Epidemiology of school injuries in Utah: a population-based study

Approaching the Causes of Unintentional Injuries in the School Environment: A Panel Analysis of Survey Data From Germany

BACKGROUND

Previous research on the correlates of unintentional school injuries is based on either process or cross-sectional data. This study aims at approaching the causal effects of risk-seeking behavior, mental health problems, physical activity, and exposure to bullying on unintentional injuries in the school environment by relying on longitudinal survey data.

METHODS

The data comes from a German panel survey, including more than 10,000 students. We estimate fixed-effects regression models that only take into account the variation within participants and are therefore most suitable for establishing causal inferences.

RESULTS

We find an increase in risk-seeking behavior on the individual level to yield an increase in students' likelihood to suffer injuries during physical education and on the schoolyard or in the school building. The same holds true for an increase in mental health problems. Finally, students who expand their degree of physical activity in club sports also show a higher risk of unintentional injuries.

CONCLUSIONS

Interventions aimed at reducing too risky behavior and mental health problems may help prevent unintentional injuries in the school environment. Since students who increase their activities in club sports are also more prone to school injuries, preventive efforts should include this group of adolescents as well.

Unintentional Injuries in Primary and Secondary Schools in the United States, 2001-2013

BACKGROUND

Unintentional injuries are the leading cause of youth morbidity. However, limited nationally representative data are available to characterize the occurrence of unintentional injuries at US schools. Given this paucity, we characterized secular trends in unintentional injuries at schools that led to emergency department (ED) visits.

METHODS

A retrospective analysis of the National Electronic Injury Surveillance System-All Injury Program from 2001 to 2013 compared injuries occurring at schools to injuries occurring elsewhere in youth ages 5-18 years. Incidence rates were calculated using weighted frequency estimates as numerators and US population estimates as denominators.

RESULTS

School injuries accounted for 21% of unintentional injury-related ED visits, with an estimated annual incidence rate of 1385 injuries per 100,000 5- to 18-year-olds. Middle school-aged youth (10-13 years) had the highest annual incidence rate (1640 per 100,000 youth) compared with younger and older counterparts. School injuries were more likely to be due to sports/recreation than nonschool injuries (55% vs 41%, p < .0001). Importantly, no detectable change in incidence rates of school injuries between 2001 and 2013 was found (p = .11).

CONCLUSIONS

Stagnant annual incidence rates of unintentional injuries at schools and large numbers of school-based injuries demonstrate that school-based injuries are a notable opportunity for future prevention efforts.

School-based injury outcomes in children from a low-income setting: results from the pilot injury surveillance in Rawalpindi city, Pakistan

Background

School-based injuries account for one in five unintentional childhood injuries. Little is known about the epidemiology of school-based injuries in low-income settings. The objective of our study was to compare emergency department (ED) outcomes of the school-based injuries with respect to age, sex, and injury mechanisms in a Pakistani urban setting.

Findings

A pilot injury surveillance study was conducted at the EDs of three major tertiary-care hospitals of Rawalpindi city from July 2007 to June 2008 and included children of less than 15 years injured at school. The World Health Organization’s questionnaire for injury surveillance was used. There were 923 school injury cases. Mean age of children involved was 8.3 years (SD ± 3.3) with male female ratio 2.9:1. Most injuries occurred while playing 85.6% (n = 789); of which the most common mechanism was falls (n = 797, 86.4%). Nineteen of twenty cases were directly discharged home from the ED (N = 861). Compared to ED discharged cases, injury characteristics overrepresented in hospital admitted cases (n = 46) were age 10–14 years (65.2% vs. 40.9%, p = 0.005), male (88.6% vs. 25.9%), involved in educational activities (39.1% vs. 5.3%), injured from fire/heat (37.8% vs. 0.6%), had burns (39.5% vs. 0.9%) and head injuries (27.9% vs. 6.4%).

Conclusion

Falls while playing are the commonest injury mechanism in school-based injuries reported in our ED sample. School officials need to prevent these injuries. Studying injury hazards present in school environment in Pakistan might facilitate developing specific prevention strategies.

Physical education class injuries treated in emergency departments in the US in 1997-2007

OBJECTIVE

The goal was to describe the epidemiological features of physical education (PE)-related injuries treated in US emergency departments.

METHODS

A retrospective analysis was conducted with data for children and adolescents (5-18 years of age) from the National Electronic Injury Surveillance Study of the US Consumer Product Safety Commission, from 1997 through 2007. Sample weights provided by the National Electronic Injury Surveillance System were used to calculate national estimates of PE-related injuries. Trend significance of the number of PE-related injuries over time was analyzed by using linear regression analysis.

RESULTS

An estimated 405305 children and adolescents were treated in emergency departments for PE-related injuries. The annual number of cases increased 150% during the study period (P = .001). Nearly 70% of PE-related injuries occurred during 6 activities, that is, running, basketball, football, volleyball, soccer, and gymnastics. Boys' injuries were more likely to involve the head, to be diagnosed as a laceration or fracture, to be attributable to contact with a person or structure, and to occur during group activities. Girls' injuries were more likely to involve the lower extremities, to be strains and sprains, to be acute noncontact injuries, and to occur during individual activities.

CONCLUSION

More research is needed to identify the cause of the increase in PE-related injuries, to examine the gender difference in PE-related injuries, and to determine appropriate injury prevention solutions and policies.

Legal liability: the consequences of school injury

BACKGROUND

Approximately 10-25% of child and adolescent injuries occur at school. Little is known about school-related injuries to teachers and other adults or about the direct cost of injuries to schools. This study examined the characteristics of cases involving injuries resulting in lawsuits against schools, compared cases in which schools paid awards with those in which schools did not pay awards, and compared student and nonstudent injuries resulting in lawsuits against schools.

METHODS

Descriptions of cases of school liability for personal injury that were tried or settled between July 1996 and May 2002 were purchased from Jury Verdict Research, which maintains a national database of verdicts and settlements. The 455 cases reviewed were coded according to the characteristics of the case, school, award, and injured party.

RESULTS

In two thirds of the cases, schools or school districts paid an award to plaintiffs (mean =$562,915, median =$50,000). In most cases, the injured party was male (57.1%) and younger than 18 years of age (79.9%). Fractures (38.9%) were the most common type of injury. Falls (21.9%) were the most common cause of injury. Among cases of intentional injury, 93.2% involved an injury to a student; among cases of unintentional injury, 74.6% involved injury to a student.

CONCLUSIONS

Preventing school-related injuries is an ethical and legal obligation for schools and school districts. Prevention is also critical because a wide range of injuries are litigated, and such lawsuits often require schools and school districts to pay costly awards to injured parties.

Emergency department visits for injury in school-aged children in the United States: a comparison of nonfatal injuries occurring within and outside of the school environment

OBJECTIVES

To compare the demographic and injury characteristics of children visiting the emergency department (ED) for nonfatal injuries occurring at school with those of same-aged children who were injured outside of school.

METHODS

Data from a stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System (NEISS) were analyzed for 2001 and 2002. School and nonschool injury-related ED visits were analyzed for patients who were 5 through 19 years of age.

RESULTS

There were an estimated 58,147,518 injury visits in all ages to the ED in 2001 and 2002. Injuries to school-aged children (ages 5-19) accounted for an estimated 15,405,392 (26%) visits overall, of which 1,859,215 occurred at school (16.5% of visits by school-aged children when location of injury was known). Males accounted for 63% of injuries at school; middle-school children (ages 10-14 yr) accounted for a significantly greater proportion of injuries (46%) than did primary- (5-9 yr, 24%) or secondary-school (15-19 yr, 30%) children (p < 0.001). In contrast, for injuries outside of school, secondary-school children were injured most (40%), followed by middle- (32%) and primary-aged children (27%). Nearly 11% of school injuries were classified as violent, whereas only 6.4% of the nonschool injuries in school-aged children were violent (p < 0.001). Similarly, sports injuries were significantly more common at school (53% of injuries) than outside of school (32.9%; p < 0.001).

CONCLUSIONS

A significant proportion of injuries to school-aged children occur at school. Notable differences exist between the epidemiology of in- and out-of-school injuries. The nature of these injuries differs by age group. Efforts to reduce school injuries will require that these differences be examined further and incorporated into prevention initiatives.

Unintentional injuries among primary and middle school students in Maanshan City, eastern China

AIM

To describe the rates and patterns of unintentional injuries among primary and middle school students in China.

METHODS

A cross-sectional survey was conducted in Maanshan City of the Anhui Province in eastern China. All students attending six primary and four middle schools, selected randomly, were asked to report unintentional injuries occurring in the 12-mo period before the survey. The occurrence of unintentional injuries that resulted in medical attendance was summarized by study grade, sex, month and external causes.

RESULTS

The annual event-based injury rate per 100 students was higher among boys (21.7) than girls (17.6). Only 1.9% of the episodes resulted in hospitalization, and 17.8% resulted in missing school. The most frequent injuries were falls (38.2%) and transportation-related injuries (19.6%). The risk of injury was lower in middle schools than primary schools. Distribution by month of occurrence showed two peaks in boys during spring and autumn, but no clear peak was observed in girls.

CONCLUSION

The descriptive epidemiology of unintentional injuries among students in China provides useful information on the distributions in person, place and time, which in turn provide hints for the further exploration of possible risk factors that are important in planning strategies for future prevention.

The causes and consequences of injury in students at UK institutes of higher education

BACKGROUND

Injuries are the leading cause of mortality and also an important cause of permanent disability in young people living in developed countries. This study aimed to inform injury prevention programmes by assessing the incidence of injury and disabling injury, and identifying factors predicting injury in students at institutes of higher education, an under-researched group with regard to injury studies.

METHODS

Secondary analysis of data obtained from a postal questionnaire survey of 1208 students at three institutions in the UK.

RESULTS

Eighteen percent (222/1208) of students reported at least one injury requiring medical attention in the last year. Males and younger students were at greater risk, as were those who reported 'seeking out risky activities because they enjoyed potential danger'. Seventy-nine percent of reported injuries caused some degree of, at least temporary, disability. Four percent of students reported an injury in the last year that interfered with studies, work or other regular daily activities for at least 1 month. Team sports increased the risk of injury by a factor of 2.5 independently of age, gender and risk-taking attitudes. Sport/physical activity injuries were much more likely to be disabling than injuries attributable to other causes.

CONCLUSIONS

There is a need for injury prevention programmes among students at institutes of higher education. Programmes need to disseminate the risk of disabling injury, particularly that attributable to participation in sport/physical activity. There is an urgent need for those working on injury prevention to collaborate with those working on other aspects of health promotion to define the net health gain from participation in sport/physical activity and to develop coherent public health messages.

Unintentional injuries at school in China--patterns and risk factors

OBJECTIVE

To describe the rate and pattern of unintentional school injuries among primary and middle school students and to explore the major risk factors involved.

STUDY DESIGN

A cross-sectional survey of more than 10,000 students attending 6 primary and 4 middle schools selected randomly from all schools in Maanshan City of Anhui Province in eastern China was conducted to collect information on school injuries occurring in the 12-month period before the survey. Rate ratios for risk factors were estimated using the negative binomial regression analysis.

RESULTS

The annual person-based school injury rate was 5.22 (95% CI: 3.90-6.53) percent. The annual event-based injury rate was 5.40 (95% CI: 4.04-6.76) per 100 students. Most injuries in school were relatively mild and only 1.53% (9/590) of the episodes resulted in hospitalization. The most frequent injures were falls (73%), and the most commonly injured sites were the upper limbs (46%). Male sex, primary school grades, poor health status, poor ability to concentrate, bad risk-taking behavior and high study-related stress were important risk factors.

CONCLUSION

This study provided useful baseline information on school injuries in China and identified important risk factors that would be important in planning prevention strategies.

Nonfatal injuries among middle-school and high-school students in Guangxi, China

OBJECTIVES

We described nonfatal injuries and calculated injury rates among middle-school and high-school students in Guangxi, China.

METHODS

Students were selected using multistage randomizing techniques, and nonfatal injuries in 1840 students from February 2002 to January 2003 were monitored with standardized injury forms. Risk factors for injury were identified in multivariate analyses.

RESULTS

The annual overall injury rate was 32.3 per 100 students. Boys had a significantly higher injury rate than the girls (34.8 vs 30.3 per 100 students), and a significantly higher proportion of injuries in boys was caused by other students (28.1% vs 19.4%). A higher proportion of injuries in girls (40.7%) occurred at home. For both boys and girls, sports were the most common activities associated with injury. Injuries from falls were the leading cause of injury, and extremities were most frequently injured. Gender, age, ethnicity, and family income levels were identified as significant risk factors for injury in multivariate analyses.

CONCLUSIONS

Nonfatal injuries in middle-school and high-school students should be recognized as a significant public health concern in China.

A population based investigation of head injuries and symptoms of concussion of children and adolescents in schools

OBJECTIVE

To examine the incidence of head injury and symptoms of concussion among children at school and to determine the relationship of age, gender, and cause to incidence rates.

DESIGN

Incident reports involving head injury for schools in the Province of Ontario, Canada during the year 2000 were evaluated.

PARTICIPANTS

The population base for the schools represented was 1 372 979 children aged 6 to 16.

SETTING

95% of schools in the province of Ontario, Canada participated in the injury reporting system.

MAIN OUTCOME MEASURES

A head injury was defined as any injury to the head that came to the attention of a school official. Head injuries accompanied by symptoms of concussion became a secondary outcome measure.

RESULTS

There were 11 068 unduplicated head injury reports for the year 2000 of which 1861 qualified as producing signs or symptoms of concussion. Young children were more likely to have a head injury than older children, but slightly less likely to experience concussive symptoms. The primary cause of injury to young children was falls. Older children were more likely to receive head injuries and symptoms of concussion from sports activities.

CONCLUSIONS

Overall rate of injury (3.98 per 100 children) was consistent with previous studies using prospective injury reporting systems. Probability of a head injury with symptoms of concussion among schoolchildren was only 1.9% for boys and <1% for girls during the course of their school years. There is ample justification for prevention efforts in schools.

Recommended minimal emergency equipment and resources for schools: national consensus group report

Providing an environment that is responsive to emergency health needs of students is essential to creating a safe setting for children in schools. The question of what minimal essential emergency equipment and resources should be available in schools brings with it many and varied opinions, issues, and concerns. Through funding from the Emergency Medical Services for Children (EMSC), the National Association of School Nurses (NASN) was charged with the task of convening a consensus group to formulate a recommended list of minimal essential emergency equipment and resources that should be present in all schools. This article provides an overview of the issues surrounding minimal emergency equipment needs for schools, presents recommended minimal emergency equipment and resources, and recommendations for further actions.

Evaluation of the Utah student injury reporting system

The Utah Student Injury Reporting System (SIRS), implemented in 1984 to monitor injuries to students in grades K-12 in Utah schools, has served as a model for surveillance systems created by other states and some European countries. This paper evaluates the Utah experience in developing and administering the SIRS. The evaluation identifies usefulness of the system, discusses the sensitivity of the system in detecting school injuries, estimates the system's costs, and provides suggestions to other states and districts interested in building a cost-effective and efficient surveillance instrument.

Analysis of school injuries resulting in emergency department or hospital admission

OBJECTIVE

To describe the epidemiology of school injuries resulting in emergency department (ED) visits, hospital admission, or death.

METHODS

Utah statewide school injuries from 1992 to 1996 were probabilistically linked to statewide ED records (1996 only), inpatient hospital records (1992-1996), and death certificate records (1992-1996).

RESULTS

There were 43,881 school injuries for the years 1992 through 1996. In 1996, 1,534 of 6,354 total school injuries (17.5%) resulted in ED evaluation. Between 1992 and 1996, 354 school injuries (0.8%) necessitated hospital admission. The overall rates of school injuries (per 1,000 students) of primary (kindergarten-grade 6) and secondary (grades 7-12) school students requiring ED evaluation were 3.29 and 3.28, respectively; for hospital admission, 0.165 and 0.139. Abbreviated Injury Scale-1990 (AIS-90) regions identified in ED patients were the upper extremity (39.2%), face (20.8%), and lower extremity (17.1%), while AIS regions among inpatients were lower extremity (29.1%), upper extremity (26.6%), and head (22.6%). There were a total of 1,123 hospital days, and total charges of $2.16 million. The ED charges totaled $545,000. Median length of hospital stay was 1 day, and median hospital charge was $3,080. There were four fatalities.

CONCLUSIONS

This study emphasizes the significance of school injuries and the need for interventions to prevent these injuries