Unintentional injury deaths in children and youth, 2010–2019

Background: Unintentional injuries are the leading cause of death for children and youth aged 1–19 in the United States. The purpose of this report is to describe how unintentional injury death rates among children and youth aged 0–19 years have changed during 2010–2019. Method: CDC analyzed 2010–2019 data from the National Vital Statistics System (NVSS) to determine two-year average annual number and rate of unintentional injury deaths for children and youth aged 0–19 years by sex, age group, race/ethnicity, mechanism, county urbanization level, and state. Results: From 2010–2011 to 2018–2019, unintentional injury death rates decreased 11% overall—representing over 1,100 fewer annual deaths. However, rates increased among some groups—including an increase in deaths due to suffocation among infants (20%) and increases in motor-vehicle traffic deaths among Black children (9%) and poisoning deaths among Black (37%) and Hispanic (50%) children. In 2018–2019, rates were higher for males than females (11.3 vs. 6.6 per 100,000 population), children aged < 1 and 15–19 years (31.9 and 16.8 per 100,000) than other age groups, among American Indian or Alaska Native (AIAN) and Blacks than Whites (19.4 and 12.4 vs. 9.0 per 100,000), motor-vehicle traffic (MVT) than other causes of injury (4.0 per 100,000), and rates increased as rurality increased (6.8 most urban [large central metro] vs. 17.8 most rural [non-core/non-metro] per 100,000). From 2010–2011 to 2018–2019, 49 states plus DC had stable or decreasing unintentional injury death rates; death rates increased only in California (8%)—driven by poisoning deaths. Conclusion and Practical Application: While the overall injury death rates improved, certain subgroups and their caregivers can benefit from focused prevention strategies, including infants and Black, Hispanic, and AIAN children. Focusing effective strategies to reduce suffocation, MVT, and poisoning deaths among those at disproportionate risk could further reduce unintentional injury deaths among children and youth in the next decade.     

Is there a link between children's motor abilities and unintentional injuries?

PROBLEM: The common view is that clumsy children experience unintentional injury more frequently. Empirical evidence supporting this position is mixed. METHOD: One hundred 6- and 8-year-olds completed a battery of nine tasks designed to assess motor ability. Mothers completed a lifetime injury history measure about their children and families completed a 2-week injury diary assessing frequency and severity of daily injuries. RESULTS: Internal reliability for the motor ability battery was good. Correlations between motor ability measures and injury risk were nonsignificant and near zero. DISCUSSION: Motor ability does not appear to be directly related to injury risk. Possible explanations include: (a) coordinated and clumsy children engage in hazardous activities with differing frequency; or (b) other individual difference factors may interact with motor ability to explain children's injury risk. IMPACT ON INDUSTRY: Children's motor abilities do not appear to be directly linked to rate of unintentional injury, but instead may influence risk for injury in conjunction with other factors. Results could have implications to the engineering of children's toys and playground equipment and to the design of appropriate supervision strategies for children engaging in potentially dangerous activities.     

Risk for household safety hazards: Socioeconomic and sociodemographic factors

IntroductionMany unintentional injuries to young children occur in the home. The current study examines the relation between family socioeconomic and sociodemographic factors and risk factors for home injury.MethodsPresence of household hazards was examined in 80 families with toddler-aged children. Parental ability to identify household hazards in pictures was also assessed. ANOVAs and Pearson product–moment correlations examined the relationship between presence of household hazards, knowledge to identify hazards, and factors of yearly family income, parental age, parental education, parental marital status, child ethnicity, and the number of children living in the home.ResultsA greater number of hazards were found in the homes of both the lowest and highest income families, but poorer knowledge to identify household hazards was found only among parents of the lowest income families and younger parents. Across family socioeconomic status, parent knowledge of hazards was related to observed household hazards.ConclusionsThe relationship between family income and risk for injury is complex, and children of both lower and higher SES families may be at risk for injury.Practical applicationsWhile historically particular focus has been placed on risk for injury among children in low income families, injury prevention efforts should target reducing presence of household hazards in both high and low SES families.     

Assessing disabling and non-disabling injuries and illnesses using accepted workers compensation claims data to prioritize industries of high risk for Oregon young workers

Introduction: Young workers are especially vulnerable to occupational injuries and illnesses. There is a continued need to investigate injury burden among young workers across demographics and industry to inform targeted interventions. Workers compensation (WC) claims are important for quantifying work-related injuries and illnesses, however published studies have focused on disabling claims. This study extended previous research on Oregon young workers by including the most recent WC claims data to identify patterns of injury and high risk industries. Methods: We obtained all accepted disabling claims (N = 13,360) and a significant portion of non-disabling claims (N = 24,660) on workers aged 24 years and under from 2013 to 2018. Claim count, rate and cost were calculated by year, age, gender, industry, and injury type. A prevention index (PI) method was used to rank industries in order to inform prevention efforts. Results: Average annual disabling and non-disabling claim rates were 111.6 and 401.3 per 10,000 young workers. Workers aged 19–21 (disabling: 119.0 per 10,000 and non-disabling: 429.3) and 22–24 years (115.7 and 396.4) and male workers (145.3 and 509.0) had higher claim rates than workers aged 14–18 (80.6 and 297.0) and female workers (79.8 and 282.9). The most frequent injury types were “struck by/against” (35.6%) and “work-related musculoskeletal disorders (WMSDs)” (19.5%). High risk industries included agriculture, construction, and manufacturing for both genders combined. For female young workers, the highest risk industry was healthcare. Conclusions: This study demonstrated the added value of non-disabling WC claims data. Using both disabling and non-disabling data and PI method, agriculture, construction, manufacturing and healthcare industries were identified as priority workplaces to prevent common and costly injuries among Oregon young workers. Practical Applications: While the industries identified are considered hazardous for all workers, findings in this study can guide targeted research and prevention efforts specific to young workers.     

The development of an instrument measuring unintentional injuries in young children in low-income settings to serve as an evaluation tool for a childhood home injury prevention program

PROBLEM: Responding to the lack of standardized instrumentation, especially as applied in low-income contexts, the researchers decided that an instrument should be developed to serve as an evaluation tool for a childhood (unintentional) injury prevention program as well as a tool from which injury risks (poisonings, burns and falls) could be identified within households. METHODS: Cross-sectional samples of 521 households in four low-income sites in Cape Town and Johannesburg, South Africa, participated in the three phases of the study. The generation of an item pool based on a table of specifications, subsequent scientific item reduction procedures, reviews from experts and pilot tests were used to develop the scales for measuring the injury risks. RESULTS: The developed instrument complies with all the requirements for a valid and reliable measurement instrument. CONCLUSION: The instrument allows valid comparison of risks between communities, as well as before and after comparisons for an intervention program. IMPACT: The provision of this instrument may bring enormous benefits to research studies. It can also provide proactive, rather than reactive, information about injury risks before they develop into injuries and thus allows focusing of safety efforts for improvement of problematic areas in the households.     

Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older,United States, 2006–2011

IntroductionWith the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern.MethodsWe analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006–2011. We examined unintentional injury trends by 5-year age groups, sex, mechanism, body region, discharge disposition, and primary payer. For 2011, we estimated the medical costs of unintentional injury and the distribution of primary payers, plus rates by injury mechanisms and body regions injured by 5-year age groups.ResultsFrom 2006 to 2011, the age-adjusted annual rate of unintentional injury-related ED visits among persons aged ≥ 65 years increased significantly from 7987 to 8163, per 100,000 population. In 2011, 65% of injuries were due to falls. Rates for fall-related injury ED visits increased with age and the highest rate was among those aged ≥ 100. Each year, about 85% of unintentional injury-related ED visits in this population were expected to be paid by Medicare. In 2011, the estimated lifetime medical cost of unintentional injury-related ED visits among those aged ≥ 65 years was $40 billion.ConclusionIncreasing rates of ED-treated unintentional injuries, driven mainly by falls among older adults, will challenge our health care system and increase the economic burden on our society. Prevention efforts to reduce falls and resulting injuries among adults aged ≥ 65 years have the potential to increase well-being and reduce health care spending, especially the costs covered by Medicare.Practical applicationsWith the aging of the U.S. population, unintentional injuries, and especially fall-related injuries, will present a growing challenge to our health care system as well as an increasing economic burden. To counteract this trend, we must implement effective public health strategies, such as increasing knowledge about fall risk factors and broadly disseminating evidence-based injury and fall prevention programs in both clinical and community settings.     

Advancing injury and violence prevention through data science

Introduction: The volume of new data that is created each year relevant to injury and violence prevention continues to grow. Furthermore, the variety and complexity of the types of useful data has also progressed beyond traditional, structured data. In order to more effectively advance injury research and prevention efforts, the adoption of data science tools, methods, and techniques, such as natural language processing and machine learning, by the field of injury and violence prevention is imperative. Method: The Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control has conducted numerous data science pilot projects and recently developed a Data Science Strategy. This strategy includes goals on expanding the availability of more timely data systems, improving rapid identification of health threats and responses, increasing access to accurate health information and preventing misinformation, improving data linkages, expanding data visualization efforts, and increasing efficiency of analytic and scientific processes for injury and violence, among others. Results: To achieve these goals, CDC is expanding its data science capacity in the areas of internal workforce, partnerships, and information technology infrastructure. Practical Application: These efforts will expand the use of data science approaches to improve how CDC and the field address ongoing injury and violence priorities and challenges.     

Environmental evaluation for workplace violence in healthcare and social services

PROBLEM: Federal policy recommends environmental strategies as part of a comprehensive workplace violence program in healthcare and social services. The purpose of this project was to contribute specific, evidence-based guidance to the healthcare and social services employer communities regarding the use of environmental design to prevent violence. METHOD: A retrospective record review was conducted of environmental evaluations that were performed by an architect in two Participatory Action Research (PAR) projects for workplace violence prevention in 2000 and, in the second project in 2005. Ten facility environmental evaluation reports along with staff focus group reports from these facilities were analyzed to categorize environmental risk factors for Type II workplace violence. RESULTS: Findings were grouped according to their impact on access control, the ability to observe patients (natural surveillance), patient and worker safety (territoriality), and activity support. DISCUSSION: The environmental assessment findings reveal design and security issues that, if corrected, would improve safety and security of staff, patients, and visitors and reduce fear and unpredictability. IMPACT ON INDUSTRY: Healthcare and social assistance employers can improve the effectiveness of violence prevention efforts by including an environmental assessment with complementary hazard controls.     

创建安全社区之伤害调查与风险辨识方法探讨

从事故与伤害预防和干预的角度,提出社区事故和伤害的种类,风险识别的范围和内容。依据较为成熟的伤害流行病学和系统安全工程理论,结合中国社区的构成特点,指出以社区事故预防为目的,不仅要提高社区居民的安全意识、行为和能力,更要为居民提供安全的工作场所和居住环境,加强危险因素的识别和控制。强调对设备设施、环境进行风险识别时,应采用安全检查表法和经验法;社区人群伤害基础调查可采用普查、随机抽样、医疗机构诊疗记录、特定人群调查、特定场所调查和伤害类型调查等6种方法;同时介绍了上述方法的基本原理、内容、实施步骤和适用范围,可供安全社区创建时参考。     

Fall-related traumatic brain injury deaths and hospitalizations among older adults--United States, 2005

PROBLEM: Among older adults, both unintentional falls and traumatic brain injuries (TBI) result in significant morbidity and mortality; however, only limited national data on fall-related TBI are available. METHOD: To examine the relationship between older adult falls and TBI deaths and hospitalizations, CDC analyzed 2005 data from the National Center for Health Statistics' National Vital Statistics System and the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample. RESULTS: In 2005, among adults>or=65 years, there were 7946 fall-related TBI deaths and an estimated 56,423 hospitalizations for nonfatal fall-related TBI in the United States. Fall-related TBI accounted for 50.3% of unintentional fall deaths and 8.0% of nonfatal fall-related hospitalizations. SUMMARY: These findings underscore the need for greater dissemination and implementation of evidence-based fall prevention interventions.     

Child passenger injury risk in motor vehicle crashes: a comparison of nighttime and daytime driving by teenage and adult drivers

INTRODUCTION: To examine the association between child passenger injury risk, restraint use, and crash time (day vs. night) for children in crashes of vehicles driven by teenage versus adult drivers. METHODS: Cross-sectional study involving telephone interviews with insured drivers in a probability sample of 6,184 crashes involving 10,028 children. RESULTS: Child passengers in teen nighttime crashes had an increased injury risk and an increased risk of restraint nonuse compared with those in teen daytime crashes. This increased injury risk can be explained by differences in the age of child passengers, collision type, and child passenger's restraint status associated with time of day. CONCLUSIONS: In order to limit the risk of injury to child passengers driven by teens, Graduated Driver Licensing (GDL) laws should include provisions restricting nighttime driving, as well as mandates for age-appropriate restraint for child passengers. Consideration should also be given for education in child passenger safety for novice teen drivers as part of the licensing process. IMPACT ON INDUSTRY: Results of this study can be used to support advocacy efforts by the automotive industry and others to promote nighttime driving restrictions on novice drivers. In addition, given that both driver groups were more likely to be involved in a single-vehicle collision during the night, technologies such as electronic stability control may offer opportunities for protection. Further reseach on specific circumstances of teen nighttime crashes is needed to inform industry efforts to improve visibility or vehicle operation under poor lighting conditions.     

Factors related to youth self-efficacy for injury prevention bicycle skills

Introduction: Bicycle riding is a common activity for children, but they are prone to bicycle-related injuries. It is well-established that injury prevention measures such as wearing a helmet and correctly riding a bicycle can reduce the severity of an injury and the likelihood of having an accident. However, how to increase bicycle injury prevention behaviors among children, who collectively fail to engage in injury prevention behaviors, is less well understood. Self-efficacy is consistently predictive of injury prevention behavior, making it an important approach to understanding injury prevention skills among this key population. The objective of this study was to explore and identify factors internal to the child as well as factors about his or her environment that predict a child’s self-efficacy for injury prevention skills. Method: Two generalized linear mixed effects models were created from survey data collected from elementary school students (n = 2,255) as part of a school-based bicycle education program. Models focused on self-efficacy for riding a bicycle and self-efficacy for wearing a helmet correctly. Results: In both models, road safety knowledge, opportunity for skill building through owning appropriate equipment (a bicycle or helmet), and situation through perception of neighborhood safety were predictive. The analyses reveal these variables as key factors for greater confidence, with feeling safe riding in the neighborhood, in particular, emerging as highly predictive of self-efficacy for injury prevention skills. Conclusions: These findings highlight the interplay of individual and environmental factors within confidence for injury prevention behavior. Given self-efficacy’s strong relationship to prevention behavior, these findings indicate actionable strategies. Practical Applications: The key factors highlighted in this study can be used by policymakers to target specific areas (e.g., neighborhood safety) to promote self-efficacy and thus improve injury prevention. These factors can also inform strategies for establishing safety skills in bicycle-safety education programs.     

Nationwide risk factors for hospital readmission for subsequent injury after motor vehicle crashes

Abstract

Objective: Some drivers involved in motor vehicle crashes across the United States may be identified as at risk of subsequent injury by a similar mechanism. The purpose of this study was to perform a national review of the risk factors for hospitalization for a new injury due to a subsequent motor vehicle crash. It was hypothesized that presenting to a different hospital after subsequent injury would result in worse patient outcomes when compared to presentation at the same hospital.

Methods: The Nationwide Readmissions Database for 2010–2014 was queried for all inpatient hospitalizations with injury related to motor vehicle traffic. The primary patient outcome of interest was subsequent motor vehicle crash–related injury within 1 year. The secondary patient outcomes were different hospital subsequent injury presentation, higher Injury Severity Score (ISS), longer length of stay (LOS), and in-hospital death after subsequent injury. The analysis of secondary patient outcomes was performed only on patients who were reinjured. Univariable analysis was performed for each outcome using all variables during the index admission. Multivariable logistic regression was performed using all significant (P < .05) variables on univariate analysis. Results were weighted for national estimates.

Results: During the study period, 1,008,991 patients were admitted for motor vehicle–related injury; 12,474 patients (1.2%) suffered a subsequent injury within 1 year. From the reinjured patients, 32.9% presented to a different hospital, 48.9% had a higher ISS, and 22.1% had a longer LOS. The in-hospital mortality rate after subsequent injury was 1.1%. Presentation to a different hospital for subsequent injury was associated with a longer LOS (odds ratio [OR]?=?1.32; 95% confidence interval [CI], 1.20–1.45; P < .01) and a higher ISS (OR?=?1.38; 95% CI, 1.27–1.49; P < .01). Motorcyclists were more likely to suffer subsequent injury (OR?=?1.39; 95% CI, 1.32–1.46; P < .01) and motorcycle passengers were more likely to present to a different hospital with a subsequent injury (OR?=?2.49; 95% CI, 1.73–3.59; P < .01). Alcohol abuse was associated with subsequent injury (OR?=?1.12; 95% CI, 1.07–1.18; P < .01).

Conclusions: Nearly a third of patients suffering subsequent motor vehicle crash–related injury after an initial motor vehicle crash in the United States present to a different hospital. These patients are more likely to suffer more severe injuries and longer hospitalizations due to their subsequent injury. Future efforts to prevent these injuries must consider the impact of this fragmentation of care and the implications for quality and cost improvements.     

高技能人才工伤保护改进路径

高技能人才由于职业、岗位、才技与众不同,其工伤保护也存在一些特殊性。实践中,并未专门针对高技能人才制定特别的工伤保护措施。为此,笔者分析高技能人才工作时段和场所较易变动、劳动强度较大等特点,提出风险和事故的高发生率是科技活动内在的客观规律等,提出应给予失败者和事故责任者必要的宽容。建议政府应结合不同行业、不同岗位的技术含量和风险特点,从工伤认定、劳动能力鉴定、工伤保险待遇及浮动费率核算几方面改进现有工伤保护政策,且应加强高技能人才工伤预防和促进高技能人才职业康复。结合前文论述,笔者提出了相应政策和实用的对策。     

Exploring the role of emotional intelligence in behavior-based safety coaching

INTRODUCTION: Safety coaching is an applied behavior analysis technique that involves interpersonal interaction to understand and manipulate environmental conditions that are directing (i.e., antecedent to) and motivating (i.e., consequences of) safety-related behavior. A safety coach must be skilled in interacting with others so as to understand their perspectives, communicate a point clearly, and be persuasive with behavior-based feedback. METHOD: This article discusses the evidence-based "ability model" of emotional intelligence and its relevance to the interpersonal aspect of the safety coaching process. RESULTS: Emotional intelligence has potential for improving safety-related efforts and other aspects of individuals' work and personal lives. Safety researchers and practitioners are therefore encouraged to gain an understanding of emotional intelligence and conduct and support research applying this construct toward injury prevention.     

Solid inertants and their use in dust explosion prevention and mitigation

This paper is a review of the use of inert dusts to reduce the risk of dust explosions through both prevention and mitigation schemes. The review is conducted by referring primarily to the research results of the author and his colleagues in this area, with appropriate reference to the work of other researchers. A functional distinction is first made between inerting and suppression by explaining each term within the contexts of explosion prevention and explosion mitigation, respectively. The use of solid inertants is then described in terms of the various inhibitor and situation-specific parameters that can influence their effectiveness. Finally, application examples of the research results are given for research laboratories, test facilities, design engineers, and industrial practitioners.     

Unintentional injuries among infants age 0-12 months

Each year an estimated 328,500 infants age 0-12 months are treated for unintentional injuries in emergency departments (EDs): one infant every minute and a half. The leading cause, overall and by month of age, was fall-related injury. The second leading cause was 'struck by or against.' The majority of patients were injured at home. Younger infants were more likely to be hospitalized than older ones and more males than females were injured. Gender differences suggest that parenting practices may play a role, but ecological approaches should be considered in an effort to understand the connection between injuries and an infant's developmental stage.     

Traumatic brain injury-related hospitalizations and deaths among American Indians and Alaska natives — United States, 2008–2014

IntroductionDespite progress, injury remains the leading cause of preventable death for American Indian and Alaska Natives (AI/AN), aged 1 to 44. There are few publications on injuries among the AI/AN population, especially those on traumatic brain injury (TBI). A TBI can cause short- or long-term changes in cognition, communication, and/or emotion. Methods: To describe changes over time in TBI incidence by mechanism of injury, injury intent, and age group among AI/ANs, the CDC analyzed hospitalization and death data from the 2008–2014 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the National Vital Statistics System (NVSS), respectively. Results: From 2008-2014, the incidence of TBI-related hospitalizations increased by 32% (1,477 in 2008 to 1,945 in 2014) and resulted in a 21% increase in age-adjusted rates of people hospitalized with TBI. TBI-related deaths increased in number (569 in 2008 to 644 in 2014) and age-adjusted rate (22.7 in 2008 to 25.4 in 2014) by approximately 13% and 12%, respectively. Motor-vehicle crashes were the leading cause of TBI-related deaths among AI/ANs aged 0–54 years. Practical application: Prevention efforts should focus on increasing motor-vehicle safety and advancing prevention strategies for other leading causes of TBI, including: falls, intentional self-harm, and assaults.     

Occupational injury rates among Norwegian farmers: A sociotechnical perspective

Introduction: This study addressed relative injury risk among Norwegian farmers, who are mostly self-employed and run small farm enterprises. The aim was to explore the relative importance of individual, enterprise, and work environment risks for occupational injury and to discuss the latent conditions for injuries using sociotechnical system theory. Method: Injury report and risk factors were collected through a survey among Norwegian farm owners in November 2012. The response rate was 40% (n = 2,967). Annual work hours were used to calculate injury rates within groups. Poisson regression using the log of hours worked as the offset variable allowed for the modeling of adjusted rate ratios for variables predictive of injury risk. Finally, safety climate measures were introduced to assess potential moderating effects on risk. Results: Results showed that the most important risk factors for injuries were the design of the workplace, type of production, and off-farm work hours. The main results remained unchanged when adding safety climate measures, but the measures moderated the injury risk for categories of predominant production and increased the risk for farmers working with family members and/or employees. An overall finding is how the risk factors were interrelated. Conclusions: The study identified large structural diversities within and between groups of farmers. The study drew attention to operating conditions rather than individual characteristics. The farmer’s role (managerial responsibility) versus regulation and safety climate is important for discussions of injury risk. Practical Applications: We need to study sub-groups to understand how regulation and structural changes affect work conditions and management within different work systems, conditioned by production. It is important to encourage actors in the political-economic system to become involved in issues that were found to affect the safety of farmers.