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The modern paediatric injury pyramid: injuries in Massachusetts children and adolescents
  1. Lois Kaye Lee1,2,
  2. Eric William Fleegler1,2,
  3. Peter Whitney Forbes3,
  4. Karen Lea Olson1,2,
  5. David Patrick Mooney4,5
  1. 1Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
  2. 2Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Clinical Research Program, Children's Hospital Boston, Boston, Massachusetts, USA
  4. 4Department of Surgery, Children's Hospital Boston, Boston, Massachusetts, USA
  5. 5Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Lois K Lee, Division of Emergency Medicine, 300 Longwood Ave, Children's Hospital, Boston, MA 02115, USA; lois.lee{at}


The objective of this study was to develop a modern version of the paediatric injury pyramid, a visual classification of injury severity, and to present mechanism-based pyramids. As the original paediatric injury pyramid was described in 1980, the injury epidemiology from 1980 was compared with 2004. Comprehensive emergency department, hospital discharge and death data for Massachusetts in 2004 were used to determine injury rates for residents aged 0–19 years. Injury pyramids were constructed on the basis of the number of injuries resulting in death, hospitalisations and emergency department visits. In 2004, unintentional and intentional injuries accounted for 197 deaths, 7120 hospitalisations and 199 814 emergency department visits giving a ratio of 1:36:1014. The 2004 injury pyramids differed by mechanism and intent. Compared with 1980, there were lower rates for overall injury and for most major injury mechanisms in Massachusetts in 2004.

  • Injuries
  • injury pyramid
  • paediatric injury
  • adolescent
  • e-code
  • public health
  • child

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  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Children's Hospital Boston Committee on Clinical Investigation.

  • Provenance and peer review Not commissioned; externally peer reviewed.