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Trauma is the “neglected disease.” It is the leading cause of death for people age 1 to 34 years of all races and socioeconomic levels and the third leading cause of death for all age groups. Injuries create a substantial burden on society in terms of medical resources used for treating and rehabilitating injured persons, productivity losses caused by morbidity and premature mortality, and pain and suffering of injured persons and their caregivers. Each year in the United States, one in six residents requires medical treatment for an injury, and one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury. Data on injury prevalence and costs from the 2000 Medical Expenditure Panel Survey (MEPS) and the National Health Accounts (NHA) reported that injury-attributable medical expenditures cost as much as $117 billion in 2000, approximately 10% of total U.S. medical expenditures. In 2001, there were 157,078 trauma-related deaths, 64% of which were due to unintentional trauma, half of which were caused by motor vehicle crashes. An estimated 29.7 million persons sustained nonfatal injuries during the same period. In 2001, the death rates for motor vehicle-related injuries were 15.3 per 100,000 people, totalling 43,987. Crash injuries result in about 500,000 hospitalizations and four million emergency department visits annually. The economic burden of motor vehicle-related deaths and injuries is also enormous, costing the United States more than $150 billion each year. In 2001, approximately 140,000 Americans sustained gunshot injuries. Twenty-nine thousand of these (21%) died as a result. In the pediatric population, 10,000 deaths associated with trauma are recorded annually in the United States. Trauma accounts for 30% of pediatric emergency room visits and is the most common cause of mortality in the noninfant child.

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Musculoskeletal disorders generated 3.5 million admissions to acute-care hospitals in the United States in 1988, more than 40% of which were trauma-related. Musculoskeletal injuries have a tremendous effect on the patient, the family, and the society in general because of the

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  1. 1. physical and psychologic effects of pain, limitation of daily activities, loss of independence, and reduced quality of life;

    2. direct expenditures for diagnosis and treatment; and

    3. indirect economic costs associated with lost labor and diminished productivity.

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Musculoskeletal injuries occur frequently, result in significant disability, and consume a major portion of health care resources. For example, the cost of hip fracture is estimated at $8.7 billion, or 43% of the total cost of all fractures. Direct costs are about 80% of the total, of which inpatient hospital care amounts to $3.1 billion and nursing home care $1.6 billion. More recent estimates show an increasing effect on the U.S. economy, including over $150 billion per year in direct and indirect cost from lost labor productivity due to trauma.

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Mass casualty situations as a result of terrorism are the challenge of the new millennium, requiring a highly organized and effective trauma system. The capability to respond in ...

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