Mechanisms of paediatric injury: an 11-year review of injury trends from the National Trauma Data Bank

Abstract

Background/purpose

Unintentional injuries are the leading cause of death among children and adolescents. The objective of this study was to describe temporal trends of paediatric traumatic injury over an 11-year period by mechanism of injury (MOI), age, sex, race and ethnicity, injury severity and hospital discharge disposition.

Methods

The National Trauma Data Bank was queried to identify paediatric patients (1–17 years old) injured from 2012 to 2022. Two-sided non-parametric Mann-Kendall trend tests were used to evaluate temporal trends of MOI for all patients and within demographic groups.

Results/outcomes

Over the 11-year period, 1 092 308 injury records met study inclusion criteria and had complete demographic and MOI data. Across all patients, there was a significant increase in bites and stings, cut/pierce injuries and firearm injuries, whereas there were decreasing trends in pedestrian and other blunt injuries over time. There was a significant increase in injury over time for Black, Hispanic or Latino, and Pacific Islander patients and those 5–9 years old. The MOIs with the highest injury severity and in-hospital mortality were firearm, pedestrian and motor vehicle transportation occupant injuries.

Conclusions

Though a few MOIs increased for all paediatric patients in the study period, disparities persist for several specific populations. As such, injury prevention strategies should be tailored based on age, sex and race or ethnicity, and relevant education and resources should be provided to both children and their adult guardians. Future research should consider additional socioeconomic and community-based characteristics.

INTRODUCTION

Injury surveillance and evaluation remain an important cornerstone for the continual improvement in treatment of injuries and efficacy of injury prevention strategies. Within the paediatric population, traumatic injuries can significantly impact the trajectory of young lives. In the USA, unintentional injuries are the leading cause of death among children and adolescents.¹ In 2021, there were 11 798 injury deaths in those aged 1–18 years, equating to 611 036 years of potential life lost.² Injury-related emergency department (ED) visits have also been increasing over time, from 367 072 (16.3% of all-cause paediatric ED visits) in 2010 to 479 458 visits (18.1% of all ED visits) in 2019 based on data from 33 US children’s hospitals for patients aged 0–19 years.³

The burden of paediatric injury is not equitably distributed by age, sex, race and ethnicity. In 2018–2019, paediatric unintentional injury death rates were highest in male children, those <1 year old, those 15–19 years old and those of American Indian, Alaska Native, or Black or African American race.⁴ The mechanisms of injury (MOI) also differ based on age and race or ethnicity, with suffocation and drowning incidents more common among younger children (≤4 years old) and motor vehicle crashes occurring in those 15–19 years old.^{1 4} Recent increases in poisoning/overdose deaths among Hispanic and Black or African American children, and increases in suffocation and motor vehicle crashes in Black or African American children have been reported.^{1 4} Despite these disparities, much of the data available at the national level are often limited to only fatalities or use self-reported data, or administrative or billing codes to identify patients for inclusion, and do not consistently report trends over time. To address this gap, the objective of this study was to describe temporal trends of paediatric traumatic injury over an 11-year period using the National Trauma Data Bank (NTDB). The NTDB affords the opportunity to evaluate trauma-specific clinical information and outcomes not captured in other national data sources. We aim to describe trends in paediatric injury by MOI, age, sex, race and ethnicity, injury severity and hospital discharge disposition.

METHODS

The NTDB is the largest aggregation of trauma registry data in the USA and is maintained by the American College of Surgeons (ACS).⁵ Over the 11-year study period 2012–2022, there were on average 768 facilities represented annually (range=721–816) with an annual average of 1 009 849 admission records (range=827 289–1 232 956).⁶ Though not all of trauma centres are represented, the data are considered nationally representative of level I and II centres.⁷ Further, some geographical data are collected by the ACS NTDB, but are not released for research purposes, so the geographical representation within these data is unknown. The data are audited and entered by trained registrars as part of the ACS trauma centre verification programme. Inclusion in the NTDB is based on clinical coding for traumatic injuries. The NTDB was queried to identify paediatric patients (1–17 years old) injured from 2012 to 2022 (n=1 207 878).

Traumatic injuries were designated by International Classification of Diseases (ICD) external cause codes and defined as injuries sustained from a physical force outside the body. The MOI was determined according to categories outlined in the respective ICD injury matrices.⁸ Traumatic MOIs were condensed across ICD codes to yield the following nine categories: bites and stings, cuts/pierce, cyclist, falls, firearm, motor vehicle transportation (MVT) occupant, and MVT other (eg, non-traffic, stationary incidents), other blunt trauma injuries (eg, fight or brawl, projected or falling object) and pedestrian struck (see online supplemental file 1). Burns were excluded from analyses as these injuries were not included in the NTDB for the full study time period. Burn trends are reported relative to other injuries in the supplement over the available years (2012–2020).

The primary demographic variables of interest were sex (male or female), age (1–4, 5–9, 10–14, 15–17 years) and race and ethnicity. Race and ethnicity were categorised to reflect US census categories: Asian, Black, Hispanic or Latino, Multiracial, Native American, Pacific Islander and White.⁹ Patients in the Hispanic or Latino category may represent additional racial identities, whereas all other categories listed were patients indicated as Not Hispanic or Latino ethnicity. The Multiracial category represents patients with more than one racial identity indicated. Records with missing ICD codes or demographic variables were excluded.

Abbreviated Injury Score-derived Injury Severity Scores (ISS; 1% missing) and hospital discharge disposition (10% missing) were assessed by MOI over time where available. The ISS was grouped into low (1–14), moderate (15–25) and high (26+) injury severity. Hospital discharge disposition was categorised into deceased, routine discharge to home, other discharge (ie, discharged from hospital to other facility for further care) and discontinued care against medical advice. Missing data for ISS and hospital discharge disposition were excluded within respective analyses.

Statistical analysis

Relative injury proportions were calculated each year, with the denominator being the total injuries that met study inclusion criteria for each specified year. As the NTDB deidentifies trauma centres in the data, we were unable to verify consistency in trauma centre representation year to year. As such, and due to non-normal distributions of injury when stratified by demographic factors, two-sided non-parametric Mann-Kendall trend tests were used, in lieu of other regression methods, to evaluate monotonic temporal trends of MOI for (1) all patients, and then stratified by (2) racial and ethnic groups, (3) age and (4) sex. Injuries according to MOI were compared among racial and ethnic groups. ISS and hospital discharge disposition trends were also evaluated using Mann-Kendall tests.

RESULTS

Demographic characteristics of injured patients

Over the 11-year period, 1 092 308 injury records met study inclusion criteria and had complete demographic and MOI data (92.9% of total records identified where age was <18). Of these, 58.7% were White, 17.6% were Black, 16.1% were Hispanic or Latino, 4.3% were Multiracial, 2.0% were Asian, <1% were Native American and <1% were Pacific Islander. Overall, 20.4% of patients were 1–4 years old, 26.9% were 5–9 years old, 26.8% were 10–14 years old and 25.9% were 15–17 years old. Most patients were male (64.7%). The most common MOIs were falls (41.7%), MVT occupant (15.8%) and other blunt trauma (11.9%).

Temporal trends by patient characteristics

Across all MOIs, there was a significant increase in injury over time for Black (z=2.26, p=0.02), Hispanic or Latino (z=3.42, p=0.0006) and Pacific Islander patients (z=2.19, p=0.02), and a significant decrease for White patients (z=−3.58, p=0.0003) (table 1; online supplemental table 1). There was no significant change over time by sex. There was a significant increase in traumatic injury over time for those 5–9 years old (z=2.02, p=0.04) and a significant decrease for those 1–4 years old (z=−2.17, p=0.02).

Table 1.

Traumatic injuries by year among children aged 1–17 years included in the NTDB

	Overall	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022	Z	P value
Total injuries (n)	1 092 308	95 899	90 343	89 705	92 955	94 098	102 570	92 708	102 142	106 025	112 905	112 958	2.64	0.008*
Mechanism (%)
Bites and stings	3.20	2.23	2.40	2.57	2.76	2.70	3.01	3.39	3.26	4.32	3.88	4.18	3.58	0.0003**
Cut/pierce	3.30	3.15	3.12	3.17	3.24	2.82	3.18	3.33	3.34	3.81	3.40	3.57	2.95	0.003*
Cyclist	5.58	6.83	6.53	6.50	5.93	5.49	4.21	3.91	5.54	7.22	5.01	4.50	−1.86	0.06
Fall	41.72	40.51	41.70	42.57	42.36	42.32	42.99	44.11	42.26	39.53	40.53	40.68	−0.31	0.75
Firearm	4.34	3.34	3.19	3.20	3.45	3.56	4.06	4.18	4.23	5.81	5.72	6.18	3.73	0.0001**
MVT occupant	15.76	15.67	15.26	14.72	15.69	15.97	15.73	16.86	15.91	15.55	16.40	15.50	0.93	0.35
MVT other	9.45	9.45	9.09	9.07	9.10	9.61	9.57	6.46	9.31	11.54	10.48	9.70	1.57	0.11
Other blunt trauma	11.86	12.99	13.05	12.63	12.23	12.32	12.12	12.64	11.86	8.91	10.80	11.58	−2.80	0.005*
Pedestrian	4.79	5.84	5.67	5.56	5.25	5.20	5.14	5.12	4.29	3.31	3.77	4.11	−3.73	0.0001**
Race and ethnicity (%)
Asian	2.00	1.82	1.88	2.06	1.89	1.84	2.14	2.09	2.08	1.84	2.03	2.25	1.48	0.13
Black	17.60	17.30	16.79	17.18	17.41	17.71	17.28	17.61	17.28	17.48	18.57	18.59	2.26	0.02*
Hispanic or Latino	16.10	12.54	13.61	13.84	15.04	16.01	17.32	17.56	17.18	16.57	17.91	18.43	3.42	0.0006**
Multiracial	4.30	4.41	4.21	4.28	4.14	4.37	4.24	4.26	4.45	4.31	4.20	4.42	0.46	0.64
Native American	0.97	0.85	1.06	1.08	1.03	0.88	0.96	1.05	0.93	0.96	1.03	0.95	−0.31	0.75
Pacific Islander	0.29	0.22	0.22	0.25	0.24	0.33	0.32	0.28	0.37	0.34	0.31	0.32	2.19	0.02*
White	58.70	62.87	62.24	61.31	60.27	58.86	57.74	57.15	57.72	58.50	55.96	55.04	−3.58	0.0003**
Age group (%)
1–4	20.40	21.04	20.92	20.64	20.47	20.69	20.96	21.92	20.11	20.43	19.39	18.76	−2.17	0.02*
5–9	26.90	25.06	26.09	26.84	26.97	27.28	27.42	27.29	27.31	26.55	27.33	27.09	2.02	0.04*
10–14	26.80	26.68	26.57	26.76	26.78	26.36	26.29	25.44	27.03	27.20	27.67	27.85	1.71	0.08
15–17	25.90	27.22	26.42	25.76	25.78	25.66	25.33	25.35	25.55	25.82	25.61	26.30	−0.93	0.35
Sex
Female	35.30	34.15	34.73	35.00	35.39	35.77	35.46	36.25	35.34	35.77	35.65	34.86	1.55	0.11
Male	64.70	65.85	65.27	65.00	64.61	64.23	64.54	63.75	64.66	64.23	64.35	65.14	−1.55	0.11

^*P<0.05

^**P<0.001.

In 2021, sole burn injuries were removed from the NTDB inclusion criteria and are therefore excluded from 2021 and 2022 analyses. See online supplemental table 2 for analyses through 2020 including burn injuries.

MVT, motor vehicle transportation; NTDB, National Trauma Data Bank; P value, Mann-Kendall test p value; Z, two-sided Mann-Kendall trend test statistic.

Across all patients, trend analysis results for MOI showed a significant increase in bites and stings (z=3.58, p=0.0003), cut/pierce (z=2.95, p=0.003) and firearm injuries (z=3.73, p=0.0001), whereas there were decreasing trends of other blunt injury (z=−2.80, p=0.005) and pedestrian injury (z=−3.73, p=0.0001; table 1). No other MOIs showed significant changes in temporal trends. Trends of injury including burns are reported in online supplemental tables 2 and 3 though largely reflect the patterns reported below.

MOI by race and ethnicity

Changes in MOI over time by racial and ethnic group are reported in table 2 and respective longitudinal injury trends shown in figure 1 and online supplemental figure 1. Bites and stings increased for Black, Hispanic or Latino, Multiracial, Pacific Islander and White patients (all p<0.03). Cut/pierce injuries increased for Multiracial, Pacific Islander and White patients (all p<0.01). Cyclist injuries decreased for Black patients (p<0.03). Fall-related injuries increased across Asian and Pacific Islander patients and decreased for Black patients (all p<0.01). Firearm injuries increased for all groups except Asian and Pacific Islander patients (all p<0.05). MVT occupant injuries increased for Black, Hispanic or Latino and Multiracial patients (all p<0.01). Other blunt injuries decreased for Black patients (z=−2.84, p=0.004). Pedestrian injuries decreased for all groups (all p<0.01).

Table 2.

Mann-Kendall results of MOI trends by race and ethnicity and age group

Mechanism	Race and ethnicity							Age group				Sex
	Asian	Black	Hispanic or Latino	Multiracial	Native American	Pacific Islander	White	1–4	5–9	10–14	15–17	Female	Male
Bites and stings	1.86	3.42**	3.58**	3.11*	1.71	2.80*	3.58**	3.73**	3.42**	3.73**	3.26**	3.89**	3.42**
Cut/pierce	0.93	−2.02	0.15	2.64*	0.46	2.02*	3.11**	2.80*	2.64*	2.49*	−0.46	1.24	2.64**
Cyclist	−0.77	−2.64*	−1.86	−1.55	−1.24	−0.62	−1.55	−2.49*	−2.49*	−1.71	−2.17*	−2.17	−1.71
Fall	2.95**	−2.64*	−0.77	−0.46	0.15	2.49*	0.62	−1.24	2.02*	−0.62	−2.17*	0.31	−0.62
Firearm	1.57	3.58**	2.80*	2.64*	3.26**	1.40	3.26**	3.73**	3.26**	3.11**	3.89**	3.58**	3.58**
MVT occupant	−1.71	2.95**	2.64*	2.02*	−0.62	−0.46	−2.17*	−0.46	0.15	2.80*	0.62	−1.40	2.64**
MVT other	−0.93	1.71	2.95*	1.40	0.15	0	1.40	1.40	1.86	0.62	0.62	1.08	1.40
Other blunt trauma	−1.08	−3.26**	−1.86	−1.55	−1.86	−1.32	−1.86	−3.42**	−1.71	−2.17*	−2.17*	−2.49	−2.95**
Pedestrian	−3.11**	−2.95**	−3.58**	−3.26**	−2.49*	−2.33*	−3.26**	−4.04**	−3.11**	−2.49*	−3.26**	−3.42**	−3.42**

^*P<0.05

^**p<0.001.

Values represent Mann-Kendall z-statistics; negative values indicate decreasing injury, positive values indicate increasing injury from 2012 to 2022.

MOI, mechanism of injury; MVT, motor vehicle transportation.

Figure 1.

Proportion of injuries over time stratified by race and ethnicity and mechanism of injury. Proportions calculated each year within each mechanism of injury (MOI). MVT, motor vehicle transportation. The “more than one” or multiracial category represents not Hispanic or Latino patients with more than one racial identity indicated.

Further examination of injury profiles indicated stark differences in relative proportions of injury by race and ethnicity (figure 1; online supplemental figure 1). There are consistent patient populations with disproportionately high burdens of injury by MOI: falls among Asian patients, firearm-related injury among Black patients and MVT other for Native American and White patients.

MOI by age

Changes in MOI over time by age group are depicted in table 2 and figure 2. Bites and stings increased for all age groups (all p<0.03). Cut/pierce injuries increased for children 1–4, 5–9 and 10–14 years old (all p<0.01). Cyclist injuries decreased for children 1–4, 5–9 and 15–17 years old (all p<0.01). Falls increased for children 5–9 years old and decreased for those 15–17 years old (p<0.05). MVT occupant injuries increased for children 10–14 years old (p<0.01). Firearm injuries increased for all age groups (all p<0.01). Other blunt trauma significantly decreased for children 1–4, 10–14 and 15–17 years old (p<0.01). Pedestrian injuries decreased across all age groups (all p<0.01).

Figure 2.

Proportion of injuries over time stratified by age group and mechanism of injury. Proportions calculated each year within each mechanism of injury (MOI). Dashed lines depict regression via local polynomial to aid visualisation of trends. MVT, motor vehicle transportation.

MOI by sex

Male patients accounted for the majority of those injured across all MOIs, except for bites and stings, falls and MVT occupant injuries, where proportions of injuries by sex were more similar (figure 3). For both male and female patients, there were increases in bites and stings, firearm injuries and decreases in pedestrian injuries (all p<0.03; table 2). For only male patients, there were increases in cut/pierce and MVT occupant injuries and a decrease in other blunt trauma injuries (all p<0.03).

Figure 3.

Proportion of injuries over time stratified by sex and mechanism of injury. Proportions calculated each year within each mechanism of injury (MOI). MVT, motor vehicle transportation.

MOI by ISS

High ISS injuries increased over time for cut/pierce (z=2.02, p=0.04), cyclist (z=2.88, p=0.003), firearm (z=2.73, p=0.006), MVT occupant (z=2.49, p=0.01), other blunt injury (z=2.17, p=0.02) and pedestrian (z=2.42, p=0.01; online supplemental figure 2). High ISS injuries decreased over time for bites and stings (z=−2.06, p=0.03). MOIs with the greatest proportions of high ISS included firearm (~11%), pedestrian (~10%) and MVT occupant (~9%).

MOI by hospital discharge disposition

The overwhelming majority of injuries across all MOIs resulted in routine discharges (75–97%). Routine discharges increased over time for bites and stings (z=3.26, p=0.001), falls (z=3.20, p=0.001), MVT occupant (z=3.11, p=0.001), MVT other (z=2.17, p=0.02) and other blunt trauma (z=2.64, p=0.008; online supplemental figure 3). Mortality in hospital decreased for cut/pierce (z=−2.03, p=0.04). The greatest number of in-hospital deaths resulted from firearm (~8%), pedestrian (~2.7%) and MVT occupant (~2%) injuries.

DISCUSSION

Evaluation of paediatric injury data over an 11-year period from the largest trauma registry in the USA indicated that relative proportions of pedestrian injuries and other blunt traumatic injuries have decreased over time, while bites and stings, cut/pierce and firearm injuries increased. Injuries also increased over time for Black, Hispanic or Latino and Pacific Islander patients, as well as children 1–4 and 5–9 years old.

Disparities by race and ethnicity have been well reported for a multitude of health outcomes in the USA among both paediatric and adult populations.^{1 10} Paediatric traumatic injuries also illustrate disparities by race and ethnicity. While the relative proportions of falls did not change significantly for the total population over the 11-year study period, significant increases were seen among Asian and Pacific Islander children, as well as those 5–9 years old. Fall injuries in children have a multitude of causes, including falls from someone’s arms, from playground equipment, downstairs, etc.^{11 12} Most research on paediatric fall injuries has focused on those ≤5 years of age, but this analysis indicates a need to ensure that fall prevention efforts are expanded to older children as well. Though the American Academy of Pediatrics (AAP) issued fall prevention guidelines in 2001 specifically addressing falls from heights, there may be a need for updated comprehensive guidelines for fall prevention in children.¹³

Since 2020, firearm injuries are the leading cause of death in U.S. children.¹⁴ This analysis illustrates firearm injuries have increased over time across all age groups, both sexes and most racial and ethnic groups, though Black children disproportionately shoulder the burden of firearm injury. These differences are consistent with other reports.^15–21 In a 2015 survey, it was estimated that 13 million households with children contained at least one gun, and 21% of those homes had a gun stored loaded and unlocked.²² More recent estimates suggest that more than 22 million US children live in homes with guns, and that 75% of these children know where the gun is stored.²³ There is an urgent need for increased firearm research in youth and firearm safety education, particularly regarding responsible gun handling and safe storage. A recent analysis of the ACS Firearm Study database has provided further contextual details about firearm injuries, including a history of adverse childhood experiences, mental illness, access to firearms and assault-related characteristics.²⁴ Another study demonstrated the effectiveness of a programme that leveraged electronic health record prompts at well-child visits, with the inclusion of a comprehensive facilitation programme to provide clinical support and counselling on firearm storage and free cable locks.²⁵

MVT injuries also increased in certain patient groups. MVT occupant injuries increased for Black and Multiracial children, while both MVT occupant and MVT other injuries increased in Hispanic or Latino children. MVT occupant injuries also increased in children 10–14 years old. Injuries related to MVT can include improper or inadequate safety restraints (car seats, booster seats, seat belts), backover or rollaway incidents, injuries related to power windows, seatbelt entrapment and trunk entrapment, among others.²⁶ Recent reports of proper restraint use ranged from 5.7% to 47% among children in MVT incidents.^27–29 The National Highway Traffic Safety Administration and the AAP have issued best practices for child safety.^{26 30} Ghetti and colleagues³¹ and Urrechaga and colleagues²⁸ noted higher rates of improper safety restraints among non-Hispanic Black and Hispanic patients versus White patients. The lack of appropriate safety restraints has also been linked to socioeconomic disadvantage, which reinforces the need to expand MVT safety efforts to those communities with higher vulnerability.³¹

Overall injuries significantly increased over time in children aged 1–4 and 5–9 years, particularly for bites and stings, cut/pierce and firearm injuries. This may represent some concerning trends where the ages of those injured by firearms are expanding to younger children. Bites and stings increased across all age groups, indicating a potential opportunity to provide safety education around animals and insects for all children. Notable decreases were seen in cyclist injuries among children 1–4, 5–9 and 15–17 years old, which could be attributable to improved cycle designs for younger riders as well as increased use of helmets.

Male patients have historically comprised the majority of those injured and those who died as a result of injuries; however, certain MOIs were more evenly observed by sex over the 11-year study period.¹ Bites and stings and firearm injuries significantly increased in both sexes, while pedestrian injuries decreased for both sexes. It is important to highlight that there are many injury prevention programmes and coalitions that cover both sexes and all paediatric age groups with safety topics ranging from motor vehicle/off-road vehicles, day care, playground and home, water, firearms, falls, poison, to sports injuries.^32–34 There is evidence showing the effectiveness of these programmes, with a recent report showing reductions in the reported injuries among children who participated in injury prevention programmes at routine well-child visits.³⁵

Injuries from firearms, pedestrian and MVT occupant incidents had the highest proportion of patients with an ISS ≥26. Although pedestrian injuries decreased over time, the ISS has increased, noting fewer, yet more severe injuries. This is consistent with a report that noted a decrease in pedestrian injuries over time, but an 11% increase in mortalities from these injuries, among children aged ≥10.³⁶ In 2023, the AAP issued a policy statement with recommendations for preventing pedestrian injuries, which includes increased advocacy, legislation and guidance for parents/supervisors.³⁷ More severe paediatric pedestrian injuries may be due to increases in car size, distracted driving and the likelihood of sustaining chest or head injuries given the smaller body sizes among children. Higher ISS has often been associated with higher trauma mortality; and within this analysis, the MOIs with the highest ISS (firearm, pedestrian and MVT occupant) also had the highest in-hospital mortalities. These findings offer specific MOIs that could be targeted for paediatric injury prevention efforts to reduce disability and in-hospital death.

When comparing the results of this analysis to the adult population in the NTDB, there are some consistent findings.³⁸ Injuries increased in both the paediatric and adult population for Hispanic or Latino and Pacific Islander patients. In both populations, male patients accounted for the majority of those injured across most MOIs. When stratified by race or ethnicity, some differences arise among the highest burden of certain MOIs, specifically falls among Asian children and White adults; MVT other for Native American and White children, whereas in adults, machinery injuries were highest in Hispanic or Latino adults and pedestrian injuries were highest in Asian adults. In both paediatric and adult populations, Black patients were most impacted by firearm-related injuries.

Limitations of this analysis included the use of a large national database, which does not provide geographical data or any contextual information or risk factors to further understand the circumstances that may have contributed to injuries. The shift from ICD-9 to ICD-10 coding systems may have also impacted the calculation of relative proportions of injury in 2016 which is impossible to avoid. Though burn injuries were excluded from the primary analyses, they constituted a considerable 4.5% of all injuries from 2012 to 2020 and are reported in the online supplemental material. Trauma centre participation in the NTDB is voluntary and thus the dataset may not represent all trauma centres or reflect national estimates; as trauma centres are deidentified in the NTDB, and geographical representation of trauma patients across centres cannot be verified. Those who died prior to presentation at a trauma centre or those who did not seek care for an injury would not be captured in the NTDB. The time period selected for this analysis includes injuries that occurred both before and after the onset of the COVID-19 pandemic in 2020. Recent data have noted changes in injury patterns after the COVID-19 pandemic period, particularly among intentional injury and those residing in communities with lower socioeconomic status.¹⁷ Though not available for this analysis, others have indicated that the neighbourhood environment, particularly areas with greater socioeconomic deprivation, has a significant impact on paediatric injuries.^{39 40} Further, race is a social construct and disparities by race reported in this analysis represent effects of structural or systemic issues.

CONCLUSIONS

Injuries remain a significant concern within the paediatric population, contributing to death and disability. Over the 11-year study period, bites and stings, cut/pierce and firearm injuries increased among children. Injuries also increased for Black, Hispanic or Latino and Pacific Islander and the youngest age groups. The burden of injury by specific MOIs also differed by age, sex, race and ethnicity. These findings reinforce the need for continual monitoring of paediatric injury trends and injury prevention efforts for children, particularly focused on firearm, pedestrian and MVT occupant injuries that accounted for the most severe injuries. Tailored prevention strategies should consider patients’ characteristics and provide appropriate education to both children and their guardians. Future research should consider socioeconomic and community characteristics and other risk factors for injury.

Supplementary Material

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

► Additional supplemental material is published online only. To view, please visit the journal online (https://doi.org/10.1136/ip-2024-045440).

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Unintentional injury is the leading cause of death for US children and adolescents and can have lasting impacts on the trajectories of young lives.

WHAT THIS STUDY ADDS

• Novel longitudinal analysis of US paediatric patients in the National Trauma Data Bank describing trends of mechanism of injury according to race and ethnicity, age and sex.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• Clear injury prevention targets for paediatric populations affected by specific mechanisms of traumatic injury.

Data availability statement

Data may be obtained from a third party and are not publicly available. All data used were obtained from the National Trauma Data Bank. Requests for data use may be sent to the American College of Surgeons who manage the data repository.