How frequently are children injured?

*Each year between 20 - 25% of all children sustain an injury sufficiently severe to require medical attention, missed school, and/or bed rest.

*For every childhood death caused by injury, there are approximately 34 hospitalizations, 1000 emergency department visits, many more visits to private physicians and school nurses, and an even larger number of injuries treated at home.

*Deaths: Unintentional injuries are the leading cause of death in children from 1-21 years of age. However, deaths are still a rare event. Even so, they are relatively easy to count accurately, given the sophisticated vital statistics surveillance system in the United States. These records are maintained by the National Center for Health Statistics, CDC

*Nonfatal: These are much less rare, but are more difficult to count accurately, since injured children are treated at so many types of sites by so many types of health care professionals. Very few national surveillance systems exist for such data. The Department of Transportation (National Highway Traffic Safety Administration) maintains the Fatal Accident Reporting System for fatal traffic-related events, and its companion General Estimates System to estimate the number of nonfatal traffic-related events. The U.S. Consumer Product Safety Commission maintains the National Electronic Injury Surveillance System to monitor hospital emergency department visits for product-related injuries.

Who is at-risk?

Each type of injury has a particular demographic pattern, which is determined by:

*Developmental level of the child: physical, mental, emotional

*Prevalence of the threat in that community (e.g., all-terrain vehicles, backyard swimming pools, firearms, kerosene heaters, etc.)

*Access to and use of environmental countermeasures (e.g., bike helmets, smoke detectors)

*Importance of supervision in avoiding the threat, relative to the degree provided (e.g., toddler living in a low-income apartment complex with an in-ground swimming pool that lacks protective fencing, with a 5-year supervising the toddler)

Several demographic features are common to most types of injuries. The injury rates are greatest in those with:

*Low socioeconomic status, especially urban African-American children and American Indians/Alaska Natives

*Males

The principal exception to this is young motor vehicle occupants before adolescence, in whom the male:female ration is nearly unity.

What are the leading causes of fatal injuries?

*Overall, motor vehicles, fires/burns, drowning, falls, poisoning.

What determines what body site(s) are injured?

Injury-specific. For example:

*Motor vehicle--blunt thoracoabdominal trauma, head injuries

*Sports--extremity fractures, sprains, and strains

*House fires--body burns, inhalation injuries

*Near-drowning--coma, brain damage

*Falls--head injuries, fractures, blunt trauma

*Poisoning--coma, kidney failure, etc.
Was the child a projectile?

*Head injury quite likely
*Bicycle-motor vehicle collision, falling forward over the handlebars
*Unrestrained occupant in a motor vehicle collision, thrown forward through the windshield or ejected from vehicle unto roadway

Where do injuries occur most commonly?

Locations and conditions associated with possible danger are:

In the home:

*Water--kitchen, bathroom, backyard swimming pool

*Intense heat or flames--kitchen, backyard barbecue pit

*Toxic agents--under the kitchen sink, bathroom medicine chest, mother's purse, garage

*High potential energy--stairwells, loaded firearms

At school:

*(Related to sports activities (especially in the absence of proper gear)

*Carrying of weapons

*Industrial arts classes

After school:

On the job:

*Hostile relationships in work environment

*Use of machinery

During transport:

*Motor vehicle crashes (especially if unrestrained or if driver has been drinking alcohol)

*Bicycle crashes

*Pedestrian injuries

What criteria determine the priority level for each type of childhood injury?

High mortality rate or hospitalization rate

*High long-term disability rate, especially mechanisms likely to result in head and spinal cord injuries

*Existence of effective countermeasure

In other words, the highest priorities are assigned to those types of injuries which are common, severe, and readily preventable.Often, however, the only difference between a nonfatal and fatal event is only a few feet (e.g., pedestrian injury which results in fracture rather than massive trauma), a few inches (gunshot wound to the arm instead of the head), or a few seconds (as in the survivor of a near-drowning event). Therefore, each nonfatal event that involves a great mismatch of momentum must be taken very seriously. Surveillance of nonfatal injuries would be appropriate to help determine risk factors and possible interventions, as a proxy for fatal events.