Injury prevention and control

Injury Prevention and Control Marion Sills, MD, MPH

Epidemiology

Injuries kill more children ages 1-21 years than any disease or illness. Nearly 100,000 people of all ages in the United States die from injury each year, roughly half of them in automobile crashes.

National Data

Mortality

Trauma is the leading cause of death in children 150,000 deaths annually 43% of all deaths from age 1 to 4 48% of all deaths in ages 5 to 14 62% of all deaths in ages 15 to 24 Homicide remains the second leading cause of death for adolescents and young adults Homicide is the leading cause of death for Black youth

Incidence of Pediatric Injuries: Cause of Death Rankings, U.S., 2005Age Groups

Rank <1 1-4 5-9 10-14 15-19 20-24

1CongenitalAnomalies

5,552

UnintentionalInjury1,664





2Short

Gestation4,714

CongenitalAnomalies

522

MalignantNeoplasms

485

MalignantNeoplasms

515

Homicide2,076

Homicide3,390

3SIDS2,230

MalignantNeoplasms

377

CongenitalAnomalies

196

Suicide270

Suicide1,613

Suicide2,599

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MaternalPregnancy

Comp.1,776

Homicide375

Homicide121

Homicide220

MalignantNeoplasms

731

MalignantNeoplasms

986

Utilization/Disability

Every 10 minutes, injury kills 2 people, and leaves 350 disabled 60 million injuries annually

o 30 million require medical care o 9 million cause disability o 3.6 million require hospitalization o 300,000 permanent disability

Injuries account for

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o Over 25% all ED visits

o 1/8 of all hospital beds

25-45% of youth (36% of high school students) have been in a fight in the last year

Costs

$ 400,000,000,000 annually More years of work life lost

than cancer and heart disease combined

Average economic cost related to motor vehicle crashes (MVC), 2006

o Death $1,210,000o Disabling injury $55,000o Property damage crash (including non-disabling injuries) $8,200

Average MVC comprehensive cost by injury severity, 2006o Death $4,000,000o Disabling injury $201,100o Non-disabling injury $50,400o Possible injury $24,400o No injury $2,200

Total injury-related non-hospitalized patients’ ED expenditures $2.3 billion (MEPS, 2003) Injury-attributable medical expenditures $19.1 billion (MEPS, 2000)

Annual cost of unintentional child injuries $300 billion (CDC)

Colorado Data

Mortality

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Age-adjusted Rate of Years of Potential Life Lost, U.S., 2005

0 200 400 600 800 1000

Unintentional Injury

Malignant Neoplasms

Heart Disease

Perinatal Period

Suicide

Homicide

Congenital Anomalies

Cerebrovascular

HIV

Liver Disease

All Others


Trauma is the leading cause of death in the first two decades of life Accidental trauma annually kills 78 Colorado children ages 0-14


1,696 children/year are admitted to hospitals and emergency departments 145,500 children/year receive other medical care

The Children’s Hospital Data

Mortality

Trauma is the leading cause of death in the first four decades of life Accidental trauma annually kills 78 Colorado children ages 0-14 Top 4 causes of death among trauma patients at TCH: (1) non-accidental trauma; (2)

motor vehicle collisions; (3) drowning; (4) pedestrian deaths.


1,200 children/year are admitted 30,000 children/year seen as outpatients

Costs

Outpatient visits alone cause $9.4 million to patients annually TCH loses $4.6 million on these outpatient visits annually More years of work life lost than cancer and heart disease combined medical expenses insurance administrative costs

Injury Prevention Research Overview

The Leading Health Indicators are a set of 10 high-priority public health issues in the United States. “Injury and Violence” is one of these 10 Leading Health Indicators.

Injury prevention interventions can make a big difference:

Child Seat Safety Laws increase seat use by 13%, decreasing fatal injuries by 35% and decreasing all injuries by 17%

Child safety seat distribution and education programs increase child safety seat use by 23%

Zero alcohol tolerance laws for drivers < 21 reduce alcohol-related crashes by 11%, resulting in 24% decrease in fatal crash outcomes

Midnight Driving Curfew Combined with Provisional Licensing for teenage drivers yields an estimated cost savings of $600 for a cost of only $74 per child.

Sobriety Checkpoints yield an estimated cost savings of $73,000 for a cost of only $9,600 per checkpoint.

Smoke Alarm Purchases yield an estimated cost savings of $940 for a cost of only $33 per smoke alarm.

Treatment Foster Care yields an estimated cost savings of $160,000 for a cost of only $2,200 per child.

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A 20% Alcohol Tax yields an estimated cost savings of $91 for an annual cost of only $9 per drinker.

Poison Control Centers yield an estimated cost savings of $290 for a cost of only $43 per call.

Functional Family Therapy results in $13.25 savings for every $1 cost, with reduction in crime

Life Skills Training results in $25.61 savings for every $1 cost, through reduction in drug use

Multidimensional Treatment Foster Care results in $10.88 savings for every $1 cost, through crime reduction

Project Towards No Drug Abuse results in $55.84 savings for every $1 cost through crime reduction

Injury Prevention Groups Affiliated with The Children’s Hospital

The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect's research programs examine a range of issues that affect abused and neglected children. A major focus of the Prevention Research Center for Family and Child Health (PRC) is on the examination of the long-term impact of a program of prenatal and infancy home visiting by nurses on the health and development of low-income, first-time mothers and their families, who have participated in a series of randomized controlled trials of this intervention. With funding from the National Institutes of Health, other federal agencies, and private philanthropies, longitudinal follow-ups of this program are being conducted in Elmira, New York; Memphis, Tennessee; and Denver, Colorado. These studies examine program effects on childhood injury, as well as on maternal economic self-sufficiency, substance abuse, and children’s adaptive functioning, including mental health, criminal behavior, and productive life course as the children reach adolescence and young adulthood.

The Center for the Study and Prevention of Violence (CSPV), a research program of the Institute of Behavioral Science (IBS) at the University of Colorado at Boulder, was founded in 1992 to provide informed assistance to groups committed to understanding and preventing violence, particularly adolescent violence. In an effort to establish more complete and valuable information to impact violence-related policies, programs, and practices, CSPV works from a multi-disciplinary platform on the subject of violence and facilitates the building of bridges between the research community and the practitioners and policy makers.

The Trauma Research Center in the Department of Surgery at the University of Colorado at Denver School of Medicine includes research using clinical patient database/samples, bench experiments and emerging knowledge on inflammatory signaling to maximize the opportunity to develop mechanistic insights into the body’s response to trauma, and improve clinical practice.

The Kiwanis Pediatric Trauma Institute (KPTI) was founded in 1994 as a partnership between The Children's Hospital and the Rocky Mountain District of Kiwanis and is dedicated to the prevention and education of childhood injuries to children in Colorado, Wyoming and western Nebraska. KPTI recognizes that injuries are not “accidental” results from chance or unpredictable occurrences. Injuries are preventable when addressed through environmental changes, public policy and education, especially with adequate funds to support these strategies. Since KPTI’s formation, Kiwanis, TCH operating, grants and other restricted funds have supported the Institute in an effort to achieve this mission with an average annual budget of almost $400,000.

The Colorado Injury Control Research Center (CIRC), located at Colorado State University, was established in 1995 as one of 12 national injury centers funded (R49) by the National Center for Injury Prevention and Control, a division of the Centers for Disease Control and Prevention. The CICRC’s research projects have addressed a wide range of injury topics including; drug use

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and risky behavior among rural youth, laboratory based research on survival of sensory and motor neurons after injury, motor vehicle mortality in rural and urban areas, rehabilitation care for individuals suffering traumatic brain injuries, risk communication for injuries, community based traumatic brain injury prevention, reduction of driving anger, laboratory based research on protective factors against brain injury, injury among disabled individuals, and development of a registry of alcohol-impaired drivers.

The Rocky Mountain Research and Prevention Institute (RMRPI) is a 501(c)3 non-profit corporation that enables prevention-minded coalitions and organizations in the Rocky Mountain region to maximize funding mechanisms for prevention projects that utilize a combined approach of education, research, advocacy, and media.

The Mile High Regional Emergency Medical and Trauma Advisory Council (Mile High REMTAC) develops and implements an integrated medical and trauma system that is designed to address all components of trauma care from injury detection/control, definitive care and rehabilitation.

Injury Prevention Researchers Affiliated with The Children’s Hospital

The Children’s Hospital

Robert B Clyman, MDAssociate Professor of Pediatrics and PsychiatryCo-Section Head, Family and Child HealthJack and Viki Thompson Chair in Child Maltreatment and Family HealthExecutive Director, Kempe Center for the Prevention and Treatment of Child Abuse and NeglectDr. Clyman’s research focuses on children in the foster care system. Two broad areas are under investigation. The first is developmental risk and prevention in infants placed in foster care, and the second concerns the relations between policy and service system variables and child and family outcomes. Child maltreatment is among the outcomes studied.

Jeannie Dise-Lewis, PhDAssociate ProfessorPediatric Psychology, Pediatric RehabilitationUniversity of Colorado Denver Health Science CenterThe Children's Hospital [email protected] Dr. Dise-Lewis is grant-funded by the National Center for Injury Prevention and Control to conduct a comprehensive, longitudinal study of the course of traumatic brain injury (TBI) in children, from initial injury through long-term community reintegration. Her research addresses tertiary injury prevention, by establishing a comprehensive database of variables related to psychosocial outcomes of TBI in children and youth and interventions that may improve these outcomes.

Steve Moulton, MDDirector Pediatric Trauma and Burn ProgramsThe Children’s HospitalProfessor of SurgeryUniversity of Colorado, School of [email protected]. Moulton was the senior author on a project entitled “Teen Traffic Safety Campaign” (presented at the 2008 Western Trauma Association meeting in Squaw Valley, manuscript submitted to the Journal of Trauma). Co-authors at TCH included Theresa Rapstine and Jeri Harwood.

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mailto:[email protected]


David Olds, Ph.D.Professor of Pediatrics, Psychiatry, Preventive Medicine, and Nursing University of Colorado Denver School of MedicineDirector, Prevention Research Center for Family and Child HealthThe Prevention Research Center is replicating its own nurse home visitation program (now called the Nurse-Family Partnership program), studying the impact of this program on childhood injuries, among other outcomes.

Theresa Rapstine, BSN, RN Director, Injury Prevention and Outreach EducationKiwanis Pediatric Trauma Institute, The Children’s [email protected]. Rapstine has been involved with several injury prevention studies including

“Appropriate use of child passenger restraints distributed at a primary care clinic” looking at parental knowledge and seat fitting pre and post a one-on-one education with family

“Teen Safety Belt Challenge” – a friendly peer-to-peer challenge conducted in 12 Metro High Schools which has increase seats belt use by 20%. Findings have been presented at several national meetings and has been submitted to the Journal of Trauma for publication

Currently surveying Colorado regional emergency trauma advisory councils and partners to identify injury prevention gaps state-wide.

Studying the effectiveness of the Colorado Shaken Baby Prevention Campaign.

Arleta Rewers, MD, PhDAssistant ProfessorDivision of Emergency Medicine, The Children's Hospital Department of Pediatrics, University of Colorado Denver School of [email protected] Dr. Rewers' injury-prevention-related research is focused on injury prevention in rural areas and among underserved pediaric populations. Another areas of focus are injury epidemiology and tertiary injury prevention.

Eric Sigel MDAssociate Professor of PediatricsUniversity of Colorado Denver Health Science CenterThe Children's Hospital [email protected]. Sigel has developed and evaluated a screening tool to assess risk for current and future violence involvement, for use in the primary care (and other) settings. He was originally funded by the Colorado Injury Control Research Center, with continued funding from The Research Institute and the CDC. Dr. Sigel currently holds a K award from the CDC to further his research. His primary mentor is Terence Thornberry, PhD director of the Center for the Study and Prevention of Violence (CSPV) at the University of Colorado at Boulder. He is working with Dr. Thornberry on developing an evidence-based program to treat gang-involved youth. He is also part of a gang consortium in Denver, and is spearheading the medical response to gang-involved youth. There is an obvious connection between gang involvement, and risk for violence related injury. Recently Dr. Sigel has been funded by the CCTSI (academic-community partnership grant) to evaluate violence risk in 9th graders at East High School starting in August 2009.

Christopher C. Silliman, MD, PhDProfessor of Pediatrics and SurgeryDr. Silliman has received many research grants for his work, including grants from both NHLBI and NIGMS at NIH. His research interests include trauma-induced multiple organ failure.

Heather Taussig, PhDDirector, Fostering Healthy Futures Program

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https://mytch.thechildrenshospital.org/CitrixFEI/[email protected]


Assistant Professor of Pediatrics and PsychiatryUniversity of Colorado School of Medicine Dr. Taussig's research interests are in the field of child abuse and neglect and foster care, with an emphasis on randomized controlled trials of interventions. This project was supported by grants from the National Institute of Mental Health and the Kempe Foundation, Pioneer Fund, Daniels Fund and Children’s Hospital Research Institute. Fostering Healthy Futures (FHF) is a randomized controlled trial of an innovative preventive intervention for preadolescent youth (ages 9–11) placed in out-of-home care. The program is designed to promote child well-being by identifying and addressing mental health issues, preventing adolescent risk behaviors, and promoting competence.

University of Colorado Denver School of Medicine

Anirban Banerjee PhDProfessor of Surgery, University of Colorado Denver School of Medicine [email protected]. Banerjee is the PI on a series of NIH-funded center grants establishing a multi-year collaboration between the Rocky Mountain Regional Trauma Center at Denver Health and University of Colorado Denver. His research seeks to understand why some patients develop multiple organ failure after severe injury. This grant focuses on tertiary injury prevention, seeking to develop methodologies to improve care for trauma patients, especially those suffering from shock and multiple organ failure. It is one of only eight federally supported initiatives for trauma research nationwide, and the only one of its kind in the central United States. Joining Dr. Banerjee as a co-investigator is Chris Silliman, MD, PhD, associate professor of pediatrics at UCD.

Colorado School of Public Health

Carolyn DiGuiseppi, MD, MPH, PhDAssociate Director for Research, Colorado Injury Control Research CenterProfessor of Epidemiology; Director, Preventive Medicine Residency Program; Associate Director for Research, CICRCColorado School of Public [email protected] Dr. DiGuiseppi has two primary areas of research: Community-based trials of interventions to prevent injuries and conduct of systematic reviews of injury prevention interventions. She is currently funded by the CDC to develop, implement and evaluate a social marketing program to promote balance classes for older adults to prevent falls; to conduct two systematic reviews of interventions to prevent suicide; to maintain a register of controlled trials that evaluated interventions to prevent drunk driving; and to analyze data on injuries and safety from the Colorado Child Health Survey. Current and recent (completed within the last 2 years) studies that she has led or in which she has participated include controlled trials and epidemiological studies related to booster seat use, seat belt use, alcohol-impaired driving, and motor vehicle crashes; screening of injured patients for problem drinking; housing safety and injury risk in Latino families; parent supervision for child safety; and survival and outcomes after traumatic brain injury.

Thao N. Le, MPH, Ph.D.Assistant ProfessorAffiliated Faculty, Psychology DepartmentAffiliated Faculty, Colorado School of Public HealthAffiliated Faculty, Colorado Injury Control Research [email protected]. Le’s research interests include Asian and immigrant youth delinquency/violence; cross-cultural development; evaluation of youth violence prevention programs; and multiculturalism.

Marilyn Leff, PhD, MSPH, MSW

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https://mytch.thechildrenshospital.org/CitrixFEI/[email protected]


Postdoctoral research associateColorado Injury Control Research CenterColorado State UniversityFt. Collins, [email protected]

Dr. Leff’s research focuses on rural and urban non-fatal injury; disability and injury; and on suicidal behaviors. Her research uses injury surveillance data that has been collected inColorado. Her recent research focus has been on suicidal ideation among women receiving government assistance as well as finishing her dissertation on depressive symptoms, drinking patterns, and farm-work injury. She is also currently studying the influence of environmental barriers on the increased risk of injury to people with disabilities. Her main collaborator in the past two years has been Dr. Lorann Stallones.

Pat L. Sample, Ph.D.Associate Professor, Department of Occupational TherapyColorado State [email protected] Director for Education and Training, Colorado Injury Control Research CenterDr. Sample’s research interests include Service Access for Persons with Traumatic Brain Injuries, School to Adult Life Transition Planning and Program Efficacy, Program Evaluation, Participatory Action Research with Individuals with Disabilities, and Specialized Support Services for Students with Emotional and Behavioral Disorders.

Lorann Stallones, MPH, PhDProfessor of EpidemiologyDirector, Colorado Injury Control Research CenterHead, Graduate Degree in Public HealthDepartment of PsychologyColorado State UniversityColorado School of Public [email protected]. Stallones' research interests include agricultural health and safety and rural/urban differences in injury patterns.

Affiliated Researchers

Lisa Van Bramer, MD, MSPHRocky Mountain Research and Prevention InstituteDr. Van Bramer has been grant-funded by the National Center for Injury Prevention and Control to develop and implement a comprehensive electronic injury surveillance system linking pre-hospital and Department of Safety data to the Denver Health trauma registry, incorporating geospatial analysis as a tool to improve the comprehensiveness, usefulness, and accessibility of the surveillance system, and providing a model for other locales to enhance public health infrastructure.

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Healthcare

Injury prevention and control