Surveillance proposal

We propose to not update the following guidelines on unintentional injuries at this time:

Please note, for the surveillance of NICE guideline PH29 national level recommendations 1,5,7,10 and 21 were not in scope for the surveillance process where they cover national policy, which is not within NICE's current remit. However, these recommendations were considered where they also covered local or sub-national areas.

Reasons for the proposal to not update the guidelines

This section provides a summary of the reasons for the 3 proposals. Some of the reasons were common across 2 or more of the unintentional injuries guidelines and are summarised together below. There were also guideline-specific reasons which are described below in separate summaries.

The reason for not updating the guidelines at this time is that the totality of evidence identified from current and previous surveillance reviews supports current recommendations across the 3 guidelines or was not deemed sufficient to impact recommendations.

Unintentional injuries: prevention strategies for under 15s (PH29)

Evidence was found to be consistent with the current guideline recommendations on:

  • inequalities in injuries attributable to household deprivation and maternal mental health

  • injury prevention briefings to parents, with supplementary ongoing training and facilitation for children centre staff

  • the use of linked primary, secondary and mortality data

  • the installation of permanent home safety equipment

  • the benefit of numerous home education interventions

  • updating playground equipment

  • education, swimming lessons and water safety, and pool fencing as effective strategies to reduce the risk of drowning

  • cycling safety education and promotion

  • the use of a safe routes to school programme, digital technology measures to increase community engagement, and visual interventions to reduce distracted cell phone usage

  • measures to reduce vehicle speed around schools and playgrounds to reduce average speed in these areas.

For further details and a summary of all evidence identified in surveillance, see appendix A1.

Unintentional injuries in the home: interventions for under 15s (PH30)

New evidence was identified which supported recommendations on coordinated delivery and integrating home safety into other home visits. There was some evidence to suggest that interventions to increase use of window locks and reduce incidents of leaving a child on a high surface showed little benefit. The guideline does not currently make specific recommendations in these areas, therefore until there is further evidence on what interventions may be effective, the recommendations are unlikely to change. Experts also highlighted evidence on new hazards that have emerged since the guideline was published. However, no evidence was identified on interventions to reduce unintentional injury from the new hazards, therefore recommendations are unlikely to be impacted.

For further details and a summary of all evidence identified in surveillance, see appendix A2.

Unintentional injuries on the road: interventions for under 15s (PH31)

New evidence was identified which supported recommendations on speed limits and speed reduction zones and measures; and on engineering measures to provide safer routes to school. Limited evidence, for which further confirmatory evidence is needed to inform new recommendations, was identified on a tramway right of way engineering intervention to reduce pedestrian motor vehicle collisions.

For further details and a summary of all evidence identified in surveillance, see appendix A3.

Issues identified across all guidelines

Age-specific recommendations

Feedback from experts called for guidelines PH29 and PH30 to be subdivided by age group, given that the risks of injury and interventions may differ for early years compared to older children. The committee took these considerations into account during guideline development by producing recommendations that cover overarching interventions around prioritisation, risk assessment and installing safety equipment that apply to all children under 15 years. Age-specific differences in delivery aspects are accounted for by the list of relevant organisations and groups in the "Who should take action?" section of the recommendation. These organisations will support delivery for different age groups, which the committee considered during guideline development.

Age range of guidelines

Experts also called for the age range in the guideline to be extended to cover people aged 15 to 20 years, to be in line with other guidance and global evidence. The original guideline referral from the Department for Health outlined a focus on unintentional injuries among under 15s. We identified several other sources of guidance and evidence on prevention of unintentional injury throughout this surveillance review and did not find the age range to be consistent. For example, some reports focused on ages 0-19, whilst others on under 5s and between 10-19. Due to this inconsistency and considering the original referral from the Department of Health, we do not propose any changes to the guideline at this time. However, we do acknowledge that there is a gap in recommendations for people aged between 15 and 20 years. The epidemiology and factors associated with unintentional injury in this age group may differ from those of the under 15 age group. For example, there is a higher incidence and risk of driving injuries in the over 15 age group.