Objective Injury prevention programmes for children should choose their target from objective data on mechanisms of injury. This study was done to identify the most important severe injury mechanisms.

Methods Retrospective review of severe paediatric trauma patients in two regional trauma centres. Injury prevention priority scores were computed with different severity measures to identify prevention priorities: injury severity score (ISS), revised trauma score (RTS), trauma-related injury severity score (TRISS), Glasgow coma scale (GCS) and mortality.

Results A total of 3732 children with severe injury were identified with a mean age of 9.0 ± 5.2 years (±SD); 2469 were boys (66.2%). GCS was 7 or less in 209 patients (5.6%) and median ISS was 9. Overall, there were 77 deaths (2.1%). “Fall from height” was the most frequent mechanism and “motor vehicle traffic injury” resulted in the most severe injuries. The most significant mechanisms, using ISS, were “fall from height”, “motor vehicle traffic injury”, “pedestrian”, “bicycle injuries” and “child abuse”. Different priorities were identified depending on the severity measures used: “fall from height” would be the priority with ISS, RTS and TRISS, “motor vehicle traffic” with mortality and “drowning/submersion” with GCS. Failure to use safety devices, such as helmets and seat belts, was a common finding among severely injured children.

Conclusion This study shows that injury prevention priorities identified vary depending on the severity measures used. The variations seen across age groups and centres are factors that must be taken into account when developing prevention programmes.