Sibling Count and Family Employment Status Shape Injury Patterns and Emergency Department Resource Use in Pediatric Trauma

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While social and household determinants are increasingly recognised in the field of paediatric injury epidemiology, their influence on injury patterns and the utilisation of emergency department resources remains insufficiently explored. Objectives This study aimed to evaluate the association between the number of siblings a patient has had, the availability of a patient's caregiver, the employment status of the patient's parents, the injury patterns exhibited by the patient, and the utilisation of resources in emergency departments by paediatric trauma patients. Methods The present prospective, single-centre observational study included children aged 0–15 years who presented at the ED with traumatic injuries. The demographic characteristics, household factors, and trauma-related variables of the subjects were recorded prospectively. The analysis encompassed a range of metrics, including injury patterns, Injury Severity Score (ISS), consultation requirements, imaging utilisation, and Emergency Department (ED) disposition. These metrics were then examined in relation to the number of siblings and the characteristics of the family unit. Results The study incorporated a total of 408 paediatric trauma patients, with a median age of 8 years and a male:female ratio of 62.3:37.7. The overall injury severity was found to be low, with a median ISS of 2. Furthermore, the sibling count was found to be non-associative with trauma severity. However, a higher number of siblings was found to be significantly associated with extremity injuries, including upper extremity fractures and hand/wrist injuries. Furthermore, an increased frequency of higher sibling counts was observed among patients who sustained injuries at school, those originating from households affected by parental unemployment, and those lacking non-family caregiver support. A notable finding was that patients requiring specialist consultation had significantly higher sibling counts compared with those managed without consultation, despite the uniform low injury severity across the cohort. Conclusions In paediatric trauma patients presenting with predominantly low injury severity, sibling count was found to be associated with distinct injury patterns and increased emergency department resource utilisation, particularly consultation demand. The findings of this study suggest that household structure exerts a significant influence on emergency care pathways and operational burden, rather than on the severity of trauma itself. This underscores the crucial need to incorporate social context into the workflow planning and resource allocation processes within emergency departments. Pediatric trauma Sibling count Family structure Emergency department Resource utilization Introduction Pediatric trauma remains a significant contributing factor to emergency department (ED) utilisation and a considerable source of preventable morbidity across healthcare systems. Contemporary trauma registry and epidemiologic analyses continue to demonstrate that unintentional injuries constitute the largest share of paediatric trauma presentations, with low-severity cases forming the majority of ED workloads and orthopedic-relevant injury patterns remaining prominent in children and adolescents ( 1 – 3 ). Despite these well-described clinical trends, there is an increasing recognition that paediatric injury epidemiology is not shaped solely by mechanism and physiology, but also by upstream social and household determinants that affect supervision, exposure environments, and care pathways. Within this theoretical framework, the household structure is identified as a plausible yet under-researched factor influencing injury patterns. The number of siblings in a household has been demonstrated to influence the supervision provided, the intensity of peer-to-peer play, and the propensity for unstructured activities in both domestic and educational environments. The extant literature on social determinants in paediatric injury indicates that socioeconomic and contextual vulnerabilities influence mechanisms and injury types. However, the majority of available evidence is either registry-based or focused on broad outcomes rather than anatomically granular injury distributions and downstream ED resource use ( 4 – 6 ). Concurrently, the prevailing literature on injury prevention continues to underscore that prevalent mechanisms such as falls constitute a considerable proportion of the paediatric injury burden, thereby underscoring the imperative for a comprehensive understanding of the "where and how" children are injured in everyday settings ( 7 , 8 ). From an emergency medicine perspective, these household-level factors may carry operational relevance. Pediatric trauma care involves frequent decisions regarding imaging, consultation pathways, and disposition choices that may vary across systems and are not always explained by injury severity alone ( 9 , 10 ). Recent multicentre validation work continues to support the utilisation of structured decision rules for CT in paediatric blunt trauma cases, while implementation studies and ED-focused reviews highlight ongoing efforts to balance diagnostic sensitivity against overuse and downstream harms. This balance is further underscored by ongoing efforts to optimise imaging decisions in pediatric trauma care, as highlighted in contemporary validation studies and ED–focused reviews addressing diagnostic accuracy and imaging stewardship ( 11 – 13 ). However, the operational implications of these low-acuity presentations remain underappreciated in emergency medicine literature. Despite their predominantly low injury severity, pediatric trauma presentations represent a significant systems-level burden for emergency departments. A substantial proportion of pediatric emergency department visits are classified as low-acuity, yet these encounters still require considerable diagnostic testing, imaging, and specialist consultation, contributing disproportionately to overall emergency department workload and resource utilization ( 22 ). Recent studies have demonstrated that caregiver decision-making, socioeconomic context, and access-related factors play an important role in seeking emergency care for low-acuity pediatric conditions, thereby shaping emergency department utilization patterns independent of clinical severity ( 23 ). In this context, factors influencing emergency department resource utilization are not always aligned with traditional measures of injury severity such as the Injury Severity Score (ISS). Understanding non-clinical determinants that shape consultation demand, imaging utilization, and care pathways is therefore essential for optimizing emergency department workflow, staffing, and resource allocation in pediatric trauma care. Household-level characteristics, including family structure and caregiver availability, may contribute to these operational demands but remain insufficiently examined within emergency medicine-focused research. The objective of this prospective observational study was to evaluate the association of sibling count, caregiver availability, and parental employment status with injury patterns and ED resource utilisation among paediatric trauma patients. The hypothesis was formulated that a higher number of siblings would be associated with distinct injury distributions and increased ED resource use, independent of overall injury severity. Rather than serving as a marker of injury severity, sibling count appears to function as a contextual determinant shaping injury patterns and ED resource demand in otherwise low-severity pediatric trauma. Methods This prospective, single-centre observational study was conducted in the ED of Van Training and Research Hospital, a tertiary-care academic centre with a high-volume paediatric emergency service. The study was conducted over the period from 1 October 2025 to 1 January 2026, during which all eligible paediatric patients presenting with trauma were evaluated in a consecutive manner. The study protocol was reviewed and approved by the local institutional ethics committee. All procedures were performed in accordance with the Declaration of Helsinki and relevant national regulations. The study population comprised children aged 0 to 15 years who presented to the ED due to traumatic injury during the study period. Patients of both genders were eligible for inclusion. Patients were included in the study if informed consent was obtained from a legal guardian and if complete clinical and sociodemographic data were available, including sibling count, parental employment status, and caregiver availability. Patients were excluded from the study if they presented with non-traumatic conditions, if their trauma-related clinical records were incomplete, or if informed consent could not be obtained. Patient enrollment continued until the predefined target sample size of approximately 400 patients was reached, as specified in the study protocol. The sample size was determined by the predefined study period and consecutive patient enrollment rather than an a priori power calculation. Data were collected prospectively at the time of ED evaluation using standardised and structured case report forms. The recorded variables encompassed demographic characteristics (age and sex), family and household factors (number of siblings, caregiver availability defined as the presence of a non-family caregiver, and maternal and paternal employment status), and trauma-related characteristics. Sibling count was defined as the number of children in the household excluding the index patient. Sibling count was analysed as a continuous variable to avoid arbitrary categorisation and to preserve potential dose–response relationships across household size. The trauma variables encompassed the following: the injury mechanism (fall, impact, motor vehicle collision, bicycle injury, or other); the location of the injury occurrence (home, school, or outdoors); the injured anatomical regions; and the Injury Severity Score (ISS). The process and outcome variables included diagnostic imaging modalities such as plain radiography and computed tomography, laboratory testing, specialist consultation, procedural interventions, ED length of stay, hospital admission, and discharge status. All data were entered into an electronic database using a double-entry system, with periodic random audits performed to ensure data accuracy and completeness. The primary objective of the study was to evaluate the association between the number of siblings a patient has had and the utilisation of resources in emergency departments (EDs) by paediatric trauma patients. The utilisation of resources was evaluated through the analysis of imaging usage, consultation requirements, procedural interventions, ED length of stay, hospital admission, and hospital invoice categories. Secondary objectives included the assessment of the relationship between the number of siblings and injury patterns, trauma mechanisms, and injury locations, as well as the exploration of the influence of caregiver availability and parental employment status through subgroup analyses. Continuous variables were summarised as medians with interquartile ranges due to non-normal distributions, while categorical variables were reported as frequencies and percentages. The Mann–Whitney U test was employed to conduct comparisons between two independent groups, while the Kruskal–Wallis test was utilised for comparisons involving more than two groups. The chi-square test was employed for the purpose of comparison of categorical variables, where such a test was deemed appropriate. All statistical analyses were predefined in the study protocol and conducted using standard statistical software. A two-sided p value of less than 0.05 was considered to be statistically significant. The present study was purely observational in nature, and no supplementary diagnostic tests or therapeutic interventions were conducted beyond the standard clinical care. No biological samples were collected during the study. Prior to analysis, all patient data were anonymised and stored in a secure database, with access limited to the study investigators. This ensured the confidentiality and protection of the data throughout the study period. Ethics Approval This study was approved by the Non-Interventional Clinical Research Ethics Committee at Van Training and Research Hospital, University of Health Sciences, Van, Turkey. Written informed consent was obtained from the parents or legal guardians of all participating children prior to enrolment. Results The study comprised a total of 408 paediatric trauma patients. The median age of subjects was 8 years (interquartile range [IQR], 4–11), and 62.3% of patients were male. The median sibling count was 2 (interquartile range, 2–3). The majority of injuries occurred in the home (47.5%) or outdoors (35.0%), with falls representing the predominant injury mechanism (74.0%) (Table 1). The overall severity of injury was found to be minimal across the entire cohort. The median Injury Severity Score (ISS) was 2 (interquartile range [IQR]: 1–4), and 97.8% of patients had an ISS ≤8. When injury severity was examined according to the number of siblings, no significant associations were observed across Injury Severity Score (ISS) values or severity categories (all p > 0.05), indicating that the number of siblings was not related to overall trauma severity (Table 2). In contrast, the sibling count exhibited substantial correlations with the distribution of injuries. Patients with any extremity injury exhibited higher sibling counts in comparison with those not exhibiting extremity involvement (median 3 [interquartile range, 2–4] vs. 2 [interquartile range, 1–3]; p = 0.003). Analogous associations were observed for upper extremity injuries (p = 0.019), hand/wrist injuries (p = 0.016), and upper extremity fractures (p = 0.005). When extremity fractures and dislocations were analysed as a composite outcome, sibling count remained significantly higher among affected patients (p = 0.005) (Table 3). Conversely, head injuries were less frequent among children with higher sibling counts. Patients with head injury exhibited a lower median sibling count in comparison with those without head injury (2 [IQR, 1–3] vs. 3 [IQR, 2–4]; p < 0.001). Among patients with cranial fracture or intracranial haemorrhage, sibling count did not differ significantly from those without severe head injury (p = 0.824). No significant associations were identified between the number of siblings and injuries involving the neck, chest, abdomen, pelvis, lower extremities, or multiple trauma (all p > 0.05). The number of siblings was found to vary according to the context of injury and the characteristics of the family unit. A higher proportion of children sustaining injuries at school were observed in comparison to those injured at home or outdoors (p = 0.032). Furthermore, a higher sibling count was observed in households experiencing paternal unemployment (p = 0.034), in families with overall parental unemployment (p = 0.026), and among children lacking non-family caregiver support (p = 0.008) (Table 3). With regard to the utilisation of ED resources, patients requiring consultation with a specialist exhibited a significantly higher median sibling count compared with those managed without consultation (3 [interquartile range (IQR), 2–4] vs. 2 [IQR, 1–3]; p = 0.007). Diagnostic imaging was frequently employed, with plain radiography being performed in 72.3% of cases and computed tomography in 24.3%. Conversely, laboratory testing and ultrasonography were utilised less frequently. The majority of patients were discharged from the ED, consistent with the overall low injury severity of the cohort. Discussion In this prospective observational study, the sibling count was not associated with the overall trauma severity among paediatric patients presenting to the ED; however, it was associated with distinct injury patterns and differences in ED resource utilisation. This observation is of particular pertinence given that the study population was characterised by uniformly low injury severity, a finding consistent with large epidemiological series demonstrating that the majority of paediatric trauma encounters in emergency care settings are low acuity in nature ( 1 – 3 ). The absence of an association between the number of siblings and the severity of injury is consistent with the extant paediatric trauma literature, which demonstrates that severe outcomes are uncommon in unselected ED trauma populations ( 1 – 3 ). Within this low-severity context, the identification of differences in injury distribution and downstream resource use suggests that household structure may influence exposure environments and care pathways rather than the physiological severity of injury itself. This interpretation is supported by a growing body of evidence highlighting the importance of social and household determinants in shaping paediatric injury risk and healthcare utilisation ( 4 – 6 ). A central finding of this study was the association between a higher number of siblings and an increased frequency of extremity injuries, particularly upper extremity and hand–wrist injuries, including fractures. Extremity injuries constitute a substantial proportion of paediatric presentations to EDs and represent a major driver of imaging utilisation and orthopaedic consultation, even among low-acuity trauma patients ( 9 – 12 ). From a clinical perspective, these injuries frequently necessitate radiographic evaluation and specialist input despite favourable prognoses, thereby contributing disproportionately to the workload of EDs. Conversely, head injuries were observed less frequently among children with higher sibling counts, and sibling count was not associated with markers of severe head injury such as cranial fracture or intracranial haemorrhage. This finding is consistent with contemporary literature on paediatric head trauma, which indicates that the majority of presentations to EDs involve mild injury patterns, and that severe intracranial pathology remains relatively rare ( 13 – 15 ). Taken together, these findings suggest that the number of siblings a person has had may be associated with the manner and location of injuries sustained, rather than with an increased risk of high-severity traumatic outcomes. From an emergency medicine operations perspective, the implications of these findings are noteworthy. Within the context of a homogenous paediatric trauma population characterised by low severity, the presence of siblings has been demonstrated to be associated with an increased frequency of consultation requirements and a distinct pattern of injuries. These factors, in turn, exert an influence on imaging workflows and the necessity for specialist involvement. It has been demonstrated by previous studies that a significant proportion of paediatric trauma-related ED resource utilisation is attributable to low-value or low-acuity care processes, as opposed to the management of severe injury ( 9 , 10 ). In this context, awareness of household-level characteristics such as the number of siblings may support anticipatory operational planning by helping EDs align staffing, consultation pathways, and imaging workflows with predictable patterns of low-acuity trauma presentations, without conflating these demands with injury severity ( 18 , 19 ). Implications for Emergency Department Operations In modern emergency departments, paediatric trauma presentations with low injury severity account for a significant proportion of the total patient volume and operational workload. The present study suggests that household-level characteristics, particularly the number of siblings, may influence emergency department resource utilisation independently of traditional measures of injury severity. Specifically, the observed association between higher sibling counts and increased consultation requirements highlights a potential driver of specialist involvement that is not captured by Injury Severity Score–based triage alone. From an operational perspective, this pattern has important implications for emergency department workflow and resource planning. It is an established fact that cases of low-acuity paediatric trauma frequently necessitate diagnostic imaging and consultation with a specialist, thus contributing to emergency department crowding and increased length of stay, despite favourable clinical outcomes. It is imperative to acknowledge the significance of contextual factors, including but not limited to family structure, in order to facilitate enhanced anticipatory capacity within emergency departments. This, in turn, can optimise staffing models and streamline imaging and referral pathways for paediatric trauma patients. Furthermore, the predominance of extremity injuries among children with higher sibling counts suggests predictable injury patterns that may be utilised for the development of targeted operational strategies. The implementation of standardised care pathways, protocol-driven imaging decisions, and the early involvement of appropriate specialties for common injury patterns have the potential to enhance efficiency without compromising patient safety. The incorporation of household context into emergency procedures is a subject that merits further consideration. The associations observed between the number of siblings, the location of injuries, and family employment characteristics further indicate that the number of siblings may function as a proxy embedded within broader social and caregiving contexts. Higher sibling counts were more frequently observed among children who sustained injuries at school, those from households affected by parental unemployment, and those without non-family caregiver support. These findings are consistent with literature emphasizing the role of social determinants of health in influencing paediatric injury exposure, supervision environments, and ED utilization patterns ( 16 , 17 , 20 , 21 ). From a prevention perspective, the observation that school-based injuries among children from larger households tend to cluster together indicates the potential value of targeted, setting-specific injury prevention strategies that extend beyond the home environment. It is imperative to acknowledge the limitations inherent in the interpretation of these findings. The observational design precludes causal inference, and the study did not directly assess such factors as supervision quality, sibling age distribution, or household behavioural dynamics. Nevertheless, the prospective design, standardised injury severity assessment, and consistency of associations across multiple injury- and resource-related outcomes serve to strengthen the internal validity of the study and support the relevance of its findings to real-world ED practice. In summary, the present study demonstrates that the number of siblings a patient has is associated with meaningful differences in injury patterns and ED resource utilisation among paediatric trauma patients, independent of overall injury severity. The incorporation of household context into the interpretation of paediatric trauma presentations has the potential to enhance injury prevention strategies and inform operational planning in emergency EDs that predominantly manage low-acuity paediatric trauma populations ( 16 – 19 ). Clinical and Public Health Implications It is imperative to comprehend the correlation between the number of siblings and the occurrence of injuries. This knowledge may facilitate the formulation of context-sensitive injury prevention strategies, particularly in school and domestic settings where extremity injuries are prevalent. For EDs serving populations with larger household sizes, awareness of these patterns may aid in anticipating consultation needs and optimising resource utilisation without overestimating injury severity. Strengths and Limitations This study has several strengths, including its prospective design, consecutive patient inclusion, and the structured assessment of household-level factors that are not routinely captured in trauma registries. The use of standardized injury severity scoring and clearly defined outcome measures further enhances the internal validity of the findings. Several limitations should also be acknowledged. First, this was a single-center study, which may limit the generalizability of the results to different healthcare settings or populations. Second, detailed measures of supervision quality, sibling age distribution, and household dynamics were not available and therefore could not be directly analyzed. Finally, as an observational study, causal relationships between family structure and injury patterns cannot be inferred. Conclusions This prospective observational study demonstrates that sibling count is associated with distinct injury patterns and ED resource utilization among pediatric trauma patients, independent of overall injury severity. In a population characterized by predominantly low-acuity trauma, household structure appears to influence how and where injuries occur, as well as consultation and imaging demands. Incorporating household context into the interpretation of pediatric trauma presentations may support targeted injury prevention strategies and anticipatory operational planning in EDs that predominantly manage low-severity pediatric injuries. Declarations Presented at a meeting No Grant No Conflicts of Interest: The authors declare no conflicts of interest related to this study. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution Author contributions: M. Şahin and M. Yorgun conceptualized the study and drafted the initial manuscript. O. Taş and M. Ş. Büyükkaya critically revised the manuscript for important intellectual content. M. Yorgun , as the corresponding author, coordinated the submission process and supervised the final revisions. All authors approved the final manuscript. Data Availability The data supporting the findings of this study are available from the corresponding author upon reasonable request. References Tomas C, Kallies K, Levas M, deRoon-Cassini T, Cassidy L, Flynn-O'Brien K. Mechanisms of paediatric injury: an 11-year review of injury trends from the National Trauma Data Bank. Inj Prev. 2025;31(2):107–13. 10.1136/ip-2024-045440 . Su Z, Zhu Y, He Y, Wang L, Wang X, Chen X, Gui J, Wang W, Liu Y, Lin R, Liu Y. Epidemiological study of trauma in children aged 0 to 14: Analysis based on data from 4450 children in a Level I trauma center in northwestern China. Med (Baltim). 2025;104(30):e43629. 10.1097/MD.0000000000043629 . Jeswani NL, Iram S, Shalash FM, Faraz R, Zeidan H, Al Reesi A. Epidemiology of Pediatric Trauma and its Outcome Presenting to an Emergency Department in a Tertiary Care Hospital in Oman. Oman Med J. 2025;40(2):e736. 10.5001/omj.2025.68 . Goodon H, Gawaziuk JP, Comaskey B, Afifi TO, Château D, Brownell M, Sareen J, Morgan C, Logsetty S, Spiwak R. Social Determinants of Health and Injury Among Children. JAMA Netw Open. 2025;8(6):e2513584. 10.1001/jamanetworkopen.2025.13584 . Avila A, Lao OB, Neville HL, Yorkgitis BK, Chang HL, Thatch K, Plumley D, Larson SD, Fitzwater JW, Markley M, Pedroso F, Fischer A, Armstrong LB, Petroze RT, Snyder CW. Social determinants of health in pediatric trauma: Associations with injury mechanisms and outcomes in the context of the COVID-19 pandemic. Am J Surg. 2024;228:107–12. 10.1016/j.amjsurg.2023.08.019 . Gnanvi JE, Yanchar N, Freire G, Beaulieu E, Tardif PA, Bérubé M, Macpherson A, Pike I, Zemek R, Gagnon IJ, Carsen S, Gabbe B, Gnanou S, Duval C, Moore L. Social determinants of health and disparities in pediatric trauma care: protocol for a systematic review and meta-analysis. Syst Rev. 2024;13(1):94. 10.1186/s13643-024-02510-7 . Vatansever G, Şimşekli E, Sivaslı İ, Özge AE, Aksu AH, Barutçu A, Özdemir İ, Karbancıoğlu EY, Göllü G, Ateş U, Ulukol B, Kendirli T, Tekin D. Home Is Not Always Safe: Pediatric Unintentional Home Injuries in a Tertiary Emergency Department Setting. J Clin Med. 2025;14(20):7444. 10.3390/jcm14207444 . Richmond SA, Mahboob M, Medeiros A, Pike I, Macpherson AK. Rates of serious injury from falls in children and adolescents: 10-year retrospective review of data from Ontario, Canada. Inj Prev. 2025 Oct;23:ip–2024. 10.1136/ip-2024-045422 . Snyder CW, Kristiansen KO, Jensen AR, Sribnick EA, Anders JF, Chen CX, Lerner EB, Conti ME. Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society. J Trauma Acute Care Surg. 2024;96(5):799–804. 10.1097/TA.0000000000004181 . Deshommes T, Freire G, Yanchar N, Zemek R, Beaudin M, Stang A, Weiss MJ, Carsen S, Gagnon IJ, Gabbe BJ, Bérubé M, Stelfox HT, Beno S, Labrosse M, Beaulieu E, Berthelot S, Klassen T, Turgeon AF, Lauzier F, Neveu X, Belcaid A, Ben Abdeljelil A, Tardif PA, Giroux M, Moore L. Low-Value Clinical Practices in Pediatric Trauma Care. JAMA Netw Open. 2024;7(10):e2440983. 10.1001/jamanetworkopen.2024.40983 . Abbott A, Swertfager K, Bloom S, Jackson NJ, Goldman J. Pediatric Fracture Epidemiology in an Orthopaedic Urgent Care Setting. J Pediatr Soc North Am. 2025;12:100216. 10.1016/j.jposna.2025.100216 . Hoveidaei AH, Mosalamiaghili S, Hosseini-Asl SH, Taghavi SP, Salmannezhad A, Adolf J, Tabaie S. Global burden of pediatric orthopaedic fractures: an epidemiological analysis from 1990 to 2021. Arch Orthop Trauma Surg. 2025;146(1):20. 10.1007/s00402-025-06141-y . Lyons TW, Mannix R, Monuteaux MC, Schutzman SA. Emergency Department Evaluation of Young Infants With Head Injury. Pediatrics. 2024;153(6):e2023065037. 10.1542/peds.2023-065037 . Holmes JF, Yen K, Ugalde IT, Ishimine P, Chaudhari PP, Atigapramoj N, Badawy M, McCarten-Gibbs KA, Nielsen D, Sage AC, Tatro G, Upperman JS, Adelson PD, Tancredi DJ, Kuppermann N. PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. Lancet Child Adolesc Health. 2024;8(5):339–47. 10.1016/S2352-4642(24)00029-4 . Alsuwais S, Kennedy C, Bressan S, Lyttle M, Body R. An update on paediatric traumatic brain injury in the emergency department: a narrative review. Eur J Pediatr. 2025;184(8):523. 10.1007/s00431-025-06345-9 . Amjad S, Tromburg C, Adesunkanmi M, Mawa J, Mahbub N, Campbell S, Chari R, Rowe BH, Ospina MB. Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies. Ann Emerg Med. 2024;83(4):291–313. 10.1016/j.annemergmed.2023.10.010 . Gaffney LK, Michelson KA, Monuteaux MC, Porter J, Hudgins J. Individual Social Determinants of Health and Location of Pediatric Low-Resource-Intensity Care. J Pediatr. 2025;289:114884. 10.1016/j.jpeds.2025.114884 . Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ, AMERICAN ACADEMY OF PEDIATRICS Committee on Pediatric Emergency Medicine, Section on Radiology; AMERICAN COLLEGE OF RADIOLOGY; AMERICAN COLLEGE OF EMERGENCY PHYSICIANS Pediatric Emergency Medicine Committee. Policy Statement Pediatr. 2024;154(1):e2024066854. 10.1542/peds.2024-066854 . Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department. Appelhaus S, Schönberg SO, Weis M. CT in pediatric trauma patients. Rofo. 2025;197(3):257–65. 10.1055/a-2341-7559 . English, German. Liu Y, Sharma P, Becker DJ, Brisendine A, McDougal J, Morrisey MA, Blackburn J, Menachemi N, Sanders T, Sen B. Social determinants of health and emergency department utilization in Alabama Children's Health Insurance Program. Am J Manag Care. 2023;29(3):159–64. 10.37765/ajmc.2023.89330 . Rigdon J, Montez K, Palakshappa D, Brown C, Downs SM, Albertini LW, Taxter AJ. Social Risk Factors Influence Pediatric Emergency Department Utilization and Hospitalizations. J Pediatr. 2022;249:35–e424. 10.1016/j.jpeds.2022.06.004 . Li J, Ramgopal S, Marin JR. Resource Utilization During Low-Acuity Pediatric Emergency Department Visits. Pediatr Emerg Care. 2022;38(2):e983–7. 10.1097/PEC.0000000000002508 . Jaboyedoff M, Starvaggi C, Suris JC, Kuehni CE, Gehri M, Keitel K. Drivers for low-acuity pediatric emergency department visits in two tertiary hospitals in Switzerland: a cross-sectional, questionnaire-based study. BMC Health Serv Res. 2024;24(1):103. 10.1186/s12913-023-10348-3 . Tables Table 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Baseline characteristics of the study population (n = 408) Baseline demographic, family-related, and trauma-related characteristics of pediatric patients included in the study. Continuous variables are presented as median with interquartile range (25th–75th percentiles), and categorical variables are presented as number (%). Injury severity was assessed using the Injury Severity Score (ISS). Caregiver status refers to the presence of a non-family caregiver. Table2.docx Distribution of trauma-related diagnoses Distribution of trauma-related diagnoses among pediatric patients presenting to the emergency department. Diagnoses are reported as number and percentage of the total study population (n = 408). Table3.docx Association between sibling count and trauma-related variables Association between sibling count and demographic characteristics, injury patterns, family and caregiving factors, and emergency department outcomes. Sibling count is presented as median with interquartile range. Group comparisons were performed using the Mann–Whitney U test for two-group analyses and the Kruskal–Wallis test for comparisons involving more than two groups. Caregiver was defined as a non-family caregiver. Cite Share Download PDF Status: Published Journal Publication published 20 Apr, 2026 Read the published version in BMC Emergency Medicine → Version 1 posted Editorial decision: Revision requested 03 Mar, 2026 Reviews received at journal 06 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers invited by journal 04 Feb, 2026 Editor assigned by journal 04 Feb, 2026 Editor invited by journal 03 Feb, 2026 Submission checks completed at journal 02 Feb, 2026 First submitted to journal 02 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8724060","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":586501361,"identity":"7646f1b1-c174-4f75-b2ec-621339f8c0de","order_by":0,"name":"Mahmut Şahin","email":"","orcid":"","institution":"Van Training and Research Hospital, University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mahmut","middleName":"","lastName":"Şahin","suffix":""},{"id":586501362,"identity":"afb1cb62-f0e3-4aae-b7c5-2b23f3e617ff","order_by":1,"name":"Osman Taş","email":"","orcid":"","institution":"Van Training and Research Hospital, University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Osman","middleName":"","lastName":"Taş","suffix":""},{"id":586501363,"identity":"ee48dbb6-73aa-4630-bf11-47744205584a","order_by":2,"name":"Mehmet Şirin Büyükkaya","email":"","orcid":"","institution":"Van Training and Research Hospital, University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Şirin","lastName":"Büyükkaya","suffix":""},{"id":586501364,"identity":"5face3de-b0ce-4d88-b806-6bc9e2b3d4ca","order_by":3,"name":"Mehmet Yorgun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDCCA1Cajb35wIEPYAaxWvh4jiUenAHSwkysFjmJHOPDPCAWIS18t88YPq74dTiPTSLH4LDNr23yfMwMjB8+5uDWInkux9jwbN/hYjaeZwWHc/tuG7YxMzBLztyGW4vBGR4zycaew4lt7MkbDuf23GYEamFj5iVKC0OCwWHLntv2xGlp+AHUwpFicJjhx+1Eglokz7AVGzY2pCe28RxLONjbcDu5jZmxGa9f+M4wb3zY8Mc6cX578+EPP/7ctgUyDn74iEcLAwOHAQNjG5QNYTA24FMPBOwPGBj+wDh/cCobBaNgFIyCEQwAHydZixrYB2cAAAAASUVORK5CYII=","orcid":"","institution":"Van Training and Research Hospital, University of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mehmet","middleName":"","lastName":"Yorgun","suffix":""}],"badges":[],"createdAt":"2026-01-28 17:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8724060/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8724060/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12873-026-01589-6","type":"published","date":"2026-04-20T16:00:04+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":107929386,"identity":"bcd02fa5-b831-4324-97b0-6528de377be8","added_by":"auto","created_at":"2026-04-27 16:15:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":184264,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8724060/v1/55e568a0-6866-411c-b933-595dcaff1fe8.pdf"},{"id":102074972,"identity":"f9547d98-66f9-41b1-babf-aabdbb402ecb","added_by":"auto","created_at":"2026-02-06 21:31:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30158,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics of the study population (n = 408)\u003c/strong\u003e\u003cbr\u003e\n \u0026nbsp;Baseline demographic, family-related, and trauma-related characteristics of pediatric patients included in the study. Continuous variables are presented as median with interquartile range (25th–75th percentiles), and categorical variables are presented as number (%). Injury severity was assessed using the Injury Severity Score (ISS). Caregiver status refers to the presence of a non-family caregiver.\u003c/p\u003e","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8724060/v1/996f04e043089533c5e19b36.docx"},{"id":102074973,"identity":"e1d4ee9c-2f0b-401a-be70-3fd6f2871475","added_by":"auto","created_at":"2026-02-06 21:31:46","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":15858,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of trauma-related diagnoses\u003c/strong\u003e\u003cbr\u003e\n \u0026nbsp;Distribution of trauma-related diagnoses among pediatric patients presenting to the emergency department. Diagnoses are reported as number and percentage of the total study population (n = 408).\u003c/p\u003e","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8724060/v1/59a96d73658915819f9b6595.docx"},{"id":102074974,"identity":"bc7c01fb-3f0a-41c5-b99f-15dbfa8e0c2b","added_by":"auto","created_at":"2026-02-06 21:31:47","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":20412,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssociation between sibling count and trauma-related variables\u003c/strong\u003e\u003cbr\u003e\n \u0026nbsp;Association between sibling count and demographic characteristics, injury patterns, family and caregiving factors, and emergency department outcomes. Sibling count is presented as median with interquartile range. Group comparisons were performed using the Mann–Whitney U test for two-group analyses and the Kruskal–Wallis test for comparisons involving more than two groups. Caregiver was defined as a non-family caregiver.\u003c/p\u003e","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8724060/v1/b43bd62690baeb310d24755a.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sibling Count and Family Employment Status Shape Injury Patterns and Emergency Department Resource Use in Pediatric Trauma","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePediatric trauma remains a significant contributing factor to emergency department (ED) utilisation and a considerable source of preventable morbidity across healthcare systems. Contemporary trauma registry and epidemiologic analyses continue to demonstrate that unintentional injuries constitute the largest share of paediatric trauma presentations, with low-severity cases forming the majority of ED workloads and orthopedic-relevant injury patterns remaining prominent in children and adolescents (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Despite these well-described clinical trends, there is an increasing recognition that paediatric injury epidemiology is not shaped solely by mechanism and physiology, but also by upstream social and household determinants that affect supervision, exposure environments, and care pathways.\u003c/p\u003e \u003cp\u003eWithin this theoretical framework, the household structure is identified as a plausible yet under-researched factor influencing injury patterns. The number of siblings in a household has been demonstrated to influence the supervision provided, the intensity of peer-to-peer play, and the propensity for unstructured activities in both domestic and educational environments. The extant literature on social determinants in paediatric injury indicates that socioeconomic and contextual vulnerabilities influence mechanisms and injury types. However, the majority of available evidence is either registry-based or focused on broad outcomes rather than anatomically granular injury distributions and downstream ED resource use (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Concurrently, the prevailing literature on injury prevention continues to underscore that prevalent mechanisms such as falls constitute a considerable proportion of the paediatric injury burden, thereby underscoring the imperative for a comprehensive understanding of the \"where and how\" children are injured in everyday settings (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom an emergency medicine perspective, these household-level factors may carry operational relevance. Pediatric trauma care involves frequent decisions regarding imaging, consultation pathways, and disposition choices that may vary across systems and are not always explained by injury severity alone (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Recent multicentre validation work continues to support the utilisation of structured decision rules for CT in paediatric blunt trauma cases, while implementation studies and ED-focused reviews highlight ongoing efforts to balance diagnostic sensitivity against overuse and downstream harms. This balance is further underscored by ongoing efforts to optimise imaging decisions in pediatric trauma care, as highlighted in contemporary validation studies and ED\u0026ndash;focused reviews addressing diagnostic accuracy and imaging stewardship (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, the operational implications of these low-acuity presentations remain underappreciated in emergency medicine literature.\u003c/p\u003e \u003cp\u003eDespite their predominantly low injury severity, pediatric trauma presentations represent a significant systems-level burden for emergency departments. A substantial proportion of pediatric emergency department visits are classified as low-acuity, yet these encounters still require considerable diagnostic testing, imaging, and specialist consultation, contributing disproportionately to overall emergency department workload and resource utilization (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRecent studies have demonstrated that caregiver decision-making, socioeconomic context, and access-related factors play an important role in seeking emergency care for low-acuity pediatric conditions, thereby shaping emergency department utilization patterns independent of clinical severity (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this context, factors influencing emergency department resource utilization are not always aligned with traditional measures of injury severity such as the Injury Severity Score (ISS). Understanding non-clinical determinants that shape consultation demand, imaging utilization, and care pathways is therefore essential for optimizing emergency department workflow, staffing, and resource allocation in pediatric trauma care. Household-level characteristics, including family structure and caregiver availability, may contribute to these operational demands but remain insufficiently examined within emergency medicine-focused research.\u003c/p\u003e \u003cp\u003eThe objective of this prospective observational study was to evaluate the association of sibling count, caregiver availability, and parental employment status with injury patterns and ED resource utilisation among paediatric trauma patients. The hypothesis was formulated that a higher number of siblings would be associated with distinct injury distributions and increased ED resource use, independent of overall injury severity.\u003c/p\u003e \u003cp\u003eRather than serving as a marker of injury severity, sibling count appears to function as a contextual determinant shaping injury patterns and ED resource demand in otherwise low-severity pediatric trauma.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis prospective, single-centre observational study was conducted in the ED of Van Training and Research Hospital, a tertiary-care academic centre with a high-volume paediatric emergency service. The study was conducted over the period from 1 October 2025 to 1 January 2026, during which all eligible paediatric patients presenting with trauma were evaluated in a consecutive manner. The study protocol was reviewed and approved by the local institutional ethics committee. All procedures were performed in accordance with the Declaration of Helsinki and relevant national regulations.\u003c/p\u003e \u003cp\u003eThe study population comprised children aged 0 to 15 years who presented to the ED due to traumatic injury during the study period. Patients of both genders were eligible for inclusion. Patients were included in the study if informed consent was obtained from a legal guardian and if complete clinical and sociodemographic data were available, including sibling count, parental employment status, and caregiver availability. Patients were excluded from the study if they presented with non-traumatic conditions, if their trauma-related clinical records were incomplete, or if informed consent could not be obtained. Patient enrollment continued until the predefined target sample size of approximately 400 patients was reached, as specified in the study protocol. The sample size was determined by the predefined study period and consecutive patient enrollment rather than an a priori power calculation.\u003c/p\u003e \u003cp\u003eData were collected prospectively at the time of ED evaluation using standardised and structured case report forms. The recorded variables encompassed demographic characteristics (age and sex), family and household factors (number of siblings, caregiver availability defined as the presence of a non-family caregiver, and maternal and paternal employment status), and trauma-related characteristics. Sibling count was defined as the number of children in the household excluding the index patient. Sibling count was analysed as a continuous variable to avoid arbitrary categorisation and to preserve potential dose\u0026ndash;response relationships across household size. The trauma variables encompassed the following: the injury mechanism (fall, impact, motor vehicle collision, bicycle injury, or other); the location of the injury occurrence (home, school, or outdoors); the injured anatomical regions; and the Injury Severity Score (ISS). The process and outcome variables included diagnostic imaging modalities such as plain radiography and computed tomography, laboratory testing, specialist consultation, procedural interventions, ED length of stay, hospital admission, and discharge status. All data were entered into an electronic database using a double-entry system, with periodic random audits performed to ensure data accuracy and completeness.\u003c/p\u003e \u003cp\u003eThe primary objective of the study was to evaluate the association between the number of siblings a patient has had and the utilisation of resources in emergency departments (EDs) by paediatric trauma patients. The utilisation of resources was evaluated through the analysis of imaging usage, consultation requirements, procedural interventions, ED length of stay, hospital admission, and hospital invoice categories. Secondary objectives included the assessment of the relationship between the number of siblings and injury patterns, trauma mechanisms, and injury locations, as well as the exploration of the influence of caregiver availability and parental employment status through subgroup analyses.\u003c/p\u003e \u003cp\u003eContinuous variables were summarised as medians with interquartile ranges due to non-normal distributions, while categorical variables were reported as frequencies and percentages. The Mann\u0026ndash;Whitney U test was employed to conduct comparisons between two independent groups, while the Kruskal\u0026ndash;Wallis test was utilised for comparisons involving more than two groups. The chi-square test was employed for the purpose of comparison of categorical variables, where such a test was deemed appropriate. All statistical analyses were predefined in the study protocol and conducted using standard statistical software. A two-sided p value of less than 0.05 was considered to be statistically significant.\u003c/p\u003e \u003cp\u003eThe present study was purely observational in nature, and no supplementary diagnostic tests or therapeutic interventions were conducted beyond the standard clinical care. No biological samples were collected during the study. Prior to analysis, all patient data were anonymised and stored in a secure database, with access limited to the study investigators. This ensured the confidentiality and protection of the data throughout the study period.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthics Approval\u003c/h2\u003e \u003cp\u003e This study was approved by the Non-Interventional Clinical Research Ethics Committee at Van Training and Research Hospital, University of Health Sciences, Van, Turkey. Written informed consent was obtained from the parents or legal guardians of all participating children prior to enrolment.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study comprised a total of 408 paediatric trauma patients. The median age of subjects was 8 years (interquartile range [IQR], 4\u0026ndash;11), and 62.3% of patients were male. The median sibling count was 2 (interquartile range, 2\u0026ndash;3). The majority of injuries occurred in the home (47.5%) or outdoors (35.0%), with falls representing the predominant injury mechanism (74.0%) (Table 1).\u003c/p\u003e\n\u003cp\u003eThe overall severity of injury was found to be minimal across the entire cohort. The median Injury Severity Score (ISS) was 2 (interquartile range [IQR]: 1\u0026ndash;4), and 97.8% of patients had an ISS \u0026le;8. When injury severity was examined according to the number of siblings, no significant associations were observed across Injury Severity Score (ISS) values or severity categories (all p \u0026gt; 0.05), indicating that the number of siblings was not related to overall trauma severity (Table 2).\u003c/p\u003e\n\u003cp\u003eIn contrast, the sibling count exhibited substantial correlations with the distribution of injuries. Patients with any extremity injury exhibited higher sibling counts in comparison with those not exhibiting extremity involvement (median 3 [interquartile range, 2\u0026ndash;4] vs. 2 [interquartile range, 1\u0026ndash;3]; p = 0.003). Analogous associations were observed for upper extremity injuries (p = 0.019), hand/wrist injuries (p = 0.016), and upper extremity fractures (p = 0.005). When extremity fractures and dislocations were analysed as a composite outcome, sibling count remained significantly higher among affected patients (p = 0.005) (Table 3).\u003c/p\u003e\n\u003cp\u003eConversely, head injuries were less frequent among children with higher sibling counts. Patients with head injury exhibited a lower median sibling count in comparison with those without head injury (2 [IQR, 1\u0026ndash;3] vs. 3 [IQR, 2\u0026ndash;4]; p \u0026lt; 0.001). Among patients with cranial fracture or intracranial haemorrhage, sibling count did not differ significantly from those without severe head injury (p = 0.824). No significant associations were identified between the number of siblings and injuries involving the neck, chest, abdomen, pelvis, lower extremities, or multiple trauma (all p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eThe number of siblings was found to vary according to the context of injury and the characteristics of the family unit. A higher proportion of children sustaining injuries at school were observed in comparison to those injured at home or outdoors (p = 0.032). Furthermore, a higher sibling count was observed in households experiencing paternal unemployment (p = 0.034), in families with overall parental unemployment (p = 0.026), and among children lacking non-family caregiver support (p = 0.008) (Table 3).\u003c/p\u003e\n\u003cp\u003eWith regard to the utilisation of ED resources, patients requiring consultation with a specialist exhibited a significantly higher median sibling count compared with those managed without consultation (3 [interquartile range (IQR), 2\u0026ndash;4] vs. 2 [IQR, 1\u0026ndash;3]; p = 0.007). Diagnostic imaging was frequently employed, with plain radiography being performed in 72.3% of cases and computed tomography in 24.3%. Conversely, laboratory testing and ultrasonography were utilised less frequently. The majority of patients were discharged from the ED, consistent with the overall low injury severity of the cohort.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this prospective observational study, the sibling count was not associated with the overall trauma severity among paediatric patients presenting to the ED; however, it was associated with distinct injury patterns and differences in ED resource utilisation. This observation is of particular pertinence given that the study population was characterised by uniformly low injury severity, a finding consistent with large epidemiological series demonstrating that the majority of paediatric trauma encounters in emergency care settings are low acuity in nature (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe absence of an association between the number of siblings and the severity of injury is consistent with the extant paediatric trauma literature, which demonstrates that severe outcomes are uncommon in unselected ED trauma populations (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Within this low-severity context, the identification of differences in injury distribution and downstream resource use suggests that household structure may influence exposure environments and care pathways rather than the physiological severity of injury itself. This interpretation is supported by a growing body of evidence highlighting the importance of social and household determinants in shaping paediatric injury risk and healthcare utilisation (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA central finding of this study was the association between a higher number of siblings and an increased frequency of extremity injuries, particularly upper extremity and hand\u0026ndash;wrist injuries, including fractures. Extremity injuries constitute a substantial proportion of paediatric presentations to EDs and represent a major driver of imaging utilisation and orthopaedic consultation, even among low-acuity trauma patients (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). From a clinical perspective, these injuries frequently necessitate radiographic evaluation and specialist input despite favourable prognoses, thereby contributing disproportionately to the workload of EDs.\u003c/p\u003e \u003cp\u003eConversely, head injuries were observed less frequently among children with higher sibling counts, and sibling count was not associated with markers of severe head injury such as cranial fracture or intracranial haemorrhage. This finding is consistent with contemporary literature on paediatric head trauma, which indicates that the majority of presentations to EDs involve mild injury patterns, and that severe intracranial pathology remains relatively rare (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Taken together, these findings suggest that the number of siblings a person has had may be associated with the manner and location of injuries sustained, rather than with an increased risk of high-severity traumatic outcomes.\u003c/p\u003e \u003cp\u003eFrom an emergency medicine operations perspective, the implications of these findings are noteworthy. Within the context of a homogenous paediatric trauma population characterised by low severity, the presence of siblings has been demonstrated to be associated with an increased frequency of consultation requirements and a distinct pattern of injuries. These factors, in turn, exert an influence on imaging workflows and the necessity for specialist involvement. It has been demonstrated by previous studies that a significant proportion of paediatric trauma-related ED resource utilisation is attributable to low-value or low-acuity care processes, as opposed to the management of severe injury (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In this context, awareness of household-level characteristics such as the number of siblings may support anticipatory operational planning by helping EDs align staffing, consultation pathways, and imaging workflows with predictable patterns of low-acuity trauma presentations, without conflating these demands with injury severity (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eImplications for Emergency Department Operations\u003c/h3\u003e\n\u003cp\u003eIn modern emergency departments, paediatric trauma presentations with low injury severity account for a significant proportion of the total patient volume and operational workload. The present study suggests that household-level characteristics, particularly the number of siblings, may influence emergency department resource utilisation independently of traditional measures of injury severity. Specifically, the observed association between higher sibling counts and increased consultation requirements highlights a potential driver of specialist involvement that is not captured by Injury Severity Score\u0026ndash;based triage alone.\u003c/p\u003e \u003cp\u003eFrom an operational perspective, this pattern has important implications for emergency department workflow and resource planning. It is an established fact that cases of low-acuity paediatric trauma frequently necessitate diagnostic imaging and consultation with a specialist, thus contributing to emergency department crowding and increased length of stay, despite favourable clinical outcomes. It is imperative to acknowledge the significance of contextual factors, including but not limited to family structure, in order to facilitate enhanced anticipatory capacity within emergency departments. This, in turn, can optimise staffing models and streamline imaging and referral pathways for paediatric trauma patients.\u003c/p\u003e \u003cp\u003eFurthermore, the predominance of extremity injuries among children with higher sibling counts suggests predictable injury patterns that may be utilised for the development of targeted operational strategies. The implementation of standardised care pathways, protocol-driven imaging decisions, and the early involvement of appropriate specialties for common injury patterns have the potential to enhance efficiency without compromising patient safety. The incorporation of household context into emergency procedures is a subject that merits further consideration.\u003c/p\u003e \u003cp\u003eThe associations observed between the number of siblings, the location of injuries, and family employment characteristics further indicate that the number of siblings may function as a proxy embedded within broader social and caregiving contexts. Higher sibling counts were more frequently observed among children who sustained injuries at school, those from households affected by parental unemployment, and those without non-family caregiver support. These findings are consistent with literature emphasizing the role of social determinants of health in influencing paediatric injury exposure, supervision environments, and ED utilization patterns (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). From a prevention perspective, the observation that school-based injuries among children from larger households tend to cluster together indicates the potential value of targeted, setting-specific injury prevention strategies that extend beyond the home environment.\u003c/p\u003e \u003cp\u003eIt is imperative to acknowledge the limitations inherent in the interpretation of these findings. The observational design precludes causal inference, and the study did not directly assess such factors as supervision quality, sibling age distribution, or household behavioural dynamics. Nevertheless, the prospective design, standardised injury severity assessment, and consistency of associations across multiple injury- and resource-related outcomes serve to strengthen the internal validity of the study and support the relevance of its findings to real-world ED practice.\u003c/p\u003e \u003cp\u003eIn summary, the present study demonstrates that the number of siblings a patient has is associated with meaningful differences in injury patterns and ED resource utilisation among paediatric trauma patients, independent of overall injury severity. The incorporation of household context into the interpretation of paediatric trauma presentations has the potential to enhance injury prevention strategies and inform operational planning in emergency EDs that predominantly manage low-acuity paediatric trauma populations (\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eClinical and Public Health Implications\u003c/h3\u003e\n\u003cp\u003eIt is imperative to comprehend the correlation between the number of siblings and the occurrence of injuries. This knowledge may facilitate the formulation of context-sensitive injury prevention strategies, particularly in school and domestic settings where extremity injuries are prevalent. For EDs serving populations with larger household sizes, awareness of these patterns may aid in anticipating consultation needs and optimising resource utilisation without overestimating injury severity.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study has several strengths, including its prospective design, consecutive patient inclusion, and the structured assessment of household-level factors that are not routinely captured in trauma registries. The use of standardized injury severity scoring and clearly defined outcome measures further enhances the internal validity of the findings.\u003c/p\u003e \u003cp\u003eSeveral limitations should also be acknowledged. First, this was a single-center study, which may limit the generalizability of the results to different healthcare settings or populations. Second, detailed measures of supervision quality, sibling age distribution, and household dynamics were not available and therefore could not be directly analyzed. Finally, as an observational study, causal relationships between family structure and injury patterns cannot be inferred.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis prospective observational study demonstrates that sibling count is associated with distinct injury patterns and ED resource utilization among pediatric trauma patients, independent of overall injury severity. In a population characterized by predominantly low-acuity trauma, household structure appears to influence how and where injuries occur, as well as consultation and imaging demands. Incorporating household context into the interpretation of pediatric trauma presentations may support targeted injury prevention strategies and anticipatory operational planning in EDs that predominantly manage low-severity pediatric injuries.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003ePresented at a meeting\u003c/h2\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGrant\u003c/strong\u003e \u003cp\u003eNo\u003c/p\u003e \u003ch2\u003eConflicts of Interest:\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest related to this study.\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e \u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor contributions: M. Şahin and M. Yorgun conceptualized the study and drafted the initial manuscript. O. Taş and M. Ş. B\u0026uuml;y\u0026uuml;kkaya critically revised the manuscript for important intellectual content. M. Yorgun , as the corresponding author, coordinated the submission process and supervised the final revisions. All authors approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTomas C, Kallies K, Levas M, deRoon-Cassini T, Cassidy L, Flynn-O'Brien K. Mechanisms of paediatric injury: an 11-year review of injury trends from the National Trauma Data Bank. Inj Prev. 2025;31(2):107\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/ip-2024-045440\u003c/span\u003e\u003cspan address=\"10.1136/ip-2024-045440\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSu Z, Zhu Y, He Y, Wang L, Wang X, Chen X, Gui J, Wang W, Liu Y, Lin R, Liu Y. Epidemiological study of trauma in children aged 0 to 14: Analysis based on data from 4450 children in a Level I trauma center in northwestern China. Med (Baltim). 2025;104(30):e43629. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MD.0000000000043629\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000043629\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeswani NL, Iram S, Shalash FM, Faraz R, Zeidan H, Al Reesi A. Epidemiology of Pediatric Trauma and its Outcome Presenting to an Emergency Department in a Tertiary Care Hospital in Oman. Oman Med J. 2025;40(2):e736. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5001/omj.2025.68\u003c/span\u003e\u003cspan address=\"10.5001/omj.2025.68\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoodon H, Gawaziuk JP, Comaskey B, Afifi TO, Ch\u0026acirc;teau D, Brownell M, Sareen J, Morgan C, Logsetty S, Spiwak R. Social Determinants of Health and Injury Among Children. JAMA Netw Open. 2025;8(6):e2513584. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamanetworkopen.2025.13584\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2025.13584\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAvila A, Lao OB, Neville HL, Yorkgitis BK, Chang HL, Thatch K, Plumley D, Larson SD, Fitzwater JW, Markley M, Pedroso F, Fischer A, Armstrong LB, Petroze RT, Snyder CW. Social determinants of health in pediatric trauma: Associations with injury mechanisms and outcomes in the context of the COVID-19 pandemic. Am J Surg. 2024;228:107\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amjsurg.2023.08.019\u003c/span\u003e\u003cspan address=\"10.1016/j.amjsurg.2023.08.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGnanvi JE, Yanchar N, Freire G, Beaulieu E, Tardif PA, B\u0026eacute;rub\u0026eacute; M, Macpherson A, Pike I, Zemek R, Gagnon IJ, Carsen S, Gabbe B, Gnanou S, Duval C, Moore L. Social determinants of health and disparities in pediatric trauma care: protocol for a systematic review and meta-analysis. Syst Rev. 2024;13(1):94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13643-024-02510-7\u003c/span\u003e\u003cspan address=\"10.1186/s13643-024-02510-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVatansever G, Şimşekli E, Sivaslı İ, \u0026Ouml;zge AE, Aksu AH, Barut\u0026ccedil;u A, \u0026Ouml;zdemir İ, Karbancıoğlu EY, G\u0026ouml;ll\u0026uuml; G, Ateş U, Ulukol B, Kendirli T, Tekin D. Home Is Not Always Safe: Pediatric Unintentional Home Injuries in a Tertiary Emergency Department Setting. J Clin Med. 2025;14(20):7444. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm14207444\u003c/span\u003e\u003cspan address=\"10.3390/jcm14207444\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichmond SA, Mahboob M, Medeiros A, Pike I, Macpherson AK. Rates of serious injury from falls in children and adolescents: 10-year retrospective review of data from Ontario, Canada. Inj Prev. 2025 Oct;23:ip\u0026ndash;2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/ip-2024-045422\u003c/span\u003e\u003cspan address=\"10.1136/ip-2024-045422\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSnyder CW, Kristiansen KO, Jensen AR, Sribnick EA, Anders JF, Chen CX, Lerner EB, Conti ME. Defining pediatric trauma center resource utilization: Multidisciplinary consensus-based criteria from the Pediatric Trauma Society. J Trauma Acute Care Surg. 2024;96(5):799\u0026ndash;804. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/TA.0000000000004181\u003c/span\u003e\u003cspan address=\"10.1097/TA.0000000000004181\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeshommes T, Freire G, Yanchar N, Zemek R, Beaudin M, Stang A, Weiss MJ, Carsen S, Gagnon IJ, Gabbe BJ, B\u0026eacute;rub\u0026eacute; M, Stelfox HT, Beno S, Labrosse M, Beaulieu E, Berthelot S, Klassen T, Turgeon AF, Lauzier F, Neveu X, Belcaid A, Ben Abdeljelil A, Tardif PA, Giroux M, Moore L. Low-Value Clinical Practices in Pediatric Trauma Care. JAMA Netw Open. 2024;7(10):e2440983. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamanetworkopen.2024.40983\u003c/span\u003e\u003cspan address=\"10.1001/jamanetworkopen.2024.40983\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbbott A, Swertfager K, Bloom S, Jackson NJ, Goldman J. Pediatric Fracture Epidemiology in an Orthopaedic Urgent Care Setting. J Pediatr Soc North Am. 2025;12:100216. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jposna.2025.100216\u003c/span\u003e\u003cspan address=\"10.1016/j.jposna.2025.100216\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoveidaei AH, Mosalamiaghili S, Hosseini-Asl SH, Taghavi SP, Salmannezhad A, Adolf J, Tabaie S. Global burden of pediatric orthopaedic fractures: an epidemiological analysis from 1990 to 2021. Arch Orthop Trauma Surg. 2025;146(1):20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00402-025-06141-y\u003c/span\u003e\u003cspan address=\"10.1007/s00402-025-06141-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyons TW, Mannix R, Monuteaux MC, Schutzman SA. Emergency Department Evaluation of Young Infants With Head Injury. Pediatrics. 2024;153(6):e2023065037. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2023-065037\u003c/span\u003e\u003cspan address=\"10.1542/peds.2023-065037\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolmes JF, Yen K, Ugalde IT, Ishimine P, Chaudhari PP, Atigapramoj N, Badawy M, McCarten-Gibbs KA, Nielsen D, Sage AC, Tatro G, Upperman JS, Adelson PD, Tancredi DJ, Kuppermann N. PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. Lancet Child Adolesc Health. 2024;8(5):339\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2352-4642(24)00029-4\u003c/span\u003e\u003cspan address=\"10.1016/S2352-4642(24)00029-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlsuwais S, Kennedy C, Bressan S, Lyttle M, Body R. An update on paediatric traumatic brain injury in the emergency department: a narrative review. Eur J Pediatr. 2025;184(8):523. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00431-025-06345-9\u003c/span\u003e\u003cspan address=\"10.1007/s00431-025-06345-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmjad S, Tromburg C, Adesunkanmi M, Mawa J, Mahbub N, Campbell S, Chari R, Rowe BH, Ospina MB. Social Determinants of Health and Pediatric Emergency Department Outcomes: A Systematic Review and Meta-Analysis of Observational Studies. Ann Emerg Med. 2024;83(4):291\u0026ndash;313. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.annemergmed.2023.10.010\u003c/span\u003e\u003cspan address=\"10.1016/j.annemergmed.2023.10.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGaffney LK, Michelson KA, Monuteaux MC, Porter J, Hudgins J. Individual Social Determinants of Health and Location of Pediatric Low-Resource-Intensity Care. J Pediatr. 2025;289:114884. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpeds.2025.114884\u003c/span\u003e\u003cspan address=\"10.1016/j.jpeds.2025.114884\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ, AMERICAN ACADEMY OF PEDIATRICS Committee on Pediatric Emergency Medicine, Section on Radiology; AMERICAN COLLEGE OF RADIOLOGY; AMERICAN COLLEGE OF EMERGENCY PHYSICIANS Pediatric Emergency Medicine Committee. Policy Statement Pediatr. 2024;154(1):e2024066854. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2024-066854\u003c/span\u003e\u003cspan address=\"10.1542/peds.2024-066854\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAppelhaus S, Sch\u0026ouml;nberg SO, Weis M. CT in pediatric trauma patients. Rofo. 2025;197(3):257\u0026ndash;65. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/a-2341-7559\u003c/span\u003e\u003cspan address=\"10.1055/a-2341-7559\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. English, German.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu Y, Sharma P, Becker DJ, Brisendine A, McDougal J, Morrisey MA, Blackburn J, Menachemi N, Sanders T, Sen B. Social determinants of health and emergency department utilization in Alabama Children's Health Insurance Program. Am J Manag Care. 2023;29(3):159\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.37765/ajmc.2023.89330\u003c/span\u003e\u003cspan address=\"10.37765/ajmc.2023.89330\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRigdon J, Montez K, Palakshappa D, Brown C, Downs SM, Albertini LW, Taxter AJ. Social Risk Factors Influence Pediatric Emergency Department Utilization and Hospitalizations. J Pediatr. 2022;249:35\u0026ndash;e424. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpeds.2022.06.004\u003c/span\u003e\u003cspan address=\"10.1016/j.jpeds.2022.06.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi J, Ramgopal S, Marin JR. Resource Utilization During Low-Acuity Pediatric Emergency Department Visits. Pediatr Emerg Care. 2022;38(2):e983\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PEC.0000000000002508\u003c/span\u003e\u003cspan address=\"10.1097/PEC.0000000000002508\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJaboyedoff M, Starvaggi C, Suris JC, Kuehni CE, Gehri M, Keitel K. Drivers for low-acuity pediatric emergency department visits in two tertiary hospitals in Switzerland: a cross-sectional, questionnaire-based study. BMC Health Serv Res. 2024;24(1):103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12913-023-10348-3\u003c/span\u003e\u003cspan address=\"10.1186/s12913-023-10348-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pediatric trauma, Sibling count, Family structure, Emergency department, Resource utilization","lastPublishedDoi":"10.21203/rs.3.rs-8724060/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8724060/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePaediatric trauma presentations to the emergency department (ED) are predominantly low in severity, yet they constitute a substantial proportion of ED workload. While social and household determinants are increasingly recognised in the field of paediatric injury epidemiology, their influence on injury patterns and the utilisation of emergency department resources remains insufficiently explored.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study aimed to evaluate the association between the number of siblings a patient has had, the availability of a patient's caregiver, the employment status of the patient's parents, the injury patterns exhibited by the patient, and the utilisation of resources in emergency departments by paediatric trauma patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe present prospective, single-centre observational study included children aged 0\u0026ndash;15 years who presented at the ED with traumatic injuries. The demographic characteristics, household factors, and trauma-related variables of the subjects were recorded prospectively. The analysis encompassed a range of metrics, including injury patterns, Injury Severity Score (ISS), consultation requirements, imaging utilisation, and Emergency Department (ED) disposition. These metrics were then examined in relation to the number of siblings and the characteristics of the family unit.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study incorporated a total of 408 paediatric trauma patients, with a median age of 8 years and a male:female ratio of 62.3:37.7. The overall injury severity was found to be low, with a median ISS of 2. Furthermore, the sibling count was found to be non-associative with trauma severity. However, a higher number of siblings was found to be significantly associated with extremity injuries, including upper extremity fractures and hand/wrist injuries. Furthermore, an increased frequency of higher sibling counts was observed among patients who sustained injuries at school, those originating from households affected by parental unemployment, and those lacking non-family caregiver support. A notable finding was that patients requiring specialist consultation had significantly higher sibling counts compared with those managed without consultation, despite the uniform low injury severity across the cohort.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn paediatric trauma patients presenting with predominantly low injury severity, sibling count was found to be associated with distinct injury patterns and increased emergency department resource utilisation, particularly consultation demand. The findings of this study suggest that household structure exerts a significant influence on emergency care pathways and operational burden, rather than on the severity of trauma itself. This underscores the crucial need to incorporate social context into the workflow planning and resource allocation processes within emergency departments.\u003c/p\u003e","manuscriptTitle":"Sibling Count and Family Employment Status Shape Injury Patterns and Emergency Department Resource Use in Pediatric Trauma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-06 21:31:42","doi":"10.21203/rs.3.rs-8724060/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-04T04:14:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-06T17:28:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303032173598522502403266938245855232869","date":"2026-02-06T14:51:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-04T10:27:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-04T10:23:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-03T08:37:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-02T13:14:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Emergency Medicine","date":"2026-02-02T12:49:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"emmd","sideBox":"Learn more about [BMC Emergency Medicine](http://bmcemergmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/emmd","title":"BMC Emergency Medicine","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c5df1806-0c26-4103-9fba-52928958557f","owner":[],"postedDate":"February 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:14:16+00:00","versionOfRecord":{"articleIdentity":"rs-8724060","link":"https://doi.org/10.1186/s12873-026-01589-6","journal":{"identity":"bmc-emergency-medicine","isVorOnly":false,"title":"BMC Emergency Medicine"},"publishedOn":"2026-04-20 16:00:04","publishedOnDateReadable":"April 20th, 2026"},"versionCreatedAt":"2026-02-06 21:31:42","video":"","vorDoi":"10.1186/s12873-026-01589-6","vorDoiUrl":"https://doi.org/10.1186/s12873-026-01589-6","workflowStages":[]},"version":"v1","identity":"rs-8724060","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8724060","identity":"rs-8724060","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}