ORIGINAL ARTICLE

Injury Analyses in Rural Children: Comparison of Old-Order
Anabaptists and Non-Anabaptists

Karen Forward, MD, Melissa Chan, MD, Tanya Charyk Stewart, MSc, Jason Gilliland, PhD,
Craig Campbell, MD, MSc, FRCPC, and Douglas D. Fraser, MD, PhD, FRCPC

Background: Southwestern Ontario largely comprises rural farming districts
and is home to numerous Old-Order Anabaptist settlements. Our objective
was to describe the injuries sustained by rural children, both Old-Order
Anabaptist and non-Anabaptist, to better target injury prevention programs.
Methods: We retrospectively examined injury data of rural children in
Southwestern Ontario with injury severity scores �12 obtained from hospital
and trauma databases (1997–2007).
Results: A total of 422 rural children were included in this study: 7.8%
Anabaptist (n � 33) and 92.2% non-Anabaptist (n � 389). The age of injured
Anabaptist children (median, 7 years; interquartile range � 10) was younger
than non-Anabaptist children (median, 14 years; interquartile range � 7; p �
0.001). Anabaptist children were most frequently injured on their property
(48.5%; n � 16 of 33; p � 0.001). Non-Anabaptist children were mostly
injured on roads (56.8%; n � 221 of 389; p � 0.05) and by motor vehicle
collisions (MVCs; 40.1%; n � 156 of 389; p � 0.02). Frequent causes of
injury among Anabaptist children were falls (24.2%; n � 8 of 33; p � 0.02),
animals (15.2%; n � 5 of 33; p � 0.004), and buggies (9.1%; n � 3 of 33).
Approximately half of both groups injured in MVCs did not use seat belts.
There were no significant differences between cohorts in sex, injury severity
scores, hospitalization days, rates of complications, interventions, comor-
bidities, or mortality rates.
Conclusions: Injuries to Anabaptist children occur at a young age, primarily
on their property, and exhibit a unique spectrum of mechanisms. In contrast,
injuries to non-Anabaptist children occur at an older age, primarily on roads,
and in MVCs. The use of protective devices was low among all rural
children. Development of collaborative injury prevention programs targeted
to distinct rural communities, including Anabaptist and non-Anabaptist, are
needed for reducing injuries among rural children.
Key Words: Rural populations, Trauma, Injury prevention, Adolescent,
Child.

(J Trauma. 2010;69: 1294 –1299)

Southwestern Ontario primarily comprises rural farmingdistricts, with a relatively large concentration of Old-
Order Anabaptist settlements. Anabaptist Old-Order Menno-
nites and Amish migrated to North America from Europe
during the 1800s to escape persecution and to preserve their
culture, practices, and beliefs.1 Anabaptist individuals pos-
sess a strong sense of social obligation, assist one another in
times of need, and oppose the need for conventional health
insurance.2 In Canada, Anabaptists are eligible for medical
insurance; however, they have negotiated with the govern-
ment to gain exemption, and most choose to pay for medical
services out of pocket. Anabaptist individuals abstain from
the use of modern technology, dress conservatively, and
engage in traditional farming practices akin to those used in
the 1700s.3

Farming can be a dangerous industry, particularly for
children among whom agricultural injury has been recog-
nized as an important public health concern.4,5 Common
farming hazards for children include animals, farming equip-
ment, and falls.4,6 –10 Head and musculoskeletal injuries are
commonly reported.4,8,11 Previous studies have shown that
children and adults living in rural areas are at higher risk of
injury requiring medical treatment,12,13 perhaps because of
limited access to definitive health care, longer travel dis-
tances, different living environments, and different behav-
ioral norms.12 For Anabaptist families, the availability of
health care may be further impaired by limited access to
automobiles and telephones, the cost of care, and an uncon-
ventional perception of illness severity. Anabaptist individu-
als frequently perceived themselves as “ill” only when they
are unable to complete routine farming tasks.2

The objective of this study was to analyze the epi-
demiology and spectrum of severe injuries occurring in
rural children, both Anabaptist and non-Anabaptist, resid-
ing locally in the same rural region. Injury analyses of
distinct communities, such as the Anabaptist population,
are essential for the development of targeted injury pre-
vention programs.

PATIENTS AND METHODS
The University of Western Ontario Ethics Review

Board approved this study. The referral region of Southwest-
ern Ontario consists of 10 counties (Gray, Bruce, Huron,
Perth, Middlesex, Elgin, Oxford, Essex, Kent, and Lambton)
and has a geographical area of �19,000 km2, with a pediatric
population of �500,000. The hospital databases and provin-

Submitted for publication August 11, 2009.
Accepted for publication September 1, 2010.
Copyright © 2010 by Lippincott Williams & Wilkins
From the Departments of Pediatrics (K.F., C.C., D.D.F.), Surgery (T.C.S.),

Geography (J.G.), Physiology and Pharmacology (D.D.F.), and Clinical Neu-
rological Sciences (D.D.F.), University of Western Ontario, London, Ontario,
Canada; Department of Pediatrics (M.C.), University of Toronto, Toronto,
Ontario, Canada; Trauma Program (T.C.S., D.D.F.), London Health Sciences
Centre, London, Ontario, Canada; Children’s Health Research Institute (J.G.,
C.C., D.D.F.), London, Ontario, Canada; and Centre for Critical Illness
Research (D.D.F.), London, Ontario, Canada.

Support by the Children’s Health Foundation and The London Health Sciences
Centre Trauma program.

Address for reprints: Douglas D. Fraser, MD, PhD, FRCPC, Pediatric Critical
Care Medicine, Room C2– 846, Children’s Hospital, London Health Sciences
Centre, 800 Commissioners Road East, London, Ontario, Canada N6C 2V5;
email: fraserd@lhsc.on.ca.

DOI: 10.1097/TA.0b013e3181fa7e25

1294 The Journal of TRAUMA® Injury, Infection, and Critical Care • Volume 69, Number 5, November 2010



cial trauma registries of two Southwestern Ontario Trauma
Centres (London Health Sciences Centre, London, ON, and
Hotel Dieu Grace Hospital, Windsor, ON) were used to
identify rural children (younger than 18 years) who presented
with an injury severity score (ISS) �12 between 1997 and
2007. Anabaptists were recognized in the database through
religious identification as “Mennonite” or “Amish” and
through the absence of a provincial health insurance number.
Rural localization of subjects was determined by mapping
their home addresses or postal codes or both within a geo-
graphic information system (ArcGIS 9.2; Environmental Sys-
tems Research Institute, Redlands, CA) and comparing the
locations against 2006 Canadian census data (Statistics Can-
ada).14 All data were checked for geographic accuracy. Rural
areas were defined as areas with a minimum population
concentration of �1,000 persons and a population density of
�400 persons/km2.

The data collected in the provincial trauma registries
comprise the Comprehensive Data Set and is collected on all
severely injured patients (ISS �12). The Comprehensive
Data Set contains �400 data elements including patient
demographics, prehospital care, hospital treatment, injury
data, and patient outcomes. Dedicated injury data specialists
with training in injury scoring analyze and enter all data. Data
were verified upon entry and in subsequent data quality
checks at each institution and provincially to ensure accuracy
and completeness. Information extracted from the trauma
databases for this study included demographics, address,
postal code, use and misuse of protective gear or devices (i.e.,
seat belt, car seat, and helmet), injury information (mecha-
nism, time, date, severity, and injury profile), and hospital-
ization data (i.e., length of stay, need for intensive care unit
admission, and operative procedures). Data on complications
and outcomes were also recorded. The Maximum Abbrevi-
ated Injury Scale score and ISS were calculated by trained
trauma data analysts.15–18

The locations where injuries occurred were grouped
into four categories: property (home or farm), road, recre-
ation facility, and other locations (industry, public building,
residential institution, and other unspecified locations).
Causes of injury included the following: falls, animals, ma-
chinery, motor vehicle collisions (MVCs), pedestrian or
bikes, buggy, other (including abuse, burns, drowning, as-
sault, and sports), and recreational motorized vehicles
(RMVs; including snowmobiles, all-terrain vehicles [ATVs],
and dirt bikes).

Data were analyzed with Excel 12.1.0 (Microsoft, Red-
mond, WA) and SigmaStat 3.5 (Systat Software, Richmond,
CA). All data sets were prescreened for normality. Data are
presented as median values with an interquartile range (IQR),
and direct comparisons were made with Mann-Whitney rank-
sum tests. Percentages were used to describe categorical
outcomes, and distributions of categorical data were com-
pared with either a Pearson’s �2 test or a Fisher’s exact test.
p values � 0.05 were considered statistically significant. An
Institutional Statistician reviewed all analyses for appropri-
ateness of selected tests and accuracy.

RESULTS
A total of 422 children injured during a 10-year period

in rural Southwestern Ontario met the inclusion criteria for
this study. Demographic features of injured children are
shown in Table 1. Anabaptist children comprised 7.8% of this
injured rural population. The ratio of males to females was
similar between Anabaptist and non-Anabaptist cohorts, with
more males in both groups. Anabaptist children were signif-
icantly younger at the time of injury (median, 7 years; IQR �
10) when compared with non-Anabaptist children (median,
14 years; IQR � 7; p � 0.001).

The most common injury location for Anabaptist chil-
dren was on their property (48.5%; p � 0.001) when com-
pared with non-Anabaptist children who were more often
injured on roads (56.8%; p � 0.02; Table 1). In subgroup
analysis of injury location stratified by age, Anabaptist chil-
dren aged 5 years to 15 years were more likely to be injured
on farms than non-Anabaptist children (p � 0.02). The peak
months for injuries were June and August for all rural
children. The peak times of injuries were similar at 6 PM to 8
PM for Anabaptist children (29.6%) and 4 PM to 6 PM for
non-Anabaptist children (19.7%). No injuries occurred in the
Anabaptist group between midnight and 6 AM.

Injury mechanism data are shown in Table 2. The most
common causes of injury among Anabaptist children were
falls (24.2%; p � 0.02). When stratified by age, more 5-year
to 15-year-old Anabaptist children were injured by falls than
non-Anabaptists children (15.2% vs. 5.6%; p � 0.04). Other
notable causes of injuries in Anabaptist children included
MVCs (18.2%; p � 0.02), animals (15.2%; p � 0.001), and
buggies (9.1%). No injuries in the Anabaptist population
were caused by abuse, suicide, or assault. Among non-

TABLE 1. Demographic Characteristics of Rural Children,
Both Anabaptist and Non-Anabaptist (Matched for Location
With Geographical Mapping)

Anabaptist
Children
(n � 33)

Non-Anabaptist
Children
(n � 389) p

Male:female 21 (63.6):12 (36.4) 284 (73.0):105 (27.0) 0.25

Age (yr)

0–1 3 (9.1) 13 (3.3) 0.24

1–4 9 (27.3) 9 (9.3) �0.001
5–9 8 (24.2) 59 (15.2) 0.26

10–15 11 (33.3) 147 (37.8) 0.75

16–17 2 (6.1) 134 (34.4) 0.02
Site of Injury

Property 16 (48.5) 84 (21.6) �0.001
Road 9 (27.3) 221 (56.8) 0.002
Other/unknown 7 (21.2) 59 (15.2) 0.50

Recreation facility 1 (3.0) 25 (6.4) 0.69

Season of injury

Summer 14 (42.4) 136 (35.3) 0.50

Fall 9 (27.3) 92 (23.9) 0.80

Winter 6 (18.2) 79 (20.5) 0.95

Spring 4 (12.1) 78 (20.3) 0.38

Data presented as n (%).

The Journal of TRAUMA® Injury, Infection, and Critical Care • Volume 69, Number 5, November 2010 Injuries in Rural Children

© 2010 Lippincott Williams & Wilkins 1295



Anabaptist children, the most common causes of injury were
MVCs (40.1%; p � 0.015). When stratified by age, MVC
injuries among 16-year to 17-year olds were more prevalent
among non-Anabaptist youth (n � 83 of 156, 53.2%) than
Anabaptist youth (n � 1 of 6; 16.7%; p � 0.18); however, the
difference was not statistically significant. Furthermore, the
age-stratified analysis comparing the groups was limited by
small sample size or did not reveal significant differences.

The injury profiles and severity of injury to each
body region, as represented by the median Maximum
Abbreviated Injury Scale scores, are listed in Table 3.
Compared with the Anabaptist children, significantly more
non-Anabaptist children sustained injuries to the chest

(43.7%; p � 0.01) and abdomen (37.8%; p � 0.02).
Significantly, more Anabaptist sustained trauma to multi-
ple systems (p � 0.047). No statistically significant dif-
ferences were noted between cohorts in ISS.

A summary of protective device data are shown in
Table 4. Injuries were classified as potentially preventable
through the correct use of seat belts or bike helmets in 46.5%
of non-Anabaptist children and in 24.2% of Anabaptist chil-
dren. Seat belts were unused or incorrectly used in 50.0% of
MVCs involving Anabaptist children and 40.4% of non-
Anabaptist children. Seventy-four non-Anabaptist children
were injured using RMVs (i.e., ATVs, snowmobiles, motor-
cycles, and dirt bikes). Of these, 68.9% reported using a
helmet, 5.4% wore helmets that fell off, and 23% did not use
a helmet. Data were unavailable on two individuals. One
Anabaptist was injured using a RMV without a helmet.

Analyses of admission and hospitalization data are
shown in Table 5. Deaths in the emergency trauma room
occurred in six (1.5%) non-Anabaptist children and two (6%)
Anabaptist children. Intensive care unit admissions and
lengths of stay were comparable among Anabaptist and
non-Anabaptist children. Lengths of stay data were unavail-
able for five non-Anabaptist children and one Anabaptist
child. More non-Anabaptist children (41.4%) underwent sur-
gical interventions than Anabaptist children (21.2%; p �
0.04). The proportions of complications, comorbidities, and
mortalities did not differ statistically between Anabaptist and
non-Anabaptist children.

DISCUSSION
In this study, we analyzed injury data for rural children

in Southwestern Ontario in comparison with Anabaptist and
non-Anabaptist populations. Our data show that Anabaptist
children are more likely to suffer severe injuries at a young
age, occurring primarily on their property, and exhibit a
unique spectrum of injury mechanisms. Given that injuries in
this population generally occur at home or farm, injury

TABLE 2. Mechanism of Injury

Anabaptist Children Non-Anabaptist Children p

Falls 8 (24.2) 37 (9.5) 0.02
MVC 6 (18.2) 156 (40.1) 0.02
Other 5 (15.2) 57 (14.7) 1.00

Animals 5 (15.2) 10 (2.6) 0.04
Buggy 3 (9.1) 0 (0) NA

Pedestrian/bike 3 (9.1) 44 (11.3) NA

Machinery 2 (6.1) 11 (2.8) NA

RMV 1 (3.0) 74 (19.0) NA

NA, not assayed.
Data presented as n (%).

TABLE 3. Injury Severity Scores for Rural Children, Both
Anabaptist and Non-Anabaptist (Matched for Location With
Geographical Mapping)

Anabaptist Children
(n � 33)

Non-Anabaptist
Children (n � 389) p

ISS

Median (IQR) 17 (11) 22 (13) 0.39

MAIS head/neck

Number (%) injured 26 (78.8) 277 (71.2) 0.47

Median (IQR) 4 (1) 4 (2) 0.40

MAIS face

Number (%) injured 6 (18.2) 82 (21.1) 0.87

Median (IQR) 2 (1) 2 (1) 0.24

MAIS chest

Number (%) injured 6 (18.2) 170 (43.7) 0.01
Median (IQR) 4 (1) 3 (1) 0.16

MAIS abdomen

Number (%) injured 5 (15.2) 147 (37.8) 0.02
Median (IQR) 4 (1.25) 3 (2) 0.65

MAIS extremity

Number (%) injured 10 (30.3) 147 (37.8) 0.51

Median (IQR) 2 (1) 3 (1) 0.11

MAIS external

Number (%) injured 16 (4.1) 202 (51.9) 0.10

Median (IQR) 1 (0) 1 (0) 0.04
�1 Body area injured

Number (%) 12 (36.4) 80 (20.6) 0.047

MAIS, Maximum Abbreviated Injury Score.
MAIS external includes burns, lacerations, abrasions, and contusions.

TABLE 4. Analyses of Protective Devices Used or Misused
by Rural Children, Both Anabaptist and Non-Anabaptist
(Matched for Location With Geographical Mapping)

Anabaptist
Children

Non-Anabaptist
Children p

MVC

Seatbelt used 3 (50.0) 87 (55.8) 1.00

No seatbelt used 3 (50.0) 61 (39.1) 0.68

Incorrect car seat use 0 (0) 2 (1.3) NA

Unreported 0 (0) 6 (3.8) NA

Bicycle injury

Helmet 0 (0) 3 (12.0) NA

No helmet 2 (100) 18 (72.0) NA

Unreported 0 (0) 4 (16.0) NA

Overall protective device use

Incidence—correct use 3 (37.5) 90 (52.6) 0.48

Incidence—incorrect/not used 5 (62.5) 81 (47.4) 0.48

NA, not assayed.
Data presented as n (%).

Forward et al. The Journal of TRAUMA® Injury, Infection, and Critical Care • Volume 69, Number 5, November 2010

© 2010 Lippincott Williams & Wilkins1296



prevention at home should be emphasized. In contrast, non-
Anabaptists are more likely to suffer injuries in adolescence,
primarily on roads and in MVCs. This study reveals impor-
tant data for developing targeted injury prevention programs
and supports the need for injury prevention in the rural
population given the relatively low use, and correct use, of
protective devices.

Previous studies relating injuries to developmental age
identify younger children as being at high risk for injury with
their tendency to fall, place objects in their mouth, and
explore independently.19 Among Anabaptist children, there
was a significantly younger median age at the time of injury
compared with non-Anabaptist children with one-third of
injuries occurring in children younger than 5 years. Injuries in
this age group are often preventable (i.e., burns, falls, and
animal-related injuries), suggesting that future injury preven-
tion strategies in the Anabaptist population should emphasize
safety to children in this age group, in addition to their
parents and caregivers. Adolescent injuries in the Anabaptist
population were remarkably low, with a significantly lower
rate of MVC, the most common mechanism of injury in
adolescence, and no intentional injuries caused by abuse,
suicide, or assault.

In pediatric populations, it is typically the late adoles-
cent age group that accounts for the majority of severe
injuries.20 Indeed, youth aged 10 years and older made up the
majority of the non-Anabaptist injured population (72.2%),
and older children were more likely to be injured in MVCs
events largely associated with rapid deceleration and blunt
trauma. This mechanism of injury could explain their signif-
icantly higher rates of chest and abdominal trauma and
significantly greater rates of operative procedures.

Common injury mechanisms noted in our Anabaptist
population were similar to mechanisms described in the

literature.3,6,7,21 Unique to the Anabaptist population, the
horse and buggy is an important method of transportation,
which contributed to 9.1% of injuries in this study. Motorized
vehicles are important causes of buggy-related trauma, rein-
forcing that slow-moving vehicle signs, reflective tape for
buggies and horses, and construction of wider rural roads
might reduce the risk of collision.21 In contrast, RMVs, such
as ATVs, snowmobiles, and two-wheeled dirt bikes, were a
cause of significant morbidity among non-Anabaptist chil-
dren. ATVs, in particular, have been recognized as significant
causes of severe injury,22,23 especially in the rural population
where these vehicles are used for both recreation and service.
In Ontario, beyond legislation, which governs the use of
ATVs, many stakeholders including the Canadian Pediatrics
Society and the Consumer Product Safety Commission rec-
ommend that children younger than 16 years should not drive
recreational vehicles because of the significant strength, co-
ordination, and judgment required for their safe opera-
tion.24 –28 A recent position article from the Ontario Medical
Association more conservatively states that children younger
than 14 years are not allowed to operate ATVs.28

Anabaptist children were more frequently injured on
their property, either house or farm, than any other location.
Farms are known to be inherently dangerous because there
are many opportunities for injury by machinery, animals, and
through falls.4,5,11 The North American Guidelines for Chil-
dren’s Agricultural Tasks have been developed to decrease
childhood farming-related injuries by outlining appropriate
farming tasks for a child’s developmental stage.29 –31 The guide-
lines are developed for the population-at-large; however, it do
not account for the cultural sensitivities of the Anabaptist
population, their involvement in farm work at a young age,
and their wish to preserve a traditional way of life. Farming
injury prevention initiatives should be developed and intro-
duced with the input of community elders.

In farming families, parental supervision of children
can sometimes be difficult while concurrently attending to
farming tasks.32 However, previous research suggests that for
young children, decreasing environmental risk may be more
effective than increasing parental supervision.33 Suggestions
to minimize risk and reduce injury have included the intro-
duction of passive barriers (i.e., fences) to contain play areas
and separate children from potential hazards (i.e., hay stacks,
water, barns, and animals).9,32 The introduction of passive
barriers may be an intervention that would not infringe on the
Anabaptist way of life while reducing children’s exposure to
hazards.9,32,34

The use of protective devices is paramount for injury
prevention in the entire rural population. MVCs were an
important cause of trauma in both cohorts. Seat belt use in
motor vehicles is mandatory by Ontario law. In a recent
survey examining seat belt use in rural areas, seat belt usage
rate in Ontario was 88.3%.35 Despite these reported compli-
ance rates, seat belts were not worn by approximately half of
injured rural children in both cohorts, making unbelted chil-
dren more likely to be severely injured when a crash occurs.
There remains a need for further injury prevention programs
targeting seat belt use among rural adolescents.

TABLE 5. Analysis of Hospitalization Data and Mortality for
Rural Children, Both Anabaptist and Non-Anabaptist
(Matched for Location With Geographical Mapping)

Anabaptist
Children

Non-Anabaptist
Children p

Hospital admission

Number admitted (%) 31 (93.9) 383 (98.5) 0.25

Days: median (IQR)* 6 (6.5) 8 (10) 0.10

Intensive care unit admission

Number admitted 24 (72.7) 272 (70.0) 0.89

Days: median (IQR)* 2 (3.25) 3 (5) 0.41

Operative procedures

No. patients (%) 7 (21.2) 161 (41.4) 0.04
Procedure: median (IQR) 1 (0) 1 (0) 0.49

Complications

Number (%) 9 (27.2) 111 (28.5) 0.96

Comorbidities

Number (%) 14 (42.4) 174 (45.0) 0.94

Mortality

No. deaths (%) 5 (15.2) 34 (8.7) 0.36

* Individuals who died were not included in the length of hospitalization
calculations.

The Journal of TRAUMA® Injury, Infection, and Critical Care • Volume 69, Number 5, November 2010 Injuries in Rural Children

© 2010 Lippincott Williams & Wilkins 1297



Numerous studies support the efficacy of helmet use to
reduce the severity of injuries; however, helmet use among
cyclists in the rural population as a whole was low. In a recent
Cochrane systemic review, bicycle helmet use in children
conferred an 88% and 65% risk reduction for head and facial
injuries, respectively.36 A statistically significant protective
effect of helmets for head, brain, facial, and fatal injury was
recently quantified in a meta-analysis providing clear evi-
dence on the benefits of helmets for cyclists.37 Multidisci-
plinary community campaigns may be effective in promoting
bike helmet use and bike safety, particularly in those who
resist helmet use.38

In the Southwestern Ontario, to our knowledge, there
are no campaigns that focus directly on the Anabaptist pop-
ulation and take into consideration their unique culture and
beliefs. Designated play areas for children, animal or machin-
ery training, and correct use of protective equipment such as
seat belts or helmets may significantly reduce injuries to
Anabaptist children.6,7,11 Future research is needed to analyze
what Anabaptist-specific safety measures (i.e., seat belts in
buggies) may be effective in reducing injuries while being
amenable to Anabaptist community members. The develop-
ment of successful injury prevention programs for Anabaptist
children requires collaboration with the Anabaptist commu-
nity and elders to ensure that all initiatives respect their
culture and lifestyle.

This study has potential limitations. First, it is possible
that some children, despite the severity of their injuries (ISS
�12), were not brought to hospital out of concern of treat-
ment cost, and we were unable to include these patients.
Second, the provincial coroner’s data do not identify religion,
cultural affiliation, or provincial health insurance status in
their database, and hence we could not identify Anabaptist
children that died before arrival to hospital. Third, the small
sample size in some subgroup analyses may have limited our
power to detect a difference between our two cohorts. Fourth,
the non-Anabaptist cohort is likely quite heterogeneous rel-
ative to the Anabaptist population; however, we were unable
to reliably identify other culturally distinct groups in our rural
area for comparison. Fifth, the Anabaptist population is
culturally distinct from other rural populations; thus, conclu-
sions drawn from the injury analyses of the Anabaptist group
cannot be applicable to rural populations at large. Finally, we
are unable to analyze the incidence of injuries within the
Anabaptist cohort as the provincial consensus data do not
report total Anabaptist population. These limitations high-
light the need for methodological enhancements to adminis-
trative health databases to facilitate the study of unique
populations. Despite these limitations, this study emphasizes
the importance of understanding the injury epidemiology of
distinct groups and is applicable to other Old-Order Anabap-
tist populations found in the United States (Indiana, Ohio,
Kansas, Pennsylvania, and Virginia). It also provides impor-
tant injury analyses on the general rural population.

CONCLUSIONS
Our data suggest significant differences in injuries be-

tween two rural cohorts that could help target injury prevention

programs. Injury prevention targeted to younger Anabaptist
children and adolescent non-Anabaptist youth may help to
reduce severe injuries in these populations. Furthermore, the
low use of protective devices among all rural children rein-
forces the need for focused initiatives to increase their use
among rural children. Collaboration with the Anabaptist com-
munity is needed to best address injury prevention in this
distinct community and create solutions that increase safety
without infringing upon their culture and way of life.

ACKNOWLEDGMENTS
D.D.F. holds a Career Development Award from the

Canadian Child Health Clinician Scientist Program, a stra-
tegic training program of the Canadian Institutes of Health
Research. The authors thank the Windsor’s Hotel Dieu Grace
Hospital Trauma program for sharing their regional trauma
data. The authors thank Mr. Jamie A. Seabrook for statistical
review and Drs. D. Matsui and K. Speechley for critical
comments on the manuscript.

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ERRATA

Elderly Hip Fracture Patients Admitted to the Trauma Service: Does it Impact Patient
Outcome?: Erratum

In the article that appeared on pages 1348 –1352 in volume 63, number 6, an author’s name was listed without a middleinitial. The author has requested his middle initial be added. The corrected list of authors is as follows: Melvin E.
Stone Jr., MD, FACS, Casey Barbaro, BS, Castigliano M. Bhamidipati, MD, Janet Cucuzzo, RN, MSN, and Ronald
Simon, MD, FACS.

REFERENCE
Stone Jr. ME, Barbaro C, Bhamidipati C, Cucuzzo J, Simon R. Elderly Hip Fracture Patients Admitted to the Trauma Service: Does it Impact Patient
Outcome? J Trauma. 2007;63:1348 –1352.

Injury Patterns and Psychological Traits of Patients With Self-Inflicted Wounds Produced by
Punching Glass: Erratum

In an article that appeared on pages 691– 693 in volume 69, number 3, the authors’ names were listed in transposed order.The authors should have been listed as: Ahmet Sönmez, MD, Kaan Kora, MD, Nurdan Öztürk, MD, Burak Ersoy, MD,
Memduha Aydın, MD and Ayhan Numanoğlu, MD.

REFERENCE
Ahmet S, Kaan K, Nurdan Ö, Burak E, Memduha A, Ayhan N. Injury Patterns and Psychological Traits of Patients With Self-Inflicted Wounds Produced
by Punching Glass. J Trauma. 2010;69:691– 693.

The Journal of TRAUMA® Injury, Infection, and Critical Care • Volume 69, Number 5, November 2010 Injuries in Rural Children

© 2010 Lippincott Williams & Wilkins 1299