Original Article

Epidemiological trends of pediatric trauma: A single-center

study of 791 patients
Mukesh Sharma, B. K. Lahoti, Gaurav Khandelwal, R. K. Mathur, S. S. Sharma,
Ashok Laddha
Department of Surgery, M. G. M. Medical College and M. Y. Hospital, Indore, Madhya Pradesh, India

Address for correspondence: Dr. Mukesh Sharma, Department of Surgery, M. G. M. Medical College and M. Y. Hospital, Indore,
Madhya Pradesh, India. E-mail: drmukesh26@gmail.com

ABSTRACT Access this article online

Website: www.jiaps.com
Aim: To assess the various epidemiological parameters that influence the causation of DOI: 10.4103/0971-9261.83484
DOI
trauma as well as the consequent morbidity and mortality in the pediatric age group. Quick Response Code:
Code
Materials and Methods: A prospective study of 791 patients of less than 12 years age,
was carried out over a period of 1 year (August 2009 to July 2010), and pediatric trauma
trends, with regards to the following parameters were assessed: Age group, sex, mode
of trauma, type of injury, place where the trauma occurred and the overall mortality as
well as mortality. Results: Overall trauma was most common in the school-going age
group (6-12 years), with male children outnumbering females in the ratio of 1.9:1. It
was observed that orthopedic injuries were the most frequent (37.8%) type of injuries,
whereas fall from height (39.4%), road traffic accident (27.8%) and burns (15.2%) were
the next most common modes of trauma. Home was found out to be the place where
maximum trauma occurred (51.8%). Maximum injuries happened unintentionally
(98.4%). Overall mortality was found out to be 6.4% (n = 51). Conclusions: By knowing
the epidemiology of pediatric trauma, we conclude that majority of pediatric injuries
are preventable and pediatric epidemiological trends differ from those in adults.
Therefore, preventive strategies should be made in pediatric patients on the basis of
these epidemiological trends.

KEY WORDS: Fall, injury, pediatric trauma, road traffic accidents

INTRODUCTION also gives an idea about the relative mortality in various

Pediatric trauma is a very significant cause of mortality
and disability, being responsible for more deaths than
all diseases combined.[1] The burden of child injuries in
India is not clearly known because our knowledge is
inadequate about their epidemiology. As per National
Crime Records Bureau (NCRB) report of 2006, there
were 22,766 deaths (<14 years) due to injuries among
children.[2] There are very few studies from developing
countries discussing the epidemiology of pediatric
trauma. Our study aims to determine the frequency
of various types of childhood injuries in different sex
and age groups and also to find out the various modes
and place of trauma among study subjects and their
distribution according to different age and sex groups. It
88 Journal of Indian Association of Pediatric Surgeons / Jul-Sep 2011 / Vol 16 / Issue 3
types of childhood injuries.
MATERIALS AND METHODS
This was a prospective study conducted at a tertiary
care hospital over a 12-month period. A total of 791
patients (age up to 12 years) with trauma were admitted
between August 2009 and July 2010. Isolated pediatric
ophthalmic trauma, drowning as well as parental
psychiatric disorders responsible for pediatric trauma,
such as battered baby syndrome, were excluded from
our study.
A detailed history taking (from parents/relatives/
children) and examination was done and all patients
 Sharma, et al.: Epidemiological trends of pediatric trauma
were assessed with regards to their age, sex, mode of
trauma/injury, type of injury, site of trauma, place of
trauma, and mortality. The children were classified
according to age as: Infants (up to 1 year), toddlers
(1-3 years), preschool (3-6 years) and school-age
children (6-12 years). Modes of trauma were divided
as: Fall from height, road traffic accident (RTA), burn,
sports related, assault (sexual, sharp, blunt), poisoning,
bites and stings. The types of injury were divided
into subgroups: Orthopedic, head, burns, abdomen,
poisoning, bites and sting, chest, poly trauma and
genital injuries. The places of trauma were divided into
the following: Home, road, farm, school/playground
or park and others. The mortality data were shown
according to different age groups as described earlier
and according to the mode of injury.
RESULTS
Out of the total 6102 pediatric patients admitted, the
cause of admission for 791 patients was trauma. The
mean age of presentation was 6.3 years. School-going
children were the most commonly injured (52.33%)
[Figure 1]. Males outnumbered females in a ratio of
1.9:1. Children mostly suffered from orthopedic injuries
(37.80%). Among the non orthopedic injuries, head and
abdominal injury was the most common seen in the
school-going children. While in burns, toddler group
was the most commonly affected age group [Table 1].
Fall from height (39.44%), RTAs (27.83%) and burns
(15.18%) were the most common mode of injury leading
to pediatric trauma [Table 1]. Most of the cases (98.36%)
were injured unintentionally. Thirteen cases (1.64%)
were injured intentionally. Out of the 13 cases, 8 were
injured by blunt object, 3 by sharp object and 2 cases
were sexually assaulted.
In our study we found the home to be the most common
place of injury [Figure 2]. The most common cause of
Figure 1: Age distribution of trauma
Journal of Indian Association of Pediatric Surgeons / Jul-Sep 2011 / Vol 16 / Issue 3
injury among all traumatized children was a fall injury.
It affected mostly school-going children. Around 59%
of all falls occurred at home, followed by farms. At
home, most of the falls occurred from stairs (31.73%),
followed by the terrace (25.32%), whereas at the farm,
the most common place of fall was from a tree (16.98%),
followed by fall into well (2.88%) [Table 2]. RTA was
the second most common mode of injury. School-
going children were affected the most. Of 220 children
involved in RTA, 64.54% were pedestrians, 20.45% were
two-wheeler passengers and 15% were four-wheeler
passengers [Table 2].
Out of total 120 burn patients, 45 (37.5%) patients
belonged to the toddler age group. Burns due to scalds
(hot liquids) accounted for 55.83% cases, while burns
due to flames and electricity accounted for 23.33%
and 10.83% of the cases, respectively. Cracker and
contact burns were the remaining cause of burn injury
[Table 2]. Preschool age group formed the largest group
of poisoning victims (71.73%). Most of these victims
had ingested kerosene (67.39%) followed by insecticide
(13%), castor seed (10.86%) and drugs (8.69%) [Table 2].
Out of 791 patients admitted, 51 died (6.44%).
Children of 1-3 years age group had the highest
mortality (39.21%) in their respective age group,
followed by infants (15.38%). Males (74.5%)
outnumbered females (25.5%) [Table 3]. Our study
also revealed RTA as one of the major causes of injury,
causing the highest mortality (35.29%), followed
by burns (27.45%) and fall from height (15.68%)
[Table 3].
DISCUSSION
The prevalence of trauma in childhood patients was
approximately 19.23%. This was probably due to
delayed presentation to our tertiary institute (either via
Figure 2: Places of trauma
89
 Sharma, et al.: Epidemiological trends of pediatric trauma

Table 1: Modes and type of injuries among children of different age groups
Age (years) Total (%)
<1% 1-3% 3-6% 6-12%
Sex distribution
M 12 81 168 258 519 (65.56)
F 14 33 69 156 272 (34.38)
Total (n = 791) 26 (3.22) 114 (14.41) 237 (29.96) 414 (52.33) 791
Modes of injury
Fall from height 10 57 114 131 312 (39.44)
RTA 4 8 40 168 220 (27.81)
Burn 11 45 24 40 120 (15.17)
Sports related 0 0 12 42 54 (6.82)
Poisoning 0 4 33 9 46 (5.81)
Bites and sting 0 0 4 22 26 (3.21)
Assault 1 0 2 10 13 (1.64)
Total (n = 791) 26 (3.22) 114 (14.41) 229 (28.95) 422 (53.35) 791
Type of injury (n = 791)
Orthopedic 4 35 74 187 299 (37.80)
Head 9 26 74 83 192 (24.27)
Burn 11 45 24 40 120 (15.17)
Abdomen 1 3 12 46 62 (7.83)
Poisoning 0 4 33 9 46 (5.81)
Bites and sting 0 0 4 22 26 (3.21)
Chest 0 1 7 14 22 (2.78)
Poly trauma 0 0 4 16 20 (2.52)
Genital 1 0 1 2 4 (0.05)
RTA = Road traffic accident

Table 2: Characteristics of injuries due to fall, road traffic Table 3: Mortality among children of different age groups
accident, burn and poisoning and with respect to modes of injury
Modes of injury Number Percentage No. of deaths Percentage (n = 51)
Fall from height (n = 312) Age group (years)
Stair 99 31.73 <1 8 15.68
Terrace 79 25.32 1-3 20 39.21
Tree 53 16.98 3-6 7 13.72
Bed 49 15.70 6-12 16 13.37
Chair 17 5.44 Sex distribution
Window 6 1.92 Male 38 74.5
Fall into well 9 2.88 Female 13 25.5
RTA (n = 220) Modes of injury
Pedestrian 142 64.54 RTA 18 35.29
Two wheeler 45 20.45 Burn 14 27.45
Four wheeler 33 15 Fall from height 8 15.68
Burn (n = 120) Poisoning 7 13.72
Scald (hot liquid) 67 55.83 Bites and Sting 2 3.92
Contact burn 28 23.33 Sports-related injury 1 1.96
Electric 13 10.83 Assault 1 1.96
Cracker 5 4.16 RTA = Road traffic accident
Flame 7 5.83
Poisoning (n = 46)
14.2%, and another study done at Naraingarh, India,[4]
Kerosene 31 67.39
reported a prevalence of 5.5%.
Insecticide 6 13
Castor seed 5 10.86
Drugs 4 8.69
Many studies have been done from Bangladesh,[5] Iran,[6]
RTA = Road traffic accident
Nigeria,[7] Thailand,[8,9] Singapore[10,11] and from major
Indian cities,[12-15] and these studies have found boys to
be more commonly injured then girls. Home was found
referrals or direct admission), or probably due to lack of to be the most common place of injury, followed by road/
knowledge and low literacy levels among the parents of street, with falls being the most common mechanism
these children. Tandon et al.[3] reported a prevalence of of pediatric trauma. The mean age of presentation in

90 Journal of Indian Association of Pediatric Surgeons / Jul-Sep 2011 / Vol 16 / Issue 3

 Sharma, et al.: Epidemiological trends of pediatric trauma
our study was 6.3 years which is in consonance with
the above studies.[7,10] In our study too, boys were more
commonly hospitalized than girls, probably since in
our country, boys are given more freedom as well as
free hand to work or play outside their homes. Male to
female ratio was 1.9:1 in our study which is similar to
the 1.5:1 to 3:1 ratio reported in the above studies.[7,16,17]
School-going children (6-12 years) were the most
common age group found to be affected in our study,
which is also similar to that reported in other previous
studies.[6,7,15]
Majority of our injuries occurred at home, followed by
road and school/playground. Studies from Trinidad
and Tobago, Ethiopia, and Nigeria[7,18,19] all found the
home environment to be the most common place for a
childhood injury to occur. In our study, falls were the
leading cause of trauma in all age groups, followed by
RTAs, except in the 6-12 year age group in which falls
were the second most common etiology after RTAs. This
finding also correlates well with reports from different
studies.[20,21] In our study, stairs and terrace were the
two most common causes of fall from height, while in
a study from Singapore, slipping and fall from bed were
the most common causes of falls, once again signifying
different epidemiological patterns in different parts of
the world.[10] In our study, most of the victims of RTAs
were pedestrians, followed by two-wheeler passengers.
This finding is similar to that derived from studies done
at Maput and Tehran.[6,22]
In our study, a vast majority of burn injuries occurred
from hot liquids, followed by flame injuries. Similar
results were drawn from studies done in Pakistan and
South Africa.[23,24] In our study, kerosene ingestion was
the most common cause of poisoning. followed by
insecticides and drugs, whereas reports from other
countries[25-27] reveal kerosene to be the most common
cause followed by drug ingestion and insecticides.
Most mortality in our study occurred in the 1-3 year
age group. Bener et al. also reported the same result in
his study.[28] Mortality was higher in males. RTA was
most common cause of death, followed by burn and
fall from height. These results are similar to those of
the studies done in developing countries,[29,30] whereas
studies from developed countries reveal RTA to be the
most common cause of death, followed by gunshot
injuries.[31,32]
CONCLUSIONS
This study gives an idea about the epidemiology of pediatric
trauma, with 6-12 years age group found to be the most
affected and 1-3 years age group found to be the most
vulnerable with regards to overall mortality. Home was
Journal of Indian Association of Pediatric Surgeons / Jul-Sep 2011 / Vol 16 / Issue 3
the most common place of injury, and fall and RTA were
the most common mechanisms of injuries. By knowing
the epidemiology of pediatric trauma, we conclude that
majority of pediatric injuries are preventable and pediatric
epidemiological trends differ from those in adults.
Therefore, preventive strategies should be made in pediatric
patients on the basis of these epidemiological trends. As
the saying rightly goes, “Prevention is better than cure”.
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Sharma M, Lahoti BK, Khandelwal G, Mathur RK, Sharma SS, Laddha
A. Epidemiological trends of pediatric trauma: A single-center study of
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Source of Support: Nil, Conflict of Interest: None declared.

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