Validation of a HOME Injury Survey

Background: There are no validated observational surveys to assess injury hazards in the home environment. Objective: To evaluate the reproducibility and reliability of a survey quantifying home injury hazards for children. Methods: A nested cohort of children in the intervention arm of the Home Observations and Measures of the Environment (HOME) Study trial were analysed. The number and density of hazards were quantified by research assistants in the homes of participants at a baseline visit (BHV) for four high-risk rooms (kitchen, main activity room, child's bathroom and child's bedroom) and stairways and later at an intervention planning visit (IPV) for the four high-risk rooms and entire household. Statistical analysis included Pearson correlation, Bland-Altman analysis of agreement, analysis of variance and kappa statistics. Results: There were 163 households with measurements at BHV and IPV. The number and density of hazards for the four high-risk rooms correlated significantly between BHV and IPV (r=0.50 and 0.75, respectively). The number and density of hazards for the four high-risk rooms correlated significantly with that for the whole household at the IPV (r=0.17 and 0.52, respectively). The number of injury hazards was significantly higher in the kitchen than in the other high-risk rooms, whereas density was highest in the child's bathroom. Inter-rater reliability between research assistants, as measured by the k statistic, was excellent with a mean of 0.81. Conclusions: The HOME Injury Survey was a reliable and replicable tool for quantifying residential injury hazards. The density of injury hazards was a more stable and valid measure than the number of injury hazards.