Penetrating pediatric trauma in the Netherlands: Findings from the Dutch National Trauma Registry, 2015-2023

According to the media, penetrating trauma and more specifically knife/firearm incidents are increasing in Europe over the past years. However, studies on incidence and trends are limited. This study aimed to describe incidence, trends, and outcome of penetrating pediatric trauma in The Netherlands.

A national database of prospectively collected data on children (<18 y/o) with traumatic injury admitted to the hospital was used to investigate penetrating trauma between 2015 and 2023. Primary outcomes were incidence and trends in frequency of penetrating trauma. Secondary outcomes included injury mechanism, morbidity (e.g. Glasgow Outcome Scale, length of stay) and mortality.

Of 727 patients, 80% were male and the median age was 14 years. There was a significant increase in firearm injuries during the measured time period. There was no increase in general incidence of hospitalized penetrating injury, with the exception of 2021 when there was a significant rise in general penetrating/knife related injury. Moreover, the proportion of non-domestic violence-related incidents increased, whereas domestic incidents became less frequent. The majority (70%) was initially transferred to the observational ward, but 17% went straight to the operating room. Median length of stay was 2 days and 13% spent at least one day in an Intensive/Medium Care Unit. At discharge, 56% still had moderate or severe disability, measured by the Glasgow Outcome Scale (4 or less) and 1% (n = 9) died during hospitalization.

Only a small part of traumatic injuries in children is penetrating and no increase was found in time, except during the COVID pandemic, but consequences may be severe. Firearm incidents and non-domestic violence related crime seem to increase, which is a worrying development.