Trends in facial injury: increasing violence more than compensates for decreasing road trauma
Assault and alcohol consumption are the two major factors responsible for serious facial injuries in young adults, suggest Shepherd et al in this week's BMJ. The authors found that one half of the facial injuries in the 15 - 25 year age group were sustained in assaults, usually in bars or streets, and were associated with alcohol consumption by the victim or the assailant. The authors note that the increase in vulnerability of those who have been drinking heavily may be more important than the effect of alcohol on aggression.
From 1977 to 1987 the proportion of patients with facial injuries sustained in road accidents fell by 34 per cent. However, according to Shepherd et al, violent crime has more than compensated for this decrease. The proportion of injuries sustained in assaults increased from 40 per cent in 1977 to 50 per cent in 1987 and since then has continued to rise. The authors estimate that around 500,000 people suffer facial injuries annually, 125,000 of them in assaults. The authors note that the psychological legacy of facial injury can persist long after the injury has occurred, as facial scars serve as a constant reminder of the assault.
Four times more men than women sustained facial injuries in assaults, but in the home the reverse was true. Nearly half of all facial injuries sustained in assaults on women occurred in the home and one half of these incidents were associated with alcohol. One fifth of the injuries involving children were related to assault, underlining the need for anti-bullying policies in schools. Road traffic accidents accounted for only five per cent of facial injuries and, interestingly, 15 per cent of road accident victims had consumed alcohol within four hours of their injury.
Contact:
Professor Jonathan Shepherd, Professor of Oral and Maxillofacial Surgery, University of Wales College of Medicine, Cardiff