Changing epidemiology of injury-related pediatric mortality in a rural state: Implications for injury control

Study Objective: To document the current epidemiology of pediatric injury-r elated deaths in a rural state and evaluate changes over time. Design: Retrospective review of injury-related deaths in children less than 15 years of age. Data were obtained from death certificates and coroner, a utopsy, prehospital, and hospital records. Analysis was done of the mechani sm of injury, age, sex, race, location of incident, toxicology, and safety device use. Comparisons with analogous data collected from an earlier time period were made. Setting: The state of Montana, from October 1989 to September 1992. Measurements: Deaths per 100,000 population, intentionality of injury, mech anism of injury, use of protective devices, and comparisons with previous d ata (1980-1985) collected by Baker and Waller (Childhood injury: State by s tate mortality facts, Baltimore: Johns Hopkins Injury Prevention Center, 19 89;148-152). Results: Of 121 patients reviewed, 56% were male and 44% were female. Mean age was 7.0 years (median, 8.0). Eighty-one percent of patients were Caucas ian, and 16% were Native American. The leading cause of injury was motor ve hicle crashes, which was followed by drowning, unintentional firearm injuri es, deaths related to house fires, homicides, and suicides. Overall, 87% of injuries were unintentional and 13% were intentional, with 62% of these su icides and 38% homicides, When considered independently of intent, firearm- related injuries ranked second. Earlier data showed motor vehicle crashes r anking second, unintentional firearm injuries seventh, and homicide fourth. Comparison of death rates per 100,000 people for the two time periods show ed increases in suicide deaths (3.2 vs 0.8) and unintentional firearm injur y deaths (2.3 vs 0.6). Conclusion: The epidemiology of rural pediatric injury-related deaths has c hanged. Deaths related to suicide and firearms have increased. Violent deat hs related to injuries caused by firearms are at a magnitude approaching al l other causes. These findings have implications for public health educatio n and injury control strategies in rural areas.