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Isbn 978-82-8121-483-5 Tittel Skadeforebygging, oversikt over gjennomførte systematiske oversikter. English title Injury prevention, a mapping of systematic reviews Institusjon Nasjonalt kunnskapssenter for helsetjenesten Ansvarlig Magne Nylenna, direktør Forfattere Holte, Hilde H, prosjektleder, forsker, Mathisen, Mariann, bibliotekar, Alle Nasjonalt kunnskapssenter for helsetjenesten ISBN 978-82-8121-483-5 Notat September –2012 Prosjektnummer --- Publikasjonstype Systematisk søk og sorter Antall sider 89 (92 inklusiv vedlegg) Oppdragsgiver Skadeforebyggende forum Emneord(MeSH) Accident prevention Sitering Holte, Hilde H, Mathisen, Mariann: Skadeforebygging, oversikt over gjennomførte systematiske oversikter. Notat 2012. Oslo: Nasjonalt kunnskapssenter for helsetjenesten, 2012. Nasjonalt kunnskapssenter for helsetjenesten fremskaffer og formidler kunnskap om effekt av metoder, virkemidler og tiltak og om kvalitet innen alle deler av helsetjenesten. Målet er å bidra til gode beslutninger slik at brukerne får best mulig helsetjenester. Kunnskapsenteret er formelt et forvaltningsorgan under Helse- direktoratet, men har ingen myndighetsfunksjoner og kan ikke instrueres i faglige spørsmål. Nasjonalt kunnskapssenter for helsetjenesten Oslo, september 2012 Tittel: [Skriv tittel] ------------------------------------------ Publikasjonstype: Hovedfunn Systematisk litteratursøk med sortering Systematisk litteratursøk med sortering er resultatet av å - søke etter relevant litteratur ifølge en søkestrategi og - eventuelt sortere denne litteraturen i grupper Nasjonalt kunnskapssenter for helsetjenesten har, basert på bestilling presentert med referanser og fra Skadeforebyggende forum, utført et systematisk litteratursøk etter vanligvis sammendrag oppsummert kunnskap med påfølgende sortering av mulig relevante ------------------------------------------ publikasjoner. Oppdraget var å finne oppsummert litteratur/forsk- Svarer ikke på alt: ning om praktisk forebygging av skader. - Ingen kritisk vurdering av studienes kvalitet - Ingen analyse eller sammenfatning av studiene Metode - Ingen anbefalinger Vi utarbeidet søkestrategi for et systematisk litteratursøk. Det ble ------------------------------------------ søkt i Medline Ovid, Pubmed, Cochrane Library og CRD etter sys- Hvem står bak denne tematiske oversikter om skadeforebygging. Søket omfatter skade- publikasjonen? forebygging generelt, samt noen spesifikke steder eller situasjoner Kunnskapssenteret har som kan føre til skade. Søket ble utført i august 2012 og tidsbegrenset gjennomført oppdraget etter bakover i tid til 2007. Begge prosjektmedarbeiderne gikk uavhengig forespørsel fra [XXX] av hverandre gjennom identifiserte publikasjoner/referanser og ------------------------------------------ vurderte relevans i forhold til inklusjonskriteriene. Publikasjonene Når ble litteratursøket ble ikke innhentet og lest i fulltekst. utført? Resultater Søk etter studier ble avsluttet Vi identifiserte totalt 1331 referanser. Av disse ble 138 vurdert som [måned, år]. mulig relevante. Vi har delt dem inn i grupper etter i hvilken sam- menheng skaden påføres, men fall er en egen gruppe, uansett hvor eller hvordan fallet skjer. 50 oversikter om ulike typer trafikkskader, - 21 for bil - 4 for motorsykkel - 11 for sykkel - 2 for fotgjengere - 12 for andre typer trafikkskader 8 oversikter om skader som følge av alkoholbruk utenom trafikkskader 14 oversikter om skader i hjemmet 5 oversikter om forgiftninger 18 oversikter om sport og treningsskader 23 oversikter om forebygging av fall 20 oversikter om andre temaer 2 Hovedfunn Key messages Norwegian Knowledge center has, based on a commission by the Norwegian Safety Forum, performed a systematic literature search for systematic reviews examining practical interventions to prevent injuries. Methods We developed and performed systematic searches in the databases Medline Ovid, Pubmed, Cochrane Library and CRD for systematic reviews about interventions to prevent injuries. The search comprised prevention of injuries in general in addition to some specific places and situations that are prone to injuries. The search was per- formed in august 2012 and was limited in time to 2007-2102. Both authors screened the identified references for relevance in accordance with the inclusion criteria. The publications were not collected or read in full text. Results We identified 1331 unique references in total. Of these were 138 considered poten- tially relevant for prevention of injuries. We arranged the references in groups ac- cording to the situation the injury could occur. However, falls is a separate group, regardless of where or how the fall happens. 50 reviews was about various types of traffic injuries o 21 about car o 4 about motorcycle o 11 about bicycle o 2 about pedestrians o 12 about various other types of traffic injuries 8 review about injuries due to alcohol, not traffic related 5 review about poisoning 18 review about sport and exercise 23 about fall prevention 20 reviews about various other topics 3 Key messages Innhold INNHOLD 4 FORORD 5 INNLEDNING 6 Styrker og svakheter ved litteratursøk med sortering 6 Begrunnelse for valg av søkestrategi 7 Problemstilling 7 METODE 8 Litteratursøking 8 Inklusjonskriterier 8 Artikkelutvelging 8 Formidlingssaker Feil! Bokmerke er ikke definert. RESULTAT 10 Resultat av søk 10 Resultat av sorteringen 10 Trafikk 11 I hjemmet 47 Forgiftning 55 Sport/trening 58 Fall 66 Annet 79 VEDLEGG 1 90 Søkestrategier 90 4 Innhold Forord Kunnskapssenteret mottok en bestilling fra Skadeforebyggende forum ved Eva Vaagland om en oppsummering av publiserte systematiske oversikter om praktisk skadeforebygging. Bakgrunnen for bestillingen er at Regjeringen har utarbeidet nasjonal strategi for forebygging av ulykker i 2009 og ny folkehelsehelselov i 2012 som begge definerer ulykkesskader som kan forhindres gjennom skadeforebyggende tiltak som et vesent- lig helseproblem. Man ønsket en oppsummering av den forskning som finnes om effekt av skadeforebygging. Prosjektgruppen har bestått av: Hilde H. Holte, seniorforsker, Kunnskapssenteret Mariann Mathisen, bibliotekar, Kunnskapssenteret Gro Jamtvedt Gunn E. Vist Hilde H. Holte Avdelingsdirektør Seksjonsleder Prosjektleder 5 Forord Innledning Styrker og svakheter ved litteratursøk med sortering I Kunnskapssenterets produkt, litteratursøk med sortering, gjennomfører vi systema- tiske søk for en gitt problemstilling. Resultatene fra søket blir i sin helhet overlevert oppdragsgiver, eller vi kan gjennomgå søkeresultatet før overleveringen og sortere ut ikke-relevante artikler. Dette gjøres basert på tittel og sammendrag. Artiklene innhentes ikke i fulltekst. Det gjør at vi kan ha inkludert titler som ville vist seg ikke å være relevante ved gjennomlesning av fulltekst. Vi benytter kun databaser for identifisering av litteratur og kan derfor ha gått glipp av potensielt relevante studier. Andre måter å identifisere studier på, som søk i referanselister, kontakt med eksper- ter på fagfeltet og upublisert litteratur, er ikke utført i dette oppdraget. Vi gjennom- førte ingen kvalitetsvurdering av artiklene. Ved en full forskningsoppsummering ville vi ha innhentet artiklene/rapportene i fulltekst for endelig vurdering opp mot inklusjonskritene. Inkluderte studier ville så blitt kvalitetsvurdert i henhold til våre sjekklister og resultater sammenstilt og dis- kutert. Vi har søkt etter allerede gjennomførte oversikter, og fanger dermed ikke opp de nyeste studiene på feltet som er publisert senere enn arbeidet med oversiktene. Vi fanger heller ikke opp studier som omhandler skadeforebygging, men som av ulike grunner ikke allerede er oppsummert. Fordelen med å fokusere på oversikter er at man får et innblikk i hva som er gjort på feltet som har vært av interesse for andre forskere å se på virkningen av. En slik oversikt over oversikter gir et godt utgangspunkt for å identifisere hvilket felt man ønsker ytterligere oppsummeringer fra, enten det gjelder effekt av gitte tiltak eller en identifisering av tiltak som er gjennomført for et spesifikt problem. Hvis man alltid skal vurdere enkeltstudier vil det bli et mye større prosjekt som krever mer arbeid for å sammenstille resultatene. 6 Innledning Begrunnelse for valg av søkestrategi Vi har søkt i elektroniske databaser etter systematiske oversikter. Søket er gjort for tidsperioden fra 2007 fram til august 2012. Vi har ikke søkt etter grå litteratur eller liknende. Innenfor temaet skadeforebygging er det noen områder som dekkes dårlig med det søket vi har gjennomført. Slike temaer omfatter alkoholrelaterte skader, voldsrela- terte skader, selvmord, soling og skader som oppstår som følge av ulike former for trening. Vi har søkt etter oversikter som omfatter forebygging mer generelt, og te- maer som krever spesifikke søk, enten på et konkret sted eller situasjon hvor skaden oppstår eller en gitt type skade, vil kreve mer spesifikke søk en det vi har gjennom- ført i dette søket. Problemstilling I prosjektet har vi søkt etter oversikter som skal belyse problemstillinger knyttet til forebygging av skader. 7 Innledning Metode Litteratursøking Vi søkte systematisk etter litteratur i følgende databaser: Medline Ovid Cochrane Database of Systematic Reviews CRD – DARE og HTA PubMed (artikler som er Ahead of print). Bibliotekar Mariann Mathisen planla og utførte samtlige søk i perioden 8. august 2012- 10.august 2012. De fullstendige søkestrategiene er visst i vedlegg 1. Vi la bestillingen til grunn ved utarbeiding av litteratursøket og søkte etter systema- tiske oversikter som
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