Nonfatal farm injury incidence and disability to children: a systematic review.

OBJECTIVE To summarize the literature on farm child nonfatal injury incidence and the subsequent disability to children. SEARCH STRATEGY We used a systematic process to search the following databases: MEDLINE, EMBASE, ERIC, NTIS and NIOSHTIC. The reference lists from each potentially eligible study were checked and experts in the field contacted for additional reports. SELECTION CRITERIA Studies for selection had to meet the following criteria: published in the last 20 years (1979-1998); located in North America; and include nonfatal farm injury cases for children under age 20. DATA COLLECTION AND ANALYSIS Thirty-two studies met the inclusion criteria and were examined for study design, location, sample size, injury rate, injury sources, and functional outcomes. RESULTS Among the 32 studies, there were 9 case series, 11 secondary analyses of administrative databases, 2 case-control studies, 6 cross-sectional surveys, one mixed-method study, 2 prospective case series reports, and 1 cohort study. Twenty-two of the studies confined the sample to agriculture, but nine of these combined children within a larger sample, creating considerable difficulty in examining only agricultural injuries to children. Only one study focused on outcome measurement. Although nearly all the reports provided some discussion about injury severity, these comments were generally limited to injury severity scores or injury type. CONCLUSIONS Despite increasing attention on farm-related child injury, the literature continues to report primarily descriptive studies that rely on small samples focusing on the nature of the injury event and immediate consequences. Analysis of larger databases, such as worker compensation claims, trauma registries, and agricultural injury surveillance, still lacks valid denominators; thus, incidence rates cannot be calculated. Very little was found regarding disability among children who experienced agricultural injury, even though the literature clearly proclaims the severity and seriousness of child injury on farms. To complete the portrait of the burden of this continuing problem, research must include functional outcome measures.