childhood injury report 2011-2014

Injury and Violence Prevention BranchNorth Carolina Division of Public Health

July 2016

North Carolina Childhood Injury Report: 2011-2014

ChildhoodInjuriesinNorthCarolina:2011-2014

NorthCarolinaDivisionofPublicHealth–2016 1

N.C.ChildhoodInjuryReport:2011-2014

July2016

ElisabethClymerSocialClinicalResearchAssistantN.C.DivisionofPublicHealth

StateofNorthCarolinaPatrickMcCrory,Governor

DepartmentofHealthandHumanServices

RickBrajer,M.B.A.,Secretary

DivisionofPublicHealthRandallWilliams,M.D.,StateHealthDirector

InjuryandViolencePreventionBranch

www.injuryfreenc.ncdhhs.gov

NorthCarolinaDHHSisanequalopportunityemployerandprovider.



Acknowledgements

ContributorsandReviewers

ScottK.Proescholdbell,M.P.H.Head,EpidemiologyandSurveillanceUnitInjuryandViolencePreventionBranchNorthCarolinaDivisionofPublicHealth

MaryBethCox,M.P.H.AlcoholEpidemiologistInjuryandViolencePreventionBranchNorthCarolinaDivisionofPublicHealth

KellaHatcher,J.D.ExecutiveDirectorNorthCarolinaChildFatalityTaskForceNorthCarolinaDivisionofPublicHealth

MegLangstonDirector,SafeKidsNorthCarolinaDeputyDirector,InjuryPreventionOfficeoftheStateFireMarshalNorthCarolinaDepartmentofInsurance

JessicaTufte,M.P.H.InjuryPreventionConsultantInjuryandViolencePreventionBranchNorthCarolinaDivisionofPublicHealth

WewishtoacknowledgetheUNCInjuryPreventionResearchCenter(IPRC)forhelpingtoestablishthereportingformatandcontent.



TableofContents

1.OverviewofChildhoodInjuryinNorthCarolina:2011-2014.....................................4Introduction............................................................................................................................................................................4TheProblemofChildhoodInjury............................................................................................................................................6LeadingCausesofChildhoodInjury........................................................................................................................................7CausesofChildhoodUnintentionalInjury..............................................................................................................................8Deaths,Hospitalizations,andEmergencyDepartmentVisitsbyAgeandSex........................................................................9RegionalInjuryRates............................................................................................................................................................10HospitalizationChargesforChildhoodInjuriesfrom2011-2013..........................................................................................12

2.TypesofChildhoodInjury.......................................................................................13

2.1UnintentionalInjury..................................................................................................................................................13MotorVehicleInjury.............................................................................................................................................................13Suffocation............................................................................................................................................................................13Drowning..............................................................................................................................................................................15Fire/Burn...............................................................................................................................................................................16Falls.......................................................................................................................................................................................17Poisoning...............................................................................................................................................................................18Pedestrian.............................................................................................................................................................................19

2.2IntentionalInjury.......................................................................................................................................................20Assault...................................................................................................................................................................................20

2.3Self-Inflicted..............................................................................................................................................................22Suicide/Self-InflictedInjury.................................................................................................................................................22

3.ConclusionsandRecommendations.......................................................................24SummaryofStatistics...........................................................................................................................................................24Recommendations................................................................................................................................................................25

4.Appendix...............................................................................................................27AppendixA:DataSourcesandTechnicalNotes...................................................................................................................27AppendixB:InjuryPreventionResources.............................................................................................................................31

5.References.............................................................................................................32



1.OverviewofChildhoodInjuryinNorthCarolina:2011-2014

IntroductionInjuryisthenumberonecauseofdeathamongchildrenintheUnitedStates[1].Injuriesaredefinedbyintentandoutcome:unintentionalorintentional,andfatalornonfatal.Unintentionalinjuryisconsistentlythenumberonecauseofdeathamongchildrenages1-18inboththestateofNorthCarolinaandnationally[2].InNorthCarolinaduringtheyear2014,therewere353deathsinthisagegroup,229ofwhichwereunintentionalinnature.Forthissamegroupnationally,therewere6,374deathsfromunintentionalinjury[3].Commoncausesofallunintentionalinjuriesaremotorvehiclecrashes,suffocation,drowning,fireandburns,falls,poisoning,andpedestrianinjuries.Thesearedistinctfromintentionalinjuries,whichareclassifiedashomicidesorassaultsandsuicidesorself-inflicted.TheCDCreports:

• OnechilddiesfrominjuryeveryhourintheUnitedStates[2].• Nearly20%(oneinfive)ofalldeathsamongchildrenareduetoinjury[2].• Everyfourseconds,achildistreatedforaninjuryinanemergencydepartmentintheUnitedStates[2].• Annually,anestimated9.2millionchildrenhaveemergencydepartmentvisitsforanunintentionalinjury

intheU.S.[4].• Thenationaleconomicburdencreatedbyunintentionalinjuries(allages)was$671billionin2013[5].

Thisreportprovidesanoverviewofthepublichealthburdenofinjuryinchildrenages0-18inthestateofNorthCarolina(N.C.).InanefforttoevaluateandunderstandthescopeoftheproblemofchildinjuryinN.C.,analyseswereperformedoninjury-relateddeathsfrom2011-2014,hospitalizationsfrom2011-2013,andemergencydepartmentvisitsfrom2013-2014.Eachcauseofinjurywasstratifiedbyageandsex.Injurydeaths,hospitalizations,andemergencydepartmentvisitrateswerecalculatedper100,000childrenresidinginthestate.AdetailedexplanationofthedataanalysisisprovidedinAppendixA.Dataforthisreporthasbeenobtainedfromthreesources:N.C.DivisionofPublicHealthdeathcertificatedata,N.C.HospitalDischargedata,andN.C.EmergencyDepartmentVisitdatahasbeenanalyzedseparatelyforthreeagegroups;0-4,5-9,10-14,and15-18.Thisreportisintendedtoincreasepublichealthpractitioners’andpolicymakers’understandingsofprevalent,yetpreventable,causesofinjuryandconsequentlydirectprogrammaticandpolicydecisionstodecreasetheburdenofchildhoodinjury.Thedatacanimproveprioritizationofinjurypreventionresources,assistresearcherswithsurveillance,andhelpphysicianseducatechildrenandparentsonpreventivemeasures.Thereportisanupdatetothe“N.C.ChildInjuryReport:2007-2010.”



Theburdencausedbychildhoodinjurycanbebetterunderstoodfromthe“InjuryIceberg”inFigure1.Deathsfrominjuryaretherepresentedbythe“tipoftheiceberg”–asmallfraction,yetthemostvisible,ofthetotalnumberofchildhoodinjuryevents.Thesecondtieroftheicebergreferstohospitalizations,whicharemoreprevalentthandeathsbutstillunderestimatethe“true”numberofinjury-relatedevents.Thethirdlevelsignifiesemergencydepartment(ED)visitsasaresultofinjury.Thelarger,lowerlayersoftheicebergembodyunidentified,highfrequenciesofchildhoodinjuriesthatarenotrecordedaspartofroutinesurveillanceefforts.Suchinjuriesincludethoseseenandtreatedinoutpatientfacilitiesorthosewherenomedicalattentionissought.In2013,foreveryonechildhoodinjurydeath,therewere29hospitalizations,710emergencydepartmentvisits,andanunknown,butlikelyhigh,numberofoutpatientmedicalvisits.Evenmoreinjuriesgounreportedandunattended.

Figure1:InjuryIceberg,NorthCarolinaChildhoodInjuries,Ages0-18:Deaths,Hospitalizations,andED,2013.InjuryandViolencePreventionBranch,ChronicDiseaseandInjurySection,DivisionofPublicHealth.

IN J URY ICEBERGINJ URY ICEBERG

251 Deaths

7,314 Hospitalizations

178,283 EDVisits

? OutpatientVisits

? MedicallyUnattendedInjury

(Home,Work,School)



TheProblemofChildhoodInjuryAmongNorthCarolinachildrenages0-18,injuriesresultedin1,068deaths(11.7per100,000)from2011-2014,22,775hospitalizations(332per100,000)from2011-2013,and352,049emergencydepartment(ED)visits(7,698per100,000)from2013-2014.Unintentionalinjuriescaused70%ofdeaths(Figure2),33%ofhospitalizations(Figure3),and69%ofEDvisits(Figure4).Figure2showsthat13%ofchildhooddeathsweretheresultofsuicide/self-inflictedinjury;15%resultedfromahomicide/assault;andtheremaining2%haveanundeterminedintentorresultedfromanothermechanism.AsdemonstratedinFigure3,theintentsofinjury-relatedhospitalizationsarewidespread.While19%ofhospitalizationsareself-inflicted,another19%aretheresultofundeterminedintent,and6%arefromotherintents.Assaultaccountsfor7%ofhospitalizationsbetween2011and2013,and6%ofhospitalizationcaseshadmissingorunknownintent.Whileunintentionalinjuryaccountedfor69%ofEDvisits,Figure4showsthat27%ofEDvisitshaveamissingorunknownintent.Theremaining4%ofEDvisitswereduetoassault(2%),otherintent(1%),andself-inflicted(1%)injuries.

15% 1%

13%

1%70%

Figure2:N.C.ChildInjuryDeathsbyIntent,Ages0-18:2011-2014(N=1,068)

AssaultOtherSelf-InflictedUndeterminedUnintenkonal

3%

25%

9%

1%

43%

19%

Figure3:N.C.ChildInjuryHospitalizaconbyIntent,Ages0-18:2011-2013(N=22,775)

Assault

Other

Self-Inflicted

Undetermined

Unintenkonal

Missing/Unknown

2% 1% 1%0%

69%

27%

Figure4:N.C.ChildInjuryEDVisitbyIntent,Ages0-18:2013-2014(N=352,049)

Assault

Other

Self-Inflicted

Undetermined

Unintenkonal

Missing/unknown



LeadingCausesofChildhoodInjuryTheleadingcauseofinjury-relateddeathamongchildreninNorthCarolinafrom2011-2014wasmotorvehiclecrashes,accountingfor32%(n=343)ofdeaths.Adverseeffectscausedbyotherintentsweretheleadingcauseofinjury-relatedhospitalizations,accountingfor24%(n=5,543)admissionsfrom2011-2013,andunintentionalfallswerethesecondleadingtypeofinjuryforEDvisits,responsiblefor20%(n=71,203)visitsfrom2013-2014.Motorvehiclecrashesarethefourthleadingcauseofhospitalizations(6%,n=1,443)andthesixthleadingcause(5%,n=17,979)ofEDvisitsforchildrenages0-18.Fallswerethemechanismresponsiblefor10%(n=2,194)ofhospitalizationsand20%(n=71,203)ofEDvisits.Suffocationwasthemechanismunderlying11%(n=116)ofdeaths.Inregardstochildhoodinjuries,19%(n=4,334)ofhospitalizationsand27%(n=95,145)ofEDvisitshavebothunknowninjurymechanismsandunknownintent.Note:Alldeathdataisfrom2011-2014;hospitalizationdatafrom2011-2013;allEDvisitdatafrom2013-2014.

Table1:N.C.LeadingTypesofChildhoodInjuryDeaths,Ages0-18:2011-2014

InjuryType NumberofDeaths

MotorVehicle(Unintentional) 343

Suffocation(Unintentional) 116

Drowning(Unintentional)

95

Firearm(Assault) 81

Suffocation(Self-Inflicted) 70

Firearm(Self-Inflicted)

59

Poisoning(Unintentional)

38

Fire/Burn(Unintentional) 34

Unspecified(Assault) 25

OtherSpecified/Classified(Assault)

24

AllOtherCauses 183

Total 1,068

Table2:N.C.LeadingTypesofChildhoodInjuryHospitalizations,

Ages0-18:2011-2013

InjuryType NumberofAdmissions

AdverseEffects(Other) 5,543

UnknownCause(UnknownIntent) 4,334

Fall(Unintentional)

2,194

MotorVehicle(Unintentional) 1,448

Poisoning(Self-Inflicted) 1,309

Fire/Burn(Unintentional)

1,010


844

OtherSpecified/Classified(Unint.) 768

Unspecified(Unintentional) 680

Natural/Environment(Unintentional)

595

AllOtherCauses 4,050

Total 22,775

Table3:N.C.LeadingTypesofChildhoodInjuryEDVisits,

Ages0-18:2013-2014

InjuryType NumberofVisits

UnknownCause(UnknownIntent) 95,145

Falls(Unintentional) 71,203

Struck(Unintentional)

43,760

Natural/Environment(Unintentional) 20,621

Unspecified(Unintentional) 18,117

MotorVehicle(Unintentional)

17,979

Overexertion(Unintentional)

16,132

OtherSpecified/Classified(Unint.) 15,096

Cut/Pierce(Unintentional) 13,518


6,714


Total 352,049



CausesofChildhoodUnintentionalInjuryUnintentionalinjuriesaccountfor70%ofallchildhoodinjury-relateddeaths(Figure2).Theleadingcausesofunintentionalinjury-relatedmortalityaremotorvehiclecrashes(46%),suffocation(16%),anddrowning(13%)for2011-2014.Whileonly9%ofchildrenmortallysufferfromfall-relatedinjuries,fallsaretheleadingmechanismofchildhoodunintentionalinjury-relatedhospitalizations(22%)andEDvisits(29%).Injury-relatedhospitalizationsforchildrenages0-18werelargelycausedbyfalls(22%),motorvehiclecrashes(15%),fire/burn(10%),andpoisoning(9%).EDvisitswerelargelycausedbyfalls(29%),strikes*(18%),andnatural/environment(9%)factors.Notethat,whilemotorvehicle-relatedinjuriescausedlargeproportionsofchildhoodmortality(46%)andhospitalization(15%),motorvehiclecrasheswerethemechanismforonly7%ofEDvisits.

Table4:N.C.LeadingTypesofChildhoodUnintentionalInjuryDeaths,Ages0-18:2011-2014

UnintentionalInjuryType

NumberofDeaths

MotorVehicle 343

Suffocation 116

Drowning 95

Poisoning 38

Fire/Burn 34

Firearm 21

OtherLandTransport

15

Pedestrian(Other) 15

Natural/Environment 14

Unspecified 13

Fall 9

AllOtherCauses 32

Total 745

Table5:N.C.LeadingTypesofChildhoodUnintentionalInjury

Hospitalizations,Ages0-18:2011-2013


NumberofAdmissions

Fall 2,194

MotorVehicle 1,448

Fire/Burn 1,010

Poisoning 844

OtherSpecified/Classified 768

Unspecified 680

Natural/Environment

595

Struck 546

Transport(Other) 487

OtherSpecified/NotClassified

315

AllOtherCauses 930

Total 9,817

Table6:N.C.LeadingTypesofChildhoodUnintentionalInjuryED

Visits,Ages0-18:2013-2014


NumberofVisits

Fall 71,203

Struck 43,760

Natural/Environment 20,621

Unspecified 18,117

Motor-Vehicle 17,979

Overexertion 16,132

OtherSpecified/Classified 15,096

Cut/Pierce 13,518

Poisoning 6,714

OtherSpecified/NotClassified 5,841


Total 242,425

*Strikeisdefinedas:beingstruckbyoragainstanobject;strikebythrown,projectedorfallingobject;accidentalstrikeagainstorbumpintoorbyanotherperson;crushed,pushed,orsteppedonbyacrowdorhumanstampede;orintentionalassault,self-harm,undeterminedintent,orlegalinterventionbybluntobjectorbodilyforce.Examplesofsuchobjectsaresportsequipment,automobileairbag,furniture,walls,andotherstationaryobjects.



Deaths,Hospitalizations,andEmergencyDepartmentVisitsbyAgeandSexChildhoodinjurymortalityratesinN.C.aredisplayedbyageandsexinFigure5for2011-2014.Deathratesarehighestforadolescents,ages15-18,withmales’mortalityratemorethantwotimeshigherthanfemales’.Childrenages5-9hadthelowestmortalityratesamongsttheotheragegroups.Malesconsistentlyhavehighermortalityratesthanfemalesinallagegroupsforinjury-relateddeaths.Overall,0.01%oftheN.C.childpopulationdiedofinjuryfrom2011-2014.ThehospitalizationratesinFigure6showthatmaleshaveahigheradmissionratethanfemalesineveryagegroup.Thehighesthospitalizationratesareseenintheyoungestagegroup,0-4yearsold,andarefollowedbytheoldestagegroup,15-18yearsold.Contrarily,10-14yearoldshadthefewesthospitalizationsasaresultofinjury.OftheentireN.C.childhoodpopulationfrom2011-2013,0.33%werehospitalizedasaresultofaninjury.AsFigure7exemplifies,maleshadaconsistentlyhigherrateofEDvisitsthanfemales,forallagesin2013-2014.Amongmales,thehighestratewas10,699visitsper100,000males,ages15-18.Femalesofthesameagegrouphadarateof7,822visitsper100,000.Childrenages10-14hadthelowestratesformaleandfemaleEDvisitsinNorthCarolina.During2013-2014,8%ofthechildhoodpopulationvisitedtheEDvisitsforaninjury.

Note:29missingsex(Figure7)

9,5468,911

7,413

10,699

7,1686,251

5,329

7,822

0

2000

4000

6000

8000

10000

12000

0-4 5-9 10-14 15-18

Rateper100,000

Age

Figure7:N.C.ChildhoodInjuryEDVisitsbyAgeandSex,Ages0-18:2013-2014(n=352,049)

MaleFemale

509

308 280

377399

276224

287

0

100

200

300

400

500

600

0-4 5-9 10-14 15-18

Rateper100,000

Age

Figure6:N.C.ChildhoodInjuryHospitalizaconsbyAgesandSex,Age0-18:

2011-2013(n=22,775)

MaleFemale



16.8

5.99.1

35.9

13.6

3.1 4.9

15.0

0

10

20

30

40

0-4 5-9 10-14 15-18

Rateper100,000

Age

Figure5:N.C.ChildhoodInjuryDeathsbyAgeandSex,Age0-18:2011-2014(n=1068)

MaleFemale

Note:4missingage(Figure5)



RegionalInjuryRatesFigure8illustratesthechildhoodinjuryratefordeaths(2011-2014),hospitalizations(2011-2013),andEDvisits(2013-2014)inthewestern,central(Piedmont)andeasternregionsofNorthCarolina.Theeasternregionhasthehighestratesofinjury-relateddeaths,hospitalizations,andEDvisits.Thecentralregionhadthelowestinjury-relateddeathrate,whilethewesternregionhadthelowestratesforinjury-relatedhospitalizationsandEDvisits.Thechildhoodinjury-relatedfatalityratewas15,11,and10deathsper100,000,intheeastern,western,andcentralregions,respectively.Thewesternregionhadthelowesthospitalizationrate(307per100,000),followedbythecentralregion(318per100,000)andtheeasternregion(370per100,000).ThewesternregionalsohadthelowestratesofEDvisits(7,022per100,000),whiletheeasternregionhadthehighestratesofchildhood,injury-relatedEDvisits(9216per100,000).

West Central EastDeathsper100,000 11 10 15Hospitalizationsper100,000 307 318 370EDvisitsper100,000 7,022 7,100 9,216

Pitt

Wake

Bladen

Duplin

Hyde

Bertie

Pender

Wilkes

Moore

Union

Halifax

Nash

Robeson

Surry

Onslow

Sampson

Iredell

Columbus

SwainBurke

Johnston

Ashe

Anson

Guilford

Randolph

Harnett

Brunswick

Jones

Wayne

Chatham

Macon

Rowan

Martin

Hoke

Stokes

LeeStanly

Lenoir Craven

Granville

Franklin

Tyrrell

Warren

BuncombeHaywood

Davidson

Person

Jackson

Gates

Dare

Carteret

CaswellForsyth

Caldwell

Beaufort

Cumberland

MadisonOrange

Rutherford

Wilson

Polk

Yadkin

GastonCherokee

Rockingham

Catawba

Richmond

Davie

McDowell

Hertford

Cleveland

Northampton

Clay

Vance

Avery

Mecklenburg

Alamance EdgecombeYancey

Montgomery

PamlicoCabarrus

Durham

GrahamGreene

Scotland

Watauga

Henderson

Washington

Transylvania

Camden

Alexander

CurrituckAlleghany

Chowan

New Hanover

FIGURE 8: North Carolina Childhood Injury Rates by Region, Ages 0-18 Deaths (n=1,064): 2011-2014, Hospitalizations (n=22,775): 2011-2013 and

ED Visits (n=352,049): 2013-2014

LEGEND: West Central/Piedmont East



Comparison to the United States and Comparison over Time

Thechildhoodinjury-relatedmortalityratesinNorthCarolinaandtheUnitedStatesfollowedsimilartrendsfrom1999-2013.In2013-2014,thechildhoodinjury-relateddeathrateinN.C.increased(13.4to14.6deaths/100,000children)whilethenationalmortalityrateplateaued(13.1deaths/100,000children).Throughoutthe15yearperiodinFigure9,N.C.hadaconsistentlyhigherinjury-relatedrateofdeathforchildrenages0-18thantheratefortheentireU.S.

Assaultandmotorvehicleinjuriesweretheleadingcausesofinjury-relateddeathfor0-18yearoldsintheU.S.andN.C.from2011-2014.N.C.’schildhoodmortalityrateformotorvehiclecrashes(4.98deaths/100,000children)wasgreaterthanthenationalrate(3.73deaths/100,000children).N.C.’smortalityratefordrowningandpoisoningalsoexceededtheU.S.’mortalityrates.However,theU.S.hadahigherassaultmortalityrate(4.6deaths/100,000children)thanN.C.(4.3deaths/100,000children)duringthesametimeperiod.NationalchildhoodmortalityrateswerealsogreaterthanN.C.’sratesforsuicide,suffocation,fire/burn,andpedestrian(other)injuries.

Note:AlltypesofinjuryinFigure10areunintentional,unlessotherwiseindicated.RatesfromWISQARSareage-adjustedandcomparabletonationalrates.

4.304.98

1.991.22 1.19

0.640.35 0.20

4.60

3.73

2.111.55

1.100.56 0.37 0.22

0

1

2

3

4

5

6

Assault(Intenkonal)

MotorVehicle Self-Inflicted(Suicide)

Suffocakon Drowning Poisoning Fire/Burn Pedestrian-Other

Ratesp

er100

,000

Figure10:ChildInjuryDeathRatesinNorthCarolinaandtheUnitedStatesbyTypeofInjury,Ages0-18:2011-2014

NorthCarolinaRateU.S.Rate

0

5

10

15

20

25

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Rateper100

,000

Figure9:ChildInjuryDeathRatesintheUnitedStatesandNorthCarolina,Ages0-18:1999-2014

NorthCarolinaRate U.S.Rate



HospitalizationChargesforChildhoodInjuriesfrom2011-2013Between2011and2013,hospitalizationsfromchildhoodinjuriesinNorthCarolinageneratednearly$842millioninmedicalandeconomicexpenses.ReferringtoFigure11,unintentionalchildhoodinjurieswerethecauseof34%($289million)oftotalhospitalizationcharges.Assaultandself-inflictedinjurieseachaccountedfor3%oftotalcharges.Figure12reflectstheeconomicburdenofunintentionalmotorvehiclecrashes,falls,andfireandburninjuriesonchildrenandtheirfamilies.MedianchargesinFigure13estimatethechargeperinjuryforspecifictypesofchildhoodinjury.Disparitiesinmedianchargescanbeattributedtodifferencesineachpatient’scase,includingtheextentoftrauma,typesofproceduresandtreatments,andlengthofhospitalstay.Firearm(assault,self-inflicted,andunintentional)injurieshavethemostexpensivemedianhospitalizationchargespercase,followedbymotorvehiclecrashes.Thesechargesprovideanestimateofthefinancialtollofthemedicalcarerequiringhospitalizationforchildhoodinjuries,butdonotaccountfortheindirectcostsofchildhoodinjurythatcontributetoagreaterburdenonchildrenandtheirfamilies.Suchindirectcostsincludelostproductivityandadecreasedqualityoflife.Note:Int=intentionalinjury;Unint=unintentionalinjury;Self-Infl=self-inflictedinjury.

$841.9

$495.5

$289.3

$26.4 $23.8 $6.9$0

$100$200$300$400$500$600$700$800$900

Millions

Figure11:TotalHospitalizaconChargesforChildhoodInjuriesinN.C.,Age0-18:2011-2013

$80.5

$42.0

$29.1$20.0

$13.2 $9.9 $9.6 $9.5

$0$10$20$30$40$50$60$70$80$90

Millions

Figure12:TotalHospitalizaconChargesforChildhoodInjuryinN.C.byTypeofInjury,

Age0-18:2011-2013

$42.5$38.4

$35.6 $33.4

$20.2 $19.9 $18.4 $16.8

$0$5

$10$15$20$25$30$35$40$45

Thou

sand

s

Figure13:MedianHospitalizaconChargesforChildhoodInjuryinN.C.byTypeofInjury,

Age0-18:2011-2013



2.TypesofChildhoodInjury2.1UnintentionalInjuryMotorVehicleInjury AmongchildhoodinjuriesinN.C.,motorvehiclecrashesweretheleadingcause(32%)ofmortality,thefourthleadingcause(6%)ofhospitalizations,andthesixthoverallcause(5%)ofEDvisits.AsseeninFigures14,15,and16,childhoodinjuriescausedbymotorvehiclecrashesresultedin:343deaths(3.7per100,000children)from2011-2014,1,448hospitalizations(21per100,000children)form2011-2013,and17,979EDvisits(393per100,000children)from2013-2014.Motorvehiclecrashes’hospitalizationchargestotaled$80.5millionfrom2011-2013.Motorvehicleinjurieswerethehighestmechanismfortotalhospitalizationchargesandthefourth-highestmechanismformedianhospitalizationchargesat$33,392,withanaveragechargeof$55,619,asshowninTable7.Childrenages15-18aresignificantlymoreaffectedbymotorvehicleinjuriesindeaths,hospitalizations,andEDvisits.Notethedistinctcorrelationbetweennovicedrivingagesandratesofincidence.Additionally,maleshavethehighestmortalityandhospitalizationrates,whilefemaleshavethehighestEDvisitrates.

Table7:EstimatedHospitalizationChargesResultingfromChildhoodUnintentional

MotorVehicleInjuriesinN.C.,Age0-18:2011-2013

TotalCharges $80,536,090MedianCharges $33,392AverageCharge $55,619

166.8

270.9

374.0

582.2

430.9356.5

0

100

200

300

400

500

600

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure16:N.C.ChildhoodUnintenconalMotorVehicleEDVisitsbyAgeandSex,Ages0-18:2013-2014(n=17,979)

2.71.9 2.2

11.2

3.24.3

0

2

4

6

8

10

12

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure14:N.C.ChildhoodUnintenconalMotorVehicleDeathsbyAgeandSex,Ages0-18:2011-2014(n=343)

10.714.7 15.2

59.3

18.323.8

0

10

20

30

40

50

60

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure15:N.C.ChildhoodUnintenconalMotorVehicleInjuryHospitalizaconsbyAgeandSex,

Ages0-18:2011-2013(n=1448)




Suffocation AmongchildhoodinjuriesinN.C.,unintentionalsuffocationwasthesecondleadingcause(11%)ofmortality,caused1%ofhospitalizations,and0.1%ofEDvisits.AsseeninFigures17,18,and19,childhoodinjuriescausedbysuffocationresultedin:116deaths(1.3per100,000children)from2011-2014,185hospitalizations(2.7per100,000children)from2011-2013,and352EDvisits(7.7per100,000children)from2013-2014.Suffocationinjuries’hospitalizationchargestotaled$9.5millionfrom2011-2013.Suffocationwastheeighthleadingmechanismforbothtotalandmedianhospitalizationchargesandhadanaveragechargeof$51,398,asshowninTable8.Childrenages0-4aremoreaffectedbysuffocationinjuriesindeaths,hospitalizations,andEDvisits.Infantsandyoungchildrenaresignificantlymoresusceptibletosuffocation.Additionally,maleshavethehighestmortalityandhospitalizationrates,whilefemaleshavethehighestEDvisitratesforsuffocationinjuries.


SuffocationInjuriesinN.C.,Ages0-18:2011-2013


4.2

0.3 0.1 0.2

1.1 1.4

0

1

2

3

4

5

6

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure17:N.C.ChildhoodUnintenconalSuffocaconDeathsbyAgeandSex,

Ages0-18:2011-2014(n=116)

7.1

1.2 1.12.3

3.2

0

2

4

6

8

10

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure18:N.C.ChildhoodUnintenconalSuffocaconHospitalizaconsbyAgeandSex,

Ages0-18:2011-2013(n=185)

24.3

2.91.0 0.4

7.9 7.5

0

5

10

15

20

25

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure19:N.C.ChildhoodUnintenconalSuffocaconEDVisitsbyAgeandSex,

Ages0-18:2013-2014(n=352)

Note:Datasuppressedifn<10(Figure18)



Drowning AmongchildhoodinjuriesinN.C.,drowningwasthethirdleadingcause(8.9%)ofmortalityandresponsiblefor0.5%ofhospitalizationsand0.05%EDvisits.AsseeninFigures20,21,and22,Childhoodinjuriescausedbydrowningresultedin:95deaths(1.0per100,000children)from2011-2014,119hospitalizations(1.7per100,000children)from2011-2013,and173EDvisits(3.8per100,000)from2013-2014.Drowninginjuries’hospitalizationchargestotaled$4.1millionfrom2011-2013.Drowningwasthe10thleadingmechanismfortotalhospitalizationchargesand13thleadingmechanismformedianhospitalizationcharges,withamedianchargeof$9,474andanaveragechargeof$34,129,asreferencedinTable9.Childrenages0-4aremostaffectedbydrowninginjuriesindeaths,hospitalizations,andEDvisits.Infantsandyoungchildrenaresignificantlymoresusceptibletodrowning.Additionally,maleshavegreatermortality,hospitalization,andEDvisitratesthanfemalesfordrowninginjuries.


DrowningInjuriesinN.C.,Ages0-18:2011-2013


2.1

0.4 0.7 0.90.5

1.5

0

1

2

3

4

5

6

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure20:N.C.ChildhoodUnintenconalDrowningDeathsbyAgeandSex,

Ages0-18:2011-2014(n=95)

4.1

0.9 0.7 1.1 1.32.1

0

2

4

6

8

10

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure21:N.C.ChildhoodUnintenconalDrowningHospitalizaconsbyAgeandSex,Ages0-18:2011-2013(n=119)

8.6

2.4 1.8 1.13.0

4.5

0

5

10

15

20

25

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure22:N.C.ChildhoodUnintenconalDrowningEDVisitsbyAgeandSex,

Ages0-18:2013-2014(n=173)




Fire/Burn AmongchildhoodinjuriesinN.C.,fire/burnsweretheeighthleadingcause(3%)ofmortality,thesixthleadingcause(4%)ofhospitalizations,andthe14thoverallcause(1%)ofEDvisits.AsseeninFigures23,24,and25,childhoodinjuriescausedbyfire/burnsresultedin:34deaths(0.4per100,000children)from2011-2014,1,010hospitalizations(14.7per100,000children)from2011-2013,and3,820EDvisits(83.5per100,000children)from2013-2014.Fireandburns’hospitalizationchargestotaled$29.1millionfrom2011-2013.Fireandburninjurieswerethethird-highestmechanismfortotalhospitalizationchargesandtheseventh-highestmechanismformedianhospitalizationchargesat$18,436,withanaveragechargeof$28,792,asshowninTable10.Childrenages0-4aremostaffectedbyfireandburnsinhospitalizationsandEDvisits,andareequallyaffectedaschildrenages5-9indeath.Additionally,maleshavethehigherratesthanfemalesformortality,hospitalizations,andEDvisitsrelatedtofireandburninjuries.

Table10:EstimatedHospitalizationChargesResultingfromChildhoodFire/Burn

UnintentionalInjuriesinN.C.,Ages0-18:2011-2013


33.0

9.2 7.0 7.212.2

17.1

0

10

20

30

40

50

60

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure24:N.C.ChildhoodUnintenconalFire/BurnHospitalizaconsbyAge&Sex,Ages0-18:2011-2013(n=1010)

163.9

57.9 43.9 38.678.1 88.7

0

100

200

300

400

500

600

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure25:N.C.ChildhoodUnintenconalFire/BurnEmergencyDepartmentVisitsbyAge&Sex,Ages

0-18:2013-2014(n=3820)

0.5 0.5 0.3 0.0 0.3 0.4

0

1

2

3

4

5

6

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure23:N.C.ChildhoodUnintenconalFire/BurnDeathsbyAge&Sex,

Ages0-18:2011-2014(n=34)



Falls AmongchildhoodinjuriesinN.C.,fallsarethesecondleadingcause(20%)ofEDvisits,andthethirdleadingcause(10%)ofhospitalizations.AsseeninFigures26,27,and28,childhoodinjuriescausedbyfallsresultedin:9deaths(0.1per100,000children)from2011-2014,2,194hospitalizations(32per100,000children)from2011-2013,and71,203EDvisits(1,557per100,000children)from2013-2014.Hospitalizationchargesresultingfromfallstotaled$42millionfrom2011-2013.Fallinjurieswerethesecond-highestmechanismfortotalhospitalizationchargesandtheseventh-highestmechanismformedianhospitalizationchargesat$13,986,withanaveragechargeof$19,137,asshowninTable11.Childrenages0-4aremostaffectedbyfallinjuriesinhospitalizationandEDvisits,whileadolescentsages15-18sufferthemostdeathsfromunintentionalfalls.However,childrenofallagessufferinjuriesfromfallsthatresultinEDvisits,hospitaladmissionsandmortality.Additionally,malesaremoresusceptibletofallinjuriesthanfemales.

Table11:EstimatedHospitalizationChargesResultingfromChildhoodUnintentionalFall

InjuriesinN.C.,Ages0-18:2011-2013


45.4

30.824.6 24.7 22.4

41.2

0

10

20

30

40

50

60

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure27:N.C.ChildUnintenconalFallInjuryHospitalizaconsbyAgeandSex,Ages0-18:2011-2013(n=2194)

2,189

1,473 1,3511,039

1,385

1,795

0

500

1000

1500

2000

2500

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure28:N.C.ChildUnintenconalFallInjuryEDVisitsbyAgeandSex,

Ages0-18:2013-2014(n=71,200)

0.1 0.0 0.1 0.3 0.0 0.20

1

2

3

4

5

6

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure26:N.C.ChildUnintenconalFallInjuryDeathsbyAgeandSex,

Ages0-18:2011-2014(n=9)



Poisoning AmongchildhoodinjuriesinN.C.,unintentionalpoisoningwastheseventhleadingcauseofbothmortality(4%)andhospitalizations(4%),andthe10thoverallcause(2%)ofEDvisits.AsseeninFigures29,30,and31,childhoodinjuriescausedbyunintentionalpoisoningresultedin:38deaths(0.4per100,000children)from2011-2014,844hospitalizations(12.3per100,000children)from2011-2013,and6,714EDvisits(146.8per100,000children)from2013-2014.Unintentionalpoisonings’hospitalizationchargestotaled$10millionfrom2011-2013.Poisoninginjurieswerethesixth-highestfortotalhospitalizationchargesandthe15thrankedmechanismformedianhospitalizationchargesat$6,368,withanaveragechargeof$11,711,asshowninTable12.Childrenages15-18andmalessufferedthemostfatalitiesasaresultofunintentionalpoisoning.Childrenages0-4weredramaticallymoreaffectedbypoisoninginhospitalizationsandEDvisits.Additionally,maleshadslightlyhigherratesofincidenceforhospitalizationsandEDvisits.Table12:EstimatedHospitalizationChargesResultingfromChildhoodUnintentional

PoisoningInjuriesinN.C.,Ages0-18:2011-2013


0.2 0.1 0.2

1.5

0.2 0.6

0

1

2

3

4

5

6

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure29:N.C.ChildhoodUnintenconalPoisoningDeathsbyAgeandSex,

Ages0-18:2011-2014(n=36)

26.4

4.4 5.2

14.8 11.8 12.8

0

10

20

30

40

50

60

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure30:N.C.ChildhoodUnintenconalPoisoningHospitalizaconsbyAgeandSex,

Ages0-18:2011-2013(n=844)

346.7

81.3 59.8 50.5

140.2 153.2

0

100

200

300

400

500

600

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure31:N.C.ChildhoodUnintenconalPoisoningEDVisitsbyAgeandSex,Ages0-18:2013-2014(n=6,714)



Pedestrian AmongchildhoodinjuriesinN.C.,unintentionalpedestrianinjurieswerethefourteenth-rankedcause(1%)ofmortality,the28thcause(0.2%)ofhospitalization,andthe25thoverallcause(0.1%)ofEDvisits.AsseeninFigures32,33,and34,childhoodinjuriescausedbypedestrianinjuriesresultedin:15deaths(0.2per100,000children)from2011-2014,50hospitalizations(0.2per100,000children)from2011-2013,and191EDvisits(191per100,000children)from2013-2014.Pedestrianinjuries’hospitalizationchargestotaled$2.1millionfrom2011-2013,the12thhighestmechanismfortotalhospitalizationcharges,andthefifth-highestmechanismformedianhospitalizationchargesat$20,187,withanaveragechargeof$42,312,asshowninTable13.Childrenages0-4aremostaffectedbypedestrianinjuriesindeathsandhospitalizations.Childrenages0-9areequallyaffectedbypedestrianinjuriesinEDvisits.MaleshavethehighestratesofhospitalizationandEDvisits,whilefemaleshaveahighermortalityrate.


PedestrianInjuriesinN.C.,Ages0-18:2011-2013


0.50.0 0.0 0.2 0.2 0.1

0

1

2

3

4

5

6

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure32:N.C.ChildUnintenconalPedestrianInjuryDeathsbyAgeandSex,Ages0-18:2011-2014(n=15)

1.2 0.8 0.3 0.5 0.5 0.9

0

2

4

6

8

10

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure33:N.C.ChildUnintenconalPedestrian-RealtedInjuryHospitalizaconsbyAgeandSex,

Ages0-18:2011-2013(n=50)

4.3 4.3 4.1 3.8 2.85.7

0

5

10

15

20

25

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure34:N.C.ChildUnintenconalPedestrianInjuryEDVisitsbyAgeandSex,Ages0-18:2013-2014(n=191)



2.2IntentionalInjuryAssault AmongchildhoodinjuriesinN.C.,assaultwasthesecondleadingoverallcause(15%)ofmortality,thefifthleadingcause(7%)ofhospitalization,andthethirdleadingcause(2%)ofEDvisits.AsseeninFigures35,36,and37,Childhoodinjuriescausedbyassaultresultedin:159deaths(1.7per100,000children)from2011-2014,712hospitalizations(10.4per100,000children)from2011-2013,and5,201EDvisits(113.7per100,000children)from2013-2014.Assaultistheintentunderlying3%oftotalhospitalizationcharges,withatotalof$26millionfrom2011-2013.Assaultinflictedbyfirearmswasninth-leadingmechanismfortotalhospitalizationchargesandtheleadingmechanismformedianhospitalizationchargesat$42,466,withanaveragechargeof$64,542,asshowninTable14.Childrenages0-14and15-18havethehighestmortalityandhospitalizationrates,withthe15-18yearoldagegroupbeingmostaffected.Additionally,malesaremoreaffectedbyassaultinjuriesthanfemales,asexemplifiedbyamortalityratemorethandoublethatoffemales.

Table14:EstimatedHospitalizationChargesResultingfromChildhoodAssaultInjuriesin

N.C.,Ages0-18:2011-2013


2.8

0.4 0.6

4.3

1.1

2.4

0

1

2

3

4

5

6

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure35:N.C.ChildhoodIntenconalAssaultInjuryDeathsbyAgeandSex,Ages0-18:2011-2014(n=159)

19.3

2.2 4.0

20.5

8.012.7

0

10

20

30

40

50

60

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure36:N.C.ChildhoodIntenconalAssaultInjuryHospitalizaconsbyAgeandSex,

Ages0-18:2011-2013(n=712)

30.5 33.4

127.1

360.4

93.8132.8

0

100

200

300

400

500

600

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure37:N.C.ChildhoodIntenconalAssaultInjuryEDVisitsbyAgeandSex,Ages0-18:2013-2014(n=5,201)



Injuriesresultingfromassaultaccountedfor15%ofoverallchildhoodinjury-relatedmortality,atarateof1.7deathsper100,000childrenfrom2011-2014.Theleadingcausesofassaultdeathsarefirearms(50%),unspecified(16%)andotherspecified/classified(15%).Hospitalizationsfromassaultonlyaccountedfor3%ofadmissionsfrom2011to2013,occurringatarateof10.4per100,000children.Theotherspecified/classifiedmechanism(44%)wastheleadingcausesofassaulthospitalizations,followedbyunspecified(13%),otherspecified/notclassified(12%),andstriking(10%).Assaultwasresponsiblefor1%ofEDvisitsfrom2013-2014,witharateof113.7visitsper100,000children.OfassaultEDvisits,theleadingmechanismsofassaultwerestriking(49%),otherspecified(bothclassifiedandnotclassified,31%),unspecified(14%),cutorpiercing(3%),andfirearms(2%).Whilefirearmsarealeadingmechanismforbothassaultmortalityandhospitalizations,therewereatotalof268assaultinjuriesinvolvingfirearms.Incontrast,therewere2,607injuriesfromstrikingand206injuriesfromacutorpiercing.

Table15:N.C.TypesofChildhoodAssaultInjury

Deaths,Ages0-18:2011-2014

InjuryType NumberofDeaths

Firearm 80

Unspecified 25


Cut/Pierce 10

Suffocation 9

OtherSpecified/NEC* 5

Poisoning 3

Drowning 1

Struck 1

Fire/Burn 1

Total 159

Table16:N.C.TypesofChildhoodAssaultInjury

Hospitalizations,Ages0-18:2011-2013

InjuryType NumberofAdmissions


Unspecified 96

Firearm 94

OtherSpecified/NotClassified 85

Struck 68

Cut/Pierce 36

Fire/Burn 12

Poisoning 5

Suffocation 2

Fall 1

Total 712

Table17:N.C.TypesofChildhoodAssaultInjuryEDVisits,Ages0-18:2013-2014

InjuryType NumberofVisits

Struck 2,538



Unspecified 746

Cut/Pierce 160

Firearm 84

Suffocation 14

Fire/Burn 13

Fall 7

Poisoning 7

MotorVehicle 2

Total 5,201

Note:NEC=notelsewhereclassified.



2.3Self-InflictedSuicide/Self-InflictedInjury AmongchildhoodinjuriesinN.C.,self-inflictedinjurieswerethethirdleadingoverallcause(13%)ofmortality,thesecondleadingcause(19%)ofhospitalization,andthefourthleadingcause(1%)ofEDvisits.Childhoodinjuriescausedbyself-inflictionresultedin:136deaths(1.5per100,000children)from2011-2014,2,086hospitalizations(30.4per100,000children)from2011-2013,and3,136EDvisits(68.6per100,000children)from2013-2014.Self-inflictionistheintentresponsiblefor3%ofallinjuryhospitalizationcharges,totalingat$24millionfrom2011-2013.Self-harmbyintentionaldrugpoisoningisthefifthleadingmechanismfortotalhospitalizationcharges;whileself-harmbyfirearmisthesecond-highestmechanismformedianhospitalizationcharges.Thoughchildrenages10-14sufferfromself-inflictedinjuries,ages15-18aremostaffectedbyself-inflictedinjuriesindeaths,hospitalizations,andEDvisits.Additionally,maleshavehighestmortalityrate,whilefemaleshavethehighesthospitalizationandEDvisitratesforself-inflictedinjuries.

Table18:EstimatedHospitalizationChargesResultingfromIntentionalSelf-Inflicted

InjuriesinChildreninN.C.,Ages0-18:2011-2013


0.0 0.0

1.9

5.7

0.9

2.1

0

1

2

3

4

5

6

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure38:N.C.ChildhoodSuicidesbyAgeandSex,Ages0-18:2011-2014(n=136)

0.4 0.7

38.0

117.3

44.7

16.8

0

20

40

60

80

100

120

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure39:N.C.ChildhoodIntenconalSelf-InflictedInjuryHospitalizaconbyAgeandSex,

Ages0-18:2011-2013(n=2086)

1.2 2.886.9

256.7

102.036.5

0

100

200

300

400

500

600

0-4 5-9 10-14 15-18 Female Male

Rateper100,000

Figure40:N.C.ChildhoodIntenconalSelf-InflictedInjuryEDVisitsbyAgeandSex,Ages0-18:2013-2014(n=3136)



Injuriesresultingfromintentionalself-inflictionsaccountedfor13%ofoverallchildhoodinjuryrelatedmortality,atarateof1.5deathsper100,000childrenfrom2011to2014.Themostprevalentmethodsofsuicidearesuffocation(51%)andfirearms(43%).Hospitalizationsfromself-inflictionsaccountedfor9%ofadmissionsfrom2011to2013,occurringatarateof30.4per100,000children.Poisoning(63%)wastheleadingcauseofintentionalself-inflictedhospitalizations,followedbycutorpiercing(19%)andunspecified(13%).Intentionalself-inflictedinjuriescaused1%ofEDvisitsfrom2013-2014,atarateof68.6visitsper100,000children.Ofintentionallyself-inflictedEDvisits,theleadingmechanismswerepoisoning(63%)andcutandpiercing(33%).Poisoningandcutsandpiercingwerethemostfrequentlyutilizedmechanismsforintentionallyself-inflictedinjuries.Fromthisdataset,therewereatotalof3,301incidencesofpoisoningand1,418incidencesofcutsandpiercing.WhilebothpoisoningandcutsandpiercingslargelycontributedtohospitalizationsandEDvisits,theywerenotprimarycausesofmortality.

Table19:N.C.TypesofChildhoodSelf-InflictedInjuryDeaths,Age0-18:2011-2014

TypeofSelf-InflictedInjury

NumberofDeaths

Suffocation 70

Firearm 58

Poisoning 3

Drowning 2


Fire/Burn 1

Total 136

Table20:N.C.TypesofChildhoodSelf-InflictedInjury

Hospitalizations,Age0-18:2011-2013

TypeofSelf-InflictedInjury

NumberofAdmissions

Poisoning 1,309

Cut/Pierce 398

Unspecified 265

Suffocation 40


Firearm 12

Fall 11

Fire/Burn 7


MotorVehicle 2

Total 2,086

Table21:N.C.TypesofChildhoodSelf-InflictedInjuryEDVisits,Age0-18:2011-2013

TypeofSelf-Inflictedinjury

NumberofVisits

Poisoning 1,989

Cut/Pierce 1,020


Unspecified 142

Suffocation 27

Fall 11

Firearm 5

Fire/Burn 4


Drowning 1

MotorVehicle 1

Natural/Environment 1

Total 3,136



3.ConclusionsandRecommendationsInjuryisasignificantsourceofmorbidityandmortalityforchildrenages0-18inNorthCarolina,anditisalargelypreventableproblem.Thepurposeofthisreportistoachieveagreaterunderstandingofthemostsignificantcausesofchildhoodinjuryinthestate,especiallythosethatcreatethegreatestsocial,psychological,andeconomicburdenonsociety.Abetterunderstandingoftheseinjuriescanhelpguidepreventioneffortstowheretheywillbemosteffective.

SummaryofStatistics• ChildhoodinjuriesinN.C.resultedinatotalof:1,068deathsfrom2011-2014,22,775hospitalizations

from2011-2013,and352,049emergencydepartmentvisitsfrom2013-2014.o 70%ofinjurydeathswereunintentionalinnature.o Overall,maleshadhigherratesofinjuryincidencethanfemales.

EverydayinN.C.…1childdiesfrominjury.

21childrenarehospitalizedforaninjury.322childrenvisittheemergencydepartmentforaninjury.

• Leadingmechanismsofdeathamongstchildrenfrom2011-2014inN.C.areunintentionalmotorvehiclecrashes(32%),unintentionalsuffocation(11%),andunintentionaldrowning(9%).

o Forchildrenages0-4,theleadingcauseofdeathwasunintentionalsuffocation,andmotorvehiclecrashesclaimedthemostlivesofchildren5-18.

• Leadingcausesofhospitalizationfrom2011-2013inN.C.childrenwereadverseeffects(24%),unknowncauses(19%),unintentionalfalls(10%),andunintentionalmotorvehiclecrashes(6%).

o Forchildrenages0-9,theleadingcauseofhospitalizationwasunintentionalfalls.Childrenages10-18sufferedthemosthospitalizationsfromself-inflictedinjuries.

o Forchildrenages10-18,theleadingcauseofhospitalizationwasintentionallyself-inflictedinjuries.

• Leadingscausesofemergencydepartmentvisitsfrom2013-2014inN.C.wereunknown(27%),unintentionalfalls(20%),unintentionalstriking(12%),andunintentionalnatural/environmentalmechanisms(6%).

o FallsweretheleadingmechanismofinjuryrelatedEDvisitsforallchildren,ages0-18.• InjurymortalityratesforchildreninN.C.havebeenconsistentlyhigherthanthenationalaverage,

withanincreaseindisparityfrom2013-2014.BothnationalandN.C.rateshaveanoveralldecreasingtrendininjuryfrom1999-2014.



RecommendationsStatewideinjurypreventioneffortsshouldmirrornationalinitiativestoreducechildhoodinjuryrates.Thefollowingevidence-basedrecommendationsarebasedonexpertreviewforTheCommunityGuideforPreventiveServicesandtheNationalActionPlanforChildInjuryPrevention.Thebelowlistofrecommendationsisnotexclusiveandaremerelyexamplesofeffortsthatcanreduceinjury.MotorVehicle&TrafficInjuryPreventionForyoungerchildren,childsafetyseatlawsandaccesscanreducethefrequencyofinjuriescausedbymotorvehicleandtrafficcrashes.

• Increasingtheenforcementofchildsafetyseatlawsthat“requirechildrenridinginmotorvehiclestoberestrainedinfederallyapprovedinfantorchildsafetyseats,”candecreasetheinjuriesincurredtosmallerchildrenuponimpact[6].

• Increaseseatdistributionprogramstoincreaseaccessofchildsafetyseatstolow-incomeparentsandcaregivers[6].

Forteenagersandyoungdrivers,whosufferthesignificantlymorefrommotorvehiclecrashinjuries,strongevidenceencouragespolicyforgraduateddriverslicensingprograms.

• Implementand/orstrengthengraduateddriverslicensingprogram[7].• Driverinexperienceisthechiefcauseofmotorvehiclecrashesinvolvingteenagers.Teenagedriversare

thebiggestsafetythreattothemselvesandtheirpeers.Hence,graduateddriverlicensingprotectsandpreventsinjuriesforalldriversandpassengersthroughthree-stagesystems:learner’spermit,provisionallicense,andthenunrestrictedlicense.

• Intermediate,orprovisional,licensescanrestrictteenagedrivers’passengers,curfews,cellphoneusage,andmore[8].

Forallpassengersanddrivers,seatbeltusageiscriticalinpreventing,oratleastlimitingtheextentof,motorvehiclecrashinjuries.

• Increasingandenhancingprimaryenforcementofsafetyseatbeltlawscandecreasethenumberofinjuriesincurredbymotorvehicles.Suchinitiativesinclude“Click-it-or-ticket”campaigns[6],[7].

Itisillegalforanychildtoconsumealcohol.Forallchildrenandadults,driversundertheinfluenceofalcoholriskthesafetyandhealthofeverypersoninamotorvehicle.

• Maintaininglawsthatprohibitpersonsages21andyoungerfromconsumeralcoholareanadditionalmeasuretopreventmotorvehiclecrashes[6].

SuffocationInjuryPreventionKnowledgeofcardiopulmonaryresuscitation(CPR)procedurescanimprovehealthoutcomesunderthecircumstancesofasuffocationinjury.

• IncreasingandfacilitatingopportunitiesforCPRtrainingtargetedtowardsolderchildren,parents,daycareprovidersandcaregiverscanpreventdeathswhenachildisdeprivedofadequateairandoxygen[7].

Youngchildrenarevulnerabletosuffocationwhilesleeping.Hence,itisimportantforallparentsunderstandhealthysleepingpositions.

• Educatingparentsontheimportanceofsafesleepingandhealthysleeppositionscandecreasetherateofchildsuffocationincidents.Well-childexamsareeffectiveplatformstodiscusshealthysleepingpositionsandforproviderstopromotethe“SafetoSleep”campaign[7].



Communityandschoolrecreationalgroundscancontributetowardpreventivemeasuresagainstchildhoodsuffocation.

• Parkandschoolgrounddesignersshouldcarefullydesignandmaintainplaygroundssothatthey“reduceentrapment,suffocation,andstrangulation”[7].

DrowningInjuryPreventionIncreasingtheknowledgeandprevalenceoflifesavingskillsincommunitiescandecreasetherateofchildrensufferingfromdrowninginjuries.

• IncreasingtheaccessibilityandavailabilityofCPRtrainingincommunitiescanincreasethenumberofolderchildrenandadultsthatareabletosavelivesindrowning(andothermedical)emergencies.OfferingfreeorreducedCPRclassesand/orofferingcoursesatmoreconvenientlocationswillincreasethenumberofpeoplewhowillbeabletoreceiveCPRtraining.

• Similarly,byincreasingtheaccessibilityandavailabilityofswimminglessonsincommunities,morechildrenwilldevelopandstrengthentheirswimmingandwatersurvivalskills.Offeringfreeorreduced-costswimminglessonsallowsmorechildrentodevelopstrongenoughwaterskillstopreventdrowning[7].

Private,backyardswimmingpoolsposeagreatrisktoyoungchildren’ssafety.Smallchildrencanaccidentallyfallintopoolswithoutparentalknowledgeorsupervisionanddrown.

• Requiringallswimmingpoolstohaveafour-sidedisolationfence,completelyseparatefromthehouseandyard,withself-closingandself-latchinggateswillpreventunsupervisedchildrenfromaccessingabodyofwaterandconsequentdrowninghazard[7].

Swimmingpoolsarenottheonlydrowninghazardforchildren;naturalbodiesofwaterthreatenchildhooddrowning,aswell.

• Enforcinglawsmandatingchildrenyoungerthan13towearlifejackets“inandaroundnaturalbodiesofwater,suchaslakesortheocean”(regardlessofswimmingability)andswimmingpools(forweakerswimmers)willreducechildren’sriskfordrowninginjuries[7].

FallsInjuryPreventionHomescontainaplethoraoffallhazards.Toreducetheriskoffallinjuriesathome,preventivemeasurescanbetakentoprotectchildren’shealthandsafety.

• “Build[ing]capacitythroughcommunitypreventiveservicesandlocalhealthdepartmentstointegrateassessmentoffallhomehazardsintootherongoinghomeassessments(e.g.leadpoisoning)”canincreasetheidentificationandrecommendationforremovaloffallhazards[7].

• Particularlyforyoungerchildren,increasingthe“amountanduseofprotectivedevices,”suchashandrailsinstairwellsandwindowguardscanreducetheriskofchildhoodfalls[7].



4.AppendixAppendixA:DataSourcesandTechnicalNotesComparisonofU.S.andNorthCarolinaInjuryRates1999-2014TheWeb-based InjuryStatisticsQueryandReportingSystem(WISQARS) fromtheCenters forDiseaseControland Prevention, National Center for Injury Prevention and Control provided the comparative U.S. and NorthCarolina fatal injury rates for the years 1999 to 2014 and by injury type for 2011 to 2014. Crude rateswerereportedunlessotherwisenoted.TheWISQARSinjurymortalityreportswereretrievedonMarch15,2016from:http://webappa.cdc.gov/sasweb/ncipc/dataRestriction_inj.html.NorthCarolinaPopulationEstimates2011-2014TheNorth Carolina State Center for Health Statistics (SCHS) providedNorth Carolina population data for theyears 2011 to 2014. SCHS obtained the population data from the CDC National Center for Health Statisticsbridgedpopulationfile(2014version).NorthCarolinaDeathData2011-2014TheNorthCarolinaStateCenter forHealthStatisticsprovideddeath certificatedata foreverydeath inNorthCarolina.OnlystateresidentswithaNorthCarolinacountyaddressandages0-18yearsoldwereanalyzedforthis report. Primary cause of death was assignedwith the International Classification, 10th Revision; ClinicalModification (ICD-10) codes. Injuries were then classified intomanner andmechanism using CDC’s standardinjurymatrixframework.NorthCarolinaHospitalDischargeData2011-2013TheNorthCarolinaStateCenterforHealthStatisticsprovideddataforeveryNorthCarolinahospitaldischargeofNorth Carolina residents ages 0-18. A hospital discharge occurs after a patient leaves a hospital followingadmission.Thesedatadonotrepresentnumberofpatients,butnumberofdischarges(multipledischargesperpatient are possible). Cause of injury was assigned with International Classification, 9th Revision, ClinicalModification (ICD-9-CM) diagnosis codes and External Causes of Injury codes (E-Codes). Injuries were thenclassified into manner and mechanism using the CDC’sRecommended Framework of E-code groupings forPresentingInjuryMortalityandMorbidityData.NorthCarolinaEmergencyDepartmentData2013-2014TheNorthCarolinaDisease Event Tracking andEpidemiologic Collection Tool (NCDETECT) isNorthCarolina'sstatewide syndromic surveillance system.NC DETECT collects data from a number of secondary sources toaddresstheneedforearlyeventdetectionandtimelypublichealthsurveillance.NCDETECTcollectsnearreal-time emergency department (ED) visit data from all civilian24/7 acute-care hospital-affiliatedEDs in NorthCarolina.In2013,NCDETECTcollectedEDvisitdatafromall124of124qualifyingEDsandin2014NCDETECTcollecteddatafromall123of123qualifyingEDs(onefacilityclosedin2014).TheEDvisitdata,deathdata,andthe hospital discharge data are notmutually exclusive. The nature andmechanismof injurywasassigned byhospital coders using theInternational Classification, 9th Revision, Clinical Modification (ICD-9-CM) diagnosiscodes and External Causes of Injury codes (E Codes) as part of standard administrative and hospitalbillingprocedures. Injuries were then classified into manner and mechanism of injury using theCDC’sRecommended Frameworkof E-code groupings for Presenting InjuryMortality andMorbidityData. FormoreinformationaboutNCDETECTEDdata,pleasevisithttp://www.ncdetect.org.



UnintentionalMotorVehicle,Traffic(MVT)Unintentional Motor Vehicle, Traffic (MVT) injuries were categorized as an occupant, pedestrian and/ormotorcyclistinjuredinamotorvehicletrafficcrashwithanunintentionalintent.Thisdefinitionincludedinjuriesfrom incidents that involved automobiles, trucks, vans,motorcycles, andmotorized cycles travelingonpublicroadways.Thisclassificationdidnotincludemotorvehiclenon-traffic,otherlandtransportandothertransport.Causeofdeath ICD-10codes:V02-V04 (.1, .9),V09.2,V12-V14 (.3-.9),V19 (.4-.6),V20-V28 (.3-.9),V29 (.4-.9),V30-V79 (.4-.9), V81.1, V82.1, V83-V86 (.0-.3), V80 (.3-.5), V87 (.0-.8), V89.2. Hospital and emergencydepartmentE-codes:E810-E819(.0-.9).UnintentionalSuffocationDeaths,HospitalizationsandEDvisits resulting fromchokingandsuffocation refer tomechanical causes (e.g.,plastic bags, refrigerator entrapment, or fallen earth); pressure on the trachea (e.g., drapery cords, clothingdrawstrings); and inhalation of food or foreign bodies. Fatal suffocation, such as choking in young children,typically involvesnotonly roundfoodproductssuchascandies,nuts,grapesandhotdogs,butalsonon-foodproductssuchasundersizedpacifiers,small toys,and latexballoons.Causeofdeath ICD-10codes:W75-W84.HospitalandEDE-codes:E911-E913.9UnintentionalDrowningorNearDrowning:Drowningandnear-drowninginjuriesrefertothoseinjuriescausesbysuffocationornear-suffocationasaresultofsubmersioninwater. Ifthevictimsurvivesthesuffocation,severneurological injuriesmayresult.Drowningand near-drowning primarily occur in three environments: pools, bathtubs, and naturally occurring bodies ofwater suchas streams, lakes, andwatersalong theNorthCarolina coast.Causeofdeath ICD-10codes:W65-W74.HospitalandEDE-codes:E830.0-.9,E832.0-.9,E910.0-.9.UnintentionalFireorBurnUnintentionalfireorburninjuriesincludedinjuriescategorizedwithanunintentionalintentandresultingfromexposuretoafireandcontactwithheatorhotsubstances.CauseofdeathICD-10codes:X00-X19.HospitalandemergencydepartmentE-codes:E890.0-E899,E924.0-.9.UnintentionalFallUnintentional falls included falls with an unintentional intent and the following mechanisms: on same levelinvolving ice and snow; on same level from slipping, tripping and stumbling; involving ice-skates, skis, roller-skatesorskateboards;onsamelevelduetocollisionwith,orpushingby,anotherperson;whilebeingcarriedorsupported by other persons; involving wheelchair, bed, chair or other furniture; involving playgroundequipment;onandfromstairsandsteps;onandfromladder;onandfromscaffolding;from,outof,orthroughabuildingorstructure;fromtree;fromcliff;divingorjumpingintowatercausinginjuryotherthandrowningorsubmersion; from one level to another; other on same level; and unspecified. Cause of death ICD-10 codes:W00-W19.HospitalandemergencydepartmentE-codes:E880.0-E-886.9,E888.UnintentionalPoisoningsUnintentionalpoisoningincludedinjurieswithanunintentionalintentresultingfromingestionofharmfuldrugs,medicines,gases,householdproducts,solvents,chemicals,acids,andpoisonousfoodsorplants.CauseofdeathICD-10codes:X40-X49.HospitalandemergencydepartmentE-codes:E850.0-E869.9.UnintentionalPedestrianInjuries(Non-motorvehiclerelated)Deaths,hospitalizations,andEDvisitsresultingfrompedestrianinjuriesarecodeintwodifferentcategories:asa subcategoryundermotorvehicle traffic collision (meaning the injury resulted froma collisionwithamotorvehicle on a public highway) or through a category labeled “Pedestrian,Other”. A “Pedestrian,Other” injury



involvesapedestrianinjuredinacollisionwitharailwayvehicle,amotorvehiclenotonpublichighway,orotherroad vehicle (e.g., bicycle, animal being ridden, streetcar, non-motorized vehicle of object in motion).“Pedestrian,other”injuriesarereportedinthisdocument.CauseofdeathICD-10codes:V01,V02-V04(.0),V05,V06,V09(.0,.1,.3,.9).HospitalandEDE-codes:800-807(.2),E820-E825(.7),E826-E829(.0)Homicide/AssaultAssaultinjurieswerecategorizedasassaultintentbyanymechanism(e.g.,firearm,struck,etc.).Causeofdeathcodes:X85-Y09,Y87.1.HospitalandemergencydepartmentE-codes:E960.0-E969.9,E979,E999.1.Suicide/Self-InflictedSelf-inflictedinjurieswerecategorizedasself-inflictedintentbyanymechanism(e.g.,firearm,poisoning,etc.).Causeofdeathcode:X60-X84,Y87.0.HospitalandemergencydepartmentE-codes:E950-E959.MethodsInordertoexploretheextentofthecurrentolderadult injuryprobleminNorthCarolina,twomethodologicalapproacheswere undertaken: (a) a quantitative analysis ofmortality, hospital dischargedata and emergencydepartmentvisitstodetermineinjuryrates;and(b)adescriptionofhospitalchargesforinjuries.InjuryRateCalculationsCruderateswerereportedunlessotherwisespecified.Mortalityandhospitalizationrateswerecalculatedbasedon theNorth CarolinaDeath andHospitalization files for 2011-2014 and 2011-2013, respectively. Emergencydepartment visit rateswere calculatedbasedonNCDETECT for 2013-2014. Theprocesses for calculating therates for North Carolina older adult injuries were similar. First, duplicate records or records with a primarydiagnosis other than injurywere excluded.Next, E-codes using CDC’s injurymatrix standard definitionswerecollapsedtocreateinjurygroupsthatweresuitablefordescribingtheexternalcausesofinjuries.Denominatorsfor rate calculationswere based upon age group population estimates over the specified time period (2011-2014fordeaths,2011-2013forhospitalizations,2013-2014forEDvisits)fromtheNorthCarolinaStateCenterforHealthStatisticsandwereexpressed“per100,000persons”unlessotherwisenoted.HospitalChargesCalculationsHospital charge estimateswere computed by summing the charges across all caseswithin each injury group(e.g.,overall,unintentionalfalls,motorvehicletraffic,etc.).Itisimportanttonotethathospitalchargesreflectonly a part of the cost of injuries. Physician charges, emergency vehicle services, out-patient drug charges,medicalequipmentandtimelostfromworkwerenotincludedinthisreport.Allchargeswerereportedinthatyear’sdollarsandwerenotadjustedforinflation.Hospitalchargesalsoreflectcontractsthathospitalshavewithinsurancecompanies.StandardizationofGraphicAnalysisUsecautionandobservethescalewhenanalyzingandcomparinggraphs.Whiletheimportanceofstandardizedscales in graphs is acknowledged, itwas not possible in this report, due to thewide variation of rate rangeswithinmortality,hospitalization,andEDvisitdata.OtherE-CodesUsedinAnalysisAdditionalinjurycodingwasusedtocategorizedifferingtypesofunintentionalinjuries.ThesecodeswerebasedontheCDCInjuryMatrixFramework:Deaths/Mortality:www.cdc.gov/nchs/data/ice/icd10_transcode.pdf



HospitalizationDischargeandEmergencyDepartmentVisitsNonfatal:www.cdc.gov/ncipc/osp/matrix2.htmAgeGroupsUsedinAnalysisThroughoutthisreport,eachagegroupisdefinedaslessthanitsupperboundaryage.Forexample,the15-18yearoldbracketincludeschildrenfrom15yearsoldthroughchildrenyoungerthan18yearsold.Itdoesnotincludechildren18yearsofageandolder.



AppendixB:InjuryPreventionResourcesCDCCentersforExcellenceUNCInjuryPreventionResearchCenterUniversityofNorthCarolinaCVSPlaza,Suite500137EastFranklinStreet,CB#7505ChapelHill,NC27599-7505Phone:(919)966-2251www.iprc.unc.edu/Director:StephenMarshall,Ph.D.InjuryandViolencePreventionBranchChronicDiseaseandInjury,NorthCarolinaDivisionofPublicHealthNorthCarolinaDepartmentofHealthandHumanServices1915MailServiceCenterRaleigh,NC27699-1915Phone:(919)707-5425Email:[email protected]/injuryBranchHead:AlanDellapenna,Jr.,R.S.,M.P.H.ChiefDirectorofChronicDiseaseandInjury:RuthPetersen,M.D.,M.P.H.NationalCenterforInjuryPreventionandControlCentersforDiseaseControlandPreventionMailstopF634770BufordHighwayNEAtlanta,GA30341-3717Phone:(800)232-4636Email:[email protected]/injuryDirector:DebraHoury,M.D.,M.P.H.SafeKidsNorthCarolinaNorthCarolinaDepartmentofInsurance–OfficeofSafetyandFireMarshall1202MailServiceCenterRaleigh,NC27699-1202Phone:(919)647-0080www.ncdoi.com/OSFM/ProgramsPreventionAndGrants/SafeKidsMesssage.aspChairman:WayneGoodwinDeputyDirector:MegLangston



5.References[1]NationalCenterforInjuryPreventionandControl(2015).10LeadingCausesofDeathbyAgeGroup,United

States–2014.CentersforDiseaseControlandPrevention.Retrievedfromwww.cdc.gov/inquiry/wisqars/leadingcauses.html

[2]NationalCenterforInjuryPreventionandControl,DivisionofUnintentionalInjuryPrevention(2012).Vital

Signs:ChildInjury.CentersforDiseaseControlandPrevention.Retrievedfromhttp://www.cdc.gov/vitalsigns/childinjury/

[3]NationalCenterforInjuryPreventionandControl.Web-basedInjuryStatisticsQueryandReportingSystem(WISQARS)(2015).CentersforDiseaseControlandPrevention.Retrievedfromhttps://www.cdc.gov/injury/wisqars/fatal_injury_reports.html

[4]NationalCenterforInjuryPreventionandControl(2015).CDCChildhoodInjuryReport.CentersforDisease

ControlandPrevention.Retrievedfromhttp://www.cdc.gov/safechild/child_injury_data.html[5]CentersforDiseaseControlandPrevention(2015).InjuriescosttheUS$671billionin2013.CDCNewsroom.

Retrievedfromhttp://www.cdc.gov/media/releases/2015/p0930-injury-costs.html[6]TheCommunityGuideforPreventiveServices(2016).Retrievedfromhttp://www.thecommunityguide.org/[7]NationalCenterforInjuryPreventionandControl(2016).NationalActionPlanforChildInjuryPrevention.

CentersforDiseaseControlandPrevention.Retrievedfromhttp://www.cdc.gov/safechild/nap/index.html

[8]NationalCenterforInjuryPreventionandControl,DivisionofUnintentionalInjuryPrevention(2015).Parents

aretheKeytoSafeTeenDrivers.CentersforDiseaseControlandPrevention.Retrievedfromhttp://www.cdc.gov/parentsarethekey/index.html


InjuryandViolencePreventionBranchwww.injuryfreenc.ncdhhs.gov

NorthCarolinaDHHSisanequalopportunityemployerandprovider.

childhood injury report 2011-2014

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