MLHU - Health Status Resource

Injury

Injury
Key Findings: 

Most child and youth injuries are preventable.1 Unintentional injuries are injuries that are not deliberate and are often referred to as accidents; examples include falls, motor vehicle collisions, poisonings, and drownings, to name a few. Intentional injuries are those that occur when someone deliberately brings harm to themselves or others; examples include violence, self-harm and suicide. Intentional injuries are also important to consider as they are a marker of mental well-being in the community. Either type of injury can result in emergency department visits, hospitalizations, or even life-long disability (e.g., brain or spinal cord injuries) or death. While children and youth had the highest rate of emergency department visits for injuries in Middlesex-London, they also had the lowest rate of injury-related deaths when comparing across age groups. As most child and youth injuries are preventable, continued public health efforts are needed to reduce the burden of injuries in this population.

All Causes of unintentional injuries  Self-harm and suicide 
Falls Road and off-road safety 
Concussions   

All causes of unintentional injuries

The All Causes of Unintentional Injuries section contains data for the overall Middlesex-London population.

When comparing across all age groups, the rate of deaths from unintentional injuries was lowest among those age 0–19 years from 2010–2012 at 4.5 per 100,000 population (Figure 4.1.2). However, this age group had the highest rate of emergency department visits from unintentional injury in 2017 (Figure 4.1.4). Age-standardized emergency department visit rates were significantly higher among males than females (not shown).

Interpretation

Unintentional injuries were the leading cause of death among children and youth (1–19 years) in Canada from 2000 to 2017.2 The leading causes of unintentional injury deaths shift as children grow into youths. For Canadian children age 1–4, the leading causes of death in 2017 were accidental drowning, collisions involving pedestrians, and threats to breathing like suffocation and chocking. For children age 5–9, the leading causes of death in 2017 were collisions involving pedestrians, accidental drowning, and other land transport collisions. For those age 10–19, the leading causes of death in 2017 were accidental poisoning, motor vehicle collisions, and other land transport collisions.3 While not a leading cause of unintentional injury death, falls have been reported as the leading cause of unintentional injury hospitalization for Canadian children and youth (age 1–19 years).4

Rates of unintentional injuries in Canadian children and youth have also been found to vary by factors such as gender4, neighbourhood income5, rural-urban setting6, and immigrant and refugee status7-9. For example, the risk of unintentional injury is lower among children and youth from immigrant families compared to those born in Canada; however, the risk rises with increasing length of duration in Canada.9 And among children and youth from immigrant families in Ontario from 2011–2012, refugees had a 20% higher rate of unintentional injuries compared with non-refugee immigrants.7

Falls

The Falls section contains data for the overall Middlesex-London population.

When comparing rates across age groups, the 0–19 age group had the second highest rate of emergency department (ED) visits from falls in 2017 (Figure 4.3.5).

For children under the age of five, males were significantly more likely to visit the ED for a fall compared to females (Figure 4.3.6). Falls on stairs represented about 10% of all ED visits for falls in this age group in 2017.

In terms of deaths from falls, the 0–19 age group had the lowest rate compared to all other age groups from 2010–2012 (Figure 4.3.3).

Interpretation

Falling is a normal part of a child’s development as they walk, climb, run, jump and play.10 While most falls among children result in only minor cuts and bruises, some can be more serious and lead to an ED visit, hospitalization, or death. In Canada, falls are the leading cause of unintentional injury hospitalization among children and youth age 1–19.4

Concussions

The Concussions section contains data for the overall Middlesex-London population from 2005–2017.

When comparing rates of emergency department visits for concussion across age groups in 2017, rates were highest in the 10–14 and 15–19 age groups, more than double all other age groups (Figure 4.5.2).

Interpretation

The short- and long-term effects of a concussion can be severe for children and teenagers, although most concussion signs and symptoms usually resolved within 10 days to four weeks.11 The effects of concussion in children and youth are different from adults, and they may take longer to recover than adults.12

Self-harm and suicide

The Self-harm and Suicide section contains data for the overall Middlesex-London population.

The proportion of the Middlesex-London population 15 years or older that had reported suicidal thoughts and attempts is shown in Figure 4.6.1.

When comparing across age groups, the rate of emergency department visits for self-harm was highest in the 10–19 age group in Middlesex-London in 2017 (Figure 4.6.8).

Conversely, the rate of deaths from suicide was lowest in the 10–19 age group in Middlesex-London from 2014–2016 when comparing across age groups (Figure 4.6.6). However, differences across age groups were not statistically significant due to the small number of events.

Interpretation

Adolescence is a period of development where many physical, psychological, and social changes occur. It can be a stressful and emotional period of life full of highs and lows, and can make teenagers vulnerable to mental health problems.13

Self-harm occurs when a person intentionally injures their own body. Examples of self-harm include cutting, burning, scratching, hair pulling, poisoning, and hitting or banging. The injuries can be minor or more serious in nature, but they are generally not life-threatening.14 There are many reasons why a person might self-harm and it is usually not an attempt to commit suicide. However, people who injure themselves are at higher risk for suicide.15, 16 In Canada, females account for 72% of hospitalizations for self-harm among children and youth age 10 to 19 years.17

Suicide is the second leading cause of death for children and youth (10–19 years) in Canada. In Canada, males account for 41% of suicide deaths in 10–14 year olds, but this increases to 70% in 15–19 year olds.17

Road and off-road safety

The Road and Off-road Safety section contains data for the overall Middlesex-London population.

The rate of alcohol-related motor vehicle collisions causing injury or death was highest among those age 16–24 years in Middlesex-London from 2013–2015 (Figure 4.4.9).

The Road and Off-road Safety section contains self-reported data for the Middlesex-London population age 12 and older on seat belt use as passengers in a vehicle (Figure 4.4.11) and helmet use while bicycling (Figure 4.4.16, Figure 4.4.17, Figure 4.4.18). The section also includes data for the population of driving age on driving after alcohol use (Figure 4.4.12), and cell phone use while driving (Figure 4.4.13, Figure 4.4.14, Figure 4.4.15).

Among the Middlesex-London population age 12 years and older, those age 12–17 had the highest proportion who reported always wearing a helmet when riding a bicycle (Figure 4.4.17).

Interpretation

Children and youth can get injured while riding a bicycle, scooter or motorized off-road vehicle (e.g., dirt bike, all-terrain vehicle), while walking as a pedestrian, or while an occupant in a motor vehicle. Road injuries were the leading cause of unintentional injury-related hospitalizations and deaths for children (age 0–14 years) in Canada from 2013–2012.18

Protective gear like car seats, booster seats, helmets, and seatbelts, and safety precautions can help to prevent road injuries and deaths among children and youth. In Ontario, cyclists under the age of 18 are required to wear an approved helmet.19

In the 2017 cycle of the Ontario Student Drug Use and Health Survey (OSDUHS), 23.7% of Ontario students reported that they do not always wear a seatbelt. Among drivers in grades 10–12, 32.5% reported texting while driving, 4.2% reported drinking and driving at least once, and 8.8% reported driving after using cannabis at least once, in the past year.20

Ontario Public Health Standard: 

Ontario Public Health Standards: Requirements for Programs, Services, and Accountability
Population Health Assessment and Surveillance Protocol, 2018
Injury Prevention Guideline, 2018

References:

1. Yanchar NL, Warda LJ, Fuselli P. Child and Youth Injury Prevention: A Public Health Approach. Paediatr Child Health [Internet]. 2012 [cited 2019 Jul 16];17(9):511–2. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24179425 DOI: 10.1093/pch/17.9.511

2. Statistics Canada. Table 13-10-0394-01 Leading Causes of Death, Total Population, by Age Group [Internet]. Ottawa, ON: Government of Canada; 2019 [cited 2019 Jul 23]. Available from: https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=1310039401

3. Statistics Canada. Table 13-10-0156-01 Deaths, by Cause, Chapter XX: External Causes of Morbidity and Mortality (V01 to Y89) [Internet]. Ottawa, ON: Government of Canada; 2019 [cited 2019 Jul 24]. Available from: https://www150.statcan.gc.ca/t1/tbl1/en/cv.action?pid=1310015601

4. Yanchar NL, Warda LJ, Fuselli P, Canadian Paediatric Society Injury Prevention Committee. Child and Youth Injury Prevention: A Public Health Approach [Internet]. Ottawa, ON: Canadian Paediatric Society, 2012 [cited 2019 Jul 22]. Available from: https://www.cps.ca/en/documents/position/child-and-youth-injury-preventi...

5. Oliver LN, Kohen DE. Neighbourhood Variation in Hospitalization for Unintentional Injury among Children and Teenagers. Health Rep [Internet]. 2010 [cited 2019 Jul 25];21(4) Available from: https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2010004/article/11351-en...

6. Kim K, Ozegovic D, Voaklander DC. Differences in Incidence of Injury between Rural and Urban Children in Canada and the USA: A Systematic Review. Inj Prev [Internet]. 2012 [cited 2019 Jul 25];18(4):264–71. Available from: http://ip.bmj.com/cgi/pmidlookup?view=long&pmid=22634742 DOI: 10.1136/injuryprev-2011-040306

7. Saunders NR, Macpherson A, Guan J, Guttmann A. Unintentional Injuries among Refugee and Immigrant Children and Youth in Ontario, Canada: A Population-Based Cross-Sectional Study. Inj Prev [Internet]. 2018 [cited 2019 Jul 22];24(5):337–43. Available from: http://injuryprevention.bmj.com/content/24/5/337.abstract DOI: 10.1136/injuryprev-2016-042276

8. Saunders NR, Macpherson A, Guan J, Sheng L, Guttmann A. Unintentional Injuries in Children and Youth from Immigrant Families in Ontario, Canada: A Population-Based Cross-Sectional Study. CMAJ Open [Internet]. 2017 [cited 2019 Jul 19];5(1):E90–6. Available from: http://cmajopen.ca/content/5/1/E90.abstract DOI: 10.9778/cmajo.20160099

9. Saunders NR, Macpherson A, Guan J, Sheng L, Guttmann A. The Shrinking Health Advantage: Unintentional Injuries among Children and Youth from Immigrant Families. BMC Public Health [Internet]. 2017 [cited 2019 Jul 25];18(1):73. Available from: https://doi.org/10.1186/s12889-017-4612-1 DOI: 10.1186/s12889-017-4612-1

10. Peden M, Oyegbite K, Ozanne-Smith J, et al., editors. 5. Falls. In: World Report on Child Injury Prevention [Internet]. Geneva: World Health Organization. 2008 [cited 2019 Jul 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310642/.

11. Government of Canada. Concussion: Symptoms and Treatment [Internet]. Ottawa, ON: Government of Canada; 2018 [cited 2019 Jul 17]. Available from: https://www.canada.ca/en/public-health/services/diseases/concussion-sign...

12. Davis GA, Anderson V, Babl FE, Gioia GA, Giza CC, Meehan W, et al. What Is the Difference in Concussion Management in Children as Compared with Adults? A Systematic Review. Br J Sports Med [Internet]. 2017 [cited 2019 Jul 17];51(12):949. Available from: http://bjsm.bmj.com/content/51/12/949.abstract DOI: 10.1136/bjsports-2016-097415

13. Bilsen J. Suicide and Youth: Risk Factors. Front Psychiatry [Internet]. 2018 [cited 2019 Jul 19];9:540. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30425663 DOI: 10.3389/fpsyt.2018.00540

14. Canadian Mental Health Association Ontario. Understanding and Finding Help for Self-Harm [Internet]. Toronto, ON: Canadian Mental Health Association, Ontario; 2019 [cited 2019 Jul 19]. Available from: https://ontario.cmha.ca/documents/understanding-and-finding-help-for-sel...

15. Asarnow JR, Porta G, Spirito A, Emslie G, Clarke G, Wagner KD, et al. Suicide Attempts and Nonsuicidal Self-Injury in the Treatment of Resistant Depression in Adolescents: Findings from the Tordia Study. J Am Acad Child Adolesc Psychiatry [Internet]. 2011 [cited 2019 Jul 19];50(8):772–81. Available from: https://doi.org/10.1016/j.jaac.2011.04.003 DOI: 10.1016/j.jaac.2011.04.003

16. Klonsky ED, May AM, Glenn CR. The Relationship between Nonsuicidal Self-Injury and Attempted Suicide: Converging Evidence from Four Samples. J Abnorm Psychol [Internet]. 2013 [cited 2019 Jul 19];122(1):231–7. Available from: https://psycnet.apa.org/record/2012-27535-001 DOI: 10.1037/a0030278

17. Public Health Agency of Canada. Suicide in Canada: Infographic Ottawa, ON: Government of Canada; 2016 [cited 2019 Jul 19]. Available from: http://healthycanadians.gc.ca/publications/healthy-living-vie-saine/suic...

18. Parachute. Unintentional Injury Trends for Canadian Children, June 2016 [Internet]. Toronto, ON: Parachute, 2016 [cited 2019 Jul 19]. Available from: http://horizon.parachutecanada.org/wp-content/uploads/2016/06/SKW-Trend-...

19. Ministry of Transportation. Bicycle Safety [Internet]. Toronto, ON: Queen's Printer for Ontario; 2009 [cited 2019 Jul 29]. Available from: http://www.mto.gov.on.ca/english/safety/bicycle-safety.shtml

20. Boak A, Hamilton HA, Adlaf EM, Henderson JL, Mann RE. The Mental Health and Well-Being of Ontario Students, 1991–2017: Detailed Findings from the Ontario Student Drug Use and Health Survey (OSDUHS) (CAMH Research Document Series No. 47) [Internet]. Toronto, ON: Centre for Addiction and Mental Health, 2018 [cited 2019 Jul 18]. Available from: https://www.camh.ca/-/media/files/pdf---osduhs/mental-health-and-well-be...

21. Centers for Disease Control and Prevention. What Is a Concussion? [Internet]. Atlanta, GA: U.S. Department of Health and Human Services; 2019 [cited 2019 Aug 14]. Available from: https://www.cdc.gov/headsup/basics/concussion_whatis.html

Last modified on: November 7, 2019

Jargon Explained: 

Concussion
“A type of traumatic brain injury. It is caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells.”21