REVIEW ARTICLE
A Comprehensive Approach to Pediatric Injury Prevention in the Emergency Department Mark R. Zonfrillo, MD, MSCE,* Marlene Melzer-Lange, MD,Þ and Michael A. Gittelman, MDþ
Abstract: Injury is the leading cause of pediatric mortality and longterm disability. Although the primary care setting has traditionally been considered as the main venue to address injury anticipatory guidance, an emergency department (ED) visit may serve as a ‘‘teachable moment’’ because most injured children are cared for in this setting and the experience may elicit a greater chance of behavior change. However, EDs can also provide additional information and services beyond counseling to prevent injuries. These adjunct efforts and activities focus on primary injury prevention (screening for and promoting safe behaviors and collecting data to survey high-risk community locations), secondary prevention (use of safety products to mitigate injury), and tertiary prevention (maximizing injury care and minimizing injury sequelae). This review will describe several ways an ED can help to mitigate the epidemic of pediatric injuries through surveillance, screening, education, product disbursement, community engagement, and quality improvement efforts. Key Words: injury prevention, injury control, safety device, interventions (Pediatr Emer Care 2014;30: 56Y62)
‘‘Emergency medicine physicians need little convincing that injury prevention is a public health priority. Clinical experience alone creates a clear appreciation for the impact that injuries have on children and their families. The role of the emergency physician is evolving from primary responsibility for the acute care of injuries to a more expanded prevention role including education, research and advocacy.’’ (M. Denise Dowd, MD, MPH, and Marilyn Bull, MD)1
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ore than 9000 children in the United States and 830,000 children worldwide younger than the age of 18 years die of injury annually,2,3 and unintentional fatal injuries in the United States account for nearly 42% of pediatric deaths.4 However, deaths due to injury are only a small component of the true impact injury on the US medical system. Each year in the United States, injured children account for more than 2 million outpatient visits, 9 million emergency department (ED) From the *Division of Emergency Medicine, Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA; †Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI; and ‡Division of Emergency Medicine, Comprehensive Children’s Injury Center, Cincinnati Children’s Hospital, Cincinnati, OH. Disclosure: The authors declare no conflict of interest. This study was presented in part at the 2012 American Academy of Pediatrics National Conference and Exhibition and at the joint program of the Section on Emergency Medicine and the Council on Injury, Violence, and Poison Prevention. Reprints: Mark R. Zonfrillo, MD, MSCE, Division of Emergency Medicine, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104 (e
A Comprehensive Approach to Pediatric Injury Prevention in the Emergency Department Mark R. Zonfrillo, MD, MSCE,* Marlene Melzer-Lange, MD,Þ and Michael A. Gittelman, MDþ
Abstract: Injury is the leading cause of pediatric mortality and longterm disability. Although the primary care setting has traditionally been considered as the main venue to address injury anticipatory guidance, an emergency department (ED) visit may serve as a ‘‘teachable moment’’ because most injured children are cared for in this setting and the experience may elicit a greater chance of behavior change. However, EDs can also provide additional information and services beyond counseling to prevent injuries. These adjunct efforts and activities focus on primary injury prevention (screening for and promoting safe behaviors and collecting data to survey high-risk community locations), secondary prevention (use of safety products to mitigate injury), and tertiary prevention (maximizing injury care and minimizing injury sequelae). This review will describe several ways an ED can help to mitigate the epidemic of pediatric injuries through surveillance, screening, education, product disbursement, community engagement, and quality improvement efforts. Key Words: injury prevention, injury control, safety device, interventions (Pediatr Emer Care 2014;30: 56Y62)
‘‘Emergency medicine physicians need little convincing that injury prevention is a public health priority. Clinical experience alone creates a clear appreciation for the impact that injuries have on children and their families. The role of the emergency physician is evolving from primary responsibility for the acute care of injuries to a more expanded prevention role including education, research and advocacy.’’ (M. Denise Dowd, MD, MPH, and Marilyn Bull, MD)1
M
ore than 9000 children in the United States and 830,000 children worldwide younger than the age of 18 years die of injury annually,2,3 and unintentional fatal injuries in the United States account for nearly 42% of pediatric deaths.4 However, deaths due to injury are only a small component of the true impact injury on the US medical system. Each year in the United States, injured children account for more than 2 million outpatient visits, 9 million emergency department (ED) From the *Division of Emergency Medicine, Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA; †Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI; and ‡Division of Emergency Medicine, Comprehensive Children’s Injury Center, Cincinnati Children’s Hospital, Cincinnati, OH. Disclosure: The authors declare no conflict of interest. This study was presented in part at the 2012 American Academy of Pediatrics National Conference and Exhibition and at the joint program of the Section on Emergency Medicine and the Council on Injury, Violence, and Poison Prevention. Reprints: Mark R. Zonfrillo, MD, MSCE, Division of Emergency Medicine, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104 (e
