Residential Injury in US Children and Adolescents

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Residential Injury in US Children and Adolescents

• Kieran J. Phelan, MD, MSc
• Assistant Professor of Pediatrics
• Cincinnati Childrens Hospital Medical Center

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...it is less trouble and more satisfaction to
bury two families than to select and equip a home
for one. Mark Twains Autobiography
Pen Ink Illustration of Samuel Clemens House
in Hartford, Connecticut, circa 1890
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Pediatric Injury

• Leading cause of morbidity and mortality in US
  children after the first year of life
• Leading mechanisms are motor vehicle crashes and
  firearm-related injury
• Leading location of injury has not been examined
  since mid-1980s

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Definition - Injury

• Damage to cells and organs from energy exposure
  or depletion that have sudden discernible effects
• exposures can be acute or chronic
• can result in varying degrees of cellular and
  tissue dysfunction

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Why Residential Injuries?

• Researchers have implicated the home as the
  predominant location of injury
• Pollock 1984 Mortality Data Tapes
• Rivara 1989 King, Co. ED visits / Hosp.
• Scheidt 1995 Child Hlth Suppl to NHS

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Fatal Injuries by place of occurrence, among
children lt 15 years, United States, 1984
Home 61
Other 26
Unspecified 12
Pollock DA, MMWR 19883713-20.
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Fatal Injuries in U.S. Childrenlt 15 years of
age, 1978-1984
Pollock DA, MMWR 19883713-20.
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Residential Injury Haddon MatrixExample
Residential Stairway Fall
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Focusing Injury Prevention Efforts

• Frequent
• Severe
• Preventable

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Injury Severity

• Death is the the most severe outcome of energy
  transfer to human soft tissue and represents the
  tip of the iceberg
• Hospital admissions and ED visits are less severe
  subsets of the injury pyramid and represent a
  substantial health services burden for US
  children
• Severity scoring (AIS) by anatomic location of
  tissue injury represents a means for comparisons
  of injury and injury outcomes over time and
  between location

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Injury Pyramid
Deaths
Hospitalizations
Emergency Visits
Events, office calls, office visits
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Emergency Visits and Hospitalizations for US
Children after Residential Injury

• National Hospital Ambulatory Medical Care Survey
  (NHAMCS)
• Probability sample of US Hospitals, emergency
  departments (EDs), clinics within hospitals, and
  patient visits within EDs / clinics
• National estimates of injury ED visits for US
  children 1993 - 99

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Phelan KJ et al. (unpublished data).
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Average annual number (in thousands), rate (per
100), and 95 confidence intervals (CI) for
estimates of United States ED visits for
residential injuries according to demographics,
location, season, and hospital admissions
NHAMCS, 1993-99.
plt0.0001, for lt1 year and 1-4 year age groups
compared to 10-14 and 15-19 years
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Average annual number (in thousands), rate (per
100), and 95 confidence intervals (CI) for
estimates of United States ED visits for
residential injuries according to demographics,
location, season, and hospital admissions
NHAMCS, 1993-99.
p0.03 April June compared to
October-December
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Leading mechanisms of unintentional residential
injury US children lt 20 years, NHAMCS 1993-99.
Rate (per 100,000) by age group of emergency
department visits.
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Number (in thousands), rate (per 100,000), and
distribution of AIS scores for Residential
Injuries in US Children lt20 years, NHAMCS
1993-1999.
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Number (in millions), rate (per 10, 000), and 95
confidence intervals (CI) of residential Injuries
according to body region US ED visits NHAMCS,
1993-97
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Number (in millions), rate (per 10, 000), and 95
confidence intervals (CI) of residential injuries
according to type of injury, NHAMCS 1993 - 99.
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Number (in thousands) and rate (per 100,000) for
hospitalizations for residential unintentional
injury US children lt20 years NHAMCS 1993-99
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Residential Injury-related Mortality in US
Children Adolescents

• NCHS Mortality data tapes 1985 - 97
• Collaborative effort with Batelle Institute
  (Columbus, OH)
• Jyothi Nagaraja, John Menkedick (Battelle)
• Bruce Lanphear, Jane Khoury, Kieran Phelan
  (Cincinnati Childrens)

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Place of Occurrence of Death for US Children and
Adolescents, 1985 - 1997
Nagaraja J et al. (in progress).
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Proportion of Injury Deaths in the Home Among U.S
Children and Adolescents, by Age, 1985 to 1997
Nagaraja J et al. (in progress).
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Fatal Residential Injuries among U.S. Children,
1985 to 1997
Mortality Rate (/100,000)
Year
Nagaraja J et al. (in progress).
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Mortality Rate (/100,000)
Year
Nagaraja J et al. (in progress).
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Mortality Rate (/100,000)
Year
Nagaraja J et al. (in progress).
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Average Annual Residential Injury Outcomes in US
Children Adolescents lt20 yrs. 1985 - 99
Deaths Vital Stats
N 2, 822
N 74, 285
Hospitalizations NHAMCS
N 4,009,692
Emergency Department Visits NHAMCS
N 13, 592, 000
Events, Office calls, Clinic Visits NHIS
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Conclusions

• Injury is a residential hazard with HUGE
  attributable risk
• Accounts for 40 of all ED visits for US Children
  lt20 yrs.
• The home environment accounts for 40 of all
  unintentional injuries
• 25 of US children and adolescents will have an
  ED visit for an unintentional residential injury
  each year
• Interventions to reduce early childhood injury
  should be targeted to the home environment

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Prevention of Morbidity and Mortality from
Residential Hazards

• Shift from over-reliance on educational to
  environmental or more passive interventions.
• Multi-disciplinary approach to research,
  evaluation, and control of residential hazards
• Controlled Trials are necessary to assess
  efficacy of hazard controls on child health
  outcomes.
• Health-based standards are needed to protect
  children from residential hazards.