School Based Education Programmes For The Prevention of Bullying

School based education programmes for the prevention of
unintentional injuries in children and young people (Protocol)

Orton E, Watson MC, Mulvaney C, Kendrick D
This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane
Library 2012, Issue 11
http://www.thecochranelibrary.com
School based education programmes for the prevention of unintentional injuries in children and young people (Protocol)
Copyright 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . .
ABSTRACT . . . . . . . . .
BACKGROUND . . . . . . .
OBJECTIVES . . . . . . . .
METHODS . . . . . . . . .
REFERENCES . . . . . . . .
APPENDICES . . . . . . . .
HISTORY . . . . . . . . . .
CONTRIBUTIONS OF AUTHORS
DECLARATIONS OF INTEREST .
SOURCES OF SUPPORT . . . .
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[Intervention Protocol]
School based education programmes for the prevention of

unintentional injuries in children and young people
Elizabeth Orton1 , Michael C Watson2 , Caroline Mulvaney1 , Denise Kendrick1
1 Division
of Primary Care, University of Nottingham, Nottingham, UK. 2 School of Nursing, University of Nottingham, Nottingham,
UK
Contact address: Elizabeth Orton, Division of Primary Care, University of Nottingham, Room 1313, Tower Building, University Park,
Nottingham, NG7 2RD, UK. elizabeth.orton@nottingham.ac.uk.
Editorial group: Cochrane Injuries Group.
Publication status and date: New, published in Issue 11, 2012.
Citation: Orton E, Watson MC, Mulvaney C, Kendrick D. School based education programmes for the prevention of unintentional injuries in children and young people. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD010246. DOI:
10.1002/14651858.CD010246.
ABSTRACT
This is the protocol for a review and there is no abstract. The objectives are as follows:
To evaluate the effects and cost-effectiveness of school-based education programmes to prevent unintentional injuries in children and
young people with respect to child characteristics, intervention type and duration.
BACKGROUND
Description of the condition

Unintentional injuries are the leading cause of death in children
aged 5-19 in Europe (WHO 2008a) and are a major cause of ill
health; in 2004 unintentional injuries accounted for 8.1% of all
global disability-adjusted life years lost among children under 15
years (WHO 2008b). In addition the financial costs associated
with treating injuries in children is significant. Injuries from road
traffic crashes alone are estimated to cost over US$ 100 billion
dollars per year in developing countries and the medical costs and
losses in productivity in adulthood (i.e. loss of wage and household
work lost due to permanent or long-term disability) as a result
of injuries in 0-14 year olds in the United States is estimated
to be US$ 50 billion annually (Sattin 2007). In the UK alone,
unintentional injuries occurring in the home are estimated to cost
society 25 billion (Audit Commission 2007). Understanding the

cost and clinical effectiveness (i.e. how effectively they prevent
injury occurrence) of preventative interventions is therefore an
important issue.
In adopting the resolution on child injury prevention at the Sixtyfourth World Health Assembly 2011, the World Health Organization (WHO) has urged its member states to prioritise the prevention of childhood injuries (WHO 2011). However, there are
still gaps in our knowledge relating to the effectiveness of different
types of injury prevention interventions.
The school setting offers the opportunity to deliver preventative
interventions to a large number of children and has been used to
address a range of public health problems. Examples from systematic reviews include the prevention of smoking uptake (Thomas
2006), drug use (Faggiano 2005) and violence (Mytton 2006)
and programmes to increase physical activity (Dobbins 2009) and
identify health problems at an early stage (Davis 1997). In terms of
injury prevention, there are Cochrane reviews showing that schoolbased interventions can improve specific injury-prevention safety
practices, such as cycle helmet wearing (Owen 2011) and improve
knowledge, such as attitudes towards dogs to prevent bite injuries
(Duperrex 2009). However, whilst there have been reviews of the
effectiveness of school-based education to prevent specific types
of injury (e.g. Duperrex 2009; Miller 2009) or prevent injuries in
specific locations such as the home (Kendrick 2007a) but to date
the evidence for the effectiveness of school-based education for the
prevention of a wide range of injuries has not been systematically
reviewed as a Cochrane review.
Description of the intervention

The injury prevention programmes to be investigated by this review are likely to be provided in addition to the core school curriculum. These interventions may be both primary or secondary injury prevention education programmes aimed at reducing a range
of injury mechanisms occurring in different settings. They may
be delivered in full or in part in a school as part of the educational
curriculum and delivered by a teacher or other individuals with
an injury prevention role to particular year groups or aimed across
the school environment as a whole-school approach.
How the intervention might work

Children spend a significant amount of time at school, providing
a convenient platform to deliver safety interventions. Tobler provided a useful classification scheme for different types of schoolbased drug prevention programmes that might also be applicable
for safety interventions (Tobler 1986). The different types of programmes work in a variety of ways as follows: 1) there are programmes that are based on imparting knowledge about the topic,
2) programmes that are affective i.e. they help develop self esteem
and attitudes and beliefs 3) programmes that offer generic skills
such as communication and assertiveness skills that will then help
establish desirable behaviours, 4) programmes that aim to develop
skills, e.g. in this case to protect oneself in a dangerous situation,
5) programmes focused on diversionary activities such as organised sports and 6) other types of programmes, such as those that
involve parents. In this classification system programmes are not
necessarily restricted to one domain and may be interactive or not.
School based safety interventions may work in a similar way. For
example, educational programmes that aim to prevent injuries in
children may provide participants with the skills to identify and
avoid high risk situations or behaviours. Alternatively they may
help to improve knowledge and awareness of high risk activities or
help children choose play and leisure activities that are within their
physical abilities and competence. In addition, some interventions
may result in knowledge transfer to adults/carers which in turn
may reduce the risk of injury to children within their care.
Why it is important to do this review

Preventing unintentional injury in children is an important public
health challenge since injuries are a leading cause of death for
children and young people. School-based education programmes
are delivered across the world and have the potential to reduce
injuries. However, whilst an existing review suggests that there
is a body of evidence regarding the effectiveness of school-based
injury prevention interventions (Mulvaney 2012) to date there
are no published Cochrane reviews on the subject, including a
lack of evidence of the cost effectiveness of such interventions. A
systematic review of the evidence is needed to help health and social
care providers and commissioners make informed decisions about
the effectiveness of this approach, ensuring appropriate resource
allocation.
OBJECTIVES
To evaluate the effects and cost-effectiveness of school-based education programmes to prevent unintentional injuries in children
and young people with respect to child characteristics, intervention type and duration.
METHODS
Criteria for considering studies for this review
Types of studies
Randomised controlled trials (RCT) and non-randomised
controlled trials.
Controlled before-and-after studies (prospective studies
with a concurrent control group allocated using a non-random
method and with a baseline period of assessment of main
outcomes).
The control group will either receive no intervention, a delayed
injury-prevention intervention or alternative curricular activities
(school-based).
Studies other than RCTs have been included because as with many
public health interventions, an assessment of the effectiveness of
injury prevention interventions is often not undertaken using a
RCT design. Restricting the review to RCT studies alone will result
in a small number of included studies.
To assess the cost effectiveness we will include full economic
evaluations (i.e. cost-effectiveness analyses, cost-utility analyses,
cost-benefit analyses) of injury prevention programmes and their
comparators or partial economic evaluations of school-based
We will only consider relevant health economics studies conducted

alongside or those based upon data sourced from effectiveness
studies that meet eligibility criteria for the effectiveness component
of the review.
Interventions delivered in youth clubs, social clubs or

informal parenting groups or interventions delivered without a
school-based component.
The review will not include school-based interventions to
promote cycle helmet use as a Cochrane systematic review
already exists on non-legislative interventions to promote cycle
helmet use which covers this topic (Owen 2011).
Types of participants
Types of outcome measures
injury prevention interventions including trials reporting more

limited information, such as estimates of resource use or costs.
The provision of state-based pre-school education and the age

of compulsory school entry, normally 4 to 7 years, varies across
the world. For this review we will include interventions for noninstitutionalised children aged 4 to 18 years that are enrolled in
a formal state-based (or equivalent independently provided) preschool setting (e.g. school nursery/foundation unit/kindergarten),
infant, primary, junior, secondary or high school or equivalent.
We will exclude youth clubs, summer clubs, sports or social clubs,
special interest clubs or informal parenting groups or interventions
delivered without a school-based component.
Primary outcomes
Self-reported or medically-attended unintentional injuries

or injuries with an unspecified intent. Where the study has
included young children (below the age of 11, self reports may
be ascertained from parents/carers, teachers or other people
considered to be in loco parentis. Medically-attended injuries are
those in which the participants seek healthcare advice by
attendance at either a primary or secondary healthcare provider.
This does not include first aid provided in other locations.
Types of interventions
Secondary outcomes
Primary and secondary injury prevention education aimed at reducing a range of unintentional injuries, delivered in full or in part
in a school or preschool setting and delivered by a teacher or other
individuals with an injury prevention role.
Primary interventions are defined as those targeted at preventing
an incident in which an injury can occur. They include interventions to prevent injury in any setting. Secondary interventions are
those that are aimed at reducing the risk of injury once an event
has occurred e.g. a smoke alarm may prevent injury but will not
prevent the fire.
Observed safety skills

Observed behaviour
Self reported behaviour and safety practices
Safety knowledge
Health economic outcomes including cost per unit of
utility gained (e.g. incremental cost per quality-adjusted life
year), cost per unit of effect (e.g. cost per injury prevented), cost
as measured in inputs and benefits (e.g. costs not incurred by
preventing injuries or cost-benefit ratios) or resource costs.
Excluded
Search methods for identification of studies
Tertiary prevention interventions aimed at minimising the

harm associated with injury occurrence e.g. first aid
interventions.
Quaternary prevention interventions aimed at preventing
repeat injuries.
Interventions to prevent intentional injuries (e.g. violence
in the home)
Any intervention where the prevention of injuries is not
stated in the aims or objectives or that involves a multiple
intervention programme in which it is not possible to isolate the
relative effects of the injury prevention component.
Interventions aimed at preventing a single type of injury
(e.g. cycling injury, road traffic injury or drowning)
Community or national campaigns supported by
classroom/school activities but where the school is not the
primary delivery platform.
The search will not be restricted by date, language, geographical

location or publication status, however, we will limit the population group to children aged 4 to 18 years.
Electronic searches
The Cochrane Injuries Group Trials Search Co-ordinator will
search the following databases:
Cochrane Injuries Group Specialised Register (to latest
version);
Cochrane Central Register of Controlled Trials (The
Cochrane Library) (latest issue)
Economic Evaluation Database (EED) (The Cochrane
Library) (latest issue)
Health Technology Assessment Database (HTA) (The
Cochrane Library) (latest issue)
MEDLINE (Ovid) (1946 to present);

EMBASE (Ovid) (1974 to present);
CINAHL (EBSCO) (1982 to present);
ISI Web of Science: Science Citation Index Expanded
(1970 to present);
ISI Web of Science: Conference Proceedings Citation
Index-Science (1990-present);
ISI Web of Science: Social Sciences Citation Index (1970 to
present);
ISI Web of Science: Conference Proceedings Citation Index
- Social Sciences & Humanities (1990 to present);
ZETOC (1993 to present);
The authors will search the following databases:
LILACS (Latin American and Caribbean Health Sciences
Literature database) (1982 to present);
UK Clinical Research Network Study Portfolio (to latest
version);
PsycINFO (Ovid) (1806 to present);
ERIC (Educational Resources Information Centre) (1966
to present);
Dissertation Abstracts Online (1988 to present);
IBSS (International Bibliography of Social Sciences) (1951
to present);
Open Grey (System for Information on Grey Literature in
Europe) (1980 to present);
Index to Theses in the UK and Ireland (1716 to present);
Bibliomap EPPI-Centre database of health promotion
research (to latest version);
BEI (British Education Index);
ASSIA (1987 to present);
CSA Sociological abstracts (1952 to present);
Injury Prevention Web (to latest version);
SafetyLit (USA) (1998 to present);
EconLit (USA) (1886-present);
TRoPHI ( The Trials Register of Promoting Health
Interventions) (2004-present
The MEDLINE search strategy (Appendix 1) will be adapted for
each database.
We will search the Internet for grey literature using the search engines Google http://www.google.co.uk/ and Google Scholar http:/
/scholar.google.co.uk/
Data collection and analysis
Selection of studies
Two authors from the review team will independently judge the
eligibility of studies by assessing the titles and abstracts. Full text
copies of all potentially relevant studies will be obtained and the
authors will independently assess whether each meet the pre-defined inclusion criteria. Any disagreement will be resolved by discussion with a third author from the review team.
We will attempt to translate the title and abstract of studies published in a language other than English that may be eligible prior
to screening.
Data extraction and management

Data from studies meeting the inclusion criteria will be extracted
independently by two authors from the review team and entered
onto a piloted data extraction form, after which results will be
compared. Discrepancies will be agreed through discussion and if
necessary referred to a third author from the team.
Data will be extracted on participants, interventions, comparisons
and outcomes in addition to evaluation outcomes, sources of funding and any adverse effects. We will extract all of the relevant outcomes, and times that outcomes have been measured, that each
study reports. We will be alert to multiple reports relating to the
same individuals to avoid duplication of results when extracting
the data.
Where necessary, missing data will be requested from study investigators, sending them a copy of the data extraction form. We will
attempt to translate studies published in a language other than
English prior to data extraction and assessment of bias.
Assessment of risk of bias in included studies

Searching other resources
We will search the reference lists of all included studies as well as
previously published reviews and relevant papers. We will contact
experts in the field and authors of included studies for information
relating to any ongoing, published or unpublished studies that
may have been missed through our searches.
We will search abstracts from the biennial World Conference on
Injury Prevention and Safety Promotion (1992 to present) as well
as the table of contents of the journal Injury Prevention from 1990
to present.
Two authors from the review team will independently assess the
quality of included studies using the Cochrane Collaborations
tool for assessing the risk of bias. Decisions will be compared and
disagreements resolved through consultation with a third author.
For randomised controlled trials the risk of bias will be assessed by
taking into account the random sequence generation, allocation
concealment, blinding of participants and personnel, blinding of
outcome assessment and completeness of data, selective reporting
and other sources of bias. For non-randomised studies this will
include an assessment of selection bias, observation bias and control of confounders. The authors will complete risk of bias tables
based on the above criteria, incorporating a judgment of low risk,

high risk or unclear with explanations for the judgement made.
For economic analyses, studies will be classified first as a type of full
or partial economic analyses including trials with additional economic data and then classified according to the type of effectiveness study that they are based on (e.g. randomised controlled trial).
Following this classification, the quality of studies and risk of bias
will be assessed using the Evers checklist and NHS EED structured abstract where they exist, as recommended by the Cochrane
Collaboration.
Measures of treatment effect

The effect of the interventions on the outcome measures will be
entered into Review Manager software, version 5.1, for analysis.
We will produce tabular summaries of the included study characteristics and a summary of findings table. The summary of findings
table will include the primary outcome (self reported or medicallyattended unintentional injuries or injuries with an unspecified intent) and any health economic outcomes that are directly related
to the review primary outcome (e.g. cost per injury averted).
Self reported or medically-attended injuries will be described in
terms of injury rates or as the percentage of children reporting
at least one injury, depending on how injuries are measured and
reported in the included studies. Dichotomous outcomes such as
observed safety skills will be described in terms of relative risk
of occurrence with 95% confidence intervals or the proportion
or differences in proportions exhibiting that outcome. Observed
or self report safety knowledge will be described in terms of test
scores, percentages or differences in percentages with 95% confidence intervals. Continuous outcomes will be presented as means
or standardised means or differences in means with standard deviations depending upon how they are measured in the reported
studies.
For the cost effectiveness studies it is likely that different studies
will report the economic benefits in different ways. For example
full economic evaluations may report benefits in terms of cost per
unit of utility gained (e.g. incremental cost per quality-adjusted
life year) in cost utility analyses, cost per unit of effect (e.g. cost per
injury prevented) in cost-effectiveness analyses, or cost as measured
in inputs and benefits (e.g. costs not incurred by preventing injuries
or cost-benefit ratios) in cost-benefit analyses. Partial economic
analyses may report the absolute cost of delivering an intervention
rather than describing incremental benefits as compared against
an alternative intervention (control).
Unit of analysis issues

One person is the unit of analysis. Where studies have used a
clustered design we will estimate the effective sample size by dividing the original sample size by the design effect (calculated as
1+(mean cluster size-1)*ICC). If the intracluster correlation co-
efficient (ICC) is not reported we will use estimates from pervious studies of injury prevention interventions (Kendrick 2004;
Kendrick 2007b; Mulvaney 2006). We will use a coefficient of
variation of 0.25 (Hayes 1999). For dichotomous outcomes the
number experiencing the event and the number of participants
will be divided by the design effect. For continuous outcomes the
number of participants will be divided by the design effect. For rate
outcomes the number of events and the number of person years
will be adjusted for clustering using the variance inflation factor
calculated using the formula given by Donner and Klar (Donner
2000).
Dealing with missing data
Attempts will be made to obtain missing data from the authors.
During data extraction we will note where standard errors or standard deviations have not been identified and where possible, will
derive standard deviations from confidence intervals, P values or
standard errors. We will undertake a complete case analysis where
data are missing and cannot be derived.
Assessment of heterogeneity
Studies that are clinically heterogeneous will not be combined.
Where it is appropriate to combine studies heterogeneity will be
assessed by observation of forest plots, by using the I-squared statistic and by the chi-squared test for heterogeneity with a p value of
<0.01 taken as statistically significant. Where significant heterogeneity exists findings will be interpreted with caution. A-priori
sub group analyses will be undertaken to explore possible reasons
for heterogeneity.
Assessment of reporting biases
If it is possible to conduct a meta-analysis, a funnel plot will be
generated to show the effect size and 95% confidence interval for
each study, sorted by variance of the log odds ratio. Where there
are 10 or more studies in a meta-analysis a statistical test such as
the Eggers test will be used.
Data synthesis
Where there are three or more clinically homogenous studies reporting the same outcome we will combine effect sizes in metaanalyses. We will estimate pooled rate ratios for injury rates, pooled
risk ratios for binary outcome variables and mean differences or
standardised mean differences for continuous outcomes, with their
95% confidence intervals. Random effects models will be used to
allow for heterogeneity between effect sizes.
If it is not possible to conduct a meta-analysis a narrative review
with subgroups will be undertaken. Subgroups will include age
of the child/school setting and the type of intervention delivered
(e.g. information giving, skills training etc).
Where outcomes have been measured at multiple time points we

will select those that are most consistent across studies for analyses.
Where studies have included more than two intervention arms we
will review only the intervention and control groups that meet the
eligibility criteria.
For the economic analysis we will conduct a narrative summary
of the included studies. Where available we will provide links to
completed NHS EED or other structured abstracts of full economic evaluation studies.
Subgroup analysis and investigation of heterogeneity
Where there is sufficient information available we will undertake
an analysis of subgroups of the intervention as follows:
1. Child age/school setting: Primary (including kindergarten)
(aged 4-11) and secondary/high school (aged12-18) or equivalent
2. Type of intervention (such as information giving, skills
training, multi component)
3. Duration of the intervention (less than 1 month, 1-6
months, longer than 6 months)
We have selected these groups because there is evidence that they
are likely to be effect modifiers for injury prevention interventions.
For example, studies have shown that the risk of different types of
injuries change as children mature and their environment changes
(WHO 2008a) and so the focus of injury prevention interventions
and their effectiveness is likely to change with age also. In addition
Owen 2011 showed that the likelihood of children wearing a cycle
helmet varied depending upon the type of intervention offered
(e.g. whether or not a free helmet had been provided or if the
intervention was community-based interventions) (Owen 2011)
and studies of other school-based prevention interventions, such
as preventing substance misuse (Broening 2012), weight gain (
Silveira 2011) and sexual abuse victimisation (Rispens 1997) have
show that the duration of the intervention is important.
Sensitivity analysis
We will perform sensitivity analyses by re-running the analyses and
excluding studies with a high or unclear risk of bias. In particular
we will perform sensitivity analyses for the quality of randomisation according to allocation concealment, detection bias based on
blinded outcome assessment and retention bias based on losses to
follow up.
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of school-based nutrition education interventions to
prevent and reduce excessive weight gain in children and
adolescents: a systematic review. Journal of Pediatrics (Rio J)
SeptOct 2011;87(5):38292.
Thomas 2006
Thomas RE, Perera R. School-based programmes for
preventing smoking. Cochrane Database of Systematic Reviews
2006, Issue 3. [DOI: 10.1002/14651858.CD001293.pub2;
: CD001293]
Tobler 1986
Tobler NS. Meta-analysis of 143 adolescent drug prevention
programs: Quantitative outcome results of program
participants compared to a control or comparison group.
Journal of Drug Issues 1986;16(4):53767.
WHO 2008a
World Health Organization. World report on child injury
prevention. WHO, Geneva 2008.
WHO 2008b
World Health Organization. The global burden of disease;
2004 update. WHO, Geneva 2008. [: ISBN 978 92 4
156371 0]
WHO 2011
World Health Organization. Child injury prevention
resolution A64/23. Sixty-fourth world health assembly 17
March 2011.
Indicates the major publication for the study
APPENDICES
Appendix 1. Search strategy

MEDLINE(Ovid)
1. exp Schools/
2. exp Students/
3. *Education/
4. *Curriculum/
5. *Teaching/
6. (student* or pupil* or peer?group* or peergroup* or peer* curricul* or teach* or mentor*).ab,ti.
7. ((young* or adolesc* or teen* or minor* or boy* or girl* or youth* or male* or female*) adj3 (educat* or school* or highschool* or
high?school*)).mp.
8. or/1-7
9. *School Health Services/
10. *Health Education/
11. *Accident prevention/
12. *Health promotion/
13. *Risk reduction behavior/
14. *Health Knowledge, Attitudes, Practice/
15. ((safety or health or accident* or risk* or behavio*) adj1 (reduc* or prevent* or train* or instruct* or demonstrat* or educat* or
aware* or teach* or inform* or chang*)).ab,ti.
16. 9 or 10 or 11 or 12 or 13 or 14 or 15
17. 8 and 16
18. exp Wounds and Injuries/pc [Prevention & Control]
19. (injur* adj3 (prevent* or control*)).ab,ti.
20. 18 or 19
21. (randomi?ed or randomly).ti,ab.
22. ((controlled or observed or observation*) adj ((before and after) or trial* or study or studies or evaluat*)).ab,ti.
23. ((before adj1 after) or (interrupted adj1 time)).mp.
24. (trial or study).ti.
25. groups.ti,ab.
26. ((program* or trial* or stud*) adj3 (controlled or observed or observation* or compar* or intervention or evaluat* or appropriate*
or effect* or sustain*)).ab,ti.
27. *prospective studies/
28. *program evaluation/
29. *follow-up studies/
30. *comparative study/
31. *cohort studies/
32. *evaluation studies/
33. *controlled clinical trials as topic/
34. *randomized controlled trials as topic/
35. *multicenter studies as topic/
36. (comparative study or controlled clinical trial or evaluation studies or multicenter study or randomized controlled trial).pt.
37. or/21-36
38. 17 and 20 and 37
HISTORY
Protocol first published: Issue 11, 2012
CONTRIBUTIONS OF AUTHORS
EO is the guarantor and co-ordinator of the review. All authors have contributed to the development of the objectives and methods
and have commented on the background sections of the protocol.
DECLARATIONS OF INTEREST
Elizabeth Orton is the public health representative from NHS Nottingham City on the steering group for the Nottingham injury
minimisation programme (IMPs) that is delivered in part in the school setting. There are however no financial incentives related to this
work and her future employment is not dependent upon the continued funding of the IMPs programme by NHS Nottingham City.
Denise Kendrick is the author of some studies that may be included in the review.
Caroline Mulvaney and Michael Watson: None known.
SOURCES OF SUPPORT
Internal sources
Elizabeth Orton, UK.
Salary paid by the University of Nottingham and the East Midlands NHS Healthcare Workforce Deanery
Denise Kendrick, UK.
Salary paid by the University of Nottingham
Michael Watson, UK.
Caroline Mulvaney, UK.
External sources
No sources of support supplied

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School based education programmes for the prevention of

unintentional injuries in children and young people (Protocol)

School based education programmes for the prevention of

Description of the condition

society 25 billion (Audit Commission 2007). Understanding the

Description of the intervention

How the intervention might work

Why it is important to do this review

Criteria for considering studies for this review

We will only consider relevant health economics studies conducted

Interventions delivered in youth clubs, social clubs or

Types of outcome measures

injury prevention interventions including trials reporting more

The provision of state-based pre-school education and the age

Self-reported or medically-attended unintentional injuries

Observed safety skills

Search methods for identification of studies

Tertiary prevention interventions aimed at minimising the

The search will not be restricted by date, language, geographical

MEDLINE (Ovid) (1946 to present);

Data collection and analysis

Data extraction and management

Assessment of risk of bias in included studies

based on the above criteria, incorporating a judgment of low risk,

Measures of treatment effect

Unit of analysis issues

Where outcomes have been measured at multiple time points we

education and provision of safety equipment for injury

Indicates the major publication for the study

Appendix 1. Search strategy

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