title: Changing epidemiology of injury-related pediatric mortality in a rural state: implications for injury control.
abstract: OBJECTIVE
  To document the current epidemiology of pediatric injury-related deaths in a rural state and evaluate changes over time.
  
  
  METHODS
  Retrospective review of injury-related deaths in children less than 15 years of age. Data were obtained from death certificates and coroner, autopsy, prehospital, and hospital records. Analysis was done of the mechanism of injury, age, sex, race, location of incident, toxicology, and safety device use. Comparisons with analogous data collected from an earlier time period were made.
  
  
  METHODS
  The state of Montana, from October 1989 to September 1992.
  
  
  METHODS
  Deaths per 100,000 population, intentionality of injury, mechanism of injury, use of protective devices, and comparisons with previous data (1980-1985) collected by Baker and Waller (Childhood injury: State by state mortality facts. Baltimore: Johns Hopkins Injury Prevention Center, 1989;148-152).
  
  
  RESULTS
  Of 121 patients reviewed, 56% were male and 44% were female. Mean age was 7.0 years (median, 8.0). Eighty-one percent of patients were Caucasian, and 16% were Native American. The leading cause of injury was motor vehicle crashes, which was followed by drowning, unintentional firearm injuries, deaths related to house fires, homicides, and suicides. Overall, 87% of injuries were unintentional and 13% were intentional, with 62% of these suicides and 38% homicides. When considered independently of intent, firearm-related injuries ranked second. Earlier data showed motor vehicle crashes ranking second, unintentional firearm injuries seventh, and homicide fourth. Comparison of death rates per 100,000 people for the two time periods showed increases in suicide deaths (3.2 vs 0.8) and unintentional firearm injury deaths (2.3 vs 0.6).
  
  
  CONCLUSIONS
  The epidemiology of rural pediatric injury-related deaths has changed. Deaths related to suicide and firearms have increased. Violent deaths related to injuries caused by firearms are at a magnitude approaching all other causes. These findings have implications for public health education and injury control strategies in rural areas.
authors.affiliation: University of Washington, Seattle, USA.
authors.forename: T K
authors.initials: TK
authors.lastname: Rausch
authors.forename: N D
authors.initials: ND
authors.lastname: Sanddal
authors.forename: T L
authors.initials: TL
authors.lastname: Sanddal
authors.forename: T J
authors.initials: TJ
authors.lastname: Esposito
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data; D000293:Adolescent; D002423:Cause of Death; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009009:Montana / Q000453:epidemiology; D012189:Retrospective Studies; D012423:Rural Health; D012424:Rural Population / Q000706:statistics & numerical data*; D013405:Suicide / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D014948:Wounds, Gunshot / Q000401:mortality / Q000517:prevention & control; D000092864:Suicide Prevention