Not everything that counts can be counted

Injury is the major cause of death in childhood in the UK and other industrialised nations.1 Moreover injury makes a considerable contribution to short and long term morbidity in children, and fear of injury to their children is one of many contributors to anxiety in parents. Injury is costly both to the NHS, and to the children and families concerned, and while there have been considerable advances in secondary and tertiary care in this area, injury prevention in childhood remains largely unevaluated in terms of its effectiveness.2 In other words, we know very little about what works in reducing child accidents. The majority of meaningful data we have on injuries in children are based on the sequelae of accidents. What was the injury? What were the consequences? What was the treatment? Data like these, while important, are unlikely to generate the kinds of information we need to prevent accidents.

In order to develop effective interventions for the prevention of injury to children, we need a better understanding of the antecedents of accidents, the environments in which injuries are produced, and the behaviours—of planners, architects, drivers and others, as well as of children and parents—which make accidents more likely.

Some of the work needed to do this will be quantitative, and recent studies in paediatric epidemiology usefully address issues such as exposure to risk, and meaningful denominators.3 4 But not everything that counts can be counted. A good deal of data are needed in order to develop and maintain effective interventions in child injury prevention, which can only be collected through careful qualitative investigation.

The preferred medical term in this area is ‘injury’ rather than ‘accident’, however, for the purposes of this note, the term accident is preferred. This is because it is both more meaningful to children …