A Closer Look at Trauma: What Mechanism of Injury Reveals

For the first time, the 2024 ESO Trauma Index examined the mechanism of injury as a metric. Mechanism of injury describes the external cause of a patient’s trauma; it details how the injury occurred. According to the Centers for Disease Control and Prevention (CDC), unintentional injuries are the third leading cause of death in the U.S.  By providing insights into how patients sustain injuries, hospital systems and trauma centers can improve response and collaborate on community prevention efforts. 

The findings may surprise you.  

The Leading Causes of Trauma – And Who Is Most at Risk 

Data from the ESO Data Collaborative, which includes nearly 1 million anonymized patient records, show that the top three causes of trauma injuries are consistent across all age groups: 

1. Falls 
2. Motor Vehicle Crashes (MVCs) 
3. Struck by/against  

The number one reason a person receives trauma care is from a fall, accounting for 52% of all injuries.  However, following the top three leading causes of injury, age-related differences emerge: 

• As a cause of trauma injury, firearms ranked fifth for pediatric patients (ages 1-18), fourth for adults (19-64 years), and tenth for older adults (65 and older)
• Interpersonal violence was 115 times more likely to be reported in pediatric patients compared to older adults, with 3% of children under 18 reporting interpersonal violence, compared to less than 1% of adults or older adults

These findings reinforce what many trauma professionals already know: Violence disproportionately affects children, and firearm-related injuries continue as a major public health crisis.  

Firearm Injuries: A Rising Concern in Trauma Centers 

According to the CDC, firearms are the leading cause of death for youth ages 1-17 years for the third year in a row. Between 2019 and 2020, firearm homicides and nonfatal firearm-related trauma increased by approximately 35–37%, marking one of the most significant spikes in recent history.  

Even more people suffer nonfatal firearm-related injuries than die, with effects reverberating across families, neighborhoods, and communities. The impact is staggering: 

• More than 40,000 people experience traumatic firearm-related injuries each year
• Youth exposed to gun violence are at higher risk of becoming victims themselves
• Firearm-related injuries and fatalities cost an estimated $410 billion annually in medical care, lost work, and quality of life losses

Firearm Injury Prevention: Recommendations for Trauma Centers 

• Hospital systems and trauma centers looking to reduce firearm-related injuries can follow these best practices: 
• Screen early – Identify risk factors for firearm-related injuries in trauma patients 
• Provide mental health support for firearm -injury victims and their families 
• Participate in the CDC’s National Syndromic Surveillance Program to track trends in gun violence by geographic area 
• Promote firearm safety – Offer free gun locks and safety resources, especially for families with children 
• Improve access to firearm injury prevention programs, particularly in under-resourced communities 
• Ensure your trauma centers follow updated trauma-informed prevention and intervention protocols to address violence effectively 

Interpersonal Violence: A Critical but Overlooked Factor in Trauma Care 

For the first time, the 2024 ESO Trauma Index also examined interpersonal violence as a mechanism of injury. Interpersonal violence – including physical, sexual, and psychological aggression – has long-term effects on victims. Interpersonal violence was 115 times more likely to be reported in pediatric patients compared to older adults, with 3% of children under 18 reporting interpersonal violence, compared to less than 1% of adults or older adults.  

It increases risks for: 

• Chronic health issues 
• Mental health disorders 
• Repeat injuries and hospital visits 

Thanks to leadership from The American College of Surgeons (ACS), all Level I trauma centers now screen for interpersonal violence, abuse, and mental health disorders. This ensures that patients receive comprehensive care beyond their physical injuries. 

Interpersonal Violence: Recommendations for Trauma Centers

• Use standardized screening protocols for all patients
• Train staff in how to recognize and document signs of abuse
• Ensure privacy and support for patients disclosing abuse
• Provide referrals to social services while using non-triggering language (e.g., labeling resources as “women’s health” or “social services” rather than “domestic violence”)

Data Drives Action 

Understanding the mechanisms of injury in U.S. populations is more than an exercise in data analysis; it’s about turning data insights into action that improves patient care and community safety. With falls, MVCs, firearms, and violence shaping trauma cases nationwide, hospitals and EMS providers must adapt protocols to better identify, treat, and prevent these injuries. 

Want to see how your trauma center compares? 

Download the 2024 ESO Trauma Index today to find trends, benchmarks, and best practices for improving trauma care in your community.