Trauma is the leading cause of death and disability in children (2). More than 950,000 children under the age of 18 died due to intentional or unintentional accidents in 2004. In 2008, the main cause of death in children older than one year were reported to be accidents (12). We found that overall, mortality rate was higher in females (6.7%) and motor vehicles accidents were associated with the highest rate of mortality amongst all evaluated causes.
In all age groups, majority of our cases were male, this finding is consistent with the 2/1 ratio reported in other studies (6, 13)but, many cases of female trauma are probably under reported due to cultural and social backgrounds of various communities. In contrast with other studies which reported as the age group increases among boys, the percentage of trauma increases as well,(14, 15) we did not find such trend in our data. It is suggested that this could be due to the fact that boys tend to express more dangerous behaviors as they age(16).
Regarding causes of injuries, falls were the most common mechanism of injury in patients under 5 years of age (52%) which is in consistent with other studies.(17–19) Previous studies, also reported that other than young age, male sex and low socioeconomic status are the other risk factors for fall injuries among those with less than 6 years of age.(20, 21)
In this study, the leading cause of mortality was motor vehicle accidents. The results of various studies on motor vehicle injuries differ due to differences in the cultural and economic status of communities, the quality of vehicles, and road construction (22). However, road traffic accidents, if not considered the most important cause, has been recognized as one of the major factors associated with mortality in pediatric trauma(13, 23).
Children are more likely to be injured following road traffic accidents, mainly due to physical and cognitive-social characteristics of different stages of development.(19). Therefore, the proper education at different ages in the field of transportation and road traffic plays a vital role in improving their behavior, awareness, and knowledge. (24)
The leading type of injury with higher mortality was the head trauma. Fetal head injuries reported to happen mostly in boys during spring and summer.(25)The mean length of hospital stay was generally higher in these injuries. It is suggested that traumatic brain injury (TBI) is associated with higher mortality and morbidity rates in children which seems to be due to the distinctive physical characteristics of children (26). The skull of children is relatively smaller but the proportion of skull to the whole body is higher than of adults, and thus the risk of head trauma in children may be higher (27). Also, due to the vulnerable sutures of the skull in children, a physical shock after head trauma is almost imminent. In addition, the child's skull bones are less intense, and if a severe injury is endured, the damage to the brain and vascular tissue would be more critical.
In this study a positive correlation between a hemoglobin(Hb) drop and the mortality rate could be recognized. However; Yee et al., unlike our results, did not find Hb status significantly correlated with mortality in pediatric trauma (28).
In 70.6% of patients, urinalysis was performed, but only 0.4% of our patients needed further evaluations because of microscopic hematuria. It was indicated that in a large number of patients, urinalysis was not necessary. Other reports also suggested that the diagnostic value of urinalysis is minimum in terms of differentiating the injuries following abdominal trauma and this test should be used only as an adjacent to other diagnostic procedures (29, 30).
The results of our study showed that there was a positive correlation between mortality and male gender, head trauma, positive brain, abdomino-pelvic CT scan findings, positive Focused assessment with sonography in trauma (FAST), Hb drops and need for surgery. Although the patients in the mortality group were 2 years younger than the study population, we could not find a correlation between age and mortality.