Injury Prevention Surveillance:
A Research Asset for Advocacy
D Grenier, MA Davis, AM Ugnat, L Painchaud
Canadian Paediatric Surveillance Program
On behalf of investigators and participants
Pan-Canadian Health Surveillance
Detection
• Systematic monthly data
collection
• Detailed reporting form
Dissemination
• Results publication
for action
Deduction
Modified from CDC
• Analysis and
interpretation
Scope of the CPSP
• Active timely surveillance.
• 7.8 million children < 19 years.
• Network of > 2,500 practicing paediatricians and
subspecialists facilitate case ascertainment.
• Average response rates
initial report
80%
detailed questionnaire
93%
Translating Surveillance into Advocacy
1. IDENTIFYING THE NEED FOR RESEARCH
• CPS Committees/Sections/Board
• CPSP Steering Committee
•
2. GETTING THE
EVIDENCE
• CPSP Survey
• CPSP Study
Researchers
•
•
•
•
4. ADVOCACY
CPSP participants
Other health professionals
Media
Government
3. DISSEMINATION OF INFORMATION
• Paediatrics and Child Health Journal
• CPS News, e-news
• Status Report
• Oral and poster presentations
Baby Walker Injuries
One-Time Survey - RR= 48% M Herbert, MSc
Background
1989 – Voluntary ban on sales
January 2002
CPSP – A minimum of 132 children <18 months of age
Source – Garage sales, internet purchase,
handed-down gift
Advocacy and Public Health Impact
April 2004
Total ban on sale, import and advertisement of
wheeled baby walkers
June 2006
Federal Minister of Health announced a board of review
CPS issued news release
Dec 2006
CPS presented at the hearing
Decision to uphold the ban
Infant Bath Seat Injuries
One-Time Survey - RR= 48% S Davidson, BSc
Background
June 2004: CPSP – 20 injuries, 12 near-miss drowning, 2 deaths
Bath seat tips over
Infant climbs out of seat
Infant slips through the leg opening
Advocacy and Public Health Impact
January 2005: CPSP Highlight – Paediatrics and Child Health Journal
Drowning hazards education
Importance of constant arms-length surveillance
April 2005: Health Canada
Advisory and public education bulletin
Risk assessment, laboratory testing and market survey
June 2007 CPS – Public education to members
July 2007 Health Canada – Public consultations
Next steps
Options on how best to mitigate the risk
* www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/2005/2005_30_e.html
* www.hc-sc.gc.ca/cps-spc/child-enfant/equip/bath-bain/index_e.html
Magnet Toy Injuries
One-Time Survey - RR= 39% L Warda
Background
Toys containing small magnets (3-8 mm) carry the risk of ingestion or aspiration.
Multiple magnets ingestion can cause serious bowel injury.
August 2007
CPSP – 20 cases, including one small bowel obstruction and one perforation.
Advocacy and Public Health Impact
February 2008: CPSP Highlight – Paediatrics and Child Health Journal
Maintain high index of suspicion
Perform an abdominal radiograph.
Keep out of play environments of children younger than six years.
Report any magnetic toy-related incidents promptly
 Health Canada Consumer Product Safety Office
 CPS-SPC@hc-sc.gc.ca
 1-866-662-0666 (toll-free)
Lap-belt syndrome
C Cyr, C Lemoine, M Santchi – Sept 2003-Aug 2005
Background
Surveillance results
MVA principal cause of
death in children.
Seat belts saves lives.
Incorrect use - LBS
28 confirmed cases
• intra-abdominal lesions
• spinal injuries
Canadian incidence
• not well documented.
• all age groups represented.
At-risk group
• 4 to 12 years - 79%
• < 8 years of age
– only 1 out of 12 adequately
restrained.
High morbidity
• 85% abdominal injury
• 43% spinal fracture
• 25% permanent spinal cord lesion.
Illustration courtesy of Partners for Child Passenger Safety, a research partnership of the Children’s
Hospital of Philadelphia and State Farm.
Lap-belt syndrome
C Cyr, C Lemoine, M Santchi – Sept 2003-Aug 2005
Advocacy
Longer use of booster seat in children.
Need for legislation and reinforcement measures.
Public Health Impact
September 2005
Ontario Ministry of Transport mandated use of
booster seats in children
– < 8 years of age
– weighing 18 kg to 36 kg
– measuring < 145 cm
CPS status reports
Preliminary Results
as of
July 2008
10
Booster Seat Legislation in 2007
8
4
2
0
Poor
Fair
Good
Status
Excellent
10
Booster Seat Legislation in 2008
8
6
4
2
0
Poor
Fair
Good
Status
Excellent
Number of Jurisdictions
6
Number of jurisdictions
Number of Jurisdictions
Booster Seat Legislation in 2005
10
8
6
4
2
0
Poor
Fair
Good
Status
Excellent
Booster Seat Legislation
Province/Territory
2005
2007
2008*
BC
Poor
Good
Excellent
AL
Poor
Fair
Fair
SK
Fair
Fair
Fair
MB
Poor
Fair
Fair
ON
Excellent Excellent
Excellent
QC
Fair
Good
Good
NB
Poor
Fair
Excellent
NS
Poor
Excellent
Excellent
PE
Poor
Fair
Excellent
NL
Poor
Good
Excellent
YK
Good
Fair
Fair
NW
Poor
Fair
Fair
NU
Poor
Fair
Fair
*Preliminary results
CPSP Injury Surveillance Conclusion
‘Results of studies reinforce the need and
importance of having a national injury
prevention strategy to prevent or reduce
injuries in the Canadian paediatric
population.’
The CPSP gratefully
acknowledges the participation of
all investigators and participants.
www.cps.ca/cpsp