title: Visitor injuries in Hawai'i.
abstract: BACKGROUND
  Over seven million tourists visit the Hawaiian Islands each year. Popular visitor activities such as surfing, scuba diving, ocean kayaking, parasailing, bicycle tours and hiking each have risks of serious injury. This study reviews visitors' activities that led to serious injuries requiring treatment at the state's only trauma center while vacationing in Hawai'i.
  
  
  METHODS
  A retrospective electronic medical record review was conducted of all visitor and resident trauma patients admitted to The Queen's Medical Center (QMC) from January 2002-December 2006. Patient demographics, injury type and severity, mechanism of injury, and discharge status were collected and analyzed.
  
  
  RESULTS
  A total of 8244 patients were admitted to QMC for major traumatic injuries over the five year study period. Of these, 466 (5.7%) were visitors. The most common mechanisms of visitor injuries were falls (23.6%), water-related injuries (22.8%), motor vehicle crashes (18.7%), motorcycle, moped, and recreational vehicle crashes (12.2%), assaults (7.3%), and bicycle crashes (4.0%). A disproportionate number of visitors sustained serious injuries while engaging in water-related activities: Visitors account for only 12.6% of the population on any given day, yet comprise 44.2% of the total admissions for Hawai'i's water-related injuries. Head and spine injuries make up over two-thirds (68.2%) of these water-related visitor injuries.
  
  
  CONCLUSIONS
  As a general category, falls were responsible for the highest number of visitor trauma admissions. Of the recreational activities leading to high numbers of trauma admissions, water-related activities are the leading causes of serious injuries among visitors to Hawai'i. Water-related injury rates are significantly higher for Hawai'i's visitors than residents. Water safety education for visitors should be developed in multiple languages to educate and protect Hawai'i's visitors and visitor industry.
authors.affiliation: Trauma Services, The Queen's Medical Center, Honolulu, HI 96813, USA. hcho@queens.org
authors.forename: Hao Chih
authors.initials: HC
authors.lastname: Ho
authors.forename: Cora S R
authors.initials: CS
authors.lastname: Speck
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kumasaki
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001265:Athletic Injuries / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D011998:Recreation; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D014195:Travel / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality; D055815:Young Adult