Intentional Injury Surveillance in a Primary Care Pediatric Setting

OBJECTIVE: To describe intentional injuries identified by primary care providers caring for children and adolescents, as reported through a prospective surveillance system. SETTING: Pediatric departments at four sites affiliated with a large health maintenance organization in eastern Massachusetts. DESIGN: Primary care providers completed brief injury encounter reports for patients aged 3 to 18 years treated for an intentional injury during a 20-month study period. For comparison purposes, a convenience sample of medical record was reviewed. RESULTS: Two hundred eleven injury encounter reports were received, representing a reported rate of 4.1 intentional injuries per 1000 panel members per year. These injuries ranged from contusions and lacerations to sexual assault and homicide. The median age of children at the time of injury was 14 years (interquartile range, 12 to 16 years), older than the population median age of 10 years (interquartile range, 6 to 14 years) (P<.001, Wilcoxon Signed Rank Test). Boys had a relative risk 1.5 times that of girls (P<.05, binomial test). Almost half of the injuries to adolescent girls resulted from encounters with other girls; 10% were the result of dating violence. In most cases, the patient and his or her assailant were friends or acquaintances (56%). This prospective surveillance detected, at most, 67% of intentional injuries seen, while medical record review detected 59% of the total identified injuries. CONCLUSIONS: Primary care pediatricians can identify and treat children and adolescents for intentional injuries. As these patients may form an appropriate group for interventions directed at reducing the risk of future intentional injuries, more effective public health surveillance must be developed.