The Pyramid of Injury: Estimation of the Scale of Adolescent Injuries According to Severity

Abstract

ObjectivesDue to their developmental characteristics, adolescents have a higher probability than other age groups of experiencing injuries caused by accidents, violence, and intentional self-harm. The severity and characteristics of injuries vary by the intentionality and mechanism of injury; therefore, there is a need for a national-level estimate of the scale and the severity of injuries in adolescents that takes these factors into account.MethodsBy using data from the Emergency Department-based Injury In-depth Surveillance Data, National Emergency Department Information System, the Korean National Hospital Discharge In-depth Injury Survey, and cause of death statistics, we calculated the emergency department (ED) visit rate, hospitalization rate, and death rate of injuries per 100 000 adolescents for each injury mechanism. The calculated rates were used to generate the injury pyramid ratio (ratio of death rate to hospitalization rate to ED visit rate) to visualize the scale and the severity of the injury.ResultsThe mortality rate in adolescents due to injury was 10/100 000; the corresponding rates for hospitalization and ED visits were 1623 and 4923, respectively, resulting in an injury pyramid ratio with the general pyramid form, with a 1:162:492 ratio of deaths to hospitalizations to ED visits. The mortality rate due to suicide/intentional self-harm was 5/100 000, while 35 were hospitalized for this reason and 74 made ED visits. The pyramid ratio of 1:7:15 for intentional self-harm/suicide showed a steep pyramidal form, indicating considerable lethality. The mortality rate due to motor vehicle collisions (MVCs) was 3/100 000; 586 were hospitalized for this reason, while 1023 made ED visits. The pyramid ratio of 1:195:341 for MVCs showed a gradual pyramid form, indicating that the lethality was low and the scale of injury was high.ConclusionsThe main categories of injuries in adolescents were visualized in pyramid form, contributing to an understanding of the scale of each injury by mechanism in terms of levels of death, hospitalization, and ED visits. These findings will be helpful for understanding how to prioritize injuries in adolescents.

The injury mechanisms and injury pyramids among children and adolescents in Zhuhai City, China

“…Wadman MC [11] believed that according to the lethality of the injury mechanism, injury data will lead to 3 different pyramid types, with an inverted pyramid indicating high-lethality injuries (C), a rectangular pyramid indicating mid-level-lethality injuries (B), and a typical pyramid indicating low-lethality injuries (A). The ratio of injury pyramid of self-harm/suicide among South Korean youth was 1:7:15 [10] , showing a steep pyramid (type C); this was similar to the injury pyramid of self-harm/suicide among children and adolescents in Zhuhai City (1:3:20), indicating that self-harm/suicide had considerable lethality. The drowning injury pyramid was in the shape of an inverted triangle, indicating that, for every outpatient/emergency department injury visit that occurred, there were 1.3 injury hospitalizations and 2 injury deaths.…”

“…Similar to the injury pyramid (1:36:1014) described by Lee [9] for children and adolescents ≤19 years old living in Massachusetts, USA, Ballesteros [44] also found that every injury death among children in the United States was accompanied by approximately 1,000 injury-related outpatient/emergency department visits. Compared with the injury pyramid for South Korean adolescents (1:162:492) [10] , for every injury death, the percentage of injury hospitalizations of children and adolescents in Zhuhai City was small, while the proportion of outpatient/emergency department visits was high. This difference may be due to different medical guarantees in different countries, and China may have a relatively heavy burden of hospitalization costs, which limits hospitalizations.…”

“…Lee [9] described the injury pyramid ratio for children and adolescents living in Massachusetts in the United States as 1:36:1014. The injury pyramid ratio among South Korean teenagers (13-18 years old) was 1:162:492 [10] . The unintentional injury pyramid ratio in South Korea was 1:54:231 [8] .…”

The injury mechanisms and injury pyramids among children and adolescents in Zhuhai City, China

“…Wadman MC [11] believed that according to the lethality of the injury mechanism, injury data will lead to 3 different pyramid types, with an inverted pyramid indicating high-lethality injuries (C), a rectangular pyramid indicating mid-level-lethality injuries (B), and a typical pyramid indicating low-lethality injuries (A). The ratio of injury pyramid of self-harm/suicide among South Korean youth was 1:7:15 [10] , showing a steep pyramid (type C); this was similar to the injury pyramid of self-harm/suicide among children and adolescents in Zhuhai City (1:3:20), indicating that self-harm/suicide had considerable lethality. The drowning injury pyramid was in the shape of an inverted triangle, indicating that, for every injury death that occurred was accompanied by 0.7 injury hospitalization and 0.5 outpatient/emergency injury visit.…”

“…Similar to the injury pyramid (1:36:1014) described by Lee [9] for children and adolescents ≤19 years old living in Massachusetts, USA, Ballesteros [[xxx]] also found that every injury death among children in the United States was accompanied by approximately 1,000 injury-related outpatient/emergency department visits. Compared with the injury pyramid for South Korean adolescents (1:162:492) [10] , for every injury death, the percentage of injury hospitalizations of children and adolescents in Zhuhai City was small, while the proportion of outpatient/emergency department visits was high. This difference may be due to different medical guarantees in different countries, and China may have a relatively heavy burden of hospitalization costs, which limits hospitalizations.…”