Banning the "A word": where's the evidence?

Background: It is argued that use of the term "accident" has a negative effect on prevention efforts as the term implies that such events are due to chance.

Aim: To test the hypothesis that use of "injury" in place of "accident" can influence professional attitudes towards "accident/injury" prevention.

Setting: Leeds Health Authority area serving the population (n=740,000) of the city of Leeds in the Yorkshire region of England.

Method: A randomised comparative study. Altogether 183 health visiting staff in the Leeds area were randomised (by place of work) to one of two groups. Each group received a similar postal questionnaire assessing attitudes relating to accident/injury prevention. One group received a questionnaire using only accident terminology while the other used injury terminology throughout.

Results: Fifty responses in the accident group were received and 39 in the injury group. Analysis by Mann-Whitney U tests showed little difference in group responses. The only significant finding was that respondents in the "accident" group were more likely to rank "accident prevention" of higher importance relative to respondents in the "injury" group (median 2, 25%-75% quartiles 1.8-4.0 compared with median 4, 25%-75% quartiles 2.0-5.0, p=0.04). However, this may have been a chance finding due to the multiple comparisons made.

Conclusions: This study has shown little difference in health visitor responses when "accident" is replaced with "injury". It is possible that the effect of changing terminology is more nebulous--influencing society at large. However, it would be as well to recognise the lack of evidence and clarity relating to the terminology debate. Otherwise, there is a danger that the "injury" believers may become alienated from the "accident" diehards.