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Inj Prev. 2007 December; 13(6): 432.
PMCID: PMC2598296

SPLINTERS AND FRAGMENTS

Two new data reports have summarized trends in suicide and non‐fatal self‐inflicted injuries among two age groups in the USA: youth for suicide, and elders over age 65 for self‐inflicted injuries. The youth report presents data from a 24‐year period, and shows that, although suicide had declined by 28.5% from 1990 to 2003, during the most recent year of data (2003–04), a disturbing trend indicates a significant increase of 8%, the largest single‐year increase recorded over the 24 years. Much of the increase was among young females, a group that had previously shown low rates, and was attributed to increases in both hanging and self‐poisoning. It remains to be seen whether this trend continues when preliminary mortality data for 2005 are released at the end of the calendar year. Suicide is already the third leading cause of death in the USA for young people aged 10–24. Centers for Disease Control and Prevention. Suicide rate trends among youth ages 10–24 years, United States, 1990–2004 MMWR Morb Mortal Wkly Rep 2007;56:905–8.

The second report examined emergency department (ED) data and found that, in 2005, of approximately 7100 visits to the ED by older adults for self‐inflicted injuries, 80.4% were due to suicidal behavior. This translates to 19.3 visits per 100 000 population. The most common mechanism for self‐injury was poisoning, and, not surprisingly, almost three‐quarters of the self‐injuring older adults had a history of depression. Although this age group does not constitute the largest proportion of ED visits overall, older adults were more likely than younger adults to be hospitalized after their ED visits. The report did not indicate whether this is due primarily to greater medical severity or to the national payment system in the USA for medical care of older adults. Centers for Disease Control and Prevention. Nonfatal self‐inflicted injuries among adults aged >65 Years, United States, 2005. MMWR Morb Mortal Wkly Rep 2007;56:989–93.

A small study on preventing suicides by erecting barriers on one bridge underscores again how environmental strategies can be a successful approach. Over a 10‐year period, 13.6% of suicides in the area were by jumping, half of which occurred from a single suspension bridge. After barriers were erected, jumps resulting in death dropped by half. Suicide deaths by jumping at other sites showed no increase. Protective barriers were not erected on the buttresses of the suspension bridge, and half of the jumps that continued to occur were from the buttresses where there was no fencing. Bennewith O, Mowers M, Gunnell D. Effect of barriers on the Cliftonsuspension bridge, England, on local patterns of suicide: implications for prevention. Br J Psychiatry 2007;190:266–7.

The American Academy of Pediatrics has had a longstanding injury prevention anticipatory guidance and counseling program: The Injury Prevention Program or TIPP. Age‐related safety advice is offered to parents through both the website and office visits. The TIPP Safety Survey has been used widely since the mid 1980s, and has the benefits of being brief, available in Spanish, and in simple language. Until recently, its reliability and validity had not been measured. Urban, low‐income, minority household parents of pre‐schoolers were given surveys (in English and in Spanish) and, for some, a home safety audit was conducted. Results found that the TIPP Safety Survey is “a good measure of the concept of injury prevention knowledge and practice” but not a valid measure of injury prevention behaviors. Parents tend to report what is expected or desired of them, rather than actual behaviors. The authors note that counseling practices that home in only on the incorrect answers to a safety questionnaire may therefore miss important opportunities to try to influence behavior. Mason M, Kaufer Christoffel K, Sinacore J. Reliability and validity of the injury prevention project home safety survey. Arch Pediatr Adolesc Health 2007;161:759–65.

The Indian Health Service offers a free online newsletter which has been highlighted in this column in previous years. This year, two issues focus on injury prevention. The July issue included articles on using evidence‐based practices to reduce motor vehicle injuries, suicide prevention, and smoke alarm promotion. A second issue, released in the autumn, is also dedicated to injury prevention practices and promotion in Indian Country. Both issues are edited by Lawrence Berger, a pediatrician and longtime injury prevention practitioner. The full text of the IHS Provider is available free online at: http://www.ihs.gov/PublicInfo/Publications/HealthProvider/issues/PROV0707.pdf.

Two studies about burns provide interesting contrast and comparison with one another. In Israel, about 5% of all hospitalized injuries are burns. Data on 5000 burns patients admitted to five major hospitals with burns units were analyzed. Twice as many males as females were burned, and 44.7% of victims were children under the age of 10, with almost one‐fifth of all cases being infants under the age of 1. Hot liquids were responsible for 45.8% of young burns victims, followed by open fire (25.7%). Adults were most often burned by open flames. Most burns (58%) occurred at home, while 15% were work‐related. Not surprisingly, there was a high correlation between burn degree, total body surface area affected, and mortality. Halik J, Liran A, Tessone A, Givon A, Orenstein A, Peleg K. Burns in Israel: demographic, etiologic and clinical trends, 1997–2003. Isr Med Assoc J 2007;9:659–62.

The second study focused on all burns cases at a single inner‐city emergency room in the UK over 1 year. Only 3% of the cases were admitted to specialized burns units. Children under the age of 10 constituted 36% of all cases, and scalds caused 52% of all the injuries. Of the scalds, more than half occurred in the kitchen, primarily from preparing and carrying hot drinks. Most cases were managed on site, with only 5% being admitted. Primary care followed up 19% of cases; 12% were reviewed by plastic surgeons. There was a peak incidence of cases in November, which is fireworks season in the UK. Khan AA, Rawlins J, Shenton AF, Sharpe DT. The Bradford Burn Study: the epidemiology of burns presenting to an inner city emergency department. Emerg Med J 2007;24:564–566.

Published or read an interesting study lately? Please advise the editor of this column. Send citation or full article to Anara Guard, Anara_guard@verizon.net or by fax to 011 617 969 9186.


Articles from Injury Prevention are provided here courtesy of BMJ Publishing Group