Abstract: The review included 27 studies reported in 30 articles. The studies had 73,557 participants with 12 studies from the US; four from China; two from each of Australia, Canada, the Netherlands and the UK; and one from each of Israel, Greece and Brazil. Thirteen studies were RCTs, six were non-RCTs and eight were CBAs. Of the included studies, 18 provided some element of the intervention in children aged four to 11 years, 17 studies included children aged 11 to 14 years and nine studies included children aged 14 to 18 years. The overall quality of the results was poor, with the all studies assessed as being at high or unclear risks of bias across multiple domains, and varied interventions and data collection methods employed. Interventions comprised information-giving, peer education or were multi-component. Seven studies reported the primary outcome of injury occurrence and only three of these were similar enough to combine in a meta-analysis, with a pooled incidence rate ratio of 0.73 (95% confidence interval (CI) 0.49 to 1.08; 2073 children) and substantial statistical heterogeneity (I2 = 63%). However, this body of evidence was low certainty, due to concerns over this heterogeneity (inconsistency) and imprecision. This heterogeneity may be explained by the non-RCT study design of one of the studies, as a sensitivity analysis with this study removed found stronger evidence of an effect and no heterogeneity (I2 = 0%). Two studies report an improvement in safety skills in the intervention group. Likewise, the four studies measuring observed safety behaviour reported an improvement in the intervention group relative to the control. Thirteen out of 19 studies describing self-reported behaviour and safety practices showed improvements, and of the 21 studies assessing changes in safety knowledge, 19 reported an improvement in at least one question domain in the intervention compared to the control group. However, we were unable to pool data for our secondary outcomes, so our conclusions were limited, as they were drawn from highly diverse single studies and the body of evidence was low (safety skills) or very low (behaviour, safety knowledge) certainty. Only one study reported intervention costs but did not undertake a full economic evaluation (very low certainty evidence). There is insufficient evidence to determine whether school-based educational programmes can prevent unintentional injuries. More high-quality studies are needed to evaluate the impact of educational programmes on injury occurrence. There is some weak evidence that such programmes improve safety skills, behaviour/practices and knowledge, although the evidence was of low or very low quality certainty. We found insufficient economic studies to assess cost-effectiveness.

Plain-language summary: The evidence is current to June 2015. It includes the results from 27 studies of 73,557 children. It included boys and girls aged four to 18. The studies compared injury prevention education with either the usual curriculum or an alternative programme unrelated to injuries. The studies we included were aimed at preventing a range of injuries. We excluded programmes that focused on just one cause of injury. The review measured the effects of the educational programmes on the occurrence of injuries in children, their safety skills, behaviour and knowledge. The review also looked at whether school-based approaches are good value for money. Only a few studies reported the effect on injury occurrence in children and so these effects were inconclusive. This does not mean that school-based programmes are ineffective but rather that more evidence is needed. The review did find evidence that school-based injury prevention education programmes can improve children's safety skills, safety behaviours and safety knowledge. However, the evidence was inconsistent, with some studies showing a positive effect and others showing no effect. Only one study reported on how cost-effective school-based programmes were and so again it is difficult to draw conclusions from this evidence alone. The studies were generally of poor quality for all the measurements of effectiveness of the programmes but particularly for behaviour and knowledge. This is because information about how the study was conducted was not usually reported very clearly in the study reports or there were major flaws in the way that the studies were undertaken. More research is needed that is of higher quality.