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OBJECTIVES: The purpose of this study was to examine the injury risk patterns among Amish children, many of whom may be exposed to uncommon injuries and limited access to care due to their agrarian lifestyle and remote communities. DESIGN: Retrospective Chart Review. METHODS: With IRB approval, we performed a retrospective review of Amish patients age ≤ 12 years presenting to a level I pediatric trauma center between January 1, 2005, and December 31, 2015. Data abstracted from the institutional trauma registry and electronic medical record were analyzed using descriptive statistics and univariate/multivariate analysis. RESULTS: One hundred eighty-three Amish children were admitted, and 2 died from injuries. Patients were 72.1% male; the median age was 5 (IQR 3-8); median injury severity score (ISS) was 9 (IQR 4-14), Most injuries were the result of blunt force trauma (91.8%). The most frequent mechanisms were falls (42.6%), followed by animal-related (15.3%), and buggy (12.5%). Most injuries occurred at home (44.4%) or on a farm (33.9%). Hay hole falls were a unique source of injury with a high ISS (12; IQR 6-17). The overall median length of stay (LOS) was 2 days (IQR 1-3), with animal-related injuries associated with the longest LOS (3 days; IQR 1-4.75). CONCLUSIONS: The majority of injuries among Amish children are due to falls. Hay hole falls and animal-related injuries result in the highest ISS and longest LOS. These findings identify the farm as a potential target for culturally appropriate interventions for risk modification.
RESUMEN
BACKGROUND: Diagnostic imaging of pediatric blunt abdominal trauma is evolving in light of increased attention to radiation exposure. We hypothesize that the implementation of imaging guidelines has reduced total CT scans without missing clinically significant injury. METHODS: We retrospectively reviewed blunt trauma patients age 0-17 with solid organ injury who underwent CT scan at our academic level 1 pediatric trauma center between 2005 and 2014. Variables including total annual trauma admissions and CT scans, demographics, injury characteristics, and procedures were recorded. Descriptive statistics, Fisher exact and rank sum testing were performed. p<0.05 defined significance. RESULTS: Overall percentage of abdominal CT scans decreased significantly after protocol implementation. There were 498 solid organ injuries in 403 subjects. There was a significant decrease in the median percentage of low grade injuries (1.3% versus 0.6%; p=0.019) but no difference in high grade injuries (1.3% versus 1.1%; p=0.394). No patient had death, readmission or delayed diagnosis of injury requiring intervention. CONCLUSION: Implementation of imaging guidelines for blunt abdominal trauma decreased the incidence of low grade solid organ injuries at our institution, but did not inhibit diagnosis and safe management of high grade injuries. Selective imaging of trauma patients decreases childhood radiation exposure and does not result in delayed bleeding or death. LEVEL OF EVIDENCE: Level III, retrospective study.