Translating Best Evidence into Best CareEDITOR’S NOTE: Journals reviewed for this issue: Archives of Disease in Childhood, Archives of Pediatrics and Adolescent Med-icine, British Medical Journal, Journal of the American Medical Association, The Journal of Pediatrics, The Lancet, New EnglandJournal of Medicine, Pediatric Infectious Diseases Journal, and Pediatrics. Heidi Marleau, MLS, Ebling Library for the HealthSciences, University of Wisconsin, contributed to the review and selection of this month’s abstracts.

—John G. Frohna, MD, MPH

Installation of home safety devices reducesincidence of preventable injury in young childrenPhelan KJ, Khoury J, Xu Y, Liddy S, Hornung R, Lanphear BP.A randomized controlled trial of home injury hazard reduc-tion: the HOME injury study. Arch Pediatr Adolesc Med2011;165:339-45.

Question Does the installation of safety devices in the homesof young children reduce the rate of injuries, compared withprovision of handouts alone?

Design A nested, prospective, randomized controlled trial.

Setting Households in the Cincinnati, Ohio regional area.

Participants 355 mothers and their children from birth to 3years old (mean age 6.3 months) participating in the HomeObservation and Measures of the Environment study.

Intervention Installation of multiple passive measures (eg,stair gates, cabinet locks, and smoke detectors) to reduce ex-posure to injury hazards. Injury hazards were assessed athome visits by teams of trained research assistants using a val-idated survey. Both intervention and control groups receivedAmerican Academy of Pediatrics’ ‘‘The Injury PreventionProgram’’ information sheets on developmentally appropri-ate injury risks and control measures.

Outcomes Modifiable and medically attended injury (ie,telephone calls, office visits, and emergency visits for injury).

Main Results Injury hazardswere reduced in the interventionhomes but not in the control homes at 1 and 2 years (P< .004).There was no difference in the rate for all medically attendedinjuries in intervention children comparedwith controls: 14.3injuries (95% CI, 9.7-21.1 injuries) vs 20.8 injuries (95% CI,14.4-29.9 injuries) per 100 child-years (P = .17); but therewas a significant reduction in the rate of modifiable medicallyattended injuries in intervention children compared withcontrols: 2.3 injuries (95% CI, 1.0-5.5 injuries) vs 7.7 injuries(95% CI, 4.2-14.2 injuries) per 100 child-years (P = .03).

Conclusions An intervention to reduce exposure to hazardsin homes led to a 70% reduction in the rate of modifiablemedically attended injury.

Commentary Injuries in the home are a major public healthconcern, and a leading cause of death in children under theage of 5 years.1 Although it is logical to deduce that hazardsin the home environment contribute to a sequence of eventsculminating in an injury, our recent Cochrane Review foundinsufficient evidence to suggest that amelioration of such haz-ards reduced injuries.2 This study by Phelan et al demon-

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strates an intervention that reduces hazards in the home,and significantly reduces the rate of modifiable medicallyattended injuries in intervention children. It is also success-fully installed and maintained home safety devices in allintervention homes. One limitation of the study is its gener-alizability. Mothers were excluded from the trial if they were:younger than 18 years, could not speak fluent English, livingin public/shelter housing, or living in a property built after1978. These criteria excluded a high percentage of house-holds, which have been shown to be at increased risk of injuryand less likely to engage in safety practices.3-4 Additionally,the main outcome was based on a relatively small numberof modifiable medically attended injuries (interventiongroup, n = 5; control group, n = 16). Nevertheless, thiswell-conducted trial is a significant advance on previouswork, and provides encouraging results for the reduction ofhome injuries. It demonstrates the importance of actively in-stalling home safety devices to ameliorate hazards, ratherthan relying solely on safety advice as in other studies. Beforestrong policy recommendations can be made, the successfulhome safety intervention described in this trial should be rep-licated with larger sample sizes, and across different popula-tions and settings.

Samantha Turner, BScSwansea University

Swansea, United Kingdom

References

1. Peden M, Oyebite K, Ozanne-Smith J, Hyder AA, Branche C,

Rahman FAKM, Rivara F, Bartolomeos K, eds. World report on child in-

jury prevention. Geneva: World Health Organization Press; 2008.

2. Turner S, Arthur G, Lyons RA, Weightman AL, Mann MK, Jones SJ, et al.

Modification of the home environment for the reduction of injuries.

Cochrane Database Syst Rev 2011;2:CD003600.

3. Kendrick D, Mulvaney C, Burton P, Watson M. Relationships between

child, family and neighbourhood characteristics and childhood injury:

a cohort study. Soc Sci Med 2005;61:1905-15.

4. KendrickD.Children’s safety in the home: parents’ possession and percep-

tions of the importance of safety equipment. Public Health 1994;108:21-5.

Omalizumab reduces frequency of asthmaexacerbations in childrenBusseWW,MorganWJ, Gergen PJ,Mitchell HE, Gern JE, LiuAH, et al. Randomized trial of omalizumab (anti-IgE) forasthma in inner-city children.NEngl JMed2011;364:1005-15.