Epidemiology, patterns, and mechanisms of pediatric trauma: a review of 12,508 patients

Abstract

Background
Pediatric traumas are common and remain a unique challenge for trauma surgeons. Demographic data provide a crucial source of information to better understand mechanisms and patterns of injury. The aim of this study was to provide this information to improve treatment strategies of potentially preventable morbidity and mortality in children.

Material and methods
A retrospective review of every pediatric trauma treated in the emergency department (ED) between 2015 and 2019 was performed. Inclusion criteria were the age between 0 and 14 years and admission to the ED after trauma. Demographic data, time of presentation, mechanism of injury and pattern of injury, treatment, and outcome were analyzed. Different injury patterns were assessed in relation to age group, sex, mechanism of injury and treatment.

Results
A total of 12,508 patients were included in this study. All patients were stratified into five age groups: babies under the age of 1 (8.8%), toddlers between 1 and 3 (16.8%), preschool children between 4 and 6 (19.3%), young school children between 7 and 10 (27.1%), and young adolescents between 11 and 14 (27.9%). The predominant sex in all age groups was male. 47.7% of patients were admitted between 4 and 10 pm; 14.8% of the patients arrived between 10 pm and 8 am. Peak months of admissions were May to July. Overall, 2703 fractures, 2924 lacerations and superficial tissue injury, 5151 bruises, 320 joint dislocations, 1284 distortions, 76 burns, and 50 other injuries were treated. Most common mechanisms for fractures were leisure activities, falls, and sports-related activities. Forearm fractures were the most common fractures (39.5%) followed by humerus fractures (14%) and fractures of the hand (12.5%). A total of 700 patients with fractures (25.9%) needed surgery. 8.8% of all patients were hospitalized for at least one day. 4 patients died in the hospital (0.03%).

Conclusion
Despite of higher risk, severe injuries in children are rare. Minor injuries and single fractures are common. Treatment should be managed in specialized centers to ensure an interdisciplinary care and fast recovery. Peak times in the late afternoon and evening and summer months should be taken into consideration of personnel planning.

Full text

Vol.:(0123456789)
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European Journal of Trauma and Emergency Surgery (2023) 49:451–459
https://doi.org/10.1007/s00068-022-02088-6
ORIGINAL ARTICLE
Epidemiology, patterns, andmechanisms ofpediatric trauma: areview
of12,508 patients
RaaelCintean1 · AlexanderEickho1· JasminZieger1· FlorianGebhard1· KonradSchütze1
Received: 28 April 2022 / Accepted: 9 August 2022 / Published online: 24 August 2022
© The Author(s) 2022
Abstract
Background Pediatric traumas are common and remain a unique challenge for trauma surgeons. Demographic data provide
a crucial source of information to better understand mechanisms and patterns of injury. The aim of this study was to provide
this information to improve treatment strategies of potentially preventable morbidity and mortality in children.
Material and methods A retrospective review of every pediatric trauma treated in the emergency department (ED) between
2015 and 2019 was performed. Inclusion criteria were the age between 0 and 14years and admission to the ED after trauma.
Demographic data, time of presentation, mechanism of injury and pattern of injury, treatment, and outcome were analyzed.
Different injury patterns were assessed in relation to age group, sex, mechanism of injury and treatment.
Results A total of 12,508 patients were included in this study. All patients were stratified into five age groups: babies under
the age of 1 (8.8%), toddlers between 1 and 3 (16.8%), preschool children between 4 and 6 (19.3%), young school children
between 7 and 10 (27.1%), and young adolescents between 11 and 14 (27.9%). The predominant sex in all age groups was
male. 47.7% of patients were admitted between 4 and 10pm; 14.8% of the patients arrived between 10pm and 8 am. Peak
months of admissions were May to July. Overall, 2703 fractures, 2924 lacerations and superficial tissue injury, 5151 bruises,
320 joint dislocations, 1284 distortions, 76 burns, and 50 other injuries were treated. Most common mechanisms for fractures
were leisure activities, falls, and sports-related activities. Forearm fractures were the most common fractures (39.5%) fol-
lowed by humerus fractures (14%) and fractures of the hand (12.5%). A total of 700 patients with fractures (25.9%) needed
surgery. 8.8% of all patients were hospitalized for at least one day. 4 patients died in the hospital (0.03%).
Conclusion Despite of higher risk, severe injuries in children are rare. Minor injuries and single fractures are common.
Treatment should be managed in specialized centers to ensure an interdisciplinary care and fast recovery. Peak times in the
late afternoon and evening and summer months should be taken into consideration of personnel planning.
Keywords Pediatric injury· Mechanism
Introduction
Unintentional injuries are a significant health risk for chil-
dren and adolescents. According to estimates by the World
Health Organization, more than 830,000 under18s are killed
in accidents worldwide every year [1]. In Germany, acci-
dent-related deaths among children and adolescents have
been declining for years, but in 2020 traumatic injuries were
still the second most common cause of death among children
aged 1 to 15 [2]. Injuries in childhood and adolescence are
also a frequent cause of hospitalization. According to the
German Federal Statistical Office, accidents are the most
common cause of hospitalization between the ages of 5 and
19 and the second most common cause between the ages of
1 and 4 [3].
* Raffael Cintean
raffael.cintean@uniklinik-ulm.de
Alexander Eickhoff
alexander.eickhoff@uniklinik-ulm.de
Jasmin Zieger
jasmin.zieger@uni-ulm.de
Florian Gebhard
florian.gebhard@uniklinik-ulm.de
Konrad Schütze
Konrad.schuetze@uniklinik-ulm.de
1 Department ofTrauma-, Hand-, andReconstructive Surgery,
Ulm University, Albert-Einstein-Allee 23, 89081Ulm,
Germany
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452 R.Cintean et al.
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The morbidity and mortality of children involved in acci-
dents not only pose great challenges for those treating them
but also long-term consequences, like physiological and eco-
nomic aspects, must be taken into account [4–6].
Numerous studies report incidence and mechanism of
severely injured children [7–11]. However, only few reports
are found on all children requiring treatment for injury
[12–14].
This study was done to provide important information on
the incidence, type, and mechanism of injury in children in
order to help in developing prevention strategies.
Methods
This study was a retrospective exploratory review at a Level
One Trauma Center in Germany. Every patient between 0
and 14years of age who was treated for a trauma in our
emergency department (ED) between January 2015 and
December 2019 was identified and included in this study.
Exclusion criteria were only patient age over 14years and
admission to the ED due to conditions other than trauma.
Patient demographics, time and month of presentation,
type and mechanism of injury, and need for surgical care
were examined. Patients were stratified in age groups babies
up to 1, toddlers between 1 and 3, preschoolers between 4
and 6, young school children from 7 to 10, and young ado-
lescents between 11 and 14years of age. All mechanisms
of injury were recorded and classified. Injuries were classi-
fied as fractures, distortions, lacerations, joint dislocations,
bruises, burns, and multiple injuries or others. The exact
body regions were recorded for all injuries. All injuries were
analyzed in terms of mechanism, necessity of surgical treat-
ment, and time of presentation in the ED.
The mechanisms of injury were classified into 8
categories:
– Leisure activity
Leisure activities include mechanisms that could not
be assigned to a sport or other mechanism. Included were
general play, walking and running, accidents on the play-
ground, and accidents at home.
– Sports-related activity
Sports-related activities include all team sports,
such as soccer, basketball, or handball. Also, winter
sports, like skiing, snowboarding, and ice skating, were
included.
– Falls
Falls include all patients who have fallen from objects.
These include beds, couches, chairs, climbing frames,
etc. Falls from standing or walking were listed under the
categories leisure activity or sports-related activity.
– Blunt trauma/collision
Blunt trauma includes any blows or impacts as well as
collisions with other people or objects.
– Road traffic accidents (RTAs)
RTAs include all accidents that have occurred on the
road. This includes accidents as a passenger in a car or on
a motorcycle as well as passengers on public transport.
In addition, all accidents that occurred as pedestrians or
cyclists in road traffic were included.
– Violence
Violence includes all acts of violence, such as violence
among persons or acts of violence with objects or weap-
ons.
– Cutting/stabbing
Cutting and stabbing mechanisms include all injuries
by sharp objects.
– Burns
Burns include all superficial and deep burns caused by
warm or hot objects and liquids. (Table1).
Results
A total of 12,508 patients were included in this study, of
which 7302 were male and 5206 female. In all age groups,
most patients were male. The age group with the most
patients was young teenagers between 11 and 14 with a total
of 3489 patients (27.9%). The demographic data are shown
Table 1 Mechanisms of injury
by age groups Mechanism < 1years 1–3years 4–6years 7–10years 11–14years All
Leisure activity 392 521 614 712 623 2862
Sports-related activity 15 212 311 892 1234 2664
Falls 281 513 524 589 504 2411
Blunt trauma 298 332 313 453 512 1908
Road traffic accident 9 231 312 321 265 1138
Force/violence 14 151 115 181 130 591
Cutting/stabbing 0 67 104 141 105 417
Burns 11 19 21 18 7 76
Misc/no documentation 83 61 101 87 109 441
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453Epidemiology, patterns, andmechanisms ofpediatric trauma: areview of12,508 patients
1 3
in Table2. The age group distribution shows two peaks at a very young age between 1 and 3years and again between
11 and 14years (Fig.1).
Injuries andmechanisms
All injuries were classified into 6 categories and further ana-
lyzed for the different body regions. Contusions and bruises
were the most common type of injury with 5151 cases, fol-
lowed by lacerations and fractures. Rare traumas as well as
multiple injuries were classified under other (Table3).
Bruises
A total of 5151 children with bruises were treated in our ED.
The most common location was the hand with 1137 patients
(22.1%) and the head with 867 patients (16.8%).
Most common accident mechanism resulting in bruises
were falls (n = 1402, 27.2%) followed by sports (n = 1099,
21.3%) and leisure activities (n = 1098, 21.3%). Patient with
bruises after blunt trauma was treated 625 times (12.1%),
RTA 576 times (11.2%), and violence 351 times (6.8%).
Lacerations
2924 patients suffered a laceration or a wound. 2089 patients
(71.4%) were treated for a laceration in the head region,
446 for wounds on the hand (15.3%) and 163 patients for
lacerations on the feet (5.6%). Most common mechanism
was a blunt trauma or collision (n = 727, 24.9%), falls in 721
patients (24.6%) and leisure activities in 566 cases (19,4%)
as well as cutting or stabbing injuries in 395 cases (13.5%).
58 (1.9%) patients were treated for animal or human bites
(Fig.2).
Table 2 Patients demographics
Patients demographics
Sex
Male 7302 (58.4%)
Female 5206 (41.4%)
Age distribution
< 1year 1103 (8.8%)
1–3years 2107 (16.8%)
4–6years 2415 (19.3%)
7–10years 3394 (27.1%)
11–14years 3489 (27.9%)
Type of injury
Bruise 5151 (41.2%)
Laceration 2924 (23.4%)
Fracture 2703 (21.6%)
Distortion 1284 (10.3%)
Joint dislocation 320 (2.6%)
Burns 76 (0.6%)
Polytrauma/other 50 (0.4%)
Mechanism of injury
Leisure activity 2862 (22.9%)
Sports-related activity 2664 (21.3%)
Falls 2411 (19.3%)
Blunt trauma 1908 (15.3%)
Road traffic accidents 1138 (9.1%)
Force/violence 591 (4.7%)
Cutting/stabbing 417 (3.3%)
Burns 76 (0.6%)
Misc./no documentation 441 (3.5%)
Fig. 1 Distribution of age and
gender
0
100
200
300
400
500
600
700
012345678910 11 12 13 14
No. of paents
Age in years
male
fe
male
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454 R.Cintean et al.
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Fractures
Fractures occurred in 2703 cases. Most common fractures
were the distal radial fractures with 503 patients (18.6%),
hand and finger fractures with 337 patients (12.5%) and the
fracture of the clavicle with 230 patients (8.5%) (Fig.3)
700 children (25.9%) with fractures needed surgical treat-
ment. The most common injuries requiring surgery were
forearm shaft fractures (54.4%), supracondylar humerus
fractures (20.1%) as well as lower leg fractures (11.9%).
(Table4) Apart from few exceptions like the distal fibula,
radial head or the distal tibia, most patients with fractures
were male. In those patients needing surgery, a steady
growth in incidence in the age group distribution with
a decline in girls in early adolescence could be found
(Fig.4).
Leisure activities (n = 872, 32.3%) and falls (n = 721,
26.7%) resulted in fractures most commonly, followed by
sports-related activities (n = 614, 22.7%).
Table 3 Injuries by age group Injury < 1years 1–3years 4–6years 7–10years 11–14years All
Bruise 681 945 1083 1180 1262 5151
Laceration 159 531 519 845 870 2924
Fracture 141 324 551 873 814 2703
Joint dislocation 76 167 12 32 33 320
Distortion 38 128 211 423 484 1284
Other 8 12 39 41 26 126
Fig. 2 Mechanisms and loca-
tions of lacerations
0
50
10
0
15
0
20
0
25
0
30
0
35
0
40
0
45
0
50
0
55
0
60
0
650
head hand feet legarm other
leisure acvies
sports
falls
blunt trauma/collision
road traffic accidents
violence and self harm
cung/stabbing
other
Fig. 3 Distribution of locations
of fractures
0
50
10
0
15
0
20
0
25
0
300
male
female
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455Epidemiology, patterns, andmechanisms ofpediatric trauma: areview of12,508 patients
1 3
Distortions
Because of the terminological similarity with bruises in the
notes, distortions were divided into only three subcategories.
The most frequent distortion was supination trauma of the
ankle joint with 1034 patients (80.5%). Cervical spine strain
was treated 238 times (18.5%). 12 patients presented with
distortion of the knee joint (0.9%). Sports-related activities
(n = 492, 38.3%) and leisure activities (n = 472, 36.8%) were
the most common mechanism for ankle sprains. In sprains of
the cervical spine, RTA is second most common mechanism
with 61 cases (25.6%).
Joint dislocations
A total of 320 patients with joint dislocations were treated.
Also included were subluxations of the radial head, also
known as Nursemaids Elbow, which are very common espe-
cially in young children. With 240 patients (75%), this group
also accounted for the majority of patients with dislocations.
Female children were significantly more likely to be treated
for subluxation of the radial head (p < 0.05). Other diagno-
ses were patellar dislocations (13.4%), elbow dislocations
(7.5%), AC joint dislocations (3.8%), and shoulder disloca-
tions (0.3%).
Leisure activities and falls were the most common
mechanism of the nursemaid’s elbow, which usually hap-
pens when preventing a fall by pulling on the arm or playing
with the child (75.0%). Further mechanisms for joint dislo-
cations were sports-related activities (n = 34, 10.6%). RTA
accounted for 2.2% of all joint dislocations.
Burns
76 patients were treated for burns in our ED. As our hospital
is not a certified burn center, the majority of burns were
of mild to moderate severity. Children are usually treated
at our affiliated children's hospital, which is why the num-
ber appears to be rather low. The hands and forearms were
most frequently affected (59.2%), followed by the thigh and
head with 8 patients each (10.5%). Other localizations were
chest (7.9%), feet (7.9%), upper arms (2.6%), and lower legs
(1.3%).
Most common mechanism was related to food (hot food,
tea, etc.) (53.9%), hot oven or fire place (30.3%), or open fire
and firecrackers (15.8%).
Polytrauma/other
6 children (0.05%) were admitted through our shock room
as polytrauma with an Injury Severity Score (ISS) > 16. One
child was buried under a stone slab and showed severe chest
and mediastinal injuries. One child was hit by a car as a
pedestrian and was admitted with a severe brain injury, a
pelvic fracture, and femur and forearm fracture. One child
showed a pelvic as well as femur and tibia fracture after fall-
ing from a horse. Two children were admitted with severe
brain injury and mediastinal injuries after an RTA as a
pedestrian and cyclist. One child was hit on the head by a
streetlight after it was knocked down by a car and showed
severe brain injuries as well as multiple scull and midfacial
fractures.
In the analyzed period, 4 patients died of an unintentional
injury (0.03%). 3 patients died on the day of admission, and
one child died on the ICU. All patients died of traumatic
brain injuries after a road traffic accident as a pedestrian or
cyclist.
In 4 patients, the pattern of injury could not be clearly
associated with the accident mechanism, so suspicion of
child abuse was raised. All 4 patients showed bruises in dif-
ferent locations. One child was diagnosed with multiple rib
fractures as well as a humerus fracture. All patients were
presented to the child protection services.
4 patients were admitted due to suicidal attempts. Mean
age in that group was 12.4years (11–14years). Most
Table 4 Distribution of fractures needing surgery
Surgery n%
Forearm fracture 381 54.4
Humerus fracture 141 20.1
Lower leg fracture 83 11.9
Hand fracture 37 5.3
Femur fracture 36 5.1
Foot fracture 11 1.6
Chest fracture 7 1.0
Spine fracture 2 0.3
Cranial bone fracture 2 0.3
0
20
40
60
80
100
120
140
160
180
babies toddlerspreschoolersschool aged
children
early
adolescent
children
No. of paents
male
female
Fig. 4 Age distribution of patients with fractures needing surgery
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456 R.Cintean et al.
1 3
common mechanism were lacerations of the wrist (n = 3) and
one jump from a height of 3m with multiple rib fractures.
20 patients (0.16%) were admitted with pathological pain
or injury, including 7 fractures without adequate trauma. In
all 20 cases, the patients were admitted as inpatients for fur-
ther diagnosis. The most common locations for pathologic
fractures were femur and tibia with 2 patients each.
A total of 174 patients (1.4%) presented to the ED due to
pain without trauma. Thereof, 49 patients were treated for
torticollis. In the remaining patients, no diagnosis could be
made during the examination.
No sufficient documentation regarding injury or trauma
mechanism was found in 233 patients.
Time ofpresentation
The highest number of presentations in our ED was regis-
tered in the months of May, June, and July. In August, there
was a significant decrease in the number of presentations
(p < 0.05) (Fig.5).
Regarding the days of the week, it was found that the
most frequent presentations in the ED were on Fridays,
with an average of 7.8 patients. Slightly more patients were
seen on weekends (6.9 patients/day) than on weekdays (6.8
patients/day).
In addition, it showed that an average of 4.0 patients came
to the ER in the out-of-office hours between 5pm and 8 am.
Between 8 am and 5pm, an average of 2.9 patients were
treated. Overall, 63% of patients were treated in the out-of-
office hours between 5pm and 8 am (Fig.6).
Discussion
In our study, in all age groups male children were more
frequently affected by unintentional injuries than females,
which is in line with most epidemiological studies [11, 12,
15–17]. This might be associated with a higher exposure to
risky sport activities and a different pattern of behavior [12,
16, 18]. The age distribution of patients showed two peaks
at ages 1–3 and 10–13years. Age was hypothesized to have
a significant effect on the pattern of physical activity, which
in turn affects the injuries associated with physical activ-
ity. Ruffing etal. as well as Voth etal. described similar
results with peaks in early ages as well as teenagers [16,
17]. In our study, leisure activities, including playground,
showed a peak within preschoolers and school-aged chil-
dren up to 10years of age. A decrease in incidence was
subsequently observed. In older adolescents over 11years of
age, the most common cause of accidents was sport-related
activities, which was also observed in other studies [19, 20].
Similar results were found for accidents at home. Al Rumhi
etal. and Chini etal. reported that children aged 1–6 and
1–5, respectively, were more likely to visit the emergency
department because of accidents at home [21, 22]. Many
studies suggest falls as main mechanism for unintentional
injuries, especially in young children. This includes falls
from low heights or while walking or running [12, 19, 23].
In our study, falls while walking or running were included
in leisure activities. Falls from objects, like climbing frames,
chairs, and stairs, are a common mechanism in among all
ages and often describe the most common cause of accidents
in children [12, 19, 20]. With regard to adolescents, many
studies describe an increasing incidence of RTA as pedestri-
ans or passengers with high mortality [13, 24]. Especially in
developing countries, RTA is described as a major cause of
injuries and mortality in older children and adolescents [14,
24, 25]. Interestingly, in our study, no significant increase
in injuries associated with RTA at older ages can be seen.
In fact, even at the age of 11–14years, a slight decrease
in injuries due to RTA is found. Gong etal. showed simi-
lar results with the highest incidence of RTA at the ages
between 3 and 6 [26]. The reason for this is probably that
many studies include children and adolescents up to 18 or
20years of age. It is believed that it is only at this age that
0
200
400
600
800
1000
1200
1400
No. of paents
Fig. 5 Months of the presentations in the ED
12
1
2
3
4
5
6
7
8
9
10
11
AM
PM
Fig. 6 Time of the presentations in the ED
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457Epidemiology, patterns, andmechanisms ofpediatric trauma: areview of12,508 patients
1 3
patients start using motorized vehicles and are more likely
to be involved in a traffic accident [7, 10, 24]. Although not
the most common mechanism of injury, all deaths in this
study are associated with road traffic accidents. Most stud-
ies suggest RTA as mechanism with the highest mortality
rate among children and young adults with a mortality rates
between 0.3% and 8.5% [7, 11–14]. In this study, the rate of
severely injured children with an ISS > 16 was low. A com-
parable study from Germany with 15.300 patients reported
an overall rate of children with an ISS > 16 of 0.5% [16].
Furthermore, the mortality rate in the present study was only
0.03% with 4 deaths, which is significantly lower than in
comparable studies. Since our hospital, as a level 1 trauma
center, is the only one in the nearby area that treats severely
injured children, it is difficult to explain the low mortality
rate. The hospital is not located in a major city which could
lead to lower rate of fatal RTA due to less traffic in general.
Additionally, children over the age of 14 are excluded in this
study. It is assumed that patients at that age might be less
likely involved in accidents in or on motorized vehicles, as
already mentioned.
In terms of injuries, all deaths associated with RTA were
caused by severe brain injury. This goes in line with most
studies saying that the head is the most vulnerable body
part, especially in young children [11, 12, 17, 26]. In the
present study, the head was the most common body part for
lacerations and second most for bruises. It has been shown
that especially the disproportionately large head is affected
more frequently in young children than in advanced age
[16, 17]. Fractures were third most common injuries with
peak incidences in school-aged children. Rennie etal. and
Randsborg etal. show in a large epidemiological study about
fractures in children a bimodal distribution with peaks at the
ages of 6–8 and 10–14 with a significant drop in girls over
the age of 12 [27, 28]. Similar results were found in our
study with a decline in the incidence of girls over 11years.
Furthermore, the prevalence of the various fractures was
remarkably similar between the study by Ruffing etal. and
the present study. Thus, the distal radius/ulna followed by
the metacarpal and fingers were found to be the most com-
mon locations of fractures in children [17]. Most common
mechanisms for fractures were leisure activities as well as
falls. This goes in line with epidemiological studies [19, 27,
29], whereas some studies suggest RTA as most common
mechanism resulting in fractures in children [11]. Concern-
ing sports-related activities, Randsborg etal. mentions soc-
cer as being the most dangerous sport with high incidences
of distal radial fractures [28]. Not surprisingly, the most
common fractures requiring surgical treatment were forearm
and humerus fractures. Further injuries were joint disloca-
tions with the nursemaids elbow being the most common
one with the highest prevalence at the age between 1 and
3years. Similar to previous studies, female predominance
was found with a ratio of 1.76:1 [30, 31]. Second most com-
mon dislocation was the patella dislocation. Studies suggest
that between 50 and 70% of patellar dislocations occur while
exercising or during other sports-related activity [32, 33].
We found similar results in the present study with the highest
prevalence in sports-related activities.
Seasonal as well as time differences could be found in the
study. In average, more patients were treated on the week-
ends than on weekdays. Most patients were admitted to the
ED during the late afternoon and early evening hours. In
fact, a large percentage of patients were treated in the out-
of-office hours. Naqvi etal. reported similar findings with
considerably more admissions during the evening with the
highest levels of attendance between 5 and 8pm [11, 19].
Randsborg etal. suggested that the time of admission relates
with the season. They found that most admissions during the
winter season are around noon, while most admissions in
summer are in the late afternoon [28]. In the present study,
most admissions were during spring and summer months
between May and July. A significant drop in admissions was
found in August, which could be explained by the school
holidays and many families traveling during that time. Simi-
lar results were reported by Ruffing etal. [17].
Suspicion of child abuse was raised in 4 cases and shows
an overall low incidence compared to similar studies. Naqvi
etal. reported an incidence of 3.8% of suspected child abuse
in their study [11]. All patients with suspected child abuse
showed typical injuries around the head and uncommon
fractures for the age. Typical characteristics described in
the literature include patient age less than 1 and head inju-
ries and strangulation marks that may indicate possible child
abuse [34, 35].
This study has several limitations. This was a retrospec-
tive single-center study. Therefore, the epidemiological data
are limited to one area. Some merging of variables had to
be done to make the amount of data manageable. This could
have resulted in loss of important information. Although the
total number of patients is large, some subgroups are small
and thus can only be insufficiently included for statistical
calculations.
Conclusion
Most injuries in children are minor in nature and do not
require further surgical treatment. The pattern of injury as
well as the mechanism of injury varies between the different
age groups. Head injuries remain the most dangerous inju-
ries with a high mortality rate in all ages. The leading cause
of fatal trauma was traffic accidents. Although in most cases
the mechanism is obvious, suspicion of child abuse should
be kept in mind. Peak times in the late afternoon and evening
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458 R.Cintean et al.
1 3
and summer months should be taken into consideration of
personnel planning.
Author contributions Raffael Cintean contributed to study design, per-
formed measurements, and manuscript preparation; Alexander Eick-
hoff was involved in performed measurements and statistical analysis;
Jasmin Zieger contributed to performed measurements and manuscript
preparation; Florian Gebhard was involved in ethical report and manu-
script preparation; Konrad Schütze performed statistical analysis, study
design, and manuscript preparation.
Funding Open Access funding enabled and organized by Projekt
DEAL. None of the authors received financial support for this study.
Declarations
Conflict of interest The authors declare no conflicts of interest.
Ethical standard This study was approved by the institutional ethics
committee.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
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