Younger children (0–5 years) were more prone to injuries at home (88.3%) compared to those aged 6–10 years (63.5%) and 11–15 years (44.4%), whereas adolescents (11–15 years) were more frequently injured on the road (17.6% vs. 8.9% for 6–10 years and 5.3% for 0–5 years) and at sports grounds (26.5% vs. 9.9% for 6–10 years and 0.6% for 0–5 years). Those children sustaining injuries on the street had a higher proportion within 6–10 years (6.5%) than those aged 11–15 years (3.6%) and 0–5 years (1.2%). These differences were statistically significant.

Younger patients (0–5 years) had higher rates of falls (57.4% vs. 49.5% for 6–10 years and 34.8% for 11–15 years) and foreign bodies (8.0% vs. 3.6% for 6–10 years and 0.3% for 11–15 years), but lower rates of assault (0.0% vs. 0.4% for 6–10 years and 1.0% for 11–15 years). Older children (11–15 years) had higher rates of sports-related injuries (26.5% vs. 9.9% for 6–10 years and 0.6% for 0–5 years) and MVC-passenger injuries (13.9% vs. 6.7% for 6–10 years and 4.7% for 0–5 years) compared to younger children with p < 0.001. Lacerations and blunt injuries were more common in the younger study population (0–5 years: 37.3% and 9.1%) compared to those aged 6–10 years (31.7% and 5.2%) and 11–15 years (19.6% and 3.6%). Conversely, fractures and soft tissue injuries were more prevalent in the oldest age group (11–15 years: 27.8% and 25.8%) compared to children aged 6–10 years (21.6% and 18.8%) and 0–5 years (9.7% and 17.2%) [Table 2].

Females were more frequently injured at home (76.0%) and had a higher incidence of fall-related injuries (52.9%) and pulled elbows (3.3%). Males were more commonly injured during sports (11.0%) and from assaults (0.5%) or fixed object collisions (13.2%). While lacerations and fractures were more common in males, females had higher rates of contusions and crush injuries. However, differences in injury types by sex were not statistically significant (p = 0.173) [Table 3].

During the ED assessment, one (0.1%) patient was declared dead on arrival. Among the patients assessed, 58.7% received a Canadian Triage and Acuity Scale yellow triage code, indicating their conditions were urgent but stable enough to wait 30 minutes for treatment. The ISS revealed that most injuries (65.7%) were classified as minor with scores < 8. Most patients (98.4%) had a normal Glasgow Coma Scale. The trauma patients who had abnormal Glasgow Coma Scale and severe or critical ISS (≥16) were involved in an MVC, falling from height, or struck by an object.

Diagnostic imaging, including X-ray, CT scan, and sonography for trauma, was performed on 733 (44.6%) patients, with 55% of these imaging studies revealing positive trauma-related findings. Emergency physicians treated 68.0% of the patients, while 32.0% required specialist care from trauma, orthopedic, neurosurgery, pediatric surgery, ENT, ophthalmology, and maxillofacial teams. Common interventions included a 4–6-hour observation period for minor injuries (29.8%). Systemic analgesia was administered in 18.2% of patients. Fracture management involved the application of back slabs for 14.3% of patients and reduction under sedation for 4.6%. Wound care included treating lacerations with skin adhesive (13.4%), sutures (10.3%), and dressings (2.7%). The majority (n = 1467, 89.3%) of patients were treated and discharged from the ED, while 111 (6.7%) required hospital admission, and 64 (3.9%) were referred to specialized trauma centers [Table 4].

Among 1643 participants, 33 (2.0%) had significant clinical outcomes. No statistically significant differences in age or sex were noted between the groups. PICU admissions were more frequent for children involved in MVC (45.4% vs. 10.3%), struck by falling objects (6.1% vs. 5.1%), and with polytrauma (54.5% vs. 12.8%), compared to those in ward or high-dependency units. Critical triage codes (blue: 42.4% vs. 1.3% and red: 45.4% vs. 35.9%) and severe (48.5% vs. 5.1%) or critical (33.3% vs. 1.3%) ISS correlated with more severe outcomes (p = 0.001). These patients often required intubation, laparotomy, and craniotomy with more extended hospital stays (10.9 vs. 2.1 days; p = 0.001) [Table 5].

Discussion

This study presents valuable insights into pediatric trauma patterns at SQUH. It highlights key injury mechanisms, types, and demographic correlations while contributing to the regional body of knowledge on pediatric trauma.

This study identified specific injury types based on age and gender, revealing that a significant number (51.4%) of younger children (0–5 years) were more prone to injuries, with males being injured at twice the rate of females (2:1 ratio). However, the overall pattern of injury types across genders did not show statistically significant differences, which may suggest that gender-based differences are more activity-related than physiological.9 These results are consistent with other epidemiological studies on pediatric trauma conducted in the Gulf Cooperation Council and sub-Saharan Africa regions.10–12

In this study, the primary trauma sites for both sexes were at home (72.7%) and on the road (8.6%). However, a higher percentage of adolescent males (11–15 years) were injured on sports grounds. This aligns with the literature, which associates this age group with increased participation in organized sports and outdoor activities, resulting in a higher incidence of injuries.13,14 Road traffic accidents, though less frequent in this study, remain a notable cause of trauma in adolescents, which corresponds to findings from other regions where traffic injuries are a common concern in this age group.15

Our findings align with previous studies that have identified falls as the leading cause of pediatric trauma, accounting for 50.8% of cases in this study. This is consistent with global reports, which indicate that falls constitute a significant proportion of pediatric injuries, particularly among younger children.2,16–18 Smaller children are vulnerable to falls due to their developmental stage, lack of coordination, and natural tendency to explore their surroundings. This highlights the need for focused preventive measures within homes, including child-friendly environments, to reduce fall risks.

Lacerations (32.3%) and soft tissue injuries (19.3%) were the most frequent types of injuries, with the face (33.0%) and upper extremities (25.3%) being the most commonly affected. These results are consistent with other studies, which have identified lacerations and soft tissue injuries as the leading types of trauma in pediatric populations.19,20 The predominance of these injury types showed the relatively minor nature of most pediatric trauma cases, many of which were caused by low-energy mechanisms. The high number of facial and upper extremity injuries likely reflects the vulnerability of these regions in common mechanisms of injury, such as falls and sports-related trauma.21,22

Interestingly, long bone fractures were more common in adolescents than in younger children. One possible explanation for this difference is that older children are more likely to engage in vigorous activities, such as sports or road traffic accidents, leading to more severe injuries like fractures. Additionally, younger children’s bones are more flexible and less likely to break than those of adolescents.23

According to the study, most (89.3%) patients were treated and discharged from the ED, indicating a pattern of non-severe injuries that could be managed with conservative treatments, such as wound closure using Dermabond or suturing, and fracture management using back slabs or reduction under sedation. This matches with other studies, showing that most pediatric trauma cases involve minor injuries that do not require surgical intervention.24,25 However, a small proportion (6.7%) of patients required hospital admission, and 2.0% experienced significant clinical outcomes, such as admission to the PICU. Patients admitted to the PICU were associated with severe trauma mechanisms, including motor vehicle collisions and polytrauma, emphasizing the importance of traffic safety measures for children.9 Preventive measures, such as enforcing child seatbelt use, promoting pedestrian safety, and implementing sports safety protocols, likely reduced the severity of injuries.26 Overall, the results of this study are consistent with global trends in pediatric trauma, underscoring the need for targeted preventive strategies to reduce the incidence and severity of injuries in children.27

To the best of our knowledge, this is the first study with a thorough understanding of pediatric trauma in this context. There were limitations in this study. The first limitation was its retrospective nature and reliance on previously recorded medical charts and electronic data. This can lead to incomplete or inaccurate information due to missing data or variability in clinical documentation. Second, the study overlooked parental supervision, or environmental factors, which can significantly influence the incidence and type of injuries among children. Third, follow-up data for patients with severe traumatic injuries were missing. Lastly, the study was conducted at a single tertiary care hospital. Therefore, the results may not generalize to other regions or healthcare settings across Oman or the Middle East.

Conclusion

This study provides valuable information about the patterns of pediatric trauma and identifies falls from height as the most common mechanism of injury, particularly among younger children. Males were more frequently affected with lacerations and soft tissue injuries, which were the most common injury types. Adolescents were more prone to road traffic and sports-related injuries. The results also highlight the importance of focused safety measures—especially at home, on the road, and during recreational activities—to prevent injuries in children. Future research should focus on intervention strategies and long-term outcomes, and include other healthcare settings to understand pediatric trauma and prevention methods better.

Disclosure

The authors declare no conflict of interest and no funding received for this study.

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