Does routine child health surveillance reach children most at risk of accidental injury?
BACKGROUND
There is currently an increasing emphasis on accident prevention as part of routine child health surveillance, which unlike opportunistic accident prevention has the potential to reach the whole population. However, non-attenders at routine child health surveillance may also be children at higher risk of accidental injury, as there is some evidence that non-attenders may be more likely to live in socio-economic disadvantage, which is a risk factor for accidental injury.


METHODS
A case control study was carried out in one general practice in Nottingham with 253 cases and 243 controls, aged four years and under, obtained from the practice age-sex register. Cases were defined as children who had attended the accident and emergency department, the general practitioner or the practice nurse after an accidental injury at any time during their life. Controls were children who had not had a medically attended accidental injury. Attendance at routine child health surveillance, before the date of the case's accidental injury, was assessed by attendance at the eight-month hearing test, immunization status, child health clinic visits and home visits by the health visitor.


RESULTS
There was no significant difference between cases and controls in attendance for the hearing test, or immunization status. Cases received significantly more home visits after adjusting for confounding variables (odds ratio 2.44, 95 per cent confidence intervals 1.28-4.66).


CONCLUSIONS
These findings suggest that non-attenders at routine child health surveillance activities are not at an increased risk of medically attended accidental injury. They also suggest that health visitors can identify those children most at risk of accidental injury using criteria for classifying priorities in caseloads.
Kendrick
D
D
Department of Public Health Medicine and Epidemiology, Nottingham University Medical School.
West
J
J
Wright
S
S
Presbury
M
M
D000056:Accident Prevention; D016022:Case-Control Studies; D002662:Child Health Services; D002675:Child, Preschool; D003625:Data Collection / Q000379:methods; D004739:England; D005194:Family Practice; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D012959:Socioeconomic Factors; D014947:Wounds and Injuries / Q000628:therapy*