Heat related deaths to young children in parked cars: an analysis of 171 fatalities in the United States, 1995-2002.

OBJECTIVE: To describe the circumstances surrounding heat related deaths to young children in passenger compartments of motor vehicles. METHODS: Cases of heat related deaths to children aged

Causes and outcomes of pediatric injuries occurring at school.

This study examines the causes and outcomes of injuries occurring at school and highlights the need for injury prevention strategies. Descriptive statistics were applied to data from a national pediatric trauma database on 1,558 K-12 graders injured at school severely enough to require hospitalization. Factors analyzed included age, gender, cause, place, time, injured body regions, use of hospital resources, in-hospital fatality rate, and functional limitations. Most injuries were unintentional (89.7%) and occurred mostly to children 10-14 years old. Almost half occurred in recreational areas. Falls and sports were the most frequent causes, but the pattern varied by grade and gender. Most children sustained injuries to the extremities (41.3%) or to the head (39.2%). Two percent sustained spinal cord injuries, mainly from sports. Eight children died, and 43.6% developed one or more functional limitations. Frequent, severe, and costly injuries should be the focus of school safety policies, and a mix of injury prevention strategies should be applied.

Work-related injuries among Massachusetts children: a study based on emergency department data.

Millions of children in the United States work and, despite federal and state laws, face safety hazards. Previous studies have documented large numbers of injuries suffered on the job by working children. This study describes work-related injuries to children 14-17 years old in 14 Massachusetts communities (representing 5% of the state population) based on data from emergency departments and hospital admissions collected as part of a large population-based surveillance study of injuries to children and adolescents from 1979 to 1982. An estimated 1,176 work-related injuries occurred during the three-year period, accounting for 7-13% of all injury-related emergency department visits in this age group; the proportion among 17-year-olds was 14-26%. Cuts and lacerations were the most frequent type of injury, cutting/piercing was the most common cause, and cutting instruments were the most frequently identified products. Seventeen children were hospitalized for work-related injuries during the course of the study. The estimated annual rate of occupational injury rose from 3.7/1,000 children for 14- to 15-year-olds to 44.7/1000 for 17-year-olds; these rates count all resident children, regardless of their employment status, in the denominator. Rates based on actual hours worked are much higher, and strongly suggest that working minors should be considered a high-risk group for occupational injury. This study adds to the mounting evidence that work-related injuries to children are a significant public health problem and contribute significantly to the overall incidence of injuries among children 14-17 years old. The study also demonstrates the potential of emergency department data as a valuable source of information about work-related injuries to children. Active surveillance systems combining data from emergency departments, workers' compensation, and other potential sources should be established to fully document the nature and extent of the problem. Efforts to prevent these injuries will require the combined attention of employers, parents, medical providers, educators and regulators, as well as working children themselves.

The cost of medical care for injuries to children.

STUDY OBJECTIVES: To estimate the mean cost of initial medical treatment for a variety of injury types and injury causes and project the national cost of initial medical care for injuries to children. DESIGN: We combined injury incidence data from the Massachusetts Statewide Childhood Injury Prevention Project (SCIPP) with a claims data set (1987 charges) from the Health Data Institute, Lexington, Massachusetts. SETTING AND STUDY POPULATION: SCIPP incidence data were obtained from hospital emergency department and inpatient facilities for a population of 87,000 Massachusetts children 0 to 19 years old between 1979 and 1982. Health Data Institute charge data for children were derived from insurance claims for 3% of all privately insured patients throughout the United States. RESULTS: The estimated mean cost of initial hospitalization for injury was $5,094, while ED care was $171. Projected annual cost for initial medical care of injury to children for the nation was $5.1 billion, which was about equally divided between cases seen in EDs and those requiring inpatient care. Although there was little difference in mean cost between the genders, mean cost increased with age. Because of both a higher injury incidence and a greater mean cost per injury, the projected initial cost of injuries to teenagers 15 to 19 years old was much higher than that of younger children. CONCLUSION: Expenditures for medical care of injured children, particularly adolescents, are great. The prevention of childhood injuries should become a higher priority in the United States. To improve the quality of national estimates of the incidence and cost of injury, a national surveillance system for nonfatal injuries should be developed. Such a system should include information on the major causes of injury and their costs.

Injury surveillance using hospital discharge abstracts coded by external cause of injury (E code).

Current knowledge of the patterns of injury in the United States derive principally from mortality statistics that constitute less than 0.1% of all injuries reaching medical attention. There presently exists no national system for the surveillance of nonfatal injuries. To illustrate the usefulness and feasibility of conducting injury surveillance using E-coded hospital discharge data, we examined the surveillance data from the Massachusetts Statewide Childhood Injury Prevention Program. By using E-coded hospital discharge data, we increased the number of cases available for analysis by 40-fold over deaths, and we were able to describe the epidemiologic characteristics of the important causes of nonfatal childhood injuries. We therefore propose the development of a national injury surveillance system based on the Uniform Hospital Discharge Data Set coded by both the nature of the injury (N Code) and external cause (E Code).

Intentional injuries among children and adolescents in Massachusetts.

We estimated age-specific and sex-specific incidence rates of intentional injuries (assaults or suicide attempts) occurring between 1979 and 1982 in a population of 87,022 Massachusetts children and adolescents under 20 years of age in 14 communities with populations of 100,000 or less. The average annual incidence of intentional injuries treated at a hospital was estimated to be 76.2 per 10,000 person-years. Overall, 1 in 130 children was treated each year for an intentional injury. More than 85 percent of the injuries resulted from assaults, such as fights, rape, and child battering; 11.4 percent were self-inflicted. Intentional injuries were most common among adolescents. Each year, 1 in 42 teenage boys was treated for an assault-related injury, and 1 in 303 teenage girls was seen for a suicide attempt. Repeated episodes of intentional injury were identified in 4.3 percent of the children. In this population, intentional injuries accounted for 3.4 percent of all injuries but 9.8 percent of hospital admissions and 15.7 percent of deaths from injury. The rate of intentional injury was directly correlated with both the degree of urbanization and the poverty level of the community of residence. We conclude that intentional injuries are relatively common in this population and that attempts to prevent them must be directed to the children who are at greatest risk.

Prevention of childhood injuries: evaluation of the Statewide Childhood Injury Prevention Program (SCIPP).

We evaluated the effectiveness of a community-based injury prevention program designed to reduce the incidence of burns, falls in the home, motor vehicle occupant injuries, and poisonings and suffocations among children ages 0-5 years. Between September 1980 and June 1982, we implemented five injury prevention projects concurrently in nine Massachusetts cities and town; five sites, matched on selected demographic characteristics, were control communities. An estimated 42 percent of households with children ages 0-5 years were exposed to one or more of the interventions over the two-year period in the nine communities. Participation in safety programs increased three-fold in the intervention communities and two-fold in the control communities. Safety knowledge and practices increased in both intervention and control communities. Households that reported participatory exposure to the interventions had higher safety knowledge and behavior scores than those that received other community exposure or no exposure to intervention activities. We found a distinct reduction in motor vehicle occupant injuries among children ages 0-5 years in the intervention compared with control communities, associated with participatory exposure of about 55 percent of households with children ages 0-5 years. We have no evidence that the coordinated intervention programs reduced the other target injuries--although exposure to prevention messages was associated with safety behaviors for burns and poisonings.

The epidemiology of injuries to bicycle riders.

Over half a million injuries related to bicycle crashes were seen in U.S. hospital emergency rooms in 1982. The data reviewed show a strong link between bicycle/motor vehicle collisions, head injury, and serious morbidity and mortality.

Falls in children and youth.

Falls account for considerable morbidity in childhood. The importance of the surface that the child strikes is highlighted as well as the parents' perceptions of the seriousness of the fall. Recommendations for prevention are made.

Injuries to adolescents and young adults.

Death rates in adolescents are on the rise--the only age group for which this is true. Unintentional injuries, homicide, and suicide account for 80 per cent of all deaths in this group. The authors summarize the available morbidity and mortality data.

An approach to the epidemiology of childhood injuries.

Injury epidemiology is summarized and important concepts such as injury versus accident, the agent-host-environment model, level of severity, morbidity versus mortality, and definitions of rates are considered. The authors suggest steps needed to improve the understanding of injury epidemiology and to remove barriers to the acceptance of injury prevention as a recognized field of study and clinical practice.

A home injury prevention program for children.

Most injuries to children under age five occur in the home. This article recounts the experience of an injury prevention project in developing and implementing an approach combining educational, regulatory, and technologic methods to reduce home injuries.

The incidence of injuries among 87,000 Massachusetts children and adolescents: results of the 1980-81 Statewide Childhood Injury Prevention Program Surveillance System.

This study describes the incidence of fatal and nonfatal injuries occurring in 87,022 Massachusetts children and adolescents during a one-year period. A surveillance system for injuries at 23 hospitals captured 93 per cent of all discharges for ages 0-19 in the 14 communities under study. Sample data were collected on emergency room visits, hospital admissions, and deaths for all but a few causes of unintentional injuries. The overall incidence was 2,239 per 10,000. The true incidence rates are probably higher than those reported. The ratio of emergency room visits to admissions to deaths was 1,300 to 45 to 1. Injury rates varied considerably by age, sex, cause, and level of severity. Age-specific injury rates were lowest for infants and elementary school age children and highest for toddlers and adolescents. The overall ratio of male to female injury rates was 1.66 to 1. Injuries from falls, sports, and cutting and piercing instruments had a high incidence and low severity. Injuries from motor vehicles, burns, and drownings had lower incidence, but greater severity. Results provide evidence that both morbidity and mortality must be considered when determining priorities for injury prevention. Current prevention efforts must be expanded to target injuries of higher incidence and within the adolescent population.