Childhood farm injuries.

During a recent 6-year period (1991-1997), 143 children and adolescents less than 18 years of age were admitted to a Level I trauma center for agriculture-related trauma. Mechanized pieces of equipment were responsible for half of the injuries. The pattern of injury was clearly seasonal and a daytime occurrence. Half of the patients came from the scene and half from rural hospital emergency rooms, with only 25 per cent being transported via advanced life support. Rural geography led to both long distance (mean, 55 miles) and long transport time to definitive care (mean, 2 hours, 15 minutes). There was a predilection for fractures, amputations, head injuries, and soft-tissue infections. Operative intervention was required immediately in two-thirds, and one-third were admitted to an intensive care unit. Whereas hospital mortality was low at 1.4 per cent, most childhood farm deaths during the study period occurred in the field. Severe permanent disability was present in one-third of children, and 7 per cent incurred a second injury during the study period. Using this review, prevention programs have been developed to minimize death and disability in children sustaining farm injuries.