The reviewers found only five quality trials that met their inclusion criteria. However, in all five the rate of injuries caused by falls decreased after population based programmes had been introduced. Reductions achieved ranged from 6% to 33%. Although they call for more research to be done, the reviewers conclude that population based falls prevention programmes are effective in reducing injuries sustained by people aged over 65.
Here then is a sector of the evidence base on injury prevention where good evidence is starting to accumulate. Things are not, however, looking so good elsewhere.
We have recently published two CIG reviews on the treatment of organophosphorus poisoning.2,3 This is one of the most common types of poisoning worldwide, most of the victims being in developing countries. Self poisoning is responsible for many of the cases. Oximes—drugs which appear to reactivate the enzyme acetylcholinesterase, which organophosphorus inhibits—form part of the standard treatment. However, a systematic review of evidence for the use of oximes found that very few studies have taken place to evaluate this treatment,2 and these had been inconclusive. A further treatment option involves alkalanisation,3 with sodium bicarbonate used in most cases. Although there are theoretical grounds for thinking that this could be useful, virtually no research has been done and the effectiveness of this approach must remain in the realm of speculation. Thus we have yet another situation where the lack of effective treatment for a condition4 has highlighted the need to know which prevention measures are effective.
In what kind of state then is the evidence base on poisoning prevention? One of the admirable features of the Cochrane Library is that, as well as including all Cochrane’s systematic reviews, it allows users to see what systematic reviews have been produced by others. A search of the Library’s Database of Abstracts of Reviews of Effectiveness (DARE) is undoubtedly the best way of tracking down non-Cochrane systematic reviews. A DARE search, however, reveals no reviews at all that specifically address interventions to prevent any kind of poisoning.
There is one poisoning prevention review in CIG’s pipeline. Reviewers working with us are examining the effectiveness of childproof containers. We have thus made a very modest start in this neglected area. More, much more, remains to be done and we would very much like to hear from anyone who would like to take on a systematic review of the evidence for the effectiveness of an intervention to prevent poisoning.