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Reducing the Burden of Injury: Advancing Prevention and Treatment
International Classification of Diseases, which requires a determination on intentionality before any other coding decisions.
Some injury scientists, however, are increasingly dissatisfied with this terminology. Among other concerns, they point out that the focus on intentionality can divert attention to issues relating to individual moral and legal responsibility and away from the broad array of risk factors and interventions represented in the Haddon matrix, many of which can prevent both intentional and unintentional injuries. Intentionality is more sensibly understood as a continuum, ranging from inadvertence to conscious risk taking to purposeful harming, rather than as two categories; and assigning cases to one of the two categories for coding purposes often requires complex judgments based on inadequate information. The committee agrees that these characterizations cannot bear too much weight, and that coding decisions will be imperfect in many cases. Notwithstanding these shortcomings, however, the committee believes that whether an injury is "intentional" or not is reasonably ascertainable in many cases, and that these terms are useable—if oversimplifying—categories for aggregating and interpreting injury data. In the absence of any alternative conceptualization, this terminology will be retained. Among intentional injuries, greater refinement can be achieved by using the terms "assaultive injuries" (including intentional homicide if death occurs) and "self-inflicted injuries" (including suicides if death occurs). Although the category of unintentional injuries encompasses a wide variety of risk-creating behavior (ranging from inattention to gross recklessness), greater refinement cannot reasonably be achieved outside a courtroom.
Prevention and Treatment
In this report, the committee has decided to simplify its vocabulary by using two terms—prevention and treatment—to refer to the array of activities variously described as prevention, control, acute care, and rehabilitation. The term "prevention" is used to refer to efforts to reduce the risk or severity of injury. This can be accomplished by preventing injury-causing events ("pre-event" interventions) or altering the circumstances or impact of the injury-causing event ("event" interventions). The term ''treatment" is used to refer to post-event efforts to ameliorate the effects of the injury through acute care and rehabilitation (Table 1.1).
The committee can see no use for the term "control," borrowed from the vocabulary of infectious disease, which has been deployed in the injury field to refer mainly to the idea of ameliorating the consequences of injury-causing events. Prevention and treatment, as defined above, appear to express these ideas