The History of Injury Control and the Epidemiology of Child and Adolescent Injuries

Abstract

Unintentional injuries claim the lives of more children each year than any other cause of death. A substantial proportion of child hospitalizations and emergency department visits also are attributable to unintentional injuries. The conceptualization of unintentional injuries as a public health problem that is preventable has gained credibility over the past few decades, as effective solutions to reduce the burden of injuries--such as child safety seats, bicycle helmets, and smoke detectors--have been identified. Successful implementation of these strategies requires a clear understanding of the circumstances surrounding injuries and the risk and protective factors that influence the likelihood that a child will be injured. Although adequate data on these factors is available for some causes of injury, such as motor vehicle crashes, it is almost nonexistent for others, such as unintentional firearm injuries. Overall, unintentional injury rates are highest among adolescents ages 15 to 19, males, children from impoverished families, and minorities. Also, some injuries occur more often in rural areas. Although these demographic risk factors cannot be modified, environmental and behavioral risks, such as unsafe roads, alcohol intoxication, unfenced swimming pools, and the absence of a smoke detector in the home, can be modified successfully with appropriate strategies. Motor vehicle occupant, drowning, and pedestrian injuries were the most common unintentional injuries causing death among children ages 0 to 19 in 1996. Together, these mechanisms accounted for more than half of all unintentional injury deaths among children and adolescents, although rates varied considerably by age. Child injury death rates across most age categories and mechanisms of injury have declined during the past 20 years, yet the reasons for these declines are poorly understood. Additional research about risk and protective factors, and efforts to implement successful injury prevention strategies among populations at highest risk for injuries, are necessary to further reduce the toll on children's lives.

The Transformation Of Child Health In The United States

“…Efforts to reduce the catastrophic toll of injuries among American children have necessarily relied on a comprehensive approach. 34 The reduction of motor vehicle occupant, bicycle, pedestrian, fire, poisoning, and drowning injuries have all relied on a mix of legislative, educational, and community-based initiatives. Clinical interventions have also been important, and injury reduction has become an integral part of recommended wellchild care.…”

Baby, Be Safe: the effect of tailored communications for pediatric injury prevention provided in a primary care setting

“…car injury, burns, falls, poisoning, and drowning), response options for each risk item were assigned numeric values to reflect the relative contribution of that item to the injury risk for that outcome (see Table 2). This process was based upon a review of the literature [6,12,[47][48][49] and consensus of the project team. To facilitate comparison and prioritization of these injury-specific risk scores across injury types, a total value of 10 was set as the maximum risk score a respondent could receive for each type of injury.…”

Injury control from the perspective of contextual pediatrics

“…Contudo, na área da saúde propriamente dita, o grande impulso só veio a ocorrer nas décadas de 1980 e 1990, um período de grande efervescência científica, em que um sem-número de estudos epidemiológicos analíticos, avaliações de programas no mundo real e projetos de intervenção consolidaram a ciência do controle de injúri-as 37,43,44 . O marco mais significativo dessa era é a criação do primeiro centro nacional dedicado ao controle de injúrias, o Centro Nacional para Prevenção e Controle de Injúrias (NCIPC), integrante dos Centros para o Controle e Prevenção de Doenças (CDC) 45 .…”

“…Na pediatria, embora a preocupação com os ditos acidentes fosse mais antiga 46 , com estudos publicados inclusive no Brasil 47 , os preceitos da nova ciência do controle de injúrias só começaram a ser incorporados à literatura médica a partir dos anos 1970 44 . Sua consolidação nas práticas clínicas tem sido ainda mais gradativa e inconstante.…”

“…Embora exista alguma relação entre ocorrência de injúrias e número de eventos traumáticos prévios 57 , assim como em casos de crianças com temperamentos menos dóceis 58 , a tentativa de reconhecer crianças potencialmente repetidoras de acidentes não é útil na prática e desvia o foco central dos cuidados com o ambiente. Em termos de estratégias preventivas, muito pouco pode ser obtido com a busca de características que poderiam colocar certos indivíduos em situações de risco aumentado 44,59 . De fato, há evidências de que a repetição de eventos traumáticos está associada com pelo menos um fator de risco socioambiental, como abuso de drogas, mãe adolescente, cuidador solteiro, cuidador com doença mental e história de violên-cia intrafamiliar 60 .…”