Pediatric Traumatic Injury in Rural and Urban Areas of Wisconsin

Objectives: Unintentional injury is the leading cause of death in American youth. Fewer children live in rural versus urban areas, yet rural children comprise nearly one-quarter of injury mortalities. We sought to describe differences in pediatric mechanism of injury (MOI), injury severity. and mortality in rural and urban areas and explore geospatial patterns of injury. Methods: Wisconsin trauma registry data were analyzed for injured pediatric patients from 2021 to 2022. Wisconsin Collaborative for Healthcare Quality and Wisconsin Health Innovation Program’s (WI-HIP) rural/urban classification assigned ZIP codes to urban-advantaged, urban, urban-underserved, rural-advantaged, rural, or rural-underserved areas. Geospatial analyses identified high-injury burden areas based on crude and indirectly age and sex-adjusted injury rates. Results: Two thousand four hundred seven children were included; mean age was 6.9±4.4 years; 738 (30.7%) lived in urban, 467 (19.4%) in urban-underserved, 452 (18.8%) in urban-advantaged, 379 (15.8%) in rural, 231 (9.6%) in rural-advantaged, and 140 (5.8%) children in rural-underserved areas. Falls were the most common among urban-advantaged and urban groups, where motor vehicle/transportation injuries were most common among the 3 rural groups; firearm injuries were highest in the urban-underserved group. In-hospital mortality was highest in the urban-underserved group (3.2%), followed by rural (1.3%), rural-advantaged (1.3%), urban (1.1%), urban-advantaged (0.9%), and rural-underserved (0.7%) groups. Crude and adjusted injury rates were highest in the rural-underserved group. Conclusions: Rural and urban MOI, injury locations, levels of trauma center differed. Tailored prevention strategies for rural and urban communities are needed, particularly in areas with higher injury rates. A community-engaged approach to prevention could reduce pediatric injuries.