Objective: To describe the demographics, mechanisms, pattern, and severity of injury, the prehospital and hospital care during the first 24 hours, and the outcome in the most severely injured children in a paediatric intensive care unit (PICU). Design: Retrospective review. Setting: Paediatric intensive care unit (PICU), Sweden. Subjects: 45 children (0-16 years of age) with multiple injuries admitted to the PICU in Gothenberg from January 1990 to October 2000, inclusive. Main outcome measure: Mortality within 30 days after injury. Results: About 2/100000 children with multiple injuries were admitted to the PICU from the greater Gothenberg area each year from 1990-2000 inclusive. Injuries were more common in boys (n = 29.64%). The mean age was 7 years (SD 5). Traffic related events (n = 29.64%) and falls (n = 11.24%) were the leading causes of injury. Thoracic and abdominal injuries were the most common (17% and 16% respectively). Three children died. Conclusion: Major trauma with multiple injuries is rare in Swedish children. When they are cared for at a centre with the necessary facilities and trained personnel they have a good chance of survival. [ABSTRACT FROM AUTHOR]