PEDIATRIC INJURY PREVENTION COUNSELING PRIORITIES

Objective. Child health care providers have a unique opportunity to co nduct: injury prevention counseling but limited empirical evidence for choosing prevention strategies. Efficient use of time requires that p revention strategies of higher priority be discussed before lower prio rity strategies. Our aim was to assess consensus among experts about t he prioritization of prevention strategies for office based injury pre vention counseling for parents of children under age two. Design. We u sed a modified Delphi technique with 23 childhood injury prevention ex perts nationwide. Participants were blinded to the identities of each other. Measures. The first questionnaire, distributed via facsimile tr ansmission, consisted of open ended questions about: prevention strate gies participants believe should be included and their prioritization methods, The second questionnaire was closed ended and based on the re sults of the first. Results. Seventeen injury problems and 21 preventi on strategies were suggested for counseling. Participants emphasized e nvironmental strategies over more active, educational ones. Motor vehi cle occupant injuries and car seats were given high priority scores by all participants. Smoke detectors, lowering the hot water heater temp erature, and pool fencing also received high priority ratings. Partici pants based their decisions on the severity of the injury, the frequen cy with which the injury occured, and the availability of environmenta l strategies. However, they disagreed about the relative importance of these factors. Time constraints and parents' inability to absorb info rmation led them to suggest limiting, to fewer than four, the number o f prevention strategies addressed at any one visit. Conclusions. This study illustrates areas of consensus as well as unresolved dilemmas ab out pediatric injury prevention counseling. A rational decision making approach to prioritizing elements of clinical counseling is needed. M eanwhile, clinicians can use the findings of this study to derive thei r own judgments.