Predicting clinician injury prevention counseling for young children

Background: Injury is the primary cause of morbidity and mortality in child ren and an important topic for counseling. Objective: To describe and explain clinicians' reported counseling behavior during the well-child examinations for children aged 5 years and younger o n the following 4 injury prevention topics: motor vehicle crashes, toxic in gestion, drowning, and firearm injuries. Methods: A random sample of 465 pediatricians, family physicians, and pedia tric nurse practitioners in an urban setting received mailed questionnaires ; 325 (69.9%) responded. Multivariate logistic regression predicting counse ling on each injury prevention topic was performed. Results: Most reported discussing motor vehicle occupant protection (66.2%) and toxic ingestion prevention (62.1%) during the well-child examination. Only 31.8% stated they counseled on drowning prevention and 15.7%, on firea rm injury prevention. Knowledge of injury mortality and morbidity rates was not associated with counseling. For most topics, female respondents were m ore likely to counsel than male respondents (motor vehicle crash odds ratio [OR], 2.24 [P = .03]; toxic ingestion OR, 1.82 [P = .05]; drowning OR, 1.9 7 [P =.04]). Wealth maintenance organization settings predicted injury prev ention counseling for most topics (motor vehicle crash OR, 2.52 [P = .04], toxic ingestion OR, 2.77 [P = .01]; firearm injury OR, 2.97 [P = .001]). Cl inicians placing lower importance on counseling were less likely to counsel on drowning and firearm injury (drowning OR, 0.73 [P = .006]; firearm inju ry OR, 0.58 [P<.001]). Conclusions: Clinicians' knowledge of local injury epidemiology did not inf luence their counseling on these topics. Clinicians and their patients migh t benefit by using programs such as The Injury Prevention Program to help t hem standardize their approach to injury prevention counseling during the r outine well-child examination.