Based on an analysis of data from the NEISS, Layne et al. (1994) estimated that 64,100 adolescents aged 14 to 17 were treated in emergency rooms for work-related illnesses in 1992. Eating and drinking establishments (38 percent), followed by grocery stores (7.8 percent), accounted for the greatest number of injuries. Lacerations were the type of injury (34 percent) most likely to be seen in the emergency departments, followed by contusions and abrasions (18 percent), and sprains and strains (16 percent) (see Table 3.2, above, for more details).

One limitation of NEISS is that it covers only injuries treated in hospital emergency departments, which comprise only an estimated one-third of all work-related injuries (Ries, 1978; Unpublished tabulations, 1988 National Health Interview Survey, Occupational Supplement, NIOSH). Furthermore, for children and adolescents, emergency department personnel may not think to ask about the work-relatedness of an injury or may not note work-relatedness in the medical records. Comparing NEISS data to those from other systems is also difficult because NEISS uses unique coding systems and does not include the standard medical external-cause-of-injury coding (E-codes). Also, although the participating emergency departments are generally representative of emergency departments throughout the country, the youth populations served by the hospitals are not necessarily representative of the national population of young workers.

In spite of its limitations, NEISS data showed more than three times as many work-related injuries to adolescents for 1992 than were reported by employers in the 1993 SOII. Some of the injuries found by NEISS may not have met OSHA's reporting requirements, but that seems unlikely to account for all the differences. In fact, follow-up interviews with youngsters identified by the system found that 68 percent of them experienced limitations in their normal activities (including school, work, and play) for at least one day (Knight et al., 1995)—which requires reporting by employers.

National Hospital Ambulatory Medical Care Survey

Beginning in December 1991, the National Center for Health Statistics began collecting information annually on emergency department and outpatient department visits from a nationally rep-



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