NCHS Data Brief ■ No. 150 ■ May 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Injury-related Emergency Department Visits by Children and 

Adolescents: United States, 2009–2010

Michael Albert, M.D., M.P.H.; and Linda F. McCaig, M.P.H.

Key findings

Data from the National 

Hospital Ambulatory 

Medical Care Survey, 

2009–2010

• In 2009–2010, an annual 

average of 11.9 million injuryrelated emergency department 

(ED) visits were made by 

children and adolescents aged 

18 years and under in the 

United States.

• The injury-related ED visit 

rate was 151 per 1,000 persons 

aged 18 years and under, and 

rates were higher for males than 

for females for all age groups 

(0–4 years, 5–12 years, and 

13–18 years).

• The injury-related ED visit 

rates among persons aged 5–12 

years and 13–18 years were 

higher for non-Hispanic black 

persons than for other race and 

ethnicity groups.

• Leading causes of injuryrelated ED visits among both 

males and females included 

falls and striking against or 

being struck unintentionally by 

objects or persons. Visit rates 

were higher for males than for 

females for both of these causes.

Injury is the leading cause of death and a major source of morbidity among 

children and adolescents in the United States (1,2). The emergency department 

(ED) plays an important role in the care of injuries, and these visits often 

represent the initial contact with a provider for the injury (3). This report 

examines nationally representative data on injury-related ED visits by children 

and adolescents aged 18 years and under in the United States during 2009–

2010. Injury-related ED visit rates were also compared for the age groups 0–4, 

5–12, and 13–18 years, as these correspond to the preschool, school-age, and 

teen life periods respectively. 

Keywords: health care utilization • injury • child health • National Hospital 

Ambulatory Medical Care Survey

What were the injury-related ED visit rates for children and 

adolescents, and did they vary by age?

• In 2009–2010, there were an estimated 33.7 million annual average ED 

visits by persons aged 18 years and under in the United States, and 

Number of visits in millions

Visits per 1,000 persons

1

Visitrate is significantly different (p < 0.05) than for other age groups, based on a two-tailed t test.

NOTES: Figures are based on 2-year averages. A sample of 6,185 injury-related emergency department visits were made by 

patients aged 18 years and under, representing an annual average weighted total of 11.9 million injury-related visits. Visit rates are 

based on the July 1, 2009, and July 1, 2010, set of estimates of the civilian noninstitutionalized population of the United States, as 

developed by the Population Division, U.S. Census Bureau.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2009–2010.

Figure 1. Number and rate of injury-related emergency department visits for persons aged 

18 years and under: United States, 2009–2010

Overall 18 years 0–4 years 5–12 years 13–18 years

 and under

0

20

40

60

80

100

120

140

160

180

0

2

4

6

8

10

12

14

11.9

3.6 4.1 4.2

151

169

1

126

170
NCHS Data Brief ■ No. 150 ■ May 2014

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11.9 million (35.3%) of these visits were injury related (Figure 1). 

• The annual average ED visit rate was 151 per 1,000 persons aged 18 years and under.

• A “u-shaped” curve was observed for the injury-related ED visit rates by children and 

adolescents, which was lowest in the 5–12 year age group compared with the 0–4 and 

13–18 year age groups.

Did the injury-related ED visit rates for children and adolescents vary by 

sex?

• In 2009–2010, the injury-related ED visit rate was higher among males than females in all 

age groups (Figure 2).

• Among both males and females, the visit rate was lowest in the 5–12 year age group 

compared with the 0–4 and 13–18 year age groups.

Patient age in years

Visits per 1,000 persons

Figure 2. Injury-related emergency department visit rates by sex for persons aged 18 years and under: United States, 

2009–2010

1

Visit rate is significantly different (p < 0.05) for males than for females in all age groups, based on a two-tailed t test.

2

Visit rate is significantly different (p < 0.05) than for other age groups, based on a two-tailed t test.

NOTES: Figures are based on 2-year averages. Visit rates are based on the July 1, 2009, and July 1, 2010, set of estimates of the civilian noninstitutionalized 

population of the United States, as developed by the Population Division, U.S. Census Bureau.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2009–2010.

0

50

100

150

200

250 Males Females

0–4 5–12 13–18

1

187

2

146

2

104

199

141

150
NCHS Data Brief ■ No. 150 ■ May 2014

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Did the injury-related ED visit rates for children and adolescents vary by 

race and ethnicity?

• In both the 5–12 and 13–18 year age groups, the injury-related ED visit rate was highest 

among non-Hispanic black persons, followed by non-Hispanic white persons, and Hispanic 

persons (Figure 3).

• In the 0–4 year age group, the injury-related ED visit rate was higher among non-Hispanic 

black persons compared with Hispanic persons. The observed difference between 

non-Hispanic black persons and non-Hispanic white persons did not reach statistical 

significance.

Patient age in years

Visits per 1,000 persons

Figure 3. Injury-related emergency department visit rates by race and ethnicity for persons aged 18 years and under: 

United States, 2009–2010

1

Visit rates within the 0–4 age group are significantly different (p < 0.05) for non-Hispanic black persons compared with Hispanic persons based on two-tailed t

tests. The difference between non-Hispanic black persons and non-Hispanic white persons did not reach statistical significance. 

2

Visit rates within the 5–12 and 13–18 year age groups are significantly different (p < 0.05) for all race and ethnicity groups shown based on two-tailed t tests.

NOTES: Figures are based on 2-year averages. Visit rates are based on the July 1, 2009, and July 1, 2010, set of estimates of the civilian noninstitutionalized 

population of the United States, as developed by the Population Division, U.S. Census Bureau.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2009–2010.

0–4 5–12 13–18

1

232

180

145

2

181

138

90

2

241

176

135

0

50

100

150

200

250

300 Non-Hispanic black Non-Hispanic white Hispanic
NCHS Data Brief ■ No. 150 ■ May 2014

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What were the leading causes of injury-related ED visits among children 

and adolescents, and did visit rates for these causes vary by sex? 

• Leading causes of injury-related ED visits among both males and females aged 18 years 

and under included falls and striking against or being struck unintentionally by objects or 

persons (Figure 4).

• Injury-related ED visit rates were higher for males than for females aged 18 years and under 

for unintentional injuries caused by falls, striking against or being struck by objects or 

persons, and cutting or piercing instruments or objects.

Cause of injury

Visits per 1,000 persons

Figure 4. Emergency department visit rates for leading causes of injury by sex for persons aged 18 years and under: 

United States, 2009–2010

1

Visit rate is significantly different (p < 0.05) for males than for females based on a two-tailed t test.

NOTES: Based on “Supplementary Classification of External Cause of Injury and Poisoning” in the International Classification of Diseases, Ninth Revision, Clinical 

Modification (ICD–9–CM). Causes shown are unintentional with the exception of assault. Figures are based on 2-year averages. Visit rates are based on the 

July 1, 2009, and July 1, 2010, set of estimates of the civilian noninstitutionalized population of the United States, as developed by the Population Division, 

U.S. Census Bureau.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2009–2010.

Males Females

0

10

20

30

40

50

Overexertion Assault

and strenuous

movements

Cutting or 

piercing

instruments 

or objects

Motor vehicle

traffic

Natural and

environmental

factors

Striking against

or struck by 

objects or

persons

Falls

1

46

33

1

28

13

11

8

10 10 1

8

5 6 6 5 5
NCHS Data Brief ■ No. 150 ■ May 2014

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What were the primary expected sources of payment for injury-related ED 

visits by children and adolescents?

• The most frequently recorded primary expected sources of payment for injury-related ED 

visits by children and adolescents were Medicaid or Children’s Health Insurance Program 

(CHIP) (41.7%) and private insurance (40.7%) (Figure 5).

• Injury-related ED visits by children and adolescents with no insurance comprised 8.6% of 

visits.

Primary expected source of payment

Percent of visits

Figure 5. Percentage of injury-related emergency department visits by primary expected source of payment for persons 

aged 18 years and under: United States, 2009–2010

1

Percentages are significantly different (p < 0.05) for Medicaid or Children’s Health Insurance Program (CHIP) and private insurance compared with no insurance or 

other payment based on two-tailed t tests. 

NOTES: The following payment types were used for this analysis: Medicaid or CHIP; private insurance; no insurance, which includes self-pay and no charge or 

charity; and other, which includes Medicare, workers’ compensation, categories not otherwise listed, unknown, and blank. Figures are based on 2-year averages. 

Numbers may not add to totals because of rounding.

SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey, 2009–2010.

No insurance

0

10

20

30

40

50

Medicaid or CHIP Private insurance Other payment

1

41.7 1

40.7

8.6 8.9

Summary

Child and adolescent injuries represent a serious public health problem in the United States. Over 

one-third of ED visits made by persons aged 18 years and under—an average of 11.9 million 

visits annually—were injury related in 2009–2010. The annual average injury-related ED visit 

rate was 151 per 1,000 persons aged 18 years and under. A number of findings related to injuryrelated ED visits during that time period were identified. The injury-related ED visit rate was 

lower in the 5–12 year age group compared with the 0–4 and 13–18 year age groups, and the 

rate was higher among males compared with females in each age group. Among persons aged 

5–12 and 13–18 years, the injury-related ED visit rate was highest among non-Hispanic black 

persons compared with other race and ethnicity groups analyzed. Leading causes of injury-related 

ED visits among both males and females aged 18 years and under included falls and striking 

against or being struck unintentionally by objects or persons. Males had higher visit rates for 

unintentional injuries caused by falls, striking against or being struck by objects or persons, and 

cutting or piercing instruments or objects.
NCHS Data Brief ■ No. 150 ■ May 2014

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Injury prevention objectives covering a broad range of issues have recently been outlined 

for Healthy People 2020 with the goal of preventing injury and violence and reducing their 

consequences (4). National Hospital Ambulatory Medical Care Survey (NHAMCS) data are 

used to track the injury prevention objectives related to reducing ED visits for nonfatal injuries 

overall and for nonfatal traumatic brain injuries (4). Monitoring and evaluating data related to 

child and adolescent injuries will remain important for informing injury prevention efforts in this 

population.

Definitions

Emergency department (ED): A hospital facility that provides unscheduled outpatient services to 

patients whose conditions require immediate care, and is staffed 24 hours a day. Onsite and offsite 

EDs that are open fewer than 24 hours are included, if staffed by the hospital.

Emergency department visit: Direct, in-person exchange between a patient seeking ED care and a 

health-care provider.

Injury-related visit: A visit that met one of the following three conditions: a “yes” was marked in 

response to the question, “Is this visit related to an injury, poisoning, or adverse effect of medical 

treatment?”; a cause of injury or a nature of injury diagnosis was provided; or an injury-related 

reason for visit was reported.

Data source and methods

Data are from the 2009–2010 NHAMCS, an annual nationally representative survey of 

nonfederal, general, and short-stay hospitals, which is conducted by the Centers for Disease 

Control and Prevention’s National Center for Health Statistics. NHAMCS uses a multistage 

probability design with samples of primary sampling units (PSUs), hospitals within PSUs, and 

patient visits within EDs. Each year, approximately 480 hospitals are selected for inclusion in 

NHAMCS, and data are collected on approximately 35,000 ED visits. Additional information on 

the methodology of NHAMCS is available (5,6).

Data were imputed for patient age, sex, race, and ethnicity. Of these variables, the imputation 

rates were highest for the variables of race and ethnicity: 10.4% for race and 13.1% for ethnicity 

in 2009, and 10.5% for race and 12.8% for ethnicity in 2010 (5,6). Race and ethnicity data were 

combined in Figure 3 to form the categories of Hispanic, non-Hispanic white, and non-Hispanic 

black; visits by other race and ethnicity groups are not shown in this figure. Multiple expected 

sources of payment may be indicated for a visit, and the following hierarchy was used to identify 

the primary expected payment source for this analysis: Medicare, Medicaid or CHIP, private 

insurance, workers’ compensation, self-pay, no charge or charity, other, and unknown. In 

Figure 5, the category “no insurance” includes self-pay and no charge or charity, and the category 

“other payment type” includes Medicare, workers’ compensation, categories not otherwise 

listed, unknown, and blank. Cause of injury was determined based on the first-listed external 

cause-of-injury code from the International Classification of Diseases, Ninth Revision, Clinical 

Modification (ICD–9–CM) (7). A detailed description of the ICD–9–CM E-codes used to create 

the groupings in Figure 4 has been previously described (8).
NCHS Data Brief ■ No. 150 ■ May 2014

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Data analyses were performed using the statistical packages SAS version 9.3 (SAS Institute, 

Cary, N.C.) and SAS-callable SUDAAN version 11.0 (RTI International, Research Triangle 

Park, N.C.). Differences among subgroups were evaluated using a two-tailed t test. Comparisons 

reported in the text are statistically significant (p < 0.05) unless otherwise indicated. A lack of 

comment regarding the difference between any two estimates does not indicate that the difference 

was tested and found to be not significant.

About the authors

Michael Albert and Linda F. McCaig are with the Centers for Disease Control and Prevention’s 

National Center for Health Statistics, Division of Health Care Statistics, Ambulatory and Hospital 

Care Statistics Branch.

References

1. Centers for Disease Control and Prevention. Protect the ones you love: Child injuries are 

preventable. Available from: http://www.cdc.gov/safechild.

2. Borse NN, Gilchrist J, Dellinger AM, Rudd RA, Ballesteros MF, Sleet DA. CDC childhood 

injury report: Patterns of unintentional injuries among 0–19 year olds in the United States, 

2000–2006. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury 

Prevention and Control. 2008.

3. Burt CW, McCaig LF, Rechtsteiner EA. Ambulatory medical care utilization estimates for 

2005. Advance data from vital and health statistics; no 388. Hyattsville, MD: National Center for 

Health Statistics. 2007.

4. Centers for Disease Control and Prevention. HealthyPeople.gov. 2020 topics and objectives: 

Injury and violence prevention overview. Available from: http://www.healthypeople.gov/2020/

topicsobjectives2020/overview.aspx?topicId=24.

5. National Center for Health Statistics. 2009 NHAMCS micro-data file documentation. 

2009. Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/

NHAMCS/doc09.pdf.

6. National Center for Health Statistics. 2010 NHAMCS micro-data file documentation. 

2010. Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/

NHAMCS/doc2010.pdf.

7. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 

Medicare & Medicaid Services. International classification of diseases, ninth revision, clinical 

modification, 6th ed. DHHS Pub No. (PHS) 06–1260. 2006. Available from: http://www.cdc.gov/

nchs/icd/icd9cm.htm.

8. McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2003 emergency 

department summary. Advance data from vital and health statistics; no 358. Hyattsville, MD: 

National Center for Health Statistics. 2005.
NCHS Data Brief ■ No. 150 ■ May 2014

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Suggested citation

Albert M, McCaig LF. Injury-related 

emergency department visits by children 

and adolescents: United States, 2009–2010. 

NCHS data brief, no 150. Hyattsville, MD: 

National Center for Health Statistics. 2014.

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