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Pediatric Traumatic Injury in Rural and Urban Areas of Wisconsin
Kara J Kallies1, Kirsten M Beyer1, William J Koehne2
1Institute for Health and Humanity, Medical College of Wisconsin, Milwaukee, WI.
Insights
Pediatric unintentional injuries show distinct patterns in rural and urban areas, with motor vehicle incidents prevalent in rural settings and firearm injuries in urban-underserved zones. Tailored prevention strategies are crucial for reducing child injury mortality.
Area of Science:
- Public Health
- Pediatric Injury Prevention
- Geospatial Analysis
Background:
- Unintentional injuries are a leading cause of death in American youth.
- Rural children represent a disproportionately high percentage of injury mortalities despite lower population density.
Purpose of the Study:
- To delineate differences in pediatric injury mechanisms (MOI), severity, and mortality between rural and urban settings.
- To investigate geospatial patterns of pediatric injury burden.
Main Methods:
- Analysis of Wisconsin trauma registry data (2021-2022) for pediatric patients.
- Utilized WI-HIP rural/urban classification for ZIP code categorization.
- Employed geospatial analyses to identify high-injury burden areas.
Main Results:
- Falls were most common in urban areas; motor vehicle/transportation injuries predominated in rural groups.
- Firearm injuries were highest in the urban-underserved group.
- In-hospital mortality was highest in the urban-underserved group (3.2%), with elevated rates in rural areas.
Conclusions:
- Significant differences exist in pediatric injury mechanisms, locations, and trauma center utilization between rural and urban environments.
- Targeted prevention strategies are essential for high-risk rural and urban communities.
- A community-engaged approach is recommended to mitigate pediatric injury rates.
Objectives:
Unintentional injury is the leading cause of death in American youth. Fewer children live in rural versus urban areas, yet rural children comprise nearly one-quarter of injury mortalities. We sought to describe differences in pediatric mechanism of injury (MOI), injury severity. and mortality in rural and urban areas and explore geospatial patterns of injury.
Methods:
Wisconsin trauma registry data were analyzed for injured pediatric patients from 2021 to 2022. Wisconsin Collaborative for Healthcare Quality and Wisconsin Health Innovation Program's (WI-HIP) rural/urban classification assigned ZIP codes to urban-advantaged, urban, urban-underserved, rural-advantaged, rural, or rural-underserved areas. Geospatial analyses identified high-injury burden areas based on crude and indirectly age and sex-adjusted injury rates.
Results:
Two thousand four hundred seven children were included; mean age was 6.9±4.4 years; 738 (30.7%) lived in urban, 467 (19.4%) in urban-underserved, 452 (18.8%) in urban-advantaged, 379 (15.8%) in rural, 231 (9.6%) in rural-advantaged, and 140 (5.8%) children in rural-underserved areas. Falls were the most common among urban-advantaged and urban groups, where motor vehicle/transportation injuries were most common among the 3 rural groups; firearm injuries were highest in the urban-underserved group. In-hospital mortality was highest in the urban-underserved group (3.2%), followed by rural (1.3%), rural-advantaged (1.3%), urban (1.1%), urban-advantaged (0.9%), and rural-underserved (0.7%) groups. Crude and adjusted injury rates were highest in the rural-underserved group.
Conclusions:
Rural and urban MOI, injury locations, levels of trauma center differed. Tailored prevention strategies for rural and urban communities are needed, particularly in areas with higher injury rates. A community-engaged approach to prevention could reduce pediatric injuries.
