OBJECTIVE: To enhance the case definition of unintentional injuries in childhood by applying an objective severity measure to fatal and non-fatal cases. DESIGN: A descriptive prospective epidemiological study of a defined resident childhood population (< 16 years of age) for a one year period, 1990. SETTING: Newcastle upon Tyne, England. Child population estimate for 1990 was 54,400. SUBJECTS: Resident children who died, were admitted to local hospitals, or attended local accident and emergency departments. OUTCOME MEASURES: Using recognised severity scoring systems (for example the injury severity score, trauma score) injuries were classified as severe, moderate, or mild. RESULTS: There were six deaths, 904 admissions, and 11,682 accident and emergency department attendances. All deaths, 25% of admissions, and 1% of accident and emergency attenders were classified as severe. The underlying determinants of severe injuries are different than those for all other injuries (for example age, social class). A comparison with a local survey in 1986 showed a 26% rise in hospital admissions, but no significant rise in the frequency of severe or moderately injured children. Comparisons with other international data showed higher rates of injury admissions and attendances for England, but no significant differences in the frequency of severe injuries. CONCLUSIONS: Objective severity scoring enhances the case definition of unintentional injuries in childhood by allowing for the identification, and, therefore, the more reliable ascertainment of severely injured children. This more completely ascertained set of population cases increases the accuracy of comparisons of injury frequency over time and by place, and, in addition, enhances our basic understanding about the epidemiological characteristics of childhood unintentional injury.
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