A Systematic Review of Prevention Strategies for Childhood Farm Injuries

Funded by Safe Kids Canada The views expressed in this report are those of the authors, and do not necessarily reflect those of Safe Kids Canada. Safe Kids Canada has developed a national campaign aimed at rural safety. As part of that initiative, it aims to distribute the North American Guidelines for Children's Agricultural Tasks (NAGCAT) to farm families. Their broader rural injury prevention strategy is called the Children's Rural Safety Program. As a starting point for this initiative, Safe Kids Canada commissioned a systematic review of the literature to synthesize the available evidence regarding: 1) the NAGCAT guidelines and their application to prevention; and 2) the efficacy or effectiveness of other prevention strategies aimed at farm injuries to children. 235 children were killed in agricultural injury events in Canada and 2,968 children were hospitalized due to traumatic injury. Overall, children accounted for 18.8% of all agricultural injury fatalities experienced in Canada and 19.0% of the identified hospitalized cases. Recurrent external causes of fatal injury included runovers of bystanders in the farm workplace, runovers of " extra-rider " on farm vehicles, vehicle rollovers, and drownings. Common external causes of hospitalized injury were machinery entanglement, falls from heights, animal-related trauma, and runovers. Toddlers and preschool-aged children were at especially high risk for fatal injury. A systematic review of high scientific quality was conducted in order to synthesize (a) the available evidence on the effect of the North American Guidelines for Children's Agricultural Tasks in minimizing the occurrence of injuries, and methods surrounding their dissemination; and (b) the general body of evidence surrounding the effectiveness of strategies for the prevention of pediatric agricultural injuries. Results We screened upwards of 5,741 unique abstracts from 17 bibliographic databases covering the medical, educational, engineering, and agricultural sciences. We also reviewed additional literature identified from reference lists of relevant studies and contact with primary authors. Nineteen controlled studies met our inclusion criteria. The literature surrounding the prevention of pediatric farm injuries is characterized by descriptive studies, studies of risk factors, program descriptions, and process evaluations. Identified Studies. Of the 19 controlled studies, four studies were randomized controlled trials, five were controlled trials, and the others employed quasi-experimental or observational methods. The lack of RCTs and community-based trials in this field means the risk of bias is high. Most of the relevant literature is either unpublished or appears in peer-review journals with low or modest impact factors. …