PEDIATRIC INJURY PREVENTION AND THE ROLE OF TRAUMA CENTERS

INTERN: EVAN PETERSMENTORS: JOYCE PRESSLEY, PHD, MPH

CHANG LIU, MPHAUGUST 5TH, 2016COLUMBIA UNIVERSITY: SUMMER PUBLIC HEALTH SCHOLARS PROGRAM

INJURY IS A SERIOUS PUBLIC HEALTH ISSUE• The most common cause of death among people 1- 44 years of age• The leading cause of disability and a significant contributor to the loss of

productive years of life and a major contributor to health care cost• Constitutes over 35% of all emergency department visits and 10% of all

physician office visits• In the U.S. 90,000 unintentional deaths, 20,000 homicides and 20,000

suicides• The life time cost of injuries in 1990 estimated at approximately $215 billion• Trauma Centers are playing a key role in hospital-based, community-focused

injury prevention

Source: Centers for Disease Control

PRACTICUM SCOPE• Read literature on injury, injury disparities, injury prevention and trauma

centers where a lot of injury prevention and injury care is delivered• Learned to use the CDCs interactive query system, WISQARS

• Updated some of the practicum sites previously published 20-year trend charts on injury by race and ethnicity

• Became familiar with the American College of Surgeon’s verification criteria for level one trauma centers• Examined ATS injury prevention coordinators course

• Reviewed a newly released landmark National Academy of Science Publication titled “Integration of Military and Civilian Trauma Care Systems Needed to Reach National Aim of Zero Preventable Deaths After Injury”• Listened to a Congressional hearing held on July 12 2016 on the future

directions of trauma care

1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

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60Trends in all Injuries by race and ethnicity from 1981-2014 Am Indian/AK

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Source(s): Pressley JC, Barlow B, Kendig T, and Paneth-Pollak R. Twenty-year trends in fatal injuries to very young children: The persistence of racial disparities. Pediatrics 2007;119(4)119;e874-84 and CDC WISQARS

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Trends in unintentional Injuries by race and ethnicity from 1981-2014

Source(s): Pressley JC, Barlow B, Kendig T, and Paneth-Pollak R. Twenty-year trends in fatal injuries to very young children: The persistence of racial disparities. Pediatrics 2007;119(4)119;e874-84 and CDC WISQARS

1981-1983 1984-1986 1987-1989 1990-1992 1993-1995 1996-1998 1999-2001 2002-2004 2005-2007 2008-2010 2011-2013 20140

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12Trends in intentional Injuries by race and ethnicity from 1981-2014 Am Indian/AK

BlacksHispanicWhiteAsian/PI

Source(s): Pressley JC, Barlow B, Kendig T, and Paneth-Pollak R. Twenty-year trends in fatal injuries to very young children: The persistence of racial disparities. Pediatrics 2007;119(4)119;e874-84 and CDC WISQARS

1981-1983 1984-1986 1987-1989 1990-1992 1993-1995 1996-1998 1999-2001 2002-2004 2005-2007 2008-2010 2011-2013 20140

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14Trends in residential fires by race and ethnicity from 1981-2014 Am Indian/AK

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Source(s): Pressley JC, Barlow B, Kendig T, and Paneth-Pollak R. Twenty-year trends in fatal injuries to very young children: The persistence of racial disparities. Pediatrics 2007;119(4)119;e874-84 and CDC WISQARS

1981-1983 1984-1986 1987-1989 1990-1992 1993-1995 1996-1998 1999-2001 2002-2004 2005-2007 2008-2010 2011-2013 20140

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12 Trends in pedestrian injuries by race and ethnicity from 1981-2014Am Indian/AK

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Source(s): Pressley JC, Barlow B, Kendig T, and Paneth-Pollak R. Twenty-year trends in fatal injuries to very young children: The persistence of racial disparities. Pediatrics 2007;119(4)119;e874-84 and CDC WISQARS

INJURY PREVENTION SUCCESS• Residential Fire Injuries

• Smoke Alarm Distribution Programs Save Lives• Poison Prevention Packaging Act

• 45% decrease in poisoning deaths • Child-proof containers • Packaging in non-lethal doses

• Motor Vehicle Injuries: • Since 1920’s Six fold increase in number of drivers • 11 times the number of motor vehicles • 10 times the number of miles traveled • 90% decrease in the annual death rate per 100 million vehicle miles traveled

Sources: US Guide to Clinical Preventive Services, report of the U.S. Preventive Services Task Force and the Institute of Medicine, Reducing the burden of Injury

INJURY PREVENTION SUCCESSES

Pressley JC, Barlow B, Durkin M, Jacko SA, Dominguez DR, Johnson L. A national program for injury prevention in children and adolescents: The Injury Free Coalition for Kids. Journal of Urban Health 2005 82: 389-402.

STRENGTHENING OUR NATIONAL TRAUMA SYSTEM• The care provided by trauma centers, including specialist physicians,

nurses and their entire trauma teams, has a dramatic and cost-effective impact on patients' subsequent quality of life. • Only one in ten hospitals serves as a major trauma center.• Trauma centers need federal funding.• Establish a permanent, self-sustaining revenue stream for these

programs.• When the system delivers optimal care, lives are saved.

Source: National Academy of Science

THE FIVE “E’S” OF INJURY PREVENTION

• Epidemiology: you can’t prevent it if you don’t understand it. Data collection is key.• Education: awareness, attitudes, cultural beliefs• Enforcement: rules, life safety codes etc.• Engineering: changing the environment to make it safer• Evaluation: did the changes made in education, enforcement,

and engineering have the desired outcome on incidence?

Source: Aehlert Redbooks

KEY ELEMENTS OF EFFECTIVE INJURY PREVENTION PROGRAM• Target the community – identify primary causes of injury and death• Work upstream to develop the “root cause” of injury and its contributing factors• Choose pre-existing proven or promising programs – work with community groups• Leverage the media to disseminate information on IP Program, why it’s important

and how the public can help• Work with political leaders – educate them and help them create laws that

promote injury prevention.• Follow data – track prevention effectiveness

Source: Occupational Safety & Health Administration

SUMMARY• Children’s and Adult trauma centers are actively providing primary injury prevention as

well as care to injured children• Injury-related racial and ethnic disparities continue in total injury, unintentional injury as

well as intentional injury• During my practicum experience, I learned to use a CDC sponsored interactive query to examine

some of these disparities• There are significant efforts at the national level to improve trauma care for all populations

• Both the National Academy of Sciences and Congress are examining how to improve trauma care and reduce disparities

• There are successes in these efforts, but challenges remain• Through my practicum experience, I was exposed to who the key players in trauma care

are and to high level late breaking initiatives in this area • Late breaking initiatives in this area that occurred during my practicum

• The National Academy of Sciences released a landmark report in late June • Congress held hearings on the findings in mid-July. I was provided with a weblink that allowed me

to listen to the hearings

QUESTIONS?

REFERENCES• Pressley JC and Barlow B. Child and adolescent injury as a result of falls from buildings and structures.

Injury Prevention 2005;11(5):267-273. • Pressley JC, Barlow B, Durkin M, Jacko SA, Dominguez DR, Johnson L. A national program for injury

prevention in children and adolescents: The Injury Free Coalition for Kids. Journal of Urban Health 2005 82: 389-402.

• Pressley JC and Barlow B. Preventing injury and injury-related disability in children and adolescents. Seminars in Pediatric Surgery 2004;13(2):133-140.

• Pressley JC, Barlow B, Kendig T, and Paneth-Pollak R. Twenty-year trends in fatal injuries to very young children: The persistence of racial disparities. Pediatrics 2007;119(4)119;e874-84.

• Pressley JC, Trieu L, Kendig T, and Barlow B. National injury-related hospitalizations in children: Public vs. private expenditures across preventable injury mechanisms. Journal of Trauma –Injury, Infection, and Critical Care 2007; 63: S10-19.