Background Traumatic injury is the leading cause of paediatric morbidity and mortality in the USA. We present updated national data on emergency department (ED) discharges for traumatic injury for a recent 7-year period.
Methods We conducted a descriptive epidemiological analysis of the Nationwide Emergency Department Sample Survey, the largest and most comprehensive database in the USA, for 2006–2012. Among children and adolescents, we tracked changes in injury mechanism and severity, cost of care, injury intent and the role of trauma centres.
Results There was an 8.3% (95% CI 7.7 to 8.9) decrease in the annual number of ED visits for traumatic injury in children and adolescents over the study period, from 8 557 904 (SE=5861) in 2006 to 7 846 912 (SE=5191) in 2012. The case-fatality rate was 0.04% for all injuries and 3.2% for severely injured children. Children and adolescents with high-mortality injury mechanisms were more than three times more likely to be treated at a level 1 trauma centre (OR=3.5, 95% CI 3.3 to 3.7), but were more no more likely to die (OR=0.96, 95% CI 0.93 to 1.00). Traumatic brain injury diagnoses increased 22.2% (95% CI 20.6 to 23.9) during the study period. Intentional assault accounted for 3% (SE=0.1) of all child and adolescent ED injury discharges and 7.2% (SE=0.3) of discharges among 15–19 year-olds. There was an 11.3% (95% CI 10.0 to 12.6) decline in motor vehicle injuries from 2009 to 2012. The total cost of care was $23 billion (SE=0.01), a 78% increase from 2006 to 2012.
Conclusions This analysis presents a recent portrait of paediatric trauma across the USA. These analyses indicate the important role and value of trauma centre care for injured children and adolescents, and that the most common causes and mechanisms of injury are preventable.
- trauma systems
- descriptive epidemiology
- traumatic brain injury
- child survival
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Contributors CJD conceived the study, acquired and had full access to data, obtained IRB approval, conducted all analyses, interpreted the results, made critical revisions and had final approval of the version to be published. JBA and MB cowrote the initial draft of the manuscript and provided important revisions and edits. SGF, DAL and MGT provided important revisions and edits, and approved the final version of the report.
Funding The study was funded by the National Institute of Child Health and Human Development (to CJD) (Grant 1 R01 HD087460). The study funder had no role in the study design, analysis, drafting of the manuscript, or decision to submit the study for publication.
Competing interests None declared.
Ethics approval The study was approved bythe New York University School of Medicine Institutional Review Board, andconforms to the STROBE statement on reporting of observational studies.
Provenance and peer review Not commissioned; externally peer reviewed.