Injuries Among Amish Children: Opportunities for Prevention
Abigail K. Koff1; Joshua Honeyman, MD2; Stephen Strotmeyer, PhD, MPH3; Barbara A. Gaines, MD4
1University of Pittsburgh School of Medicine, Pittsburgh, PA; 2Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA; 3University of Pittsburgh, Pittsburgh, PA; 4Children's Hospital of Pittsburgh of UPMC, Lancaster, PA
Background: Children living in Amish communities may be exposed to uncommon injuries and limited access to care due to their agrarian lifestyle and remote communities.
Methodology: With IRB approval, we performed a retrospective review of Amish patients age ≤12 years presenting to a level I pediatric trauma center between January 1, 2005 and December 31, 2015. Data abstracted from the institutional trauma registry and electronic medical record were analyzed utilizing descriptive statistics and univariate/multivariate analysis.
Results: 183 Amish children were admitted, and 2 died from injuries. Patients were 72.1% male; the median age was 5 (IQR 3-8); median injury severity score (ISS) was 9 (IQR 4-14), Most injuries were the result of blunt force trauma (91.8%). The most frequent mechanisms were falls (62.7%), followed by animal-related (19%), and buggy (15.1%). Most injuries occurred at home (44.4%) or on a farm (33.9%). Hayhole falls were a unique source of injury with a high ISS (12; IQR 6 - 17). Overall median length of stay (LOS) was two days (IQR 1-3), with animal-related injuries associated with the longest LOS (3 days; IQR 1-4.75).
Conclusions: The majority of injuries among Amish children are due to falls. Hayhole falls and animal-related injuries result in the highest ISS and longest LOS. These findings identify the farm as a potential target for culturally appropriate interventions for risk modification.
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