Decades-old AAP program reduces pediatric injuries, study shows

Key takeaways:

• In 1983, the AAP established a primary care-based program to prevent pediatric injuries.
• The first evaluation of the 41-year-old program found that it works.

A decades-old AAP program that was created to help pediatricians prevent unintentional injuries in their patients was shown to be effective in the first ever randomized trial testing its use, according to findings published in Pediatrics.

The primary care-based Injury Prevention Program (TIPP), which was created by the AAP in 1983, is comprised of materials to help providers identify at-risk parental behaviors and counsel them on anticipatory guidance to prevent injury.

The new study grew out of a large study on obesity prevention, which used TIPP as a control arm, according to Eliana M. Perrin, MD, MPH, Bloomberg Distinguished Professor of Primary Care and professor of pediatrics at Johns Hopkins University Schools of Medicine and Nursing and a co-author of the study.

“When my site was randomized to the TIPP arm instead of the obesity prevention arm, I was disappointed because I’m an obesity prevention researcher and it meant that ... we would be rolling out injury prevention,” Perrin told Healio. “I decided to make lemonade out of lemons and turn this cluster randomized trial of our obesity prevention program on its head and look at how effective [TIPP] was.”

Perrin and colleagues studied the effectiveness of TIPP in a study that included four academic medical centers — two that implemented an obesity prevention program and two that trained providers and implemented the TIPP program.

“We then had all the trained providers use TIPP throughout all well-child care visits from 2 months through 2 years,” Perrin said. “For example, at 6 months, TIPP materials remind parents that their children will be crawling soon, so they should put in stair gates to prevent injuries from a fall down the stairs.”

Depending on the study arm, providers implemented either obesity prevention or TIPP screening and materials at each well-child check up to age 24 months. In TIPP medical centers, this involved parents reporting the number of child injuries since the previous well-child check.

In all, 781 parent-infant dyads were included in the analysis: 349 in the TIPP group and 432 in the control group. The researchers compared the rates of parent-reported injuries in each group, controlling for factors that increase risk, Perrin explained.

Among the parent-infant dyads, 51% were Hispanic, 28% were non-Hispanic Black and 87% were insured by Medicaid.

Reported injuries were significantly less likely at TIPP sites compared with non-TIPP sites throughout the follow-up, with adjusted ORs of 0.77 (95% CI, 0.66-0.91) at 4 months, 0.6 (95% CI, 0.44-0.82) at 6 months, 0.32 (95% CI, 0.16-0.62) at 12 months, 0.26 (95% CI, 0.12-0.53) at 18 months and 0.27 (95% CI, 0.14-0.52) at 24 months.

“When we were teaching the residents to use this program, we really thought, ‘This is so rote! So, we were not expecting the effect sizes we saw,” Perrin said. “This program really cut down on the reported injuries, and it was a more effective intervention than others we try in practice.”

Perrin is interested in whether TIPP can prevent more serious injuries, and if there is a way to make the program even easier to use.

“We hope this will encourage providers to use The Injury Prevention Program and to incorporate developmentally based injury prevention guidance into their practice,” Perrin said. “These are the conversations we are wanting pediatric providers and parents to have so we can keep children safe.”