A randomized trial of an intervention to prevent lawnmower injuries in children

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Abstract

The U.S. Consumer Product Safety Commission reports about 60 000 emergency room visits for lawnmower injuries annually with 20% to children under 15 years. Employing a randomized pre-post control group design, the current study evaluated a 20-minute video intervention to increase parents' (n=80) safety awareness and preventive actions. The setting was an outpatient clinic at a Children's Hospital. Differences favoring the intervention group were found for four of six behavior outcomes. For example, the proportion reporting never allowing children near operating mowers increased from half to two-thirds with no change among comparison group parents. In addition, significant increases in severity beliefs were found. The results provide formative support for the video intervention which possesses the key advantages of ease of use and constancy of message.

Introduction

Ninety-one percent of non-fatal injuries and half of fatal injuries to children under five years occur at home 1, 2. Prior to age six most home injuries occur indoors. For older children most occur outdoors typically in front or back yards [3]. Accordingly, investigators have developed and evaluated approaches to prevent varied types of childhood injuries in and around the home. Injuries addressed by these approaches have included scald burns from excessive hot water temperatures [4], drowning in backyard pools [5], poisonings from hazardous kitchen and bathroom products [6], and falls from stairs and windows [7]. Although the topic of reports in the surgical literature for more than 30 years [8], childhood injuries associated with lawnmowers have not been the subject of preventive research and rarely have received attention from injury epidemiologists.

The Consumer Product Safety Commission (CPSC) using data from the National Electronic Injury Surveillance System estimates that there were 58 800 emergency room visits associated with lawn mower injury in 1990: 27 000 involving ride-on, tractor style mowers and 31,800 involving traditional, walk-behind mowers. About 7% of these visits required hospitalization. Following the July 1982 CPSC regulation which required `deadman' switches on all newly manufactured walk behind mowers, the incidence of injury involving this mower type decreased by 40% by 1990. However, for ride-on mowers where safety features remain only voluntary, there has been no change in injury incidence. In 1990 the CPSC estimates that there were 45 million walk-behind and 10.5 million ride-on mowers owned and operated by consumers in the U.S. This yields a rate of 2.5 injuries per 1000 units for ride-on mowers and 0.70 per 1000 units for walk-behind mowers [9]. While deaths due to walk-behind mowers are rare, ride-on mowers are responsible for about 75 deaths annually [10]. Nevertheless, walk behind mowers still account for a larger number of injuries overall than ride-on mowers.

The type of injury received from mowers is varied. Injury types include incidents of runover, backover, passenger falls from ride-on mowers, mower tip overs, and burns. Lacerations are the most common type of injury. Seventy-one per cent are to hands or feet, or distal areas of arms or legs [10]. Not all involve direct blade contact. About 17% of lawn mower injuries result from the striking of persons by objects thrown by mowers, typically rocks, wire, or glass. Rotary mower blades travel at speeds up to 3000 rpm, and can hurl objects up to 50 feet. Reports have documented `missile' injuries to the eyes, abdomen, chest and face 11, 12.

A fairly large proportion of lawn mower associated injuries involve children. Cutting and piercing by powered tools or other household appliances or objects (E-codes 919–920) are the fourth leading cause of childhood injury accounting for 11% of all childhood injury hospital emergency room visits 13, 14. For ride-on mowers 26% of injuries involve persons <15 years of age [10]. For walk-behind mowers about 13% of injuries involve persons <14 years [15]. Injured younger children usually are bystanders; with older children and young adolescents operator injuries are more common 16, 17. Case reports also suggest that the severity of mower injury is greater for children than for adults [18].

Several reports have called for multi-faceted efforts to prevent lawnmower injury to children 19, 20, 21. According to the Committee on Accident and Poison Prevention of the American Academy of Pediatrics, these efforts should include requirements for a minimum operating age, more safely designed products, and parent education [19]. Specifically, the Committee called for physicians to advise parents that children should not be allowed to play or be adjacent to areas where mowers are being used. In addition, children under age 5 should be kept indoors during mowing and no children should be allowed to operate mowers, even with adult supervision.

The purpose of this study was to evaluate the effectiveness of a video-based intervention to prevent childhood lawnmower injury. A video intervention does not require large physician or staff effort and therefore could be easily implemented in pediatric practices. Specifically, we hypothesized that parents viewing the preventive video would be more likely to keep children away from operating mowers and to clear the area of rocks and other objects prior to mowing. Recognizing the need for an improved theory base for pediatric patient education, the objectives of the study also included assessment of changes in parents' beliefs concerning the risk of lawnmower injury, its probable severity, the efficacy of preventive parental actions, and barriers to routinely performing them.

Section snippets

Setting

This study was conducted at the outpatient orthopedic clinic at Cardinal Glennon Children's Hospital in St. Louis, Missouri which serves a heterogeneous pediatric population from throughout the metropolitan area. Patients' diagnoses include a range of congenital, developmental and traumatic orthopedic conditions. In general, parents bring their children to the clinic for post-operative follow-up services. These parents were the target group for the injury prevention intervention that is the

Results

Of the 130 eligible parents approached in the clinic, 80 (62%) agreed to participate in the study. Half were randomly assigned into either the intervention or comparison group. Three-month follow-up data were received from 30 intervention group parents and 35 comparison group parents comprising the final study sample. This attrition difference (25.0% vs. 12.5%, respectively) between groups was not significant (X2=2.05, df=1, P=0.152).

However, since attrition differences approached statistical

Discussion

Between 1984 and 1992, twenty-three children were admitted to Cardinal Glennon Childrens Hospital in St. Louis for injuries resulting from direct contact with the rotary blade of a power mower. The children ranged in age from 27 months to 15 years. About one-third were mower operators, another third passengers of ride-on mowers, and the final third bystanders. All injuries occurred between April and August. The incidence and severity of these cases in our own setting prompted us to assess the

Practice implications

In summary, this study offers preliminary evidence that intervention at a clinical setting can produce changes in parental behaviors associated with the prevention of childhood lawnmower injury. Although a number of tertiary medical case reports exist, and although the CPSC has conducted occasional epidemiologic studies, we could not locate any other report of a proactive, systematic effort to prevent child mower injury. Further study is needed, particularly replication at a non-orthopedic,

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