Introduction: The Scientific Basis for Injury Control

• Frederick P. Rivara ^[1]
  1. [1] Harborview Injury Prevention and Research Center

     Harborview Injury Prevention and Research Center

     Estados Unidos

     
• Localización: Epidemiologic reviews, ISSN 0193-936X, ISSN-e 1478-6729, Vol 25, 2003, págs. 20-23
• Idioma: inglés
• Enlaces
  • Texto Completo Ejemplar
• Resumen

  • Archie Cochrane was a British epidemiologist whose guiding motto was, All effective health care should be free (1). While there is a spectrum of availability of health care across nations of the world, there is increasing unanimity on the need to base what is done on scientific evidence of effectiveness. This movement to evidence-based medicine has expanded beyond the boundaries of traditional personal health care and now includes efforts in nursing, public health, the social sciences, health policy, and health management. In these fields, application of scarce resources to accomplish the greatest good demands that only effective interventions be implemented.

    This is certainly true of the field of injury control. The magnitude of the problem is very large, and resources devoted to prevention, treatment, and rehabilitation of trauma are scarce. The argument that an intervention is worthwhile if it “can save just one life” is specious. The same resources applied to an effective intervention might save one hundred or one thousand lives. Moreover, the potential to do harm by implementing ineffective interventions is great. For example, the Cambridge-Somerville Project was an ambitious randomized controlled trial to prevent juvenile delinquency, violence, and injury (2). Social workers were assigned to visit families of intervention group participants monthly for a mean of 4.5 years to provide concrete services to high-risk boys and to act as their advocates with schools, courts, and other official agencies. When these boys were followed into adulthood, the rate of crime, violence, and untimely death in the intervention group was found to be higher than that in the control group. In another example, treatment of severe traumatic brain injury has traditionally included control of increased intracranial pressure through hyperventilation. However, when subjected to a randomized controlled trial, hyperventilated patients were found to have worse outcomes than patients not undergoing …