Mortality data traditionally have been used to describe the epidemiology of childhood injury. Fatal outcomes, however, represent less than 1% of injury events and thus provide a limited characterization of the problem. Future epidemiologic study resulting in injury prevention depends upon the development of morbidity-based injury surveillance systems. "E-coded" hospital discharge data bases (used to indicate external cause of injury) are a valuable source of information for monitoring and controlling serious, nonfatal injuries. An E-coded injury discharge data base was developed and evaluated at The Children's Hospital of Alabama in Birmingham. In addition to patient demographics, length of stay, total charge, and method of payment, E-code and "N-code" (to indicate the anatomic site of injury) data were collected. During the 2-year study period, 1077 discharges from the hospital were documented in children with serious injuries under 15 years of age for an adjusted discharge rate of 78.0 per 10,000 child-years. Injuries accounted for $5.3 million in total charges and 4899 total days of stay. Falls, unintentional poisonings, burns, and bicycle, motor vehicle-passenger, and motor vehicle-pedestrian injuries were the six most common causes of injury. Closed-head trauma accounted for 55.4% of motor vehicle-passenger injuries, 67.6% of bicycle injuries, and 51.8% of falls. Hot water scalds caused 36.4% of burns, and clonidine ingestion accounted for 22.1% of unintentional poisonings.