The U.S. Preventive Services Task Force (USPSTF) grades its recommendations (A, B, C, D, or I) and identifies the Levels of Certainty regarding Net Benefit (High, Moderate, and Low). The definitions of these grades can be found at the end of the "Major Recommendations" field.
Summary of the Recommendations
Recommendation 1: Counseling about Proper Use of Motor Vehicle Occupant Restraints to Prevent Motor Vehicle Occupant Injuries (MVOIs)
The USPSTF concludes that the current evidence is insufficient to assess the incremental benefit, beyond the efficacy of legislation and community based interventions, of counseling in the primary care setting, in improving rates of proper use of motor vehicle occupant restraints (child safety seats, booster seats, and lap-and-shoulder belts). (See Clinical Considerations section below for definitions of proper use.) This is an I statement.
Recommendation 2: Counseling to Prevent Alcohol-related MVOI in Adolescents and Adults
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine counseling of all patients in the primary care setting to reduce driving while under the influence of alcohol or riding with drivers who are alcohol-impaired. This is an I statement.
Clinical Considerations
Patient Population
This recommendation refers to behavioral counseling interventions performed in the primary care setting, addressing parents of all infants and children, children, adolescents, and adults.
Elements of Effective Counseling Interventions
The injury prevention benefits of child safety seat and booster seat use require proper use. (That is, the seats should be age- and weight-appropriate and should be installed and placed into the vehicle correctly.) Infants younger than 1 year of age and weighing less than 20 pounds should be placed in rear-facing, infant-only car safety seats or convertible seats positioned in the back seat. Infants younger than 1 year of age and weighing between 20 and 35 pounds should be placed in rear-facing convertible seats positioned in the back seat. Rear-facing child safety seats must not be placed in the front passenger seat of any vehicle that is equipped with an airbag on the front passenger side. Death or serious injury can result from the impact of the airbag against the child safety seat. Toddlers 1 to 4 years of age weighing 20 to 40 pounds should be restrained in a forward-facing convertible seat or forward-facing only seat positioned in the back seat. Young children 4 to 8 years of age and up to 4'9" (57 inches) in height should be placed in a booster seat in the back seat. After this age (or height), lap-and-shoulder belt use is appropriate. Children younger than 13 years of age should sit in the back seat with lap-and-shoulder belts.
Behavioral counseling interventions that include an educational component, as well as a demonstration of use or a distribution component, are more effective than those that include education alone.
Other Approaches to Prevention
Clinical counseling in conjunction with community-based interventions has been effective in increasing proper use of child safety seats. Over the past decade, legislation and enforcement have contributed substantially to the increasing trends in child safety seat and seat belt usage. A comprehensive strategy that includes community-based interventions, primary care counseling in the primary care setting, legislation, and enforcement is critical to the improvement of proper safety restraint usage and decrease in the incidence of MVOI.
Other Relevant USPSTF Recommendations
The USPSTF currently recommends screening for alcohol misuse and counseling targeted to those patients identified as risky or harmful drinkers (see the National Guideline Clearinghouse [NGC] summary of the USPSTF recommendations on Screening and behavioral counseling interventions in primary care to reduce alcohol misuse.
Definitions:
What the United States Preventive Services Task Force (USPSTF) Grades Mean and Suggestions for Practice
| Grade |
Grade Definitions |
Suggestions for Practice |
| A |
The USPSTF recommends the service. There is high certainty that the net benefit is substantial. |
Offer/provide this service. |
| B |
The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. |
Offer/provide this service. |
| C |
The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is moderate or high certainty that the net benefit is small. |
Offer/provide this service only if there are other considerations in support of the offering/providing the service in an individual patient. |
| D |
The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. |
Discourage the use of this service. |
I
Statement
|
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality or conflicting, and the balance of benefits and harms cannot be determined. |
Read "Clinical Considerations" section of USPSTF Recommendation Statement (see "Major Recommendations" field). If offered, patients should understand the uncertainty about the balance of benefits and harms. |
USPSTF Levels of Certainty Regarding Net Benefit
Definition: The U.S. Preventive Services Task Force defines certainty as "likelihood that the USPSTF assessment of the net benefit of a preventive service is correct." The net benefit is defined as benefit minus harm of the preventive service as implemented in a general, primary care population. The USPSTF assigns a certainty level based on the nature of the overall evidence available to assess the net benefit of a preventive service.
| Level of Certainty |
Description |
| High |
The available evidence usually includes consistent results from well-designed, well-conducted studies in representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies. |
| Moderate |
The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by factors such as:
- the number, size, or quality of individual studies;
- inconsistency of findings across individual studies;
- limited generalizability of findings to routine primary care practice; or
- lack of coherence in the chain of evidence.
As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.
|
| Low |
The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of:
- the limited number or size of studies;
- important flaws in study design or methods;
- inconsistency of findings across individual studies
- gaps in the chain of evidence;
- findings not generalizable to routine primary care practice; or
- a lack of information on important health outcomes.
More information may allow an estimation of effects on health outcomes.
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