Objective-To examine the risk of disability from unintentional injury in teenagers and young adults. Methods -Analyses of data from the National Child Development Study, a follow up study of 98% of all children born in England, Scotland, and Wales in one week in March, 1958. In 1981 537 study participants, 76% of the original cohort, were asked about unintentional injuries since age 16 years requiring hospital treatment, and whether these injuries resulted in permanent disability. Results-62% of men and 26% of women reported at least one accident since age 16 resulting in injury that required hospital treatment. Of these accidents, 3.2% caused permanent disability. The risk of disability increased with accident frequency. Injuries requiring hospital admission carried the highest risk of disability (9.7%). However, 54% of permanent disability reported by men and 74% reported by women resulted from injuries treated as outpatients. Road traffic accidents caused 42% of admissions and 31% of disability. Fractures constituted 21% of all injuries but were responsible for 32% of permanent disabilities. Of the permanent disabilities resulting from work related accidents, 82% involved the hand. Of the permanent disabilities resulting from accidents in the home, 32% involved the hand. Conclusions -The targeting of prevention strategies towards the major causes of injury mortality may have a smaller impact on population levels of injury related disability. Non-life threatening injuries, in particular injuries to the hand and limb fractures, resulting from accidents in the workplace, the home, and during sports, make a significant contribution to the prevalence of permanent injury related disability in young adults. (Arch Dis Child 1996;75:156-158)

BackgroundLarge numbers of people are killed or severely injured following injuries each year and these injuries place a large burden on health care resources. The majority of the severely injured are not fully recovered 12-18 months later. Psychological disorders are common post injury and are associated with poorer functional and occupational outcomes. Much of this evidence comes from countries other than the UK, with differing health care and compensation systems. Early interventions can be effective in treating psychological morbidity, hence the scale and nature of the problem and its impact of functioning in the UK must be known before services can be designed to identify and manage psychological morbidity post injury.Methods/DesignA longitudinal multi-centre study of 680 injured patients admitted to hospital in four areas across the UK: Nottingham, Leicester/Loughborough, Bristol and Surrey. A stratified sample of injuries will ensure a range of common and less common injuries will be included. Participants will complete a baseline questionnaire about their injury and pre-injury quality of life, and follow-up questionnaires 1, 2, 4, and 12 months post injury. Measures will include health and social care utilisation, perceptions of recovery, physical, psychological, social and occupational functioning and health-related quality of life. A nested qualitative study will explore the experiences of a sample of participants, their carers and service providers to inform service design.DiscussionThis study will quantify physical, psychological, social and occupational functioning and health and social care utilisation following a range of different types of injury and will assess the impact of psychological disorders on function and health service use. The findings will be used to guide the development of interventions to maximise recovery post injury.

ObjectiveTo explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision.DesignQualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers’ views were elicited through semistructured interviews. Data were analysed using thematic analysis.SettingParticipants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas.Participants40 service providers from a range of disciplines.ResultsService providers described two distinct models of trauma care: an ‘ideal’ model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a ‘real’ model based on the realities of National Health Service (NHS) practice. Participants’ ‘ideal’ model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, ‘real’ care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients’ needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice.ConclusionsService providers envisage an ‘ideal’ model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between ‘real’ and ‘ideal’ care. Using service provider views to inform service design and delivery could enhance the quality, patient experience and outcomes of care.