• Open Access

Beyond fatal injury: disability, traumatic stress and tertiary prevention

Authors

  • Mark R. Zonfrillo,

    Corresponding author
    1. Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, United States
    2. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, United States
    • Correspondence to: Dr Mark R. Zonfrillo, Children's Hospital of Philadelphia, Division of Emergency Medicine, 34th and Civic Center Boulevard, Philadelphia, PA 19104, US; e-mail: zonfrillo@email.chop.edu

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  • Flaura K. Winston,

    1. Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, United States
    2. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, United States
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  • Nancy Kassam-Adams

    1. Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, United States
    2. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, United States
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We read with great interest the recent article by Shepard et al, ‘Preventing child unintentional injury deaths: prioritising the response to the New Zealand Child and Adolescent Injury Report Card.”1 We applaud the authors for developing recommendations for injury prevention in children, and using a well-developed European Child Safety Report Card model as a metric for comparison. Establishing sound policy and legislation that can reduce injury mortality is essential, as road traffic deaths remain a huge global burden in children.2

While it is critical to reduce fatal injuries, the ongoing morbidity and sequelae of non-fatal injuries must also be seriously considered. Survivors of moderate to severe injury often endure considerable rehabilitation and a difficulty recovery, with the potential for cognitive and physical disability that could be long-term or permanent.3,4 These disabled patients will require technological and programmatic assistance, and face a challenging re-integration into their schools, jobs and society.

In addition to the implications of disabling injuries, all survivors, even those with minor injuries or no injuries, are at high risk for post-traumatic stress. The ensuing injury event or the medical care provided (including transportation from the scene, hospital stay, and painful procedures) are all part of the injury experience. Therefore, many injured patients may meet criteria for the recently revised Diagnostic and Statistical Manual (DSM-5) diagnosis for post-traumatic stress (Criterion A: Traumatic Stressor of exposure to real or threatened death, injury or sexual violence).5 Patients should be screened for traumatic stress reactions following injuries of any mechanism or severity, as about one in 10 injured children and their parents suffer from persistent stress symptoms for a year or more.6,7

‘Tertiary prevention’ aims to minimise the ongoing damage of existing injury to survivors through pre-hospital, acute, critical, rehabilitation and ambulatory care. Fortunately, through prompt and quality medical care, many survivors recover from injury quickly and completely. Medical providers should consistently address post-injury care and recovery for disabling injuries and post-traumatic stress. This is a crucial role for the healthcare system, and has significant implications for these patients’ functionality and quality of life.

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