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To determine the epidemiology of traumatic death in pediatric patients in a rural state, we reviewed all deaths caused by injury in victims <19 years old between 1985 and 1990. We hypothesized that mortality would be higher than equivalent populations in urban areas. During the study period, 5,322 children were hospitalized for trauma (14% of total admissions for children in the state) and 36 died (0.67%). For this subgroup, head injury was the most common cause of death (72%). When compared with data from the National Pediatric Trauma Registry from urban centers, the mortality rate for hospitalized children in this rural state was lower (0.67% vs. 2.7%, p < 0.001). On review of the population-based statistics for the entire state, we found that these numbers were deceivingly low. In all, 731 children died during the study period, of which 283 were determined by autopsy or coroner's report to have died of trauma (38.7%). Eighty-seven percent of children who died never reached the hospital. Mortality (age-adjusted) was highest in the 15- to 18-year-olds (68.5 of 100,000), then <1-year-old (26.8 of 100,000), 1- to 5-year-olds (15.6 of 100,000), and 5- to 14-year-olds (11.8 of 100,000), which significantly exceeds the predicted national averages for these age groups. In addition, the overall mortality for children in this state (29.5 of 100,000) doubled that estimated for New York City (13.3 of 100,000), confirming the allegation that pediatric deaths from injury in a rural setting are more frequent than that encountered in an urban setting, in spite of the recent increase in gunshot wounds in the urban population. Data on children admitted to the hospital in this rural state underestimate mortality caused by trauma. Population-based studies are therefore optimal to assess incidence and outcome accurately. Although overall mortality in children is higher than urban rates, medical care in this population compares well with statistics reported in predominantly urban centers for similar Injury Severity Scored patients. These data substantiate that programs to improve trauma mortality in this rural state must be concentrated on enhancing access to the hospital system to have a significant effect.

(C) Williams & Wilkins 1995. All Rights Reserved.