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A decades-old American Academy of Pediatrics (AAP) primary care-based program designed to help pediatricians prevent unintentional injuries in patients was found to be effective in the first ever randomized trial testing its use, reported researchers in Pediatrics.

The Injury Prevention Program (TIPP), when implemented with support of resident training and tangible tools, reduced parent-reported injuries throughout the first 2 years of life, “supporting effectiveness of primary care-based injury prevention approaches,” wrote authors.

For the past 2 decades, injuries ranging in severity from cuts and burns to choking and motor vehicle crashes have been a leading cause of death among young children. For this reason, TIPP was designed by the AAP in 1983 to help pediatricians identify at-risk parental behaviors and counsel them on anticipatory guidance to prevent injury.

“Studies comparing TIPP to other injury prevention interventions have been equivocal, suggesting that basic education may be just as good as enhanced counseling when it comes to injury prevention anticipatory guidance,” stated first author Eliana Perrin, MD, MPH, Bloomberg Distinguished Professor of Primary Care and professor of pediatrics at Johns Hopkins University Schools of Medicine and Nursing, and colleagues. “To our knowledge, however, there have been no previous experimental studies examining TIPP’s effectiveness.”

Perrin and colleagues conducted a stratified, cluster-randomized controlled trial, known as the Greenlight Study, in a large, diverse sample of children to compare participants who received an obesity prevention intervention to a group that focused on injury prevention using TIPP.

“This unique design allowed us to evaluate the impact of the obesity intervention, but also to evaluate the impact of TIPP compared with the obesity intervention (with injury prevention usual care),” said investigators. “We sought to examine the extent to which the number of injuries reported was reduced at TIPP intervention sites compared with non-TIPP sites.”

The study was conducted at 4 academic medical centers — 2 that trained their pediatric residents and implemented TIPP screening and counseling materials at all well-child checks (WCCs) for ages 2 to 24 months, and 2 that implemented obesity prevention.

At each WCC, parents reported the number of child injuries since the previous WCC, according to the study.

“Proportional odds logistic regression analyses with generalized estimating equation examined the extent to which the number of injuries reported were reduced at TIPP intervention sites compared with control sites, adjusting for baseline child, parent, and household factors,” wrote researchers.

FINDINGS

A total of 781 parent-infant dyads were included in the analysis: 349 in the TIPP group and 432 in the control group. Among the cohort, 51% were Hispanic, 28% were non-Hispanic Black, and 87% were insured by Medicaid.

Investigators observed that 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.

“Further research is needed to determine if the use of TIPP results in reduction of serious injury and to examine the mechanisms by which TIPP leads to a reduction in injuries, including the role of parent attitudes, knowledge, and behaviors,” noted investigators. “Further research is also needed to determine the best TIPP implementation strategies, because implementation by pediatric providers or primary care teams is often difficult in busy practice settings.”

Source: Perrin EM, Skinner AC, Sanders LM, et al. The Injury Prevention Program to reduce early childhood injuries: A cluster randomized trial. Pediatrics. Published online April 1, 2024. doi:10.1542/peds.2023-062966