Injuries

Posted by • May 3rd, 2013

Injuries, whether intentional or unintentional, account for a substantial burden on the health care system. The latest article in our new Global Health series describes the magnitude of the problem worldwide, enumerates ongoing efforts to prevent injuries, and summarizes systems that need to be in place to care for the injured.

In 2010, there were 5.1 million deaths from injuries — almost 1 out of every 10 deaths in the world — and the total number of deaths from injuries was greater than the number of deaths from infection with the human immunodeficiency virus (HIV)-acquired immune deficiency syndrome (AIDS), tuberculosis, and malaria combined (3.8 million).

Clinical Pearls

What demographic groups are more likely to sustain injuries?

Male children, adolescents, and men, who accounted for about 68% of all injury-related deaths in 2010, sustain a disproportionate number of injuries. Although injuries are sustained across the life cycle, they affect young people (persons between 10 and 24 years of age) in particular, accounting for 40% of deaths in this age group. More than half of all deaths (52%) occurring in male adolescents and young men 10 to 24 years of age are caused by injuries.

• What was the leading cause of injury-related death in 2010?

In 2010, unintentional injuries were the cause of the majority of injury-related deaths (69%), as well as the majority of DALYs [disability-adjusted life-years] (72%). Transportation-related injuries (including injuries from both road-traffic incidents and non-road-traffic causes, such as incidents on the water or in the air) were the leading cause of injury-related deaths in 2010 and were responsible for 1.4 million deaths. Injuries from road-traffic incidents were the eighth leading cause of death overall and the leading cause of death among persons 10 to 24 years of age and were responsible for 17% of all deaths among males in this age group.

Table 1. Deaths from Cause-Specific Injuries in 2010.

Table 2. Estimates of the Rate of Death per 100,000 Persons Associated with Cause-Specific Injuries, According to Income Level and Region, in 2008.

Morning Report Questions

Q: What is the best means of preventing self-directed violence?

A: The best available evidence regarding the prevention of self-directed violence suggests that the medical sector has a significant role to play. Specifically, there is increasingly strong evidence of the effectiveness of educating clinicians in the appropriate identification and treatment of persons with mood disorders. In addition, there is good evidence to suggest that restricting access to the means of committing suicide, including access to pesticides, guns, and unprotected heights, is an effective preventive strategy, although it is one that is outside the realm of the health sector.

Q: How has in-hospital management for injured patients changed over the past decade?

A: In the past decade, large-scale, randomized, controlled trials conducted in emergency departments and intensive care units, including research focused specifically on the care of injured patients, have set new benchmarks for the provision of evidence-based, in-hospital trauma care. Not only are these trials providing evidence regarding effective treatments, such as the use of tranexamic acid to reduce the risk of death in patients with trauma-related bleeding (as shown in the Clinical Randomisation of an Antifibrinolytic in Significant Hemorrhage 2 [CRASH 2] study), but they are also providing evidence of useless and potentially harmful practices, such as the administration of glucocorticoids and the use of albumin for fluid resuscitation in the treatment of patients with major head injury. In low-resource settings, where surgeons are not readily available, evidence indicates that outcomes can be improved if general practitioners (or even nondoctors) can be trained in certain skills that would normally be carried out by emergency physicians or trauma surgeons in centers with better resources.

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