Less Anticipatory Guidance is Associated with More Subsequent Injury Visits among Infants

Objective

To describe clinician delivery of injury prevention anticipatory guidance and injury visits in a birth cohort, and to describe the association of injury prevention anticipatory guidance with subsequent injury visits.

Methods

We performed a prospective cohort study of 2610 infants born from July 1, 1998 to June 30, 1999, at an urban safety-net hospital and seen subsequently for well child care (WCC, visits = 10558) and/or injury by 16 months of age. Injury guidance was defined as the proportion of recommended injury prevention anticipatory guidance items delivered to those expected, given the WCC visits the child attended. The outcome was a first injury visit to a clinic, emergency department, or hospital.

Results

The injury prevention items most discussed were car seats (84%–95% of all WCC visits) and rolling over at the 2-month WCC visit (80%). Other items were addressed at 36%–69% of visits. A total of 1931 (74%) of children received ≥50% expected injury guidance. A total of 277 children (11%) had an injury visit, primarily for minor injuries. In unadjusted analysis, children receiving <25% expected injury guidance were more likely to have a subsequent injury visit (unadjusted odds ratio 6.2; 95% confidence interval [95% CI] 3.2–9.7). In adjusted analysis, children who received <25% and 25%–49% expected injury guidance were more likely to have a subsequent injury visits (adjusted odds ratio [AOR] 6.6; 95% CI 3.8–11.2; and AOR 2.9, 95% CI 2.0–4.3, respectively).

Conclusions

Disadvantaged children whose families received less injury guidance than other children in their cohort were more likely to have a subsequent injury visit. Further studies are needed to determine whether increased injury prevention counseling reduces injury visits.

Key words: anticipatory guidance, counseling, injury prevention and control, safety-net setting