title: Paediatric trauma on the Last Frontier: an 11-year review of injury mechanisms, high-risk injury patterns and outcomes in Alaskan children.
abstract: BACKGROUND
  Paediatric trauma system development in Alaska is complicated by a vast geographic coverage area, wide regional variations in environment and culture, and a lack of available published data.
  
  
  OBJECTIVE
  To provide a detailed description of paediatric trauma mechanisms, high-risk injury patterns and outcomes in Alaska.
  
  
  METHODS
  This retrospective study included all children aged 17 years or younger in the State of Alaska Trauma Registry database admitted with traumatic injury between 2001 and 2011. Each injury record was reviewed individually and assigned a mechanism based on Centers for Disease Control E-codes. Geographic definitions were based on existing Emergency Medical Services regions. Mechanisms were compared by geographic region, patient demographics, injury characteristics and outcome. Subgroup analysis of fatal injuries was performed to identify causes of death.
  
  
  RESULTS
  Of 5,547 patients meeting inclusion criteria, the most common mechanisms of injury were falls (39%), motor vehicle collisions (10%) and all-terrain vehicle (ATV) accidents (9%). The overall case fatality rate was 2%. Mechanisms with the greatest risk of death were gunshot wounds (21%), pedestrians struck by motorized vehicles (9%) and motor vehicle collisions (5%). These 3 mechanisms accounted for 15% of injuries but 60% of deaths in the overall cohort. Injury patterns involving combined central nervous system (CNS) and torso injuries were unusual but especially lethal, occurring in 3% of patients but carrying a case fatality rate of 18%. Although the distribution of mechanisms was generally similar for each geographic region, ATV and snowmobile injuries were significantly more common in remote areas (23% remote vs. 7% non-remote, p < 0.0001).
  
  
  CONCLUSIONS
  Mechanisms of paediatric trauma in Alaska have widely varying impacts on outcome and show some variation by region. Highest-risk mechanisms include gunshot wounds and motorized vehicle-related accidents. Prevention efforts should give special attention to CNS injury prevention, ATV and snowmobile safety in remote areas, and optimization of management of multisystem trauma. Further studies should investigate predictors of outcome in greater detail.
authors.affiliation: Department of Surgery, 6th Medical Group, MacDill Air Force Base, Tampa, FL, USA ; Department of Surgery, The Children's Hospital, Providence Alaska Medical Center, Anchorage, AK, USA ; Division of Acute Care Surgery, University of South Florida, Tampa, FL, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Snyder
authors.affiliation: Division of Paediatric Surgery, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Muensterer
authors.affiliation: Department of Surgery, Alaska Native Medical Center, Anchorage, AK, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Sacco
authors.affiliation: Division of Paediatric Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Safford
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D017677:Age Distribution; D000413:Alaska / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D010372:Pediatrics; D012189:Retrospective Studies; D018570:Risk Assessment; D012309:Risk-Taking; D017678:Sex Distribution; D015996:Survival Rate; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
keywords: Alaska; epidemiology; injury; resource utilization; youth