A Review of Orthopaedic Trauma Injuries in Amish Pediatric Patients

abstract Background Amish children may experience traumatic Orthopaedic injuries related to agriculture and other high-energy mechanisms unique to their communities. Geographic, cultural, and healthcare access factors may influence care. Despite this, Orthopaedic literature describing pediatric trauma within Amish communities remains limited. This study characterizes traumatic Orthopaedic injury patterns, clinical presentation, barriers to care, vaccination status, and follow-up rates among Amish pediatric patients treated at a Level 1 pediatric trauma hospital. Methods This is a retrospective descriptive case series of 58 Amish pediatric patients with traumatic Orthopaedic injuries treated at a Level 1 children’s hospital. Patients were identified through the institutional trauma data base and using documented Amish/self-pay status in the insurance section of each patient’s chart on the electronic medical record. Information including demographic data, injury presentation and pattern, vaccination status, and follow-up characteristics were collected through chart review. Treatment was categorized as operative or nonoperative and findings were interpreted descriptively. Results Among 58 Amish pediatric trauma patients, 48 (82.8%) required operative management. Most were male (n=43, 74.1%) and 1-5 years old (n= 25, 43.1%). The majority (n=45, 77.6%) initially presented to an outside hospital, with a mean distance of approximately 100 miles to the tertiary referral center. Nearly all patients were unvaccinated (87.9%). Among patients requiring surgery, lower-extremity injuries were most common (n=26, 54.2%), with 11 open fractures (22.9%) and 6 amputations (12.5%). PICU admission occurred in 8 patients (13.8%) and 22 (37.9%) were lost to follow-up. Mean Injury Severity Score was 9.1 across all patients. Conclusions Traumatic Orthopaedic injuries in this Amish pediatric case series were characterized by frequent operative management, initial outside hospital presentation, high morbidity, and substantial loss to follow-up after inpatient discharge. It is critical to address vaccination status and provide tetanus prophylaxis given patients’ low immunization rates and the farm and soil related contamination risks with open fractures. These findings may inform targeted injury prevention initiatives and strategies to improve continuity of care and long-term outcomes. Level of Evidence Level III: Retrospective cohort study Key Concepts 1. Amish pediatric patients are at increased risk for traumatic Orthopaedic injuries, which are commonly related to their agricultural environments, animal interactions, preferred modes of transportation, and farm equipment and machinery. 2. Amish children with traumatic Orthopaedic injuries frequently require transfer from regional hospitals to tertiary referral center, resulting in extended time from injury to definitive care. 3. Most Amish children who presented to a tertiary referral center with traumatic Orthopaedic injuries required operative intervention. 4. Vaccination rates are extremely low among Amish pediatric patients, necessitating frequent tetanus prophylaxis, particularly among those with amputations and open fractures. 5. Loss to follow-up is regularly seen among operative and nonoperative trauma in Amish pediatric patients (total loss to follow-up of 37.9% in our data), which may be a major barrier to comprehensive and longitudinal care.