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Purpose Trauma is the leading cause of death and disability in children. We aimed to compare the clinical characteristics of children with trauma and disease. Methods We reviewed the medical records of children (< 19 years) who visited the emergency department of Pusan National University Hospital from 2016 through 2018. Data on the age, age group, sex, details of trauma or disease, severe trauma or disease (Korean Triage Acuity Scale 1-2), hospitalization rate (overall and intensive care unit [ICU]), hospital length of stay, in-hospital mortality, and the Injury Severity Score were compared between the children with trauma and those with disease. Results In a total of 10,205 children, 3,028 (29.7%) had trauma. The children with trauma were older than those with disease (median age, 78.5 months [interquartile range, 35.0-165.0] vs. 49.0 [16.0-120.0]; P < 0.001). Boys were more common in the former group than the latter (63.7% vs. 56.3%; P < 0.001). The most common injury mechanism was traffic accident (16.0%), followed by fall and foreign body. The overall hospitalization rate was higher in the children with disease (17.1% vs. 35.9%; P < 0.001). However, the children with trauma underwent more frequent ICU hospitalization, and showed higher in-hospital mortality rate and longer hospital length of stay than those with disease (all P < 0.001). The children with severe trauma showed higher median age, percentage of boys, in-hospital mortality, and ICU hospitalization rate, and longer hospital length of stay than those with severe disease (all P < 0.001). Conclusion Children with trauma tend to be older, and their condition may be more critical in severity than those with disease. This difference is more prominent in those with severe trauma or disease.