title: Trends in moderate to severe paediatric trauma in Central Netherlands.
abstract: BACKGROUND
  Trend analyses of hospital discharge data can raise signals for prevention policies, but are often flawed by changes in health care consumption. This is a trend analysis of the clinical incidence of paediatric trauma that used international criteria to overcome this bias. The objective is to describe trends in clinical incidence of moderate to severe paediatric trauma, and to identify target groups for prevention activities.
  
  
  METHODS
  Included were all paediatric trauma patients (0-18 years) that were discharged from the hospitals of trauma care region Central Netherlands from 1996 to 2009. Selection was made on ISS ≥ 4, and on trauma related International Classification of Diseases diagnostic codes, and trauma related external causes of injury and poisoning codes. Trend analyses were performed using Poisson loglinear regression with correction for age and gender.
  
  
  RESULTS
  23,682 Patients were included, the mean incidence rate was 477/100,000 person-years. Since 2001 the incidence rate of moderate to severe trauma increased with 1.1% annually (95% confidence interval (CI) 0.7-1.5), caused by an increase of falls (3.9%, 95% CI 3.3-4.5), sport injuries (5.4%, 95% CI 4.3-6.5), and bicycle injuries (3.8%, 95% CI 2.8-4.8). The incidence of falls and sport injuries peaked in young children (0-9) and older boys (10-18) respectively. Bicycle injuries affected all children between 5 and 18.
  
  
  CONCLUSIONS
  The incidence of paediatric trauma in the centre of the Netherlands increased since 2001. Trend analyses on moderate and severe injuries may identify target groups for prevention in a trauma region.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands. Electronic address: eljanssens@hotmail.com.
authors.forename: Loes
authors.initials: L
authors.lastname: Janssens
authors.affiliation: Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, The Netherlands; Rudolf Magnus Institute of Neuroscience of the University Medical Center Utrecht, The Netherlands. Electronic address: h.r.holtslag@umcutrecht.nl.
authors.forename: Herman R
authors.initials: HR
authors.lastname: Holtslag
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen
authors.affiliation: Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, The Netherlands; Rudolf Magnus Institute of Neuroscience of the University Medical Center Utrecht, The Netherlands.
authors.forename: Eline
authors.initials: E
authors.lastname: Lindeman
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
authors.forename: Caspar W N
authors.initials: CW
authors.lastname: Looman
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
authors.forename: Ed F
authors.initials: EF
authors.lastname: van Beeck
mesh_terms: D000056:Accident Prevention / Q000639:trends; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data; D000293:Adolescent; D017677:Age Distribution; D001265:Athletic Injuries / Q000453:epidemiology / Q000517:prevention & control*; D001642:Bicycling / Q000293:injuries* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D006293:Health Promotion; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends*; D011041:Poisoning / Q000453:epidemiology / Q000517:prevention & control*; D011159:Population Surveillance; D017678:Sex Distribution; D015599:Trauma Severity Indices
keywords: Incidence; Paediatric; Trauma; Trends