The problem of injuries to children and adolescents is not a new one. In recent years, however, interest in trauma has increased dramatically for a number of reasons. Advances in the treatment and prevention of a wide variety of acute and chronic diseases have highlighted the importance of trauma as a cause of mortality, morbidity, and disability.1 An increasingly scientific approach to injury causation over the last 2 decades has led to progressively more effective prevention programs.2 The interest of government agencies at the national level such as the Centers for Disease Control and Prevention has been accompanied by an infusion of money for both research and prevention. As a result, the scientific and academic communities have taken a greater interest in this problem, and in the last decade, a large number of important contributions have appeared.3,,4
This article addresses where we have come and where we must go to reduce further the impact of unintentional injuries on children and adolescents in our society. Self-inflicted injuries and injuries attributable to interpersonal violence are not discussed. The publication of this article in the new Journal of the Ambulatory Pediatric Association is appropriate, because additional advances primarily will come from investigators in academic centers using basic and applied science and collaborating with clinicians to address the injury problem from the point of primary, secondary, and tertiary prevention.
REDUCTION IN INJURY MORTALITY
There have been some remarkable gains in injury control over the last 2 decades. Data are limited on the true incidence of injuries as well as its consequences; we must rely primarily on mortality data to track trends over time. In the pediatric age group, unintentional injury mortality has fallen by 45.3% between 1979 and 1996 (Table 1). The largest decreases have been among those 5 to 9 years of …