Even with improved and improving understanding and documentation of injuries, there are numerous unmet needs that represent challenges for the future. These range from logistical challenges brought about by the complexity of our healthcare system to the actual improvement of the provision of care for members of our society. While a comprehensive discourse cannot be provided here, we propose some timely thoughts.

While ICD-10 coding of diagnoses will provide greater resolution of the types of injuries sustained, it represents a challenge to the longitudinal tracking of injuries as we fully transition from one to the other. Discrepancies between providers, coders, healthcare and payment systems need to be recognized, minimized, and resolved.  

Also, despite the availability of some very robust data systems, we still lack the ability to track many common injuries in our societies; those include injuries during pregnancy, due to domestic violence, due to animals, that are self-inflicted, and of great recent interest, due to gunshot / ballistic violence. Greater granularity regarding common injuries such as fall in the elderly (e.g., home, facilities, circumstances of fall) and motor vehicle crashes (e.g., under the influence, phones/devices) may help formulate interventions and policies to prevent injuries.

On the outcome side, the US still lacks comprehensive and mandatory treatment and outcomes registries that will allow us to understand the spectrum of treatment rendered and the outcomes obtained. We also have an opportunity to understand the relationship between treatment and outcomes.

The link between opioid use and injuries will also be important to understand and study. The current opioid "crisis" and the utilization of medications to treat injury-related pain drives the need for both ways to prevent injury and offer alternatives for treatment. For example, not only is there greater availability and use of cannabis-based products and medications, there has been increasing interest in substituting them for opioids. These changes should be carefully monitored so the epidemiologic and care implications are understood.

As we move forward, there will be a continued need to reflect on the data we have and how we can enhance that data to improve the prevention, evaluation and treatment of injuries.