Children at risk of medicinal and non-medicinal poisoning: a population-based case-control study in general practice

Tyrrell, Edward; Orton, Elizabeth; Tata, Laila J.; Kendrick, Denise

doi:10.3399/bjgp12x659303

Cited by 20 publications

(24 citation statements)

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“…To our knowledge, few studies have assessed the impact of maternal alcohol misuse on childhood fractures; although there are studies of other injury types where an association has been found. 22 35 Associations between maternal alcohol misuse and childhood injuries could relate to alcohol influencing supervisory practices, the presence of hazards or the uptake of injury prevention practices; although our interpretation is limited by not having data on mothers’ alcohol consumption at the time of the fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Statistical power was calculated using the prevalence of the rarest risk factor, recording of alcohol misuse within the same primary care population (0.48%). 22 To obtain 80% power to detect an OR of 2.2 at the 5% significance level, using a correlation coefficient of 0.2 to allow for matching by general practice, 23 2019 cases with 10 matched controls per case were required. For all other risk factors of higher prevalence there was a greater level of power.…”

Section: Methodsmentioning

confidence: 99%

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Risk factors for long-bone fractures in children up to 5 years of age: a nested case–control study

et al. 2014

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AimTo investigate risk factors for first long-bone fractures in children up to 5 years old in order to provide evidence about which families could benefit from injury prevention interventions.MethodsPopulation-based matched nested case–control study using The Health Improvement Network, a UK primary care research database, 1988–2004.Maternal, household and child risk factors for injury were assessed among 2456 children with long-bone fractures (cases). 23 661controls were matched to cases on general practice. Adjusted ORs and 95% CIs were estimated using conditional logistic regression.ResultsFractures of long-bones were independently associated with younger maternal age and higher birth order, with children who were the fourth-born in the family, or later, having a threefold greater odds of fracture compared to first-born children (adjusted OR 3.12, 95% CI 2.08 to 4.68). Children over the age of 1 year had a fourfold (13–24 months, adjusted OR 4.09 95% CI 3.51 to 4.76) to fivefold (37+ months, adjusted OR 4.88 95% CI 4.21 to 5.66) increase in the odds of a long-bone fracture compared to children aged 0–12 months. Children in families with a history of maternal alcohol misuse had a raised odds of long-bone fracture (adjusted OR 2.33, 95% CI 1.13 to 4.82) compared to those with no documented history.ConclusionsRisk factors for long-bone fractures in children less than 5 years old included age above 1 year, increasing birth order, younger maternal age and maternal alcohol misuse. These risk factors should be used to prioritise families and communities for injury prevention interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Risk factors for long-bone fractures in children up to 5 years of age: a nested case–control study

et al. 2014

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“…Factors influencing risk for childhood poisoning include the child's age,15–18 25 26 gender,16 25 birth order,27 socioeconomic disadvantage,26–29 single parenthood,26 maternal age26 27 and maternal depression,26 in addition to presence, accessibility and unsafe storage of poisoning agents 5 30 31. Although the strongest evidence on reducing poisoning relates to use of CRCs,4 32 33 as CRCs are not ‘child proof’, other poison prevention practices still require evaluation 34.…”

Section: Introductionmentioning

confidence: 99%

Keeping children safe at home: protocol for a matched case-control study of modifiable risk factors for poisoning

et al. 2014

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“… 0.90 Fixed pEff Probability of safe storage of medicines given the intervention Achana et al, 2015 [ 9 ] (1) Usual care (2) Education (3) Provision of low cost/free low cost/free equipment (4) Education + provision of low cost/free equipment (5) Education + equipment + home safety inspection (6) Education + equipment + fitting (7) Education + equipment + home safety inspection + fitting 0.87 (95%CrI 0.56, 0.98) 0.90 (95%CrI 0.61, 0.98) 0.93 (95%CrI 0.65, 0.99) 0.94 (95%CrI 0.74, 0.99) 0.90 (95%CrI 0.56, 0.99) 0.90 (95%CrI 0.59, 0.98) 0.93 (95%CrI 0.66, 0.99) Posterior distribution of absolute intervention effects from network meta-analysis. pIngest Probability of unintentional exposure/ingestion Orton et al, 2014 [ 10 ] Tyrrell et al, 2012 [ 33 ] Office for National Statistics, 2013 [ 34 ] Orton et al [ 10 ] – incidence of poisonings in the UK for period 2005–2009 is 30.1 (95 % CI 29.1–31.2). Mid-year population estimates of under 5 year olds in the UK in 2012 = 3996400 [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

A decision analytic model to investigate the cost-effectiveness of poisoning prevention practices in households with young children

et al. 2016

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BackgroundSystematic reviews and a network meta-analysis show home safety education with or without the provision of safety equipment is effective in promoting poison prevention behaviours in households with children. This paper compares the cost-effectiveness of home safety interventions to promote poison prevention practices.MethodsA probabilistic decision-analytic model simulates healthcare costs and benefits for a hypothetical cohort of under 5 year olds. The model compares the cost-effectiveness of home safety education, home safety inspections, provision of free or low cost safety equipment and fitting of equipment. Analyses are conducted from a UK National Health Service and Personal Social Services perspective and expressed in 2012 prices.ResultsEducation without safety inspection, provision or fitting of equipment was the most cost-effective strategy for promoting safe storage of medicines with an incremental cost-effectiveness ratio of £2888 (95 % credible interval (CrI) £1990–£5774) per poison case avoided or £41,330 (95%CrI £20,007–£91,534) per QALY gained compared with usual care. Compared to usual care, home safety interventions were not cost-effective in promoting safe storage of other household products.ConclusionEducation offers better value for money than more intensive but expensive strategies for preventing medicinal poisonings, but is only likely to be cost-effective at £30,000 per QALY gained for families in disadvantaged areas and for those with more than one child. There was considerable uncertainty in cost-effectiveness estimates due to paucity of evidence on model parameters. Policy makers should consider both costs and effectiveness of competing interventions to ensure efficient use of resources.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3334-0) contains supplementary material, which is available to authorized users.

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Children at risk of medicinal and non-medicinal poisoning: a population-based case-control study in general practice

Cited by 20 publications

References 24 publications

Risk factors for long-bone fractures in children up to 5 years of age: a nested case–control study

Risk factors for long-bone fractures in children up to 5 years of age: a nested case–control study

Keeping children safe at home: protocol for a matched case-control study of modifiable risk factors for poisoning

A decision analytic model to investigate the cost-effectiveness of poisoning prevention practices in households with young children

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