To elucidate the epidemiological characteristics of childhood trauma, we conducted a retrospective analysis of paediatric trauma patients admitted to our hospital's ICU from January 1, 2009, to December 31, 2018. A total of 951 trauma cases were included, with a male-to-female ratio of 1.55:1, highlighting a slight predominance of boys among trauma victims; this finding is consistent with that in a previous study [13]. Further stratification analysis by age revealed a significantly higher proportion of boys in the ‘6–12 years’ age group than in the ‘under 6 years’ group. Boys are recognised as a high-risk group for accidental injuries, and those aged 6–12 years, who are more energetic and curious about their surroundings, are prone to engage in high-risk behaviours that increase their injury risk. This sex disparity in childhood injuries is a global phenomenon that tends to intensify with age.
Our findings echoed existing literature [14–16], with the majority of the injured children (673 cases, 70.77%) being under 6 years old. This prevalence aligns with developmental stages at this age [17], where children under 6 years old have limited environmental awareness and motor skills, coupled with an inadequate understanding of danger, necessitating close supervision [18]. As children mature, improved abilities contribute to reduced trauma incidence [19]. Infants, unable to communicate and reliant on caregivers for their needs, face heightened risks of traffic accidents, falls, and burns/scalds. Consequently, developmental characteristics pertinent to paediatric trauma should guide prevention strategies and be integral to all injury prevention initiatives.
In our study, traffic accidents emerged as the leading cause of trauma, followed by falls, burns/scalds, blast injuries, sharp object injuries, animal attacks, and electrical injuries. Consistently, road traffic accidents are the principal cause of unintentional deaths among children aged 0–14 years in developed countries [20, 21]. Notably, within our sample, the ‘6–12 years’ age group had a higher incidence of traffic-related injuries than the ‘under 6 years’ and ‘12–18 years’ groups. Children aged 6–12 years, transitioning from kindergarten to primary school, have an expanded range of activities, heightened curiosity, weaker self-control, and insufficient understanding of traffic safety. Since the early 1990s, alongside improved living standards in China, there has been a surge in vehicle production, consequently leading to a rise in traffic injury-related mortality and morbidity rates [22]. To address traffic injuries, recurrent training for drivers on relevant regulations and raising public awareness are imperative. Additionally, traffic authorities and educational institutions should enhance traffic management and increase education on child traffic safety to elevate children's awareness. Studies suggest that high fatality rates from traffic injuries in China may be related to the low usage of child safety seats and seat belts [23]. In China, it is common practice for adults to hold infants on the front passenger seat, exposing them to direct airbag impact in case of accidents. Thus, the current traffic laws emphasise the use of child safety seats and seat belts in vehicles [24, 25]. Falls, ranking second to traffic injuries, occur in children mainly due to accidents; in contrast, in adults, intentional falls (such as suicide) are more common [26]. Factors contributing to paediatric falls include increased incidents in high-rise living; lack of protective barriers around balconies, windows, and staircases; and children's curiosity-driven risky behaviours, such as climbing [27]. Installing guardrails on balconies and windows in high-rise apartments, placing carpets to soften falls, and rounding furniture edges can help reduce the risk of injuries. Additionally, enhancing children's motor skills through supervised climbing and tumbling exercises can minimise falling risks.
Regarding injury aetiology, burn/scald injuries, blast injuries, sharp object injuries, animal attacks, and electrocutions exhibit clear regional characteristics, with a significantly higher incidence among children residing in rural or peri-urban areas than among urban children. Tailored intervention strategies can be formulated by compiling paediatric trauma data and understanding its epidemiological features [28]. Effective preventive guidance is derived from comprehensive datasets detailing injuries, which illuminate the shifting risks children encounter throughout their development. Some evidence suggests that burns are the second most common cause of unintentional childhood injuries [29]. In our study, burn/scald injuries ranked third after traffic accidents and falls. The lower rate of ICU admission due to burns/scalds than due to traffic injuries and falls reflects the possible nature of paediatric burns, which are often caused by hot water at home rather than by fires or chemicals. Childhood burns/scalds are influenced not only by age, sex, environment, and behaviour but also by parents' socioeconomic status and education level. Accumulating evidence suggests that 90% of paediatric burns/scalds occur within the home, underscoring the importance of proper first aid knowledge in such scenarios [30]. Our findings revealed that the top three injury locations were roadsides (466 cases, 49.0%), homes (403 cases, 42.4%), and public places (66 cases, 6.9%). The ‘under 6 years’ group sustained more injuries at home than the ‘6–12 years’ group, while the ‘under 6 years’ group experienced fewer injuries on roadsides than the ‘6–12 years’ group, aligning with the injury causes discussed. Hence, reinforcing traffic safety awareness, enhancing child supervision, and broadly disseminating safety education are of utmost importance.
Our analysis of the timing of injuries found that 423 cases (44.5%) occurred between 12 PM and 6 PM, and Saturdays (96 cases, 20.6%) and Sundays (162 cases, 17.0%) showed significantly higher incidences than weekdays, indicating a heightened rate of trauma during non-working days. Furthermore, studies in developing countries have identified inadequate supervision, lower safety standards of household items, insufficient public safety warnings, and uneven road surfaces as risk factors for paediatric trauma [31, 32]; these issues necessitate a more comprehensive investigation to better understand the myriad causes of child injuries in low- and middle-income nations [33, 34]. Seasonally, winter showed a relatively lower trauma incidence, likely due to reduced outdoor activities because of colder weather. Notably, among children aged 12–18 years, a higher likelihood of trauma was observed from June through August, coinciding with the nearly two-month-long summer vacations. During this period, children aged ≥ 12 years gain more independence in mobility, highlighting the imperative for intensified safety education during these months.
Among the 951 paediatric patients, ‘single site injuries’ (58.78%) were more prevalent than ‘multiple-site injuries’ (41.22%), with head injuries constituting the primary type among single-site traumas (81.57%), followed by abdominal and thoracic injuries. Cranio-cerebral trauma, a common and critical condition in emergency medicine [35–37], is categorised into various forms, including epidural hematoma, subdural hematoma, traumatic subarachnoid haemorrhage, and severe cerebral contusions. These conditions necessitate prompt intervention due to their severity, high mortality, and disability rates [38, 39]. In the United States, approximately 500,000 children annually present to emergency departments for head injuries, with approximately 7,000 fatalities [40]. In our study, 529 patients (55.6%) underwent emergency surgical intervention. Trauma can lead to various complications, with respiratory failure being the most frequent [41]. Notably, in our study cohort, 466 patients (49%) required mechanical ventilation, with an average duration of 70.19 ± 146.62 hours, indicating that invasive ventilation complications significantly impact the duration of ICU stays [42].
Childhood trauma incidence is intricately linked with economic, cultural, behavioural, and living conditions [43–45]. Prior research has exhibited distinct geographic and demographic patterns in childhood trauma incidence. Our study also discerned variances in injury types and causes among urban, suburban-rural fringe, and rural children, with a lower incidence in urban and suburban-rural fringe areas than in rural locales. Despite China's rapid economic progress, which has narrowed the urban-rural gap, trauma incidence remains disproportionately high in rural areas. Prolonged transportation times to urban medical facilities and less advanced emergency care in rural regions contribute to this discrepancy. In rural areas, traffic restrictions can lead to prolonged transit times for children needing medical attention in urban centres, thereby delaying access to optimal intervention periods. Moreover, the relative inadequacy of local emergency response facilities and technological capabilities further contributes to this disparity. Another report highlights that left-behind children (those residing in rural China while their parents work in cities, typically cared for by extended family members such as grandparents or other close relatives) face a significantly higher risk of injury than their urban counterparts. [46]
This study, confined to a single-centre retrospective summary over nearly a decade, inherently limits its scope in comprehensively depicting the characteristics of trauma. Expanding to a nationwide, multicentre, prospective investigation encompassing diverse geographic regions would afford a broader perspective, enabling a deeper understanding of the current state of trauma in China. Such an endeavour would not only provide a more nuanced picture of trauma epidemiology but also illuminate the effectiveness of educational campaigns, policy improvements, and other preventive measures in mitigating the burden of trauma across the country.
Paediatric trauma constitutes a major public health concern, representing a substantial proportion of unintentional injuries and exhibiting an alarming upward trend in recent years [47]. Traffic injuries stand as the paramount cause of paediatric trauma, underscoring the ongoing significance of appropriate utilisation of child restraint systems and protective equipment in prevention efforts. The heightened vulnerability of children under 6 years old and those residing in rural areas, with correspondingly higher injury rates, highlights the pressing need for targeted preventive strategies and public policies tailored to these high-risk demographics. A more thorough comprehension of the characteristics of paediatric trauma can facilitate enhanced public awareness campaigns and educational initiatives, leading to more efficacious prevention measures. The literature has documented that the establishment of trauma systems can reduce mortality rates by 15% [48], emphasising the imperative to strengthen rural healthcare systems and capabilities. Efforts must be directed toward enhancing medical institutions' capacity to provide advanced care for injured children and ensuring efficient patient transfer, collaboratively working to mitigate the multifaceted physiological and psychological impacts that trauma inflicts upon these young patients.