Characteristics and trends of traumatic injuries in children visiting emergency departments in South Korea: A retrospective serial cross-sectional study using both nationwide-sample and single-institutional data

Abstract

We investigated the incidences and characteristics of pediatric traumatic injuries requiring emergency department visits, through a complementary approach using both nationwide-sample and single-institutional data. Data for children (aged <15 years) identified with traumatic injuries during a 10-year period from the Korean National Health Insurance Sharing Service (n = 35,064 among 10,114,909 randomly sampled cases from the claim records of the National Health Insurance) and the authors' institute (n = 39,228) were retrospectively reviewed. The incidences and characteristics of the injuries were investigated using both datasets; additionally, detailed information regarding the injury environments was investigated using the single-institutional data. The findings were similar across both datasets. The incidence of injuries increased during the study period; the head was most commonly injured, whereas the trunk or proximal extremities were rarely injured; low-energy head injuries accounted for >50% of the cases in children aged <5 years, although the incidences of lower-extremity injuries and fractures increased in older children. Single-institutional data demonstrated that the proportion of indoor playground and trampoline-related injuries increased rapidly during the study period, and outdoor injuries and seasonal variation (with peak incidences in May and June) were more prominent in older children. Based on similarities between both datasets, the detailed results regarding pediatric traumatic injuries obtained from the single-institutional data could be generalized nationally with adequate external validity. To prevent traumatic injuries, it may be more effective to wear protective equipment covering the head and distal extremities rather than the trunk or proximal extremities; simple clothing, such as caps, could prevent many injuries in preschoolers. Among older children, safety guidelines for outdoor sports/leisure activities are needed. The increase in pediatric traumatic injuries may be partially explained by the increased availability of indoor playgrounds and installation of trampolines. Stricter adherence to the preventive guidelines is needed.

Fig 1

(A) Injured body part. In both the Korean National Health Insurance Sharing Service and single-institutional data, the most commonly injured body part was the head, followed by the upper extremities distal to the elbow (that is, the elbow to hand) and the lower extremities distal to the knee (that is, the knee to foot). Injuries of the trunk or proximal extremities such as the shoulders or hips were rare. (B) Injury type. Low-energy injuries such as open wounds or superficial injuries were most common in both datasets.

Fig 2

(A) Korean National Health Insurance Sharing Service (NHISS) data for the injury incidence rate per 1 million claim cases according to year. The incidence rate tended to increase during the 10-year study period (β = 0.877, p = 0.001). The decrease in 2015 may be explained by the outbreak of Middle East respiratory syndrome, when there was an attempt to reduce emergency department visits to prevent the spread of the virus. (B) Single-institutional data for visiting patients by year. The number of injured patients tended to increase over the study period (β = 0.933, p < 0.001) with more rapid changes occurring after 2010, which coincides with the opening of a pediatric emergency center in December of that year. (C) When the numbers of cases of single-institutional data were weighted for age and body part using the NHISS data, there was a greater increase in the single-institutional data. (D) NHISS data for the standardized injury incidence rate per 1 million claim cases by year. Although there appeared to be a greater increase in the single-institutional data in Fig 2C, the rate of increase in the NHISS data became more rapid after standardization to the population composition in 2006 (β = 0.964, p < 0.001). Despite a decreased proportion of children aged 0–14 years, the injury incidence rate increased over time. Therefore, the rate of pediatric traumatic injuries may have increased more rapidly than assumed.

Fig 3

(A) Place of injury by age. The home was the most common location where injury occurred in young children. As age increased, the injury rates outside the home also increased. (B) Monthly visit frequencies by age. The differences in the frequencies of emergency department visits by month became more apparent as age increased. For older children, the visit frequency peaked in May and June, which is a period suitable for outdoor activities. By contrast, the frequency of visits was lowest during winter. (C) Time of emergency department visits. The most common time when emergency departments were visited was between 7 and 10 pm.

Fig 4

The proportions of indoor playground (A) and trampoline-related (B) injuries increased rapidly during the study period.