Introduction and epidemiology

Injury is the leading cause of death and disability in the first four decades of life and is the third most common cause of death overall. This holds true even in acquired immunodeficiency syndrome (AIDS)-prevalent areas of the world. Yet, the National Academy of Science in the United States has labelled injury as the ‘neglected disease of modern society’. A similar view prevails in the UK, where a leading emergency surgeon has referred to ‘trauma as the neglected stepchild of modern medicine’. Public health officials world-wide con­cede that there is a global epidemic of violence with an increasing trend towards penetrating injury caused by knives, guns and terrorist devices. This has led to injury as a subject of study undergoing a renaissance over the last 10 years.

In the UK accidental and deliberate injury results in more than 18 000 deaths annually, with 60 000 hospital admis­sions costing £2.2 billion, which represents 1 per cent of gross national product (GNP). For every injury-related death there are 10 other survivors with serious injury, two of whom will have permanent disabilities. A staggering 120 000 people die from trauma each year in the USA. Ballistic trauma accounts for more than 30 000 of these, most of them in the prime of life. The cost to the USA is between $75 and $100 billion — more than the cost of the Gulf war in 1990.