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BASICS

  • Injury (intentional or unintentional) is largely predictable and preventable.
  • As of 2020, unintentional injury is the 4th leading cause of death in the U.S.
  • Injury is the leading cause of death in people aged 1-44 years.
  • Violence-related deaths in 2020: >58,000 (36,000 suicides, 21,000 homicides).

EPIDEMIOLOGY

  • Children mostly die from unintentional injuries: motor vehicle traffic (MVT), drowning, poisoning, suffocation.
  • MVT most common injury death in adolescents.
  • Poisoning (including drug overdose) is the leading injury death cause overall since 2011.
  • Firearms contribute heavily to suicide and homicide rates.
  • Homicide is second leading cause of death in ages 15-24 years.
  • Pedestrians and bicyclists also at high risk for fatal and nonfatal injuries.

ETIOLOGY AND PATHOPHYSIOLOGY

  • Injury causes are multifactorial including behavioral, environmental, social, and economic factors.

RISK FACTORS

Motor Vehicle Accidents (MVA)

  • Leading cause of death for U.S. teens.
  • Risk factors: high speed, teen drivers, alcohol/drug use, fatigue, distracted driving.
  • Motorcycle riders have higher death risk; helmets reduce mortality by 37%.
  • Nonuse of seat belts, drunk driving, speeding increase death risk.

Pedestrians and Cyclists

  • 7,000 pedestrian deaths; 104,000 treated for nonfatal pedestrian injuries (2020).

  • Bicycle deaths >800; injuries ~357,000 (2020).
  • Risk factors: age (5-19 for injury, 50-59 highest death rate), male sex, urban settings, alcohol.

Sports and Recreation

  • 2.6 million children treated for injuries annually.

  • Prevention: proper protective gear, concussion protocols, heat injury monitoring.

Drowning and Suffocation

  • Leading cause of injury death in young children.
  • Risk: African American children, unsafe sleeping, lack of supervision.

Falls

  • Leading cause of nonfatal injury and traumatic brain injury (TBI).
  • Risk factors: weakness, vitamin D deficiency, balance/gait issues, medication use, vision problems, home hazards.

Violence

  • Risk factors: adverse childhood experiences, lack of social/economic resources, familial instability, firearm access, mental health issues, substance abuse.
  • Firearms involved in over half of U.S. homicides.
  • Suicide: males 4x more likely to complete suicide; firearms and poisoning most common methods.
  • Adolescent violence includes physical fights, weapon carrying, bullying (20% report school bullying, 15% cyberbullying).

DIAGNOSIS

History

  • Assess injury mechanism, timing, location.
  • Intentionality, substance use, restraint use.
  • IPV screening in women of childbearing age.
  • Neurologic, psychiatric, obstetric, and social context.

TREATMENT

Prevention

  • Tailored individual and population-level interventions.
  • Motor vehicle safety: child seats, seat belts, DUI laws, graduated licensing.
  • Pedestrian/cyclist safety: helmets, reflective clothing, urban planning.
  • Sports: protective gear, concussion protocols.
  • Drowning: supervision, swimming lessons, pool safety.
  • Falls: home safety, exercise programs.
  • Violence: screening, mental health services, firearm access reduction.

Poisoning

  • Address opioid epidemic: improve prescribing, reduce exposure, naloxone availability, MOUD (buprenorphine, methadone).

ONGOING CARE

  • Address social burden: productivity loss, mental health impact, rehabilitation needs.

COMPLICATIONS

  • Emotional, physical, social sequelae including chronic pain, substance use, altered relationships.

REFERENCES

  1. Sleet DA, Dahlberg LL, Basavaraju SV, et al; CDC. Injury prevention, violence prevention, and trauma care: building the scientific base. MMWR Suppl. 2011;60(4):78-85.
  2. CDC, National Center for Injury Prevention and Control. Injury prevention and control. https://www.cdc.gov/injury. Accessed January 12, 2023.
  3. Mowry JB, Spyker DA, Brooks DE, et al. 2015 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). 2016;54(10):924-1109.

CLINICAL PEARLS

  • Injury and violence are largely predictable and preventable.
  • Unintentional injury is a leading cause of death in the United States.
  • Primary prevention measures must target risk factors specific to injury type and population.