Evidence

2019 surveillance of unintentional injuries (NICE guidelines PH29, PH30 and PH31)

Overview of 2019 surveillance methods

Overview of 2019 surveillance methods

NICE's surveillance team checked whether recommendations in the following guidelines remain up to date:

The surveillance process consisted of:

  • Feedback from topic experts via a questionnaire.

  • A search for new or updated Cochrane reviews and national policy.

  • Consideration of evidence from previous surveillance.

  • Examining related NICE guidance and quality standards and NIHR signals.

  • A search for ongoing research.

  • Examining the NICE event tracker for relevant ongoing and published events.

  • Literature searches to identify relevant evidence.

  • Assessing the new evidence against current recommendations to determine whether or not to update sections of the guideline, or the whole guideline.

  • Consulting on the proposal with stakeholders.

  • Considering comments received during consultation and making any necessary changes to the proposal.

For further details about the process and the possible update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.

Evidence considered in surveillance

Search and selection strategy

For details of the individual search and selection strategies used please refer to the following appendices:

  • Appendix A1 (unintentional injuries: prevention strategies – NICE guideline PH29)

  • Appendix A2 (unintentional injuries in the home – NICE guideline PH30)

  • Appendix A3 (unintentional injuries on the road – NICE guideline PH31)

Intelligence gathered during surveillance

Views of topic experts

We considered the views of topic experts who were recruited to the NICE Centre for Guidelines Expert Advisers Panel to represent their specialty. For this surveillance review, topic experts completed a questionnaire about developments in evidence, policy and services related to each of the 3 guidelines.

The following responses were received from 16 topic expert questionnaires sent for each guideline:

  • NICE guideline PH29 – 8 responses were received, 5 of the experts felt an update was needed.

  • NICE guideline PH30 – 8 responses were received, 6 of the experts felt an update was needed.

  • NICE guideline PH31 – 8 responses were received, 4 of the experts felt an update was needed.

In the areas where topic experts felt an update was necessary, no published evidence was identified in the surveillance review to indicate a need for new or updated recommendations. These included:

  • Home injuries: new hazards, home safety assessments and equipment provision.

  • Road injuries: subgroups who are potentially at greater risk of injury, parking bans around schools.

  • Outdoor play and leisure injuries: skate parks.

  • Strategies: coverage and quality of hospital admissions data, socioeconomic inequalities and the Healthy Child Programme.

For full details of the topic expert feedback for these 3 guidelines, please see appendices A1–A3.

Implementation of the guidelines

Topic experts and stakeholders raised concerns around the lack of resources available to implement the guideline recommendations, but this is a general point that is affecting commissioning of all services at the local level and cannot be addressed by the guideline.

Views of stakeholders

Stakeholders were consulted on the decision to not update NICE guidelines PH29, PH30 and PH31. Responses were received from 2 local authorities, Public Health England, the Royal College of Paediatrics and Child Health, and London Fire Brigade.

Unintentional injuries: prevention strategies for under 15s

Overall, 4 stakeholders commented, of whom 3 agreed and 1 disagreed with the decision to not update the guideline.

One stakeholder suggested updating several areas of the guideline. However, no evidence was submitted or identified in the surveillance review to support proposed changes to the recommendations. The areas included:

  • The need to notify fire and rescue services of observed repeated fire or injury risk (recommendation 3 for identifying and responding to emergency department attendances). However, the guideline recommends ensuring that health visitors, school nurses and GPs are aware of families which might benefit from injury prevention advice and a home safety assessment. This encompasses prevention of all unintentional injuries, including fire related, and the need to notify fire and rescue services where risk or injury is repeatedly observed.

  • Sources of national data on fire related injuries for recommendation 8 on gathering high quality data. The National Fire Chief Council's Data team was proposed as a source of national data on fire related injuries. This will be noted for consideration alongside further data on unintentional injuries that is awaited to strengthen the coverage and quality of hospital admissions data.

  • Establishing acceptable and unacceptable levels of risk for outdoor play and leisure relating to recommendation 12 in developing policies in this area. However, the guideline advice is to ensure that a policy takes a balanced approach to assessing the risks and benefits of play and leisure environments and activities and avoids excessive risk aversion.

  • The concern that advice for cycling training and off-road helmet use (recommendation 15) could impact adversely on perceived safety and deter rather than encourage cycling. When developing the guideline, the committee was aware of the debate on cycle helmets.

  • Changes to the text of recommendation 9 on smoke and carbon monoxide alarms in the home were also suggested but this recommendation is already proposed for editorial amendment to bring it in line with current legislation.

Unintentional injuries in the home: interventions for under 15s

Overall, 3 stakeholders commented and all disagreed with the decision not to update the guideline. Stakeholders queried the proposal not to add recommendations on new hazards that have emerged since the guideline was published, such as button batteries, trampolines and hair straighteners. However, as no evidence was identified on interventions to reduce unintentional injury from the new hazards, recommendations are unlikely to be impacted. There is a related research recommendation covering home safety interventions to drive research activity. Despite disagreeing with the overall decision not to update the guideline, the proposed changes and new evidence highlighted were broadly consistent with the current recommendations. One stakeholder called for new recommendations to provide a framework for health referrals during home safety assessments; however, this is out of scope for the guideline, so no changes will be made at this point.

Unintentional injuries on the road: interventions for under 15s

Overall, 6 stakeholders commented, of whom 3 agreed and 3 disagreed with the decision to not update the guideline. Stakeholders suggested a number of changes to recommendations. One suggestion was to include car manufacturers in the 'who should take action' section of recommendation 1, but this would be out of scope as their role is limited to secondary prevention design measures. One stakeholder noted that the evidence base around 20 mph zones had strengthened and that there was value in sharing this with relevant professionals. Whilst the additional evidence supports the current recommendation 3, it does not indicate any revision to the guideline is needed.

See appendices B1, B2 and B3 for full details of stakeholders' comments and our responses.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.

Equalities

Information identified by intelligence gathering and stakeholders highlighted that fatal and serious injuries among pedestrians and cyclists aged 5 to 14 years are significantly higher in the 20% most deprived areas compared with the 20% least deprived. The same information also highlighted that the transition from primary to secondary school appears to be associated with an increased risk of injury. These disparities are highlighted in the current guidance and no evidence was found during surveillance to suggest that current recommendations, which recommend needs assessment and strategies to reduce inequalities, are not appropriate to address them.

One stakeholder highlighted evidence to suggest that there are still social inequalities that exist in childhood unintentional injuries at home and on the road. This is consistent with the current recommendations across the guidelines, which advise that households and areas at high risk of injury are prioritised when delivering prevention services.

One stakeholder called for home safety assessments and follow-ups to be available for all children and not just targeted groups. It is acknowledged that recommendations across the guidelines will be interpreted in the context of varying budgetary constraints, which is why specific advice is given on how to prioritise those at highest risk of unintentional injuries if resources are limited (see recommendations on home safety in NICE guideline PH29 and recommendations 1 and 3 in NICE guideline PH30). The original guideline committee considered these recommendations important, given that unintentional injuries and deaths are highest among children and young people from lower socioeconomic groups.

Editorial amendments

During surveillance of the guideline we identified the following points in the guideline that should be amended.

Unintentional injuries: prevention strategies (PH29)

Unintentional injuries in the home (PH30)

Unintentional injuries on the road (PH31)

Overall decision

After considering all evidence and other intelligence and the impact on current recommendations across the 3 guidelines, we decided that no update is necessary.

ISBN: 978-1-4731-3557-4


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