Pre-hospital paediatric preventable injuries: Who, what, when and where?

Trauma remains the leading cause of mortality among children over one year of age in the United Kingdom (UK). Accidental injuries and violence represent some of the most preventable contributors to childhood morbidity and mortality. This study aimed to analyse data from a physician-led, urban pre-hospital service to identify paediatric populations at risk of preventable injury, characterise common mechanisms of injury, and explore temporal and geographic trends to inform targeted prevention strategies.

A retrospective review was conducted of paediatric patients (aged ≤16 years) attended by a physician-led pre-hospital trauma service between January 2017 and June 2022. Data collected included age, sex, time of day, location of incident and mechanism of injury. Cases were divided into three subgroups representing potentially preventable injuries: Falls from height (>2 m), penetrating trauma, and road traffic collisions (RTCs). Regression analysis was performed to assess for any association between injury and index of deprivation.

782 patients met inclusion criteria. 607 (78%) patients sustained injuries classified as potentially preventable, the majority of which involved male patients (n = 483, 79.6%). Adolescents aged 12-16 years accounted for the highest proportion of penetrating trauma (n = 279, 96%) and RTCs (n = 92, 54%), whist falls from height were seen most frequently in pre-school children aged 0-4 years (n = 73, 50%). A significant association was observed between rate of preventable injury and level of socioeconomic deprivation.

This study identified distinct patterns in paediatric trauma presentations. Pre-school aged children were disproportionately affected by falls from height, whereas school-aged children were more frequently injured through penetrating trauma and RTCs, particularly in the early evening period following school hours. Socioeconomic deprivation was strongly associated with increased risk of all types of preventable injury. These findings underscore the need for targeted, multi-agency interventions, including collaboration with injury prevention programmes, police, and public health bodies to reduce the burden of preventable paediatric trauma.