Fatal childhood injury patterns in an urban setting

Ann Emerg Med. 1994 Feb;23(2):231-6. doi: 10.1016/s0196-0644(94)70036-2.


Study objective: To describe fatal childhood injury patterns in an urban county and evaluate the use of the emergency medical services system.

Design: Retrospective chart review of medical examiner files, prehospital and hospital records, and police and fire personnel reports.

Setting: Milwaukee County, Wisconsin, an urban county with a population of approximately 1 million.

Participants: All children 15 years old or younger who sustained a fatal injury in 1989 or 1990 (70).

Results: House fires were the leading cause of death by injury (34%), followed by firearms (19%), and drowning (11%). Motor vehicle occupant deaths occurred less frequently (7%). One-third of deaths were homicides (48% firearms and 30% assault). Twenty-four percent of deaths were pronounced at the scene, 12% were dead-on-arrival (no emergency department resuscitative efforts), and 37% were dead-on arrival ED resuscitations. Only 27% of victims survived to become inpatients (84% died within 72 hours). Mean scene time (16.1 +/- 7.9 minutes), transport time (9.5 +/- 5.1 minutes), and success rates for prehospital peripheral IV insertion (72%), endotracheal intubation (91%), and intraosseous line (86%) were not significantly different among those who were dead-on-arrival, dead-on-arrival failed resuscitations, or eventual inpatients.

Conclusion: Fatal childhood injury patterns in this urban setting differed from reported national injury patterns. This study found a higher percentage of deaths from fire, gunshot wounds, and homicides but a lower percentage of motor vehicle-related deaths. Prevention strategies need to address the injury patterns of a particular community. Only a small percentage of victims survived to receive inpatient care following their injuries, suggesting that primary prevention of injury may be the most effective intervention.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Drowning / mortality
  • Emergencies
  • Female
  • Fires / statistics & numerical data
  • Humans
  • Infant
  • Male
  • Retrospective Studies
  • Urban Health / statistics & numerical data*
  • Wisconsin / epidemiology
  • Wounds and Injuries / mortality*
  • Wounds, Gunshot / mortality