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Injuries remain the most important cause of loss of potential years of life before age 65. Homicide and motor vehicle accidents are a major cause of injury-related deaths among young adults, and accidental falls are the most common cause of injury-related death in older adults. Approximately one-third of all injury deaths include a diagnosis of traumatic brain injury, which has been associated with an increased risk of suicide. Other causes of injury-related deaths include accidental exposure to smoke, fire, and flames.

Although motor vehicle accident deaths per miles driven have declined in the United States, there has been an increase in motor vehicle accidents related to distracted driving (using a cell phone, texting, eating). Evidence also suggests that motorists’ use of sleeping medications (such as zolpidem) almost doubles the risk of motor vehicle accidents. Clinicians should discuss this risk when selecting a sleeping medication. For 16- and 17-year-old drivers, the risk of fatal crashes increases with the number of passengers.

Each year in the United States, more than 500,000 people are nonfatally injured while riding bicycles. The rate of helmet use by bicyclists and motorcyclists is significantly increased in states with helmet laws. Young men appear most likely to resist wearing helmets.

Men ages 16–35 are at especially high risk for serious injury and death from accidents and violence, with blacks and Latinos at greatest risk. Deaths from firearms have reached epidemic levels in the United States. In 2015, a total of 13,286 people were killed in the United States in a gun homicide, unintentional shooting, or murder/suicide. Having a gun in the home increases the likelihood of homicide nearly threefold and of suicide fivefold. Educating clinicians to recognize and treat depression as well as restricting access to lethal methods have been found to reduce suicide rates.

In addition, clinicians should try to educate their patients about always wearing seat belts and safety helmets, about the risks of using cellular telephones or texting while driving and of drinking and driving—or of using other intoxicants (including marijuana) or long-acting benzodiazepines and then driving—and about the risks of having guns in the home.

Clinicians have a critical role in the detection, prevention, and management of intimate partner violence (see Chapter e6-08). The USPSTF recommends screening women of childbearing age for intimate partner violence and providing or referring women to intervention services when needed. Inclusion of a single question in the medical history—“At any time, has a partner ever hit you, kicked you, or otherwise physically hurt you?”—can increase identification of this common problem. Assessment for abuse and offering of referrals to community resources create the potential to interrupt and prevent recurrence of domestic violence and associated trauma. Clinicians should take an active role in following up with patients whenever possible, since intimate partner violence screening with passive referrals to services may not be adequate. Evaluation of services available to patients after identification of ...

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