Trends in Pediatric Nonfatal and Fatal Injuries

Fatal (2011–2021) and nonfatal injury (2011–2020) data for children aged <18 years were derived from the Centers for Disease Control and Prevention, the National Center for Health Statistics’ Web-based injury statistics query and reporting system (WISQARS). Fatal injury data in WISQARS are based on death certificates from the National Vital Statistics System. WISQARS provides exact death counts and death rates for the United States by age, intent, and mechanism. Nonfatal injuries presented in WISQARS provide national estimates on the basis of weighted data from the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System. Case fatality rates were calculated as the percentage of injuries that were fatal for each intent or mechanism. Linear regressions were used to evaluate time trends in fatal and nonfatal injury rates on the basis of intent and mechanism. The study is exempt from the institutional review board.

At the beginning of the study period in 2011, fatal injury rates were 14.07 per 100 000 children and increased to 17.30 per 100 000 by 2021 (P = .006 for linear trend). In contrast, nonfatal injuries decreased from 11 592.56 per 100 000 to 5359.73 per 100 000 in 2020 (P < .0001) (Fig 1A). Nonfatal unintentional injuries and assaults decreased (54.9% and 59.8%, respectively, P < .0001), whereas nonfatal self-harm injuries increased by 57.1% (P < .0001) (Fig 1B). Firearm fatalities increased by 87.1%, drug poisoning fatalities increased by 133.3%, and suffocation-related fatalities increased by 12.5% (Fig 1C). At the same time, although the leading causes of nonfatal injuries decreased across most mechanisms (52.8% decrease in injuries from falls, P < .0001; a 66.7% decrease in injuries from overexertion, P < .0001; a 63.0% decrease in struck by against injuries, P < .0001; a 47.3% decrease in motor vehicle occupant injuries, P = .005; a 36.7% decrease in cut pierce injuries, P < .0001), nonfatal injuries from drowning did not change (P = .715) and nonfatal firearm- and poison-related injuries increased (113.1%, P = .015 and 9.9%, P = .013, respectively) (Fig 1C). From 2011 to 2020, the overall case fatality rate increased by 250% (P = .0012) (Fig 1D), with the highest case fatality rates in firearm, drowning, and suffocation (Fig 1E).

Over the past decade, we observed dramatic increases in pediatric case fatality rates, driven both by declining nonfatal injuries and increasing fatal injuries. The divergent trends between fatal and nonfatal injuries highlight the need for a comprehensive approach to childhood injury prevention. Notably, pediatric injury fatalities sharply increased in the pandemic years of 2020 to 2021, and it remains unclear whether these trends will continue. In contrast, nonfatal injuries showed a steady declining trend throughout the study period, driven largely by decreases in falls (3564 per 100 000 in 2011 vs 1682 per 100 000 in 2020) and struck by/against (2945 per 100 000 in 2011 vs 1088 per 100 000 in 2020) mechanisms. The decrease in nonfatal injuries may also be driven, in part, by recent public health interventions targeting pediatric safety partnered with technological advancements and legislative requirements. For example, improved booster seat technology has been paired with effective legislative and education campaigns.⁴  Yet, despite the progress in reducing most nonfatal injuries, the trends in increasing nonfatal firearm and poisoning injuries defy the overall trend in nonfatal injuries, in part because public health legislative support has lagged in these critical injury mechanisms. This is especially concerning given the high case fatality rate of these injury mechanisms in children. Targeted interventions, such as strengthening legislation, enhancing public awareness, and improving health care systems are needed to address both fatal and nonfatal injuries among children, but these efforts alone are likely not sufficient, given the myriad societal forces that impact pediatric injuries. Continued research and surveillance are crucial to monitor trends, evaluate interventions, and inform evidence-based strategies for effective injury prevention and mitigation.

WISQARS

Web-based injury statistics query and reporting system