You have probably noted in your practice that injured patients are not presenting to the emergency department nearly as frequently. The National Center for Health Statistics (NCHS) released its ongoing statistical survey of emergency department visits for 2015, identifying this fact on the long-term trendlines.

The 2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) report is an extension of the survey process that began in 1992. It is used to identify trends in ED visits that are important for emergency physicians and public health practitioners to understand.

The year 2015 saw an estimated 137 million ED visits.¹ The 20-year volume trend remains upward, at about 1.9 percent per year. Of those visits, the survey estimated that 38.9 million (28.4 percent of all ED visits) were for the category summarized as “injury, poisoning, and adverse effect-related.”

By comparison, in 2009, there were an estimated 45 million encounters for injuries. The relatively stable number of injured patients seen in the emergency department is noted in Table 1, and the decreasing trend in mix of injuries since 1992 is reflected in Figure 1. This trend likely reflects the success of many injury prevention programs, leading to an ED population distribution that is less “injured” and more “ill.”

Table 1. Estimated ED Visits for Injury and Percent of Overall ED Population

The reported injury count may even overstate the number of patients. The NCHS classifications of ED visits and chief complaints are very well structured. However, the injury count is higher than would typically be counted in most ED accounting systems. About 4.4 million of those visits were for issues that emergency physicians would not typically consider injuries, including “adverse effects of medical treatment,” “medical and surgical complications,” and “adverse drug effects.”

Figure 1. Injury as Percent of ED Visits

The leading causes of injury-related visits were falls (10.6 million visits, 26 percent of total injury visits) and motor vehicle traffic crashes (4.5 million visits, 11 percent of total injury visits).

Self-inflicted injuries accounted for 575,000 visits, with a volume that is increasing over the years. Self- inflicted injuries represented 0.4 percent of total injuries in 1992, and increased to 2 percent by 2011, where it has remained.

The highest injury incidence per age population was in those persons age 75 and older. This reflects the demographics of the American population. Reflecting the prevalence of aging for women, there were an estimated 1.9 million females over age 75 who were injured, versus 1.1 million males. The population incidence was 191 ED injury visits for women over age 75 and 154 for men. Injury prevention programs should target women in this older age group.