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Severe Paediatric Trauma in Australia: A 5-Year Retrospective Epidemiological Analysis of High-Severity Fractures in
David Leonard Mostofi Zadeh Haghighi1,2, Milos Spasojevic3,4, Anthony Brown1,5
1Sydney Medical School, The University of Sydney, Sydney, NSW 2050, Australia.
Insights
Paediatric fractures in rural Australia often result from high-energy dirt bike accidents, particularly in older children. Targeted prevention and regulation are needed for these unique regional injury patterns.
Area of Science:
- Orthopaedic trauma
- Paediatric injury epidemiology
- Rural health challenges
Background:
- Paediatric fractures are common, posing unique challenges due to ongoing skeletal development.
- Existing research on paediatric fractures often focuses on urban populations, limiting applicability to rural settings.
- Urban-centric data can bias healthcare guidelines and infrastructure planning for regional areas.
Purpose of the Study:
- To analyze paediatric fracture data from rural trauma centers in New South Wales, Australia.
- To identify common fracture types, injury mechanisms, and treatment approaches in a rural context.
- To highlight demographic differences and healthcare challenges specific to regional paediatric trauma.
Main Methods:
- Analysis of paediatric injury data from two major rural referral hospitals in NSW.
- Inclusion of 150 patients with severe fractures (Australasian Triage Scale categories 1 and 2) between 2018 and 2022.
- Focus on severe injury mechanisms relevant to rural environments.
Main Results:
- 150 severe paediatric fractures identified, predominantly affecting upper and lower limbs.
- Males and children aged 10-14 years were most frequently affected.
- High-energy motorcycle (dirt bike) accidents were the leading cause, accounting for over 50% of injuries in the 10-14 age group, with clavicle and radius/ulna fractures being most common.
Conclusions:
- Paediatric trauma in regional Australia presents distinct challenges, often involving high-energy injuries from unregulated underage dirt bike use.
- Rural areas necessitate targeted prevention strategies, differing from urban low-energy injury patterns.
- Region-specific policy reform, including improved injury surveillance, prevention initiatives, and regulation of off-road vehicle use, is recommended.
Abstract:
Background: Trauma-related injuries are among the most common reasons for paediatric hospital presentations and represent a substantial component of orthopaedic care. Their management poses unique challenges due to ongoing skeletal development in children. While most reported fractures occur at home or during sports, prior studies have primarily used data from urban European populations, limiting the relevance of their findings for rural and regional settings. Urban-centred research often informs public healthcare guidelines, treatment algorithms, and infrastructure planning, introducing a bias when findings are generalised outside of metropolitan populations. This study addresses that gap by analysing fracture data from two rural trauma centres in New South Wales, Australia. This study assesses paediatric fractures resulting from severe injury mechanisms in rural areas, identifying common fracture types, underlying mechanisms, and treatment approaches to highlight differences in demographics. These findings aim to cast a light on healthcare challenges that regional areas face and to improve the overall cultural safety of children who live and grow up outside of the metropolitan trauma networks. Methods: We analysed data from two major rural referral hospitals in New South Wales (NSW) for paediatric injuries presenting between 1 January 2018 and 31 December 2022. This study included 150 patients presenting with fractures following severe mechanisms of injury, triaged into Australasian Triage Scale (ATS) categories 1 and 2 upon initial presentation. Results: A total of 150 severe fractures were identified, primarily affecting the upper and lower limbs. Males presented more frequently than females, and children aged 10-14 years old were most commonly affected. High-energy trauma from motorcycle (dirt bike) accidents was the leading mechanism of injury among all patients, and accounted for >50% of injuries among 10-14-year-old patients. The most common fractures sustained in these events were upper limb fractures, notably of the clavicle (n = 26, 17.3%) and combined radius/ulna fractures (n = 26, 17.3%). Conclusions: Paediatric trauma in regional Australia presents a unique and under-reported challenge, with high-energy injuries frequently linked to unregulated underage dirt bike use. Unlike urban centres where low-energy mechanisms dominate, rural areas require targeted prevention strategies. While most cases were appropriately managed locally, some were transferred to tertiary centres. These findings lay the groundwork for multi-centre research, and support the need for region-specific policy reform in the form of improved formal injury surveillance, injury prevention initiatives, and the regulation of under-aged off-road vehicular usage.
