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Current knowledge of the patterns of injury in the United States derive principally from mortality statistics that constitute less than 0.1% of all injuries reaching medical attention. There presently exists no national system for the surveillance of nonfatal injuries. To illustrate the usefulness and feasibility of conducting injury surveillance using E-coded hospital discharge data, we examined the surveillance data from the Massachusetts Statewide Childhood Injury Prevention Program. By using E-coded hospital discharge data, we increased the number of cases available for analysis by 40-fold over deaths, and we were able to describe the epidemiologic characteristics of the important causes of nonfatal childhood injuries. We therefore propose the development of a national injury surveillance system based on the Uniform Hospital Discharge Data Set coded by both the nature of the injury (N Code) and external cause (E Code).