2. 2
Overview of Injuries in Childhood
• Unintentional injuries are the leading cause of death in children from
1 - 21 years of age in the U.S.
• Each year, 20-25% of children sustain an injury requiring medical
attention, missed school, and/or bedrest
• Leading cause of childhood medical spending in U.S.
3. Average Day in U.S.
• > 80,000 injuries resulting
in hospitalizations and ED
visits; >28,000 in kids 0-19
y.o.
• > 400 deaths due to
injuries; > 50 in kids 0-19
y.o.
Source: National Center for Injury Prevention and control, 2008
4. Childhood Injuries - Deaths
0
10
20
30
40
50
60
70
80
90
1-4 yr 5-9 yr 10-14 yr 15-19 yr
1955
1967
1988
1998
2001
2006
% total mortality
Source: National Center for Injury Prevention and Control, 2008
6. Functional Outcomes after Trauma
Children
• 10-25% with severe injuries have
functional limitations
• 30% of LE fracture and 15% of UE
fracture have physical limitations at
12 mos.
• 2% of mild TBI, 50% of moderate TBI
and >90% of severe TBI have
disability
• 20% of children and 40% of
adolescents have signs of PTSD
Adults
• 50% are not back to work at 1
year
• 35% report health as fair-poor at
1 year
• 40% of elderly have difficulty
walking
• No effect of TC care on functional
outcomes in TBI or elderly
• 40% of adults have PTSD sxs at
one year
9. Why has there been success in other areas of child
health versus injuries?
• Increase in new knowledge and development of new technologies has
been responsible for most of the advances and gains in life
expectancies.
• Efforts to improve health systems and policies have been central to
success in these other diseases
• Increases in life expectancies increased incomes and GDP
10. Resources for injury control
YLL DALYs WHO
reg. $
WHO
extra $
Communicable disease & maternal,
perinatal and nutritional conditions
54% 41% 68% 91%
Non-communicable dis. 33% 47% 31% 8%
Injuries 13% 12% <1% <1%
Lopez, The Lancet Nov 2008
11. 11
Basics of Injury Prevention
• INJURIES ARE NOT ACCIDENTS
• Injuries are often understandable, predictable, and preventable
• Specific injuries share similar characteristics of person, place , and
time
• By understanding injuries, interventions can be developed and
implemented to prevent or limit the extent of a given injury
12. 12
Strategies for Prevention
Intervention or countermeasures are classified based on requirements
for behavior change
• Active - rely on actions taken by an individual (e.g. keeping firearms in
locked cabinets)
• Passive - do not rely on the efforts of an individual to be successful
(restricting access to firearms)
14. Bicycles
• 700-900 people die in bicycle-related
injuries each year in the United States
• The majority of bicycle injuries occur in
children less than 15 years old
• 90% of patients killed in bicycle crashes
were not wearing helmets
15. Why Wear a Helmet?
• The skull is less than a ¼ inch thick.
• You do not need to be going fast or fall far to
injure the brain.
• Children riding a tricycle should wear a helmet.
• Bicycles are not toys, and should be considered a child’s first vehicle.
16. Bicycle Injury Prevention Research
Helmets provide a 63% to 88%
reduction in the risk of head, brain
and severe brain injury for all ages
of bicyclists.
17. Bicycle Injury Prevention Research
18% reduction in head
injury crashes among
children versus adults
who were not subject to
the law.
18. Bicycle Injury Prevention Research
Racial disparities in helmet use; little effect if no primary
enforcement.
19. Pediatric Firearm Injury Statistics
• 30,000+ firearm-related
deaths/year in the United States
• 12,000 homicides, 20,000
suicides
• 110,000 firearm injuries that are
brought to medical or legal
attention
20. Pediatric Firearm Injury Statistics
• 4 children killed daily by guns
• 50 injured seriously
• 40% American households have
guns
• 1.7 million children live with
unlocked/loaded guns in the home
(that’s 40% of the 40%)
• 75% of kids know where “hidden”
guns are in the home
21. Firearm Injury Prevention Research
7-40% reduction in
firearm related injuries in
states with stricter
licensing. No effect with
concealed carry laws.
27. 10 year old Male
• Back seat passenger
• Wearing lap belt ONLY
• MVC going 40 mph
• No LOC, no vomiting
• ABCs intact
• GCS 15
• + Seatbelt Sign
• Right hip TTP
28.
29. 3 year old Female
• Sitting in aunt’s lap in backseat
• MVC at 40 mph
• + LOC
• GCS 9 at scene
• In trauma center:
• Intubated
• Bradycardic
• Hypertensive
30.
31. Motor
Vehicle
Crashes
• LEADING CAUSE OF CHILD DEATH
• Car seats reduce risk of injury and fatality
• Especially in infants & toddlers
• Up to 7 out of every 10 children are improperly
restrained
32. AAP 2011 Recommendations
Age Restraint
Up to 2 years Rear-facing car seat
Up to 4 years Forward-facing car seat
Up to 8 years Belt-positioning booster seat
Outgrown Booster Seat Lap-and-shoulder seat belts
Up to 13 years Ride in the back seat
33.
34. Clear as Crystal?
Clear as Mud?
• www.healthychildren.org
• www.nhtsa.org
• www.safekids.org
35. Car Seat
Programs
• Car Seat Screening
Programs
• ED/Trauma
• Primary Care
• Child Passenger Safety
(CPS) Certification
• Community
37. 7 year old Female
• Playing at park after school
• On the monkey bars
• Fell on outstretched arm
38.
39. Fall out of two story
window
• 5 year old boy
• History ADHD
• Beautiful 70 degree sunny day
40.
41. Falls
Leading cause of non fatal injury
for children 0-19 years (CDC)
8,000 ED visits every day
Leading cause of hospitalization
for ages < 14 years
42. While Playing
• Playground Deisgn - woodchips
or sand (no dirt, concrete, grass)
• Helmets – inline skating,
skateboarding, bicycle, ATV, dirt
bike
• Supervision
43. Home
• Window guards and/or stops (screens keep
bugs out)
• Move furniture away from windows (kids climb
up)
• Stair gates
• Secure young children when seated
• Never leave children alone in shopping carts
47. Scald Burns
• Younger children
• Traditional Counseling: Set hot water
temperature at 120 degrees F
• Closer monitoring in high risk areas
(kitchen, bath)
• Safety gates around fireplaces, ovens,
furnaces
• Cooking safety
• Deep child safe distance away
• Avoid carrying /holding child
while cooking
• Turn pot handles away from the
edge
• Close, snug-fitting clothes
49. Flame burns
• Older Children
• Fire extinguishers on every level
• Every room with potential for open flame
• Space heaters, kerosene heaters
• Stop, drop, roll
50. 2/3 of household fire
deaths in homes without
smoke detectors or
without working smoke
detectors
Dual smoke
detector/carbon
monoxide alarms
preferred
51. Smoke Detectors
Test Once a MonthTest
Replace Battery Once a YearReplace
Replace Detector Every 10 years (or per manufacturer)Replace
Place on every floor, outside each sleeping area and inside each bedroomPlace on