Paediatric trauma on the Last Frontier: an 11-year review of injury mechanisms, high-risk injury patterns and outcomes in Alaskan children

Figures & data

Table I. Demographics and injury mechanisms, stratified by Emergency Medical Services geographic regions

	Overall (n=5,547)	Anchorage/Mat-Su (n=2,498)	Fairbanks (n=507)	Southeast (n=442)	Remote (n=2,100)
Age, years	12 (6–15)	12 (6–15)	12 (5–15)	12 (6–15)	12 (6–15)
Female sex	1,869 (34)	803 (32)	169 (33)	169 (38)	728 (35)
Ethnicity^a
Alaska Native/American Indian	2,148 (39)	504 (20)	97 (19)	175 (40)	1,372 (65)
Other	441 (8)	348 (14)	41 (8)	23 (5)	29 (1)
Unknown	24 (<1)	104 (4)	20 (4)	24 (5)	127 (6)
White	2,683 (48)	1,542 (62)	349 (69)	220 (50)	572 (27)
Recent alcohol use^a	253 (5)	86 (3)	19 (4)	23 (5)	125 (6)
Recent drug use	184 (3)	84 (3)	11 (2)	21 (5)	68 (3)
Penetrating mechanisms
Gunshot wound	116 (2)	54 (2)	7 (1)	3 (1)	52 (2)
Stab, cut, or impalement	66 (1)	29 (1)	11 (2)	5 (1)	24 (1)
Blunt mechanisms
Motor vehicle-related
Motor vehicle occupant^a	529 (10)	277 (11)	58 (11)	59 (13)	135 (6)
Motorcycle/dirt bike^a	183 (3)	77 (3)	26 (5)	9 (2)	71 (3)
All-terrain vehicle^a	486 (9)	120 (5)	29 (6)	22 (5)	315 (15)
Snowmachine^a	254 (5)	58 (2)	15 (3)	5 (1)	176 (8)
Bicycle vs. motorized vehicle	86 (2)	47 (2)	11 (2)	10 (2)	18 (1)
Pedestrian vs. motorized vehicle	201 (4)	90 (4)	7 (3)	18 (4)	86 (4)
Non-motor vehicle-related
Bicycle	374 (7)	192 (8)	32 (6)	26 (6)	124 (6)
Fall – from skateboard	92 (2)	57 (2)	4 (1)	6 (1)	25 (1)
Fall – from building	139 (3)	66 (3)	12 (2)	11 (2)	50 (2)
Fall – from skis/snowboard^a	197 (4)	131 (5)	23 (5)	19 (4)	24 (1)
Fall – from playground equipment	250 (5)	110 (4)	18 (4)	20 (5)	102 (5)
Fall – other	1,464 (26)	645 (26)	142 (28)	138 (31)	539 (26)
Sports	414 (7)	200 (8)	48 (9)	34 (8)	132 (6)
Struck by person or object  (non-motorized)^a	358 (6)	188 (8)	31 (9)	27 (6)	112 (5)
Sledding	108 (2)	60 (2)	14 (3)	12 (3)	22 (1)
Animal-related	69 (1)	34 (1)	4 (1)	3 (1)	28 (1)
Other^b	161 (3)	63 (3)	18 (4)	15 (3)	65 (3)

Data presented as N (%) and median (interquartile range) for categorical and continuous variables, respectively.

^aStatistically significant difference between regions (p<0.05) on Chi-square and Kruskal–Wallis tests for categorical and continuous variables, respectively.

^bOther category includes water transport, explosion, airplane crash, strain/overexertion and abuse/neglect not elsewhere classifiable.

Table II. Mechanisms of injury, by age group^a

	0–4 years (n=1,074)	5–9 years (n=1,113)	10–14 years (n=1,726)	15–17 years (n=1,628)
Penetrating mechanisms
Gunshot wound	4 (<1)	8 (1)	37 (2)	66 (4)
Stab, cut, or impalement	12 (1)	10 (1)	14 (1)	30 (2)
Blunt mechanisms
Motor vehicle-related
Motor vehicle occupant	50 (9)	59 (5)	91 (5)	328 (20)
Motorcycle/dirt bike	0	8 (1)	93 (5)	82 (5)
All-terrain vehicle	19 (2)	58 (5)	208 (12)	201 (12)
Snowmachine	8 (1)	21 (2)	88 (5)	136 (8)
Bicycle vs. motorized vehicle	4 (<1)	20 (2)	43 (2)	19 (1)
Pedestrian vs. motorized vehicle	55 (5)	57 (5)	46 (3)	42 (3)
Non-motor vehicle-related
Bicycle	13 (1)	58 (5)	176 (10)	65 (4)
Fall – from skateboard	2 (<1)	7 (1)	47 (3)	36 (2)
Fall – from building	70 (7)	34 (3)	24 (1)	11 (1)
Fall – from skis/snowboard	1 (<1)	18 (2)	97 (6)	81 (5)
Fall – from playground equipment	46 (4)	141 (13)	57 (3)	6 (<1)
Fall – other	559 (52)	393 (35)	339 (20)	172 (11)
Sports	7 (1)	22 (2)	190 (11)	195 (12)
Struck by person or object  (non-motorized)	147 (14)	53 (5)	68 (4)	90 (6)
Sledding	7 (1)	39 (4)	42 (2)	20 (1)
Animal-related	13 (1)	23 (2)	25 (1)	8 (<1)
Other^b	57 (5)	22 (2)	41 (2)	40 (2)

Data presented as N (%).

^aAll mechanisms demonstrated statistically significant variation by age group (p<0.05) on Chi-square test.

^bOther category includes water transport, explosion, airplane, strain/overexertion and abuse/neglect not elsewhere classifiable.

Table III. Comparison of mechanisms by injury severity, resource utilization and outcome^a

	Injury Severity Score (ISS)	ISS≥15	Hospital days	Hospital charges, thousands of $US	Death	Unfavourable outcome
Penetrating
Gunshot wound	9 (4–16)	34 (30)	4 (1–8)	24.1 (10.2–52.9)	24 (21)	30 (26)
Stab, cut, or impalement	4 (4–9)	4 (6)	2 (1–5)	12.7 (6.5–29.5)	0	0
Blunt
Motor vehicle-related
Motor vehicle occupant	9 (5–17)	153 (30)	3 (1–6)	16.9 (8.1–38.8)	28 (5)	73 (14)
Motorcycle/dirt bike	5 (4–9)	25 (14)	2 (1–5)	14.2 (7.3–30.7)	2 (1)	13 (7)
All–terrain vehicle	5 (4–9)	58 (12)	2 (1–4)	11.3 (4.8–23.3)	10 (2)	20 (4)
Snowmachine	5 (4–9)	21 (8)	2 (1–4)	9.8 (4.2–25.4)	1 (<1)	5 (2)
Bicycle vs. motorized vehicle	9 (8.5–14)	15 (18)	3 (1–6)	17.4 (7.8–38.8)	3 (3)	11 (13)
Pedestrian vs. motorized vehicle	9 (4–13)	39 (20)	2 (1–4)	12.0 (4.8–26.8)	18 (9)	23 (11)
Non-motor vehicle-related
Bicycle	4 (4–9)	27 (8)	1 (1–3)	9.0 (4.6–19.1)	3 (1)	6 (2)
Fall – from skateboard	4 (4–9)	5 (5)	1 (1–2)	9.5 (6.4–14.3)	0	0
Fall – from building	5 (4–10)	22 (16)	1 (1–3)	10.3 (4.9–21.1)	1 (1)	6 (4)
Fall – from skis/snowboard	4 (4–9)	13 (7)	1 (1–3)	9.9 (6.3–21.2)	0	3 (2)
Fall – from playground equipment	4 (4–5)	4 (2)	1 (1–2)	7.0 (4.1–12.4)	0	2 (1)
Fall – other	4 (4–9)	79 (6)	1 (1–2)	7.5 (4.1–13.5)	5 (<1)	25 (2)
Sports	4 (4–4)	18 (5)	1 (1–2)	10.4 (5.5–18.8)	1 (<1)	3 (1)
Struck by person or object  (non–motorized)	4 (4–9)	49 (15)	2 (1–3)	8.4 (4.3–17.8)	10 (3)	21 (6)
Sledding	8 (4–9)	7 (7)	2 (1–4)	13.0 (5.6–27.6)	2 (2)	7 (6)
Animal–related	9 (4–10)	9 (13)	2 (1–6)	16.7 (6.9–43.0)	2 (3)	5 (7)
Other^b	4 (4–9)	12 (8)	1 (1–3)	6.8 (3.4–19.6)	6 (4)	14 (9)

Data presented as N (%) and median (interquartile range) for categorical and continuous variables, respectively.

^aAll variables demonstrated statistically significant variation by mechanism (p<0.05) on Chi-square and Kruskal–Wallis tests for categorical and continuous variables, respectively.

^bOther category includes water transport, explosion, airplane, strain/overexertion and abuse/neglect not elsewhere classifiable.

Table IV. Comparison of mechanisms by prevalence of high-risk injury patterns^a

		Non-CNS torso injury
	CNS injury	Thoracic organ	Abdominal/ pelvic organ	Pelvic fracture	Vascular disruption	Combined CNS and non-CNS injury
Overall	1,179 (21)	323 (6)	435 (8)	133 (2)	39 (1)	142 (3)
Penetrating
Gunshot wound	27 (23)	22 (19)	17 (15)	0	7 (6)	2 (2)
Stab, cut, or impalement	5 (8)	14 (21)	11 (17)	0	6 (9)	1 (2)
Blunt
Motor vehicle-related
Motor vehicle occupant	202 (38)	112 (21)	114 (22)	49 (9)	5 (1)	69 (13)
Motorcycle/dirt bike	24 (13)	14 (8)	25 (14)	4 (2)	3 (2)	5 (3)
All-terrain vehicle	124 (26)	36 (7)	39 (8)	20 (4)	4 (1)	10 (2)
Snowmobile	44 (17)	15 (6)	14 (6)	10 (4)	2 (1)	4 (2)
Bicycle vs. motorized vehicle	24 (28)	15 (17)	7 (8)	8 (9)	0	6 (7)
Pedestrian vs. motorized vehicle	48 (24)	29 (14)	25 (12)	20 (10)	0	14 (7)
Non-motor vehicle-related
Bicycle	67 (18)	4 (1)	49 (13)	0	1 (<1)	4 (1)
Fall – from skateboard	14 (15)	0	3 (3)	0	0	0
Fall – from building	48 (35)	9 (6)	6 (4)	2 (1)	0	7 (5)
Fall – from skis/snowboard	10 (5)	5 (3)	26 (13)	7 (4)	1 (1)	2 (1)
Fall – from playground equipment	16 (6)	0	5 (2)	0	3 (1)	0
Fall – other	287 (20)	12 (1)	25 (2)	3 (<1)	2 (<1)	3 (<1)
Sports	36 (9)	8 (2)	26 (6)	4 (1)	0	0
Struck by person or object (non-motorized)	139 (39)	9 (3)	24 (7)	3 (1)	0	6 (2)
Sledding	21 (19)	5 (5)	7 (6)	0	0	2 (2)
Animal-related	17 (25)	6 (9)	6 (9)	0	4 (6)	2 (3)
Other^b	26 (16)	8 (5)	6 (4)	3 (2)	1 (1)	5 (3)

Data presented as N (%). CNS, central nervous system.

^aAll injury patterns demonstrated statistically significant variation by mechanism (p<0.05) on Chi-square test.

^bOther category includes water transport, explosion, airplane crash, strain/overexertion and abuse/neglect not elsewhere classifiable.

Table V. Prevalence of high-risk injury patterns among fatalities

High-risk injury pattern	Frequency among fatalities (n=116)
CNS injury	85 (73)
Non-CNS torso injury
Thoracic organ	32 (28)
Abdominal/pelvic organ	20 (17)
Pelvic fracture	7 (6)
Vascular disruption	5 (4)
Combined CNS + non-CNS injury	26 (22)

Data presented as N (%). CNS, central nervous system.