Determinants of pediatric injuries.

Injuries are an important health issue for children. Previous research, however, has presented confusing and conflicting results on the determinants of childhood injuries, particularly psychosocial predictors, largely due to methodologic problems. The purpose of this analysis, based on a prospective follow-up study of 532 children, was to identify factors related to injuries encountered in a prepaid group practice during a 12-month period. Using logistic regression, we found four factors independently associated with the risk of at least one treated injury: high activity level, high rate of pediatric utilization for non-injury-related visits during the follow-up period, occurrence of a treated injury during the year preceding the follow-up period, and negative attitude toward medical care providers by the child's mother. In addition, four factors were found to be independent predictors of injuries judged severe enough to always warrant medical care: occurrence of a treated injury in the preceding year, high rate of pediatric utilization for non-injury-related visits during the follow-up period, working more than 15 hours a week outside the home by the child's mother, and more life events reported by the mother for the year preceding the follow-up period. Since family stressors are related specifically to the risk of more severe injuries, which are unlikely to escape medical attention, we conclude that these factors probably are related to the occurrence of common injuries of early childhood and not exclusively to utilization behavior. We therefore suggest that children from families with these characteristics be targeted for injury prevention strategies.