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Epidemiology of Pediatric Injury—Related Primary Care Office Visits in the United States

Simon J. Hambidge, MD, PhD^*,, Arthur J. Davidson, MD, MSPH^*,,||, Ralph Gonzales, MD, MSPH^,¶ and John F. Steiner, MD, MPH^,¶

^* Department of Community Health, Denver Health and Hospital Authority, Denver, Colorado
Department of Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado
Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
^|| Department of Family Medicine, University of Colorado Health Sciences Center, Denver, Colorado
^¶ Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, Colorado

--> Objectives. Unintentional injuries are a major cause of childhood mortality and morbidity in the United States. However, there is little epidemiologic information about pediatric injuries seen in primary care settings. The objective of this study was to characterize types and external causes of childhood injuries seen by primary care physicians and to compare the demographic and visit characteristics of children with injury-related visits (IRVs) and non-IRVs.

Methods. A stratified random sample survey of office-based practicing physicians in the National Ambulatory Medical Care Survey (1997 and 1998) was conducted. Injury-related primary care office visits were measured for patients who were <19 years (number of patient visits = 6358).

Results. Visits for childhood injuries composed >10 million primary care office visits per year (a rate of 13.8 visits per 100 person-years). The most common diagnoses assigned to these injuries were open wounds, sprains and strains, contusions, and superficial injuries such as abrasions and splinters. Leading external causes of these injuries were sports and overexertion, accidental falls, natural factors such as bites and stings, and cutting instruments. The single most common cause of pediatric injuries was sports/overexertion. Children who had IRVs were more likely to be older (odds ratio [OR]: 1.10/year of age; 95% confidence interval [CI]: 1.08–1.12), to be male (OR: 1.5; 95% CI: 1.2–1.9), and to reside in the West (OR: 1.9; 95% CI: 1.4–2.6) or in a rural area (OR: 1.4; 95% CI: 1.1–1.9). They were less likely to be Asian (OR: 0.2; 95% CI: 0.1–0.5) or Hispanic (OR: 0.5; 95% CI: 0.3–0.8). At the visit, children with IRVs were more likely to see a physician who was not their primary care physician (OR: 1.8; 95% CI: 1.4–2.3) and to see a family physician rather than a pediatrician (OR: 2.3; 95% CI: 1.8–2.9).

Conclusions. IRVs account for a significant portion of primary care for children in the United States. Identifying potentially preventable external causes of injury and characteristics of children who are more likely to be injured is important both for injury prevention programs and for the education of physicians who care for children.

Key Words: pediatric injury • primary care • sports injuries • NAMCS

Abbreviations: ED, emergency department • IRV, injury-related visit • NAMCS, National Ambulatory Medical Care Survey • PCP, primary care physician • NCHS, National Center for Health Statistics • PRF, patient record form • PSU, primary sampling unit • RSE, relative standard error • SE, standard error • CI, confidence interval • OR, odds ratio

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