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Understanding a community’s needs for an emergency department-based childhood injury prevention programme: a mixed-methods study
  1. Hamzah Majid Yusuf1,
  2. Efrat Rosenthal2,
  3. Aaron Kornblith2,
  4. Christine Sowar2,
  5. Rigoberto Del Toro2,
  6. Carol C Chen2
  1. 1 Emergency Medicine, Stanford Medicine, Stanford, California, USA
  2. 2 Emergency Medicine, UCSF, San Francisco, California, USA
  1. Correspondence to Dr Hamzah Majid Yusuf, Emergency Medicine, Stanford Medicine, Stanford, CA 94305, USA; hyusuf{at}


Objective Unintentional injuries are the most common cause of childhood death in the USA and are preventable. We developed a framework for an injury prevention programme using local injury data and understanding stakeholder perspectives.

Methods We used a mixed-methods approach. We performed a retrospective cross-sectional analysis of children presenting to an academic hospital system between January 2019 and December 2020 with an injury-related diagnosis. The primary outcome was encounters with an injury-related ICD-10 code. We conducted a thematic analysis by interviewing caregivers and emergency department (ED) providers.

Results There were 10 193 unique injury-related encounters. Most common injuries were natural/environmental (22.9%), falls (20.0%) and striking an object (5.1%). Highest rates of injury were seen in children who identified as Native Hawaiian or Pacific Islander (154 injuries per 10 000 children per year), followed by Hispanic or Latino (148). Three out of 20 zip code areas represented 43.4% of all injuries and correlated with lower household income. Twenty-five caregivers and eight ED providers participated in interviews that resulted in four major themes: perceptions of injury risk, caregiver receipt of injury prevention information, barriers and provider counselling.

Conclusion Clear differences exist within the injury burden in San Francisco by demographics, geography and type of injury. The findings from the study will guide the first steps in designing a strategic paediatric injury prevention centre. The methods may guide future investigations into the dynamic needs of clinicians and caregivers regarding injury. A strategic programme focused on the community’s unique needs and barriers may effectively reduce injury rates.

  • Behavior Change
  • Education
  • Health Disparities
  • Child
  • Mixed methods

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors CCC, ER and CS conceived the study. HMY, CCC, CS and ER designed the study. CCC supervised the conduct of the data collection. HMY conducted interviews, collected data, managed and analysed data. HMY and CCC coded interviews and derived themes. CCC provided statistical advice. CCC, AK and RDT provided specialty specific advice. HMY drafted the manuscript, and all authors contributed substantially to its revision. HMY is responsible for the overall content as guarantor, accepting full responsibilty for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish. All authors read and approved the final manuscript.

  • Funding This project was funded by an NIH TL1 grant.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.