Childhood Injury Fact Sheet

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)

Facts on Adolescent Injury
 

How big is the problem of injuries for U.S. adolescents?

• At least one adolescent (10-19 years old) dies of an injury every hour of every day; about 15,000 die each year.1
• Injuries kill more adolescents than all diseases combined.2
• For every injury death, there are about 41 injury hospitalizations and 1100 cases treated in emergency departments.2
• Unintentional injury accounts for around 60% of adolescent injury deaths, while violence (homicide and suicide) accounts for the remaining 40%.1

Who is most at risk for injury death?

• In general, males are more likely than females to die of any type on injury.
• The most pronounced differences between sexes in injury death rates occur within the older adolescent group (15-19 years). In this group, males are about 2.5 times more likely to die of any unintentional injury and 5 times more likely to die of homicide or suicide. The gender difference is most pronounced in drowning, where males are 10.6 times more likely to die than females of the same age.
• Among adolescents 15-19 years old, one in every four deaths is caused by a firearm. For this age group, the risk of dying from a firearm injury has increased by 77% since 1985.3

What are the most common types of injuries among adolescents?

• The largest proportion of adolescent injuries are due to motor vehicle crashes.
• Adolescents are far less likely to use seat belts than any other age group.2
• Adolescents are especially vulnerable to fatal crashes at night; they do 20% of their driving at night, but they have more than 50% of their fatalities at night.2
• When adolescents drive after drinking alcohol, they are more likely than adults to be in a crash, even when drinking less alcohol than adults.2
• Adolescents also cause a disproportionate number of deaths among nonadolescent drivers, passengers, and pedestrians.2

Does alcohol contribute to adolescent injuries?

• Alcohol is involved in about 35% of adolescent (15-20 years) driver fatalities.
• Alcohol is involved in about 40% of all adolescent drownings.s
• 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

 Playground Injuries

 
Each year in the United States, emergency departments treat more than 200,000 children ages 14 and younger for playground-related injuries (Tinsworth 2001).

 
Occurrence and Consequences

• About 45% of playground-related injuries are severe—fractures, internal injuries, concussions, dislocations, and amputations (Tinsworth 2001).
    

• About 75% of nonfatal injuries related to playground equipment occur on public playgrounds (Tinsworth 2001). Most occur at schools and daycare centers (Phelan 2001).
   
• Between 1990 and 2000, 147 children ages 14 and younger died from playground-related injuries. Of them, 82 (56%) died from strangulation and 31 (20%) died from falls to the playground surface. Most of these deaths (70%) occurred on home playgrounds (Tinsworth 2001). 

  Groups at Risk

• While all children who use playgrounds are at risk for injury, girls sustain injuries (55%) slightly more often than boys (45%) (Tinsworth 2001).   
• Children ages 5 to 9 have higher rates of emergency department visits for playground injuries than any other age group. Most of these injuries occur at school (Phelan 2001). 

 
Risk Factors

• On public playgrounds, more injuries occur on climbers than on any other equipment (Tinsworth 2001).
   
• On home playgrounds, swings are responsible for most injuries (Tinsworth 2001).
   
• A study in New York City found that playgrounds in low-income areas had more maintenance-related hazards than playgrounds in high-income areas. For example, playgrounds in low-income areas had significantly more trash, rusty play equipment, and damaged fall surfaces (Suecoff 1999).

Teen Drivers

Two out of five deaths among U.S. teens are the result of a motor vehicle crash (IIHS 2001).  
   

Occurrence and Consequences

• In 1999, more than 4,700 teens ages 16 to 19 died of injuries caused by motor vehicle crashes (CDC 2001).  
   
• The risk for motor vehicle crashes is higher among 16- to 19-year-olds than among any other age group. In fact, per mile driven, teen drivers ages 16 to 19 are four times more likely than older drivers to crash (NHTSA 2002a).
   
• Teenagers represented 10% of the U.S. population in 2000 and accounted for 14% of all motor vehicle–related deaths (IIHS 2001).
   
• The presence of teen passengers increases the crash risk for unsupervised teen drivers; the risk increases with the number of teen passengers (Chen 2000).
• Cost

In 2000, the estimated economic cost of police-reported crashes (both fatal and nonfatal) involving drivers ages 15 to 20 was $32.8 billion (NHTSA 2002a).

Groups at Risk

• In 1999, the motor vehicle death rate for male occupants age 16 to 19 was nearly twice that of their female counterparts (18.4 per 100,000 compared with10.6 per 100,000) (CDC 2001).  
    
• Crash risk is particularly high during the first years that teenagers are eligible to drive (NHTSA 2002a). 

 
Risk Factors

• Teens are more likely than older drivers to underestimate the dangers in hazardous situations, and they have less experience coping with such situations (Jonah 1987).
   
• Teens are more likely than older drivers to speed, run red lights, make illegal turns, ride with an intoxicated driver, and drive after using alcohol or drugs. (Jonah 1987).
   
• Compared with other age groups, teens have the lowest rate of seat belt use.  In 2001, 14% of high school students reported they rarely or never wear seat belts when riding with someone else (CDC 2002).  
   
• Male high school students (18%) were more likely than female students (10%) to rarely or never wear seat belts (CDC 2002).  
   
• African American students (16%) were more likely than white students (14%) to rarely or never wear seat belts (CDC 2002).  
• At all levels of blood alcohol concentration, the risk of being involved in a motor vehicle crash is greater for teens than for drivers who are older(IIHS 2000).  
   
• In 2000, 30% of drivers ages 15 to 20 who died in motor vehicle crashes had been drinking alcohol (NHTSA 2002a).
   
• Analysis of data from 1991–1997 found that, consistently, more than one in three teens reported they had ridden with a driver who had been drinking alcohol in the past month.  One in six reported having driven after drinking alcohol within the same one-month time period (Everett 2001).  
   
• In 2000, among teen drivers who were killed in motor vehicle crashes after drinking and driving, 80% were unrestrained (NHTSA 2002a).  
   
• In 2000, 41% of the teen motor vehicle deaths occurred between 9 p.m. and 6 a.m. (IIHS 2001).