Preventing childhood falls at home: meta-analysis and meta-regression.
BACKGROUND
Childhood falls are an important global public health problem, but evidence on their prevention has not been quantitatively synthesized. Despite social inequalities in childhood injury rates, there is a lack of evidence examining the effect of fall-prevention practices by social group.


METHODS
A systematic review of literature was conducted up to June 2004 and meta-analysis using individual patient data to evaluate the effect of home-safety interventions on fall-prevention practices and fall-injury rates. Meta-regression examined the effect of interventions by child age, gender, and social variables. Included were 21 studies, 13 of which contributed to meta-analyses.


RESULTS
Home-safety interventions increased stair-gate use (OR=1.26; 95% CI=1.05, 1.51), and there was some evidence of reduced baby-walker use (OR=0.66; 95% CI=0.43, 1.00), but little evidence of increased possession of window locks, screens, or windows with limited opening (OR=1.16, 95% CI=0.84, 1.59) or of nonslip bath mats or decals (OR=1.15; 95% CI=0.51, 2.62). Two studies reported nonsignificant effects on falls (baby-walker-related falls on flat ground [OR=1.35; 95% CI=0.64, 2.83] or down steps or stairs [OR=0.70; 95% CI=0.14, 3.49]) and medically attended falls (OR=0.78; 95% CI=0.61, 1.00).


CONCLUSIONS
Home-safety education and the provision of safety equipment improved some fall-prevention practices, but the impact on fall-injury rates is unclear. There was some evidence that the effect of home-safety interventions varied by social group.
Kendrick
Denise
D
Division of Primary Care, School of Nursing, University of Nottingham, Hucknall Primary Care Trust, Hucknall Health Centre, Nottingham, England, UK. denise.kendrick@nottingham.ac.uk
Watson
Michael C
MC
Mulvaney
Caroline A
CA
Smith
Sherie J
SJ
Sutton
Alex J
AJ
Coupland
Carol A C
CA
Mason-Jones
Amanda J
AJ
D000056:Accident Prevention / Q000379:methods*; D000058:Accidental Falls / Q000517:prevention & control*; D000061:Accidents, Home / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D011482:Protective Devices