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Kolbow M, Quick JD, Powell LE, Wang Q, Nguyen MDT, Barta RJ. A 10-Year Retrospective Review of Playground-Associated Craniofacial Injuries in the Pediatric Patient Population. Clin Pediatr (Phila) 2024; 63:680-688. [PMID: 38142360 DOI: 10.1177/00099228231219871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
This retrospective study utilized the National Electronic Injury Surveillance System (NEISS) database to identify pediatric emergency department (ED) patients with playground-associated craniofacial injuries between January 2012 and December 2021. A total of 25 414 patients were identified. The majority of injuries occurred in preschool and elementary school-age children (90.3%) and patients were more commonly boys (59.3%). Injuries most often involved the head/scalp (52.4%), face (30.4%), and mouth (11.9%). Infant (32.7%) and teen (40.0%) injuries most commonly involved swings, whereas preschool (23.1%) and elementary school (28.1%) injuries were mostly associated with slides and climbers, respectively. Most patients were treated in the ED and discharged to home (96.5%), a small portion required hospitalization (1.6%), and one death was reported. Although the majority of the injuries were relatively minor and resulted in same-day discharges, these injuries can result in serious physical harm, emotional stress, and unexpected financial burdens. Proper education and supervision regarding safe play is important to prevent these injuries.
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Affiliation(s)
- Madison Kolbow
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Lauren E Powell
- Division of Plastic & Reconstructive Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Minh-Doan T Nguyen
- Department of Plastic & Reconstructive Surgery, Regions Hospital, Saint Paul, MN, USA
| | - Ruth J Barta
- Department of Plastic & Reconstructive Surgery, Gillette Children's Hospital, Saint Paul, MN, USA
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Blanchard A, Hamilton A, Li G, Dayan PS. Playground equipment-related extremity fractures in children presenting to US emergency departments, 2006-2016. Inj Epidemiol 2020; 7:56. [PMID: 32951594 PMCID: PMC7504645 DOI: 10.1186/s40621-020-00275-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Despite updated playground equipment and improved industry standards, playgrounds remain a common source of childhood injury. Fractures account for 35% of all playground injuries presenting to emergency departments (EDs). We aimed to examine the time trends and epidemiologic patterns of playground equipment-related extremity fractures in children in the United States. Methods We analyzed data from the National Electronic Injury Surveillance System. Children ≤14 years presenting to US emergency departments from 2006 to 2016 with playground equipment-related injuries were included. We used weighted complex survey analysis to describe the epidemiologic patterns and severity of playground equipment-related extremity fractures and Joinpoint linear weighted regression analysis to determine trends in extremity fractures. Results An annual average of 72,889 children were treated in US EDs for playground equipment-related extremity fractures, yielding a national annual incidence rate of 119.2 per 100,000 children. Playground equipment-related extremity fractures accounted for 33.9% of ED presentations and 78.7% of hospitalizations for playground equipment-related injuries. Of patients with playground equipment-related extremity fractures, 11.2% had severe fractures requiring hospitalization. The annual rate of ED visits due to playground equipment-related extremity fractures remained stable (annual rate of change = 0.74, p = 0.14) from 2006 to 2016. Adjusted for age, injuries on monkey bars or climbing gyms were associated with significantly increased odds of extremity fractures in comparison to injuries from other playground equipment (adjusted odds ratio [aOR]: 2.0; 95% CI: 1.9–2.1). Overall, 49.8% of extremity fractures and 54.7% of severe extremity fractures (i.e. those requiring hospitalization) occurred on monkey bars or climbing gyms. Conclusions Despite enhanced playground safety standards, national rates of playground equipment-related extremity fractures have remained stable in the US. Extremity fractures remain the most common type of playground injury presenting to EDs and most commonly occur on monkey bars and climbing gyms.
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Affiliation(s)
- Ashley Blanchard
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHN-1-116, New York, NY, 10032, USA.
| | - Ava Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street #724, New York, NY, 10032, USA
| | - Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street #724, New York, NY, 10032, USA.,Department of Anesthesiology, Vagelos College of Physicians and Surgeons, Columbia University, 722 West 168th Street, Rm 524, New York, NY, 10032, USA
| | - Peter S Dayan
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHN-1-116, New York, NY, 10032, USA
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Ali B, Lawrence BA, Miller T, Allison J. Products and activities associated with non-fatal traumatic brain injuries in children and adolescents - United States 2010-2013. Brain Inj 2019; 33:1425-1429. [PMID: 31355679 DOI: 10.1080/02699052.2019.1631483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Traumatic brain injury (TBI) is prevalent in children and adolescents ages <1-19 years, yet we have limited understanding of consumer products that are associated with TBIs in children and adolescents of varying ages. To address this gap, we combined two data sources to investigate leading products and activities associated with TBIs in children and adolescents in different developmental age groups (i.e. <1, 1-4, 5-9, 10-14, and 15-19 years). Methods: We analysed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), augmented with product information from the National Electronic Injury Surveillance System (NEISS), for the years 2010 through 2013. Results: From 2010 to 2013, children and adolescents aged <1-19 years accounted for 4.1 million non-fatal TBI-related emergency department visits. TBIs from home furnishings and fixtures, primarily beds, were highest among infants aged <1 year and children aged 1-4 years. TBIs from sports/recreation, especially bicycles and football, were highest among those aged 5-9 years, 10-14 years, and 15-19 years. Conclusions: The combined NEISS and NEISS-AIP data allow us to comprehensively examine products and activities that contribute to emergency department visits for TBIs in children and adolescents. Our findings indicate priority areas for TBI prevention and intervention.
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Affiliation(s)
- Bina Ali
- a Pacific Institute for Research and Evaluation , Calverton , MD , USA
| | - Bruce A Lawrence
- a Pacific Institute for Research and Evaluation , Calverton , MD , USA
| | - Ted Miller
- a Pacific Institute for Research and Evaluation , Calverton , MD , USA
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Almansour KS, Arisco NJ, Woo MK, Young AS, Adamkiewicz G, Hart JE. Playground lead levels in rubber, soil, sand, and mulch surfaces in Boston. PLoS One 2019; 14:e0216156. [PMID: 31022281 PMCID: PMC6483242 DOI: 10.1371/journal.pone.0216156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/15/2019] [Indexed: 11/18/2022] Open
Abstract
Rubber surfacing is often used in playgrounds due to its potential injury prevention benefits and as a way to recycle waste tires. Available research on chemicals in recycled rubber has focused on synthetic turf applications, but is limited for playground rubber surfacing. Potential lead contamination from vulcanizing agents used in rubber surfacing are a possible concern; however this has not been researched. We examined levels of lead in poured-in-place rubber and compared them to levels in soil, sand, and wood mulch materials from 28 randomly selected playgrounds in Boston, MA, USA using X-ray fluorescence. To evaluate the association between material type and lead concentrations, we conducted a two-way ANOVA with repeated measures and built a linear regression model controlling for distance to major roadway, neighborhood-level status as an environmental justice area, peeling paint on the playground, and rubber condition. Average lead levels were 65.7 μg/g for soil, 22.0 μg/g for rubber, 8.5 μg/g for sand, and 9.0 μg/g for mulch. Our finding of lower concentrations of lead in sand and mulch compared to rubber and soil should be used to inform playground design to optimize children's health, alongside other chemical and safety considerations.
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Affiliation(s)
- Khaled S. Almansour
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Nicholas J. Arisco
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - May K. Woo
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Anna S. Young
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jaime E. Hart
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
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Falls in Hospitalized Children With Neurodevelopmental Conditions: A Cross-sectional, Correlational Study. Rehabil Nurs 2019; 43:335-342. [PMID: 29200409 DOI: 10.1097/rnj.0000000000000112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the current study was to investigate in-hospital falls among children with neurological or neurodevelopmental conditions and investigated associated child characteristics. DESIGN A cross-sectional, correlational study design was used in this study. A total of 446 patients were enrolled in the study, of which 298 were admitted with neurological conditions and 148 with neurodevelopmental conditions. METHODS Intelligent quotient (IQ) was assessed according to age, and the Humpty Dumpty Falls Scale (HDFS) was completed and scored for each participant. FINDINGS The neurodevelopmental group showed higher HDFS total mean score (p = .001) compared to the neurological group. We found that fall rates are more frequent (p = .003) in the neurodevelopmental group (12.9%) compared with the neurological group (5.1%). In addition, we found that, in both groups, HDFS total mean score correlates negatively with children's age, gender and IQ. CONCLUSIONS AND CLINICAL RELEVANCE The results of this study suggest that the fall prevention programs must be implemented in children with neurodevelopmental conditions, not only in children with neurological conditions.
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Outdoor Fitness Equipment Usage Behaviors in Natural Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030391. [PMID: 30704116 PMCID: PMC6388239 DOI: 10.3390/ijerph16030391] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/19/2019] [Accepted: 01/25/2019] [Indexed: 01/10/2023]
Abstract
Outdoor fitness equipment (OFE) areas have become a popular form of built environment infrastructure in public open spaces as a means to improve public health through increased physical activity. However, the benefits of using OFE are not consistent, and several OFE accidents have been reported. In this study, we videotaped how OFE users operate OFE in parks and selected four types of popular OFE (the waist twister, air walker, ski machine, and waist/back massager) for video content analysis. Furthermore, we established coding schemes and compared results with the instructions provided by OFE manufacturers. The results revealed various usage behaviors for the same OFE types. In addition, we observed that a significant portion of user behaviors did not follow manufacturers' instructions, which might pose potential risks or actually cause injuries. Children are especially prone to act improperly. This study provides empirical evidence indicating the existence of potential safety risks due to inappropriate usage behaviors that might lead to accidents and injuries while using OFE. This study provides crucial information that can be used to evaluate the effectiveness of OFE and to develop future park or open space initiatives.
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Suh D, Jung JH, Chang I, Lee JH, Jung JY, Kwak YH, Kim DK. Epidemiology of playground equipment related/unrelated injuries to children: A registry-based cohort study from 6 emergency departments in Korea. Medicine (Baltimore) 2018; 97:e13705. [PMID: 30558086 PMCID: PMC6320008 DOI: 10.1097/md.0000000000013705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of study was to understand the epidemiology of playground injury and to find the factors related to the clinically significant injuries. This retrospective observational study enrolled children (age 0-18 years old) who visited the emergency departments (ED) of 6 hospitals in Korea.We obtained and analyzed the data from the ED injury surveillance system, which was supported by the Korea Centers for Disease Control. Clinically significant injury (Cs injury) was defined as the injuries that caused hospital admission for more than one day. The factors associated with injury and clinical outcome were compared between admitted and discharged patient groups. Multivariable logistic regression and the population attributable fraction were used to identify significant factors for hospitalization.A total of 1458 patients were enrolled. The proportion of patients who visited ED due to injuries unrelated to the playground equipment use was 57.8%. The majority of Cs injury was upper extremity fractures (68.1%). The risk factors for admission were the 6- to 11-year old age group (OR 5.7, 95% CI 1.3-25.0) and public playground (OR 2.4, 95% CI 1.1-5.3); the population attributable factor of these factors was 51.3% and 36.0%, respectively.This study shows that approximately 60% of the patients visited ED due to injury unrelated to the playground equipment use. The risk factors of Cs injuries were ages 6 to 11 and public playgrounds. The results of the study can be helpful to formulate the prevention policy against playground injury.
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Affiliation(s)
- Dongbum Suh
- Department of Emergency Medicine, Seoul National University Hospital, Seongnam, Gyeonggi-do
| | - Jin Hee Jung
- Department of Emergency Medicine, Seoul National University Boramae Hospital, Seoul
| | - Ikwan Chang
- Kangwon National University College of Medicine, Chuncheon, Gangwon-do
| | - Jin Hee Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seongnam, Gyeonggi-do
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul
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Adelson SL, Chounthirath T, Hodges NL, Collins CL, Smith GA. Pediatric Playground-Related Injuries Treated in Hospital Emergency Departments in the United States. Clin Pediatr (Phila) 2018; 57:584-592. [PMID: 28937299 DOI: 10.1177/0009922817732144] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study analyzed pediatric playground-related injuries data from the National Electronic Injury Surveillance System. An estimated 5 025 440 children <18 years were treated in US emergency departments for playground-related injuries during 1990-2012, averaging 218 497 children annually. The average patient age was 6.5 years. The overall annual injury rate declined during 1990-2007 ( P < .001) and then increased during 2007-2012 ( P < .001). The climbing equipment-related injury rate remained constant during 1990-2009 and then increased during 2007-2012 ( P = .014). The concussion/closed head injury rate increased during 1990-2008 ( P < .002) with the rate almost doubling from 2008-2012 ( P < .001). Falls accounted for 76.7% of all injuries and 87.7% of injuries to the upper extremities. Injuries resulted in hospitalization for 4.3% of patients. Despite current playground safety standards and guidelines, a large number of playground-related injuries continue to occur. Revised impact attenuation criteria for playground surfacing materials should be implemented and evaluated to more adequately prevent fall-related upper extremity fractures.
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Affiliation(s)
- Sarah L Adelson
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,2 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Thitphalak Chounthirath
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA
| | - Nichole L Hodges
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,2 The Ohio State University College of Medicine, Columbus, OH, USA
| | - Christy L Collins
- 3 Datalys Center for Sports Injury and Prevention, Inc., Indianapolis, IN, USA
| | - Gary A Smith
- 1 Center for Injury Research and Policy at Nationwide Children's Hospital, Columbus, OH, USA.,2 The Ohio State University College of Medicine, Columbus, OH, USA.,4 Child Injury Prevention Alliance, Columbus, OH, USA
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Bierbaum M, Curtis K, Mitchell R. Incidence and cost of hospitalisation of children with injuries from playground equipment falls in New South Wales, Australia. J Paediatr Child Health 2018; 54:556-562. [PMID: 29111619 DOI: 10.1111/jpc.13777] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 09/10/2017] [Indexed: 11/30/2022]
Abstract
AIMS To describe the epidemiological profile and cost of hospitalised injuries caused by playground equipment falls of children aged 0-14 years, in New South Wales, Australia. METHODS Linked New South Wales hospitalisation data from 1 January 2010 to 30 June 2014 were used to describe the incidence of hospitalisation for playground falls, the age-standardised rate of hospitalisation per year, age group and gender, the characteristics of the injured children and the injury incident. Health outcomes, such as length of stay in hospital, and the hospital costs associated with the injuries were examined by age group. Negative binomial regression assessed the trend in hospitalisation rates over time. RESULTS There were 7795 hospitalisations of children for playground fall injuries. The highest hospitalisation rate was for the 5-9 year olds (220.7 per 100 000 population) and was higher in males than females (234.2 and 206.3 per 100 000 population, respectively). The majority of these injuries occurred in schools (17.1%) and homes (14.6%), and were as a result of falls from trampolines (34.3%) and climbing apparatuses (28.2%). Over half the playground falls led to fractures of the elbow and wrist (54.7%). The total hospital cost of playground fall-related injuries was $18 million. CONCLUSION Rates of hospitalisation of children for playground fall injuries remain high despite implementation of national playground safety standards in Australia. This research highlights where interventions should be targeted to reduce the incidence and burden of injuries following falls from playground equipment.
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Affiliation(s)
- Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Curtis
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Playground slide-related injuries in preschool children: increased risk of lower extremity injuries when riding on laps. Inj Epidemiol 2018; 5:13. [PMID: 29637487 PMCID: PMC5893512 DOI: 10.1186/s40621-018-0139-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this study was to better understand the factors associated with playground slide-related injuries in preschool children and to test the hypothesis that riding on laps increases the likelihood of lower extremity injuries. Methods Playground slide-related injuries (product code 1242) in children ≤5 years of age treated in emergency departments from 2002 to 2015 were identified (N = 12,686) using the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS). Descriptive and comparative analyses, including chi-square testing and binary logistic regression, were performed. Results Based on NEISS stratified national sampling estimates, over 350,000 children ≤5 years of age were injured on slides from 2002 to 2015. Overall, 59% of the children were male, and 65% were white. Almost 60% of injuries occurred in parks or other public areas. The most frequent diagnosis was a fracture (36%); lacerations were 19% of the injuries. A higher proportion of musculoskeletal injuries were seen in toddlers < 3 years old as compared to those 3–5 years of age (p < 0.001). Injuries to the lower extremities increased in frequency as age decreased, whereas injuries to the upper extremities and head/neck/face were more common in older preschoolers. Children < 3 years of age were 12 times more likely to be identified from narratives as being on another person’s lap at the time of injury. Children identified as being on a lap had an increased odds of injury to the lower extremity than to other body parts (OR 43.0, 95% confidence interval (CI) 32.0–58.0), and of lower leg/ankle fracture than fractures elsewhere (OR 49.5, 95% CI 31.7–77.4). Conclusions Decreasing age was associated with a higher likelihood of being identified as sliding down on another person’s lap and a higher likelihood of lower extremity injuries. Healthcare providers should be mindful of the potential for these slide-related injuries as they can result in a toddler’s fracture of the tibia, which may be occult. Parents should also be made aware of this increased risk and counseled that a child’s foot can catch on the slide’s surfaces when going down on a person’s lap with subsequent twisting forces that can result in a fracture.
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Richmond SA, Clemens T, Pike I, Macpherson A. A systematic review of the risk factors and interventions for the prevention of playground injuries. Canadian Journal of Public Health 2018; 109:134-149. [PMID: 29981068 DOI: 10.17269/s41997-018-0035-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/25/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The primary objectives of this work were to (1) identify the risk and/or protective factors associated with playground injuries among children less than 18 years of age and (2) identify interventions/programs/policies aimed at preventing playground-related injuries among children less than 18 years of age. Secondary objectives include a summary of the data that reflect alignment with current playground standards. METHODS For the primary outcome, 4 databases and 12 online resources were systematically searched to include observational and experimental studies examining risk and/or protective factors or interventions associated with playground injury or outcomes related to playground injury (e.g., risky playground behaviour). Data extraction included study design, participants, outcome, exposure or intervention, data analysis, and effect estimates. The quality of evidence for all studies was assessed using the Downs and Black criteria. RESULTS This review included studies of moderate quality, revealing a number of risk factors and effective interventions for playground injury. Risk factors included absence of handrails and guardrails on playground equipment, non-impact-absorbing surfacing, and critical fall heights. Effective interventions included modifying playground surfacing and reducing equipment height to less than 1.5 m. CONCLUSION Equipment- and structure-based playgrounds should adhere to and maintain playground standards in order to reduce the risk of serious injury. Organizations responsible for installing and maintaining playgrounds should consider alternative play spaces that allow children to play outdoors, in a natural environment that supports healthy child development and promotes physical activity.
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Affiliation(s)
- Sarah A Richmond
- Faculty of Health, Kinesiology and Health Science, York University, 339 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada.
| | - Tessa Clemens
- Faculty of Health, Kinesiology and Health Science, York University, 339 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, BC, Canada
| | - Alison Macpherson
- Faculty of Health, Kinesiology and Health Science, York University, 339 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
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Abib SDCV, Françóia AM, Waksman R, Dolci MI, Guimarães HP, Moreira F, BoarettoCezillo MV, Góes AM. Unintentional pediatric injuries in São Paulo. How often is it severe? Acta Cir Bras 2017; 32:587-598. [PMID: 28793043 DOI: 10.1590/s0102-865020170070000010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/05/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose: To evaluate severity and built a pilot of a national databank about pediatric trauma and to determine its severity. Methods: Prospective study of unintentional pediatric trauma in five hospitals in the city of São Paulo, Brazil. Results: 916 patients in 4 months. 61.5% of traumatized children were male, average 6.5 years. 48. 4% were falls. Most families had an average monthly income less than three minimum wages. 42% of accidents occurred at home. 18.9% of children were alone. 59,8% of parents thought it could be prevented. 26.5% of children had previous accidents. GCS was severe: 5 patients, moderate: 8 patients. 21 patients were intubated (2.4%), RTS <7 in 10.2%, PTS<8 in 3.6%. 8.5% patients were considered severe, which was related to falls (p=0.001); sports (p=0.045); pedestrian (p=0.006); child education (p=0.015) and cared by male (p=0.007). Conclusions: Severity occurred in 8.5% and was associated to falls, sports, traffic, child education, and cared by male. Simple preventive measures could have prevented most of the accidents. The tested tool for details was successful and can be used throughout the country.
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Affiliation(s)
- Simone de Campos Vieira Abib
- Associate Professor, Department of Surgery, Universidade Federal de São Paulo (UNIFESP). President, Organização Não Governamental (ONG) Criança Segura, Brazil. Conception and design of the study, analysis and acquisition of data, approval the final version to be published
| | - Alessandra Mara Françóia
- Ms, National Coordinator, ONG Criança Segura, São Paulo-SP, Brazil. Design of the study, analysis and acquisition of data
| | - Renata Waksman
- PhD, Department of Childhood Safety, Sociedade Brasileira de Pediatria, São Paulo-SP, Brazil. Design of the study, critical revision, approval the final version to be published
| | - Maria Inês Dolci
- Associação Brasileira de Defesa do Consumidor (PROTESTE), São Paulo-SP, Brazil. Design of the study, critical revision, approval the final version to be published
| | - Hélio Penna Guimarães
- PhD, Teaching and Simulation Center of HCor (CETES-HCor), São Paulo-SP, Brazil. Statistical analysis
| | - Frederico Moreira
- PhD, Teaching and Simulation Center of HCor (CETES-HCor), São Paulo-SP, Brazil. Statistical analysis
| | - Marcus Vinícius BoarettoCezillo
- Associate Professor, Department of Surgery, Universidade Federal de São Paulo (UNIFESP). President, Organização Não Governamental (ONG) Criança Segura, Brazil. Conception and design of the study, analysis and acquisition of data, approval the final version to be published
| | - Adenauer Marinho Góes
- Associate Professor, Department of Surgery, UNIFESP, and Universidade Federal do Pará (UFPA), Brazil. Critical revision, approval the final version to be published
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Cheng TA, Bell JM, Haileyesus T, Gilchrist J, Sugerman DE, Coronado VG. Nonfatal Playground-Related Traumatic Brain Injuries Among Children, 2001-2013. Pediatrics 2016; 137:peds.2015-2721. [PMID: 27244845 PMCID: PMC5599106 DOI: 10.1542/peds.2015-2721] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the circumstances, characteristics, and trends of emergency department (ED) visits for nonfatal, playground-related traumatic brain injury (TBI) among persons aged ≤14 years. METHODS The National Electronic Injury Surveillance System-All Injury Program from January 1, 2001, through December 31, 2013, was examined. US Census bridged-race population estimates were used as the denominator to compute rates per 100 000 population. SAS and Joinpoint linear weighted regression analyses were used to analyze the best-fitting join-point and the annual modeled rate change. These models were used to indicate the magnitude and direction of rate trends for each segment or period. RESULTS During the study period, an annual average of 21 101 persons aged ≤14 years were treated in EDs for playground-related TBI. The ED visit rate for boys was 39.7 per 100 000 and 53.5 for persons aged 5-9 years. Overall, 95.6% were treated and released, 33.5% occurred at places of recreation or sports, and 32.5% occurred at school. Monkey bars or playground gyms (28.3%) and swings (28.1%) were the most frequently associated with TBI, but equipment involvement varied by age group. The annual rate of TBI ED visits increased significantly from 2005 to 2013 (P < .05). CONCLUSIONS Playgrounds remain an important location of injury risk to children. Strategies to reduce the incidence and severity of playground-related TBIs are needed. These may include improved adult supervision, methods to reduce child risk behavior, regular equipment maintenance, and improvements in playground surfaces and environments.
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Affiliation(s)
- Tabitha A. Cheng
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia,The CDC Experience Applied Epidemiology Fellowship, Division of Scientific Education and Professional Development, Atlanta, Georgia
| | - Jeneita M. Bell
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Tadesse Haileyesus
- Division of Analysis, Research, and Practice Integration, National Center for Injury Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julie Gilchrist
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - David E. Sugerman
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
| | - Victor G. Coronado
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
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Sims-Gould J, Race D, Hamilton L, MacDonald H, Mulpuri K, McKay H. 'I fell off and landed badly': Children's experiences of forearm fracture and injury prevention. J Child Health Care 2016; 20:98-108. [PMID: 25326540 PMCID: PMC5059151 DOI: 10.1177/1367493514551311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Forearm fractures are one of the most common injuries sustained by children. Our descriptive study addressed, from the perspective of a child, the following research objectives: (1) to describe their fracture experience and (2) to describe how fractures might be prevented. Photovoice is a unique research strategy by which people create and discuss photographs. This technique has been used to elicit the perspectives of those whose voices are often 'not heard' in research, like children. Participants were recruited from a larger three-year prospective trial and included 10 boys (12.3 ± 1.6 years) and 7 girls (11.3 ± 1.6 years). We asked participants to take pictures to explain where their injury occurred (place), what they were doing at the time (context) and how the fracture had happened (mechanism). We also used semi-structured interview techniques. The following key themes emerged from our interviews: (1) the built environment as a key factor that 'caused' their fracture, (2) the fracture experienced as a journey not an event and (3) strategies to prevent fractures. A simple clinical step to potentially reduce subsequent fractures will be for clinicians to have a brief conversation with their young patients and to listen to the child's personal preventive strategies.
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Affiliation(s)
- Joanie Sims-Gould
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Douglas Race
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacDonald
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kishore Mulpuri
- Department of Orthopaedic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Heather McKay
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:6423-54. [PMID: 26062038 PMCID: PMC4483710 DOI: 10.3390/ijerph120606423] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/29/2015] [Accepted: 04/08/2015] [Indexed: 12/02/2022]
Abstract
Risky outdoor play has been associated with promoting children’s health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression. The review indicated the need for additional “good quality” studies; however, we note that even in the face of the generally exclusionary systematic review process, our findings support the promotion of risky outdoor play for healthy child development. These positive results with the marked reduction in risky outdoor play opportunities in recent generations indicate the need to encourage action to support children’s risky outdoor play opportunities. Policy and practice precedents and recommendations for action are discussed.
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Measurement of the Effect of Playground Surface Materials on Hand Impact Forces During Upper Limb Fall Arrests. J Appl Biomech 2014; 30:276-81. [DOI: 10.1123/jab.2013-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Distal radius fractures are common on playgrounds. Yet current guidelines for the selection of playground surface materials are based only on protection against fall-related head injuries. We conducted “torso release” experiments to determine how common playground surface materials affect impact force applied to the hand during upper limb fall arrests. Trials were acquired for falls onto a rigid surface, and onto five common playground surface materials: engineered wood fiber, gravel, mulch, rubber tile, and sand. Measures were acquired for arm angles of 20 and 40 degrees from the vertical. Playground surface materials influenced the peak resultant and vertical force (P< .001), but not the peak horizontal force (P= .159). When compared with the rigid condition, peak resultant force was reduced 17% by sand (from 1039 to 864 N), 16% by gravel, 7% by mulch, 5% by engineered wood fiber, and 2% by rubber tile. The best performing surface provided only a 17% reduction in peak resultant force. These results help to explain the lack of convincing evidence from clinical studies on the effectiveness of playground surface materials in preventing distal radius fractures during playground falls, and highlight the need to develop playground surface materials that provide improved protection against these injuries.
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Abstract
OBJECTIVES To assess playground safety and quality in Chicago, Illinois, identify disparities in access, and use the data to inform collaborative improvement. METHODS A cross-sectional survey of public park playgrounds in Chicago, Illinois, was conducted in 2009, 2010, and 2011 by using the National Program for Playground Safety Standardized Survey. All playgrounds were surveyed in 2009 and 2010; those that failed in 2010 were resurveyed in 2011. Playgrounds were assessed in 4 main categories: age-appropriate design, fall surfacing, equipment maintenance, and physical environment. Safety scores were generated from the assessment. Geographic information system mapping provided a visual description of the playground pass/fail rate based on neighborhood, child population, race/ethnicity, and poverty level. RESULTS Of the ∼500 playgrounds, 467 were assessed in 2009, and 459 were assessed in 2010. In 2009, half of all playgrounds (55%) and in 2010, nearly two-thirds (61%) earned scores consistent with safe playgrounds (P < .001). Playgrounds scored poorest in fall surfacing and equipment maintenance. Geographic information system mapping showed neighborhoods with a higher percentage of children and impoverished families had fewer playgrounds and more failing playgrounds. In 2011, 154 (85%) of the playgrounds that failed in 2010 were surveyed. The mean playground score among failing playgrounds improved significantly between 2010 (61%) and 2011 (67%, P < .001). CONCLUSIONS Since the playground improvement initiative began in 2009, considerable progress has been made in the safety scores, although access to high-quality playgrounds varies by neighborhood. Many failing playgrounds can be brought up to standard with improvement in fall surfacing and equipment maintenance.
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Affiliation(s)
- Erin M Allen
- Baylor College of Medicine, 3925 Fairmont Parkway, Pasadena, TX 77504, USA.
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Branson LJ, Latter J, Currie GR, Nettel-Aguirre A, Embree T, Hagel BE. The effect of surface and season on playground injury rates. Paediatr Child Health 2012; 17:485-489. [PMID: 24179416 PMCID: PMC3496349 DOI: 10.1093/pch/17.9.485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2012] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To examine the effect of season on playground surface injury rates. METHODS Injuries were identified through student incident report forms used in school districts in Calgary (Alberta) and the surrounding area. Playground surface exposure data were estimated based on school enrollment. RESULTS A total of 539 injuries were reported during the 2007/2008 school year. Abrasions, bruises and inflammation were the most frequently reported injuries. The head, neck or face were most commonly injured. Injury rates per 1000 student days ranged between 0.018 (rubber crumb in spring) and 0.08 (poured-in-place and natural rock in the fall). Rubber crumb surfacing, compared with natural rock, had a significantly lower rate of injury in the spring, but no other season-surface comparisons were statistically significant. CONCLUSIONS Rates of injury were similar for natural rock, poured-in-place, and crushed rock in the fall and winter. There was some evidence of a lower rate of injury on rubber crumb surfaces in the spring.
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Affiliation(s)
| | - John Latter
- Department of Clinical Neurosciences and Paediatrics, Faculty of Medicine
| | - Gillian R Currie
- Department of Paediatrics
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Alberto Nettel-Aguirre
- Department of Paediatrics
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta
| | | | - Brent Edward Hagel
- Department of Paediatrics
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta
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Abstract
Obese children have a theoretically increased risk of sustaining an extremity fracture because of potential variations in their bone mineral density, serum leptin levels, and altered balance and gait. Trauma databases suggest an increased rate of extremity fractures in obese children and adolescents involved in polytrauma compared with nonobese children and adolescents. Anesthetic and other perioperative concerns for obese pediatric trauma patients undergoing surgery include higher baseline blood pressures, increased rates of asthma, and obstructive sleep apnea. A child's weight must be considered when choosing the type of implant for fixation of pediatric femoral fractures. Fracture prevention strategies in obese pediatric patients consist of ensuring properly sized safety gear for both motor vehicles and sporting activities and implementing structured weight-loss programs.
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Affiliation(s)
- Meredith A Lazar-Antman
- Pediatrics Division, Department of Orthopaedic Surgery, Winthrop-University Hospital 222 Station Plaza North, Suite 305, Mineola, NY 11501, USA.
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Abstract
Background Rapid urbanization and unplanned population development can be detrimental to the safety of citizens, with children being a particularly vulnerable social group. In this review, we assess childhood playground injuries and suggest safety mechanisms which could be incorporated into playground planning. Methods Inclusion criteria were “children” as the focus group, “playground” as the main field of study, and “unintentional injury” and “safety” as the concepts of study. The keywords used for the PubMed search were “playground”, “children”, and “injury”. Initially we 182 articles. After screening according to inclusion criteria, 86 articles were found, and after reading the abstracts and then the full text, 14 articles were finally included for analysis. The papers reviewed included four case-control studies, three case studies, three descriptive studies, two interventional studies, one retrospective study, one cross-sectional study, and one systematic review. Results Playground-related fractures were the most common accidents among children, underscoring the importance of safety promotion and injury prevention in playgrounds, lowrisk equipment and playing hours (week days associated with higher risk), implementation of standards, preventing falls and fall-related fractures, and addressing concerns of parents about unsafe neighborhoods. With the exception of one study, all of the reviewed papers had not implemented any practical safety plan. Safe engineering approaches were also ignored. Conclusion We recommend a systematic safety approach based on the “safety circle” which includes three main areas, ie, equipment, environment, and children.
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Abstract
PURPOSE To study the cost of sustaining a fracture of the extremity caused by playground equipment. These costs include financial, psychological, clinical and others like loss of school days. METHOD This is a prospective study of 226 children seen at the Paediatric Orthopaedic Department for a1-year period starting June 2005. Once confirmed to have a playground related fracture by the Orthopaedic specialist, three sets of data are collected. First is the clinical data. Second is the playground related data. This is done on site independently by another investigator. Third is the radiological data,which is assessed independently by an Orthopaedic surgeon to ensure consistency. RESULTS Out of the 226 children seen, two-thirds were boys. The average age was 7.5 years. 35.8% were forearm fractures and 28.8% were supracondylar fractures with the rest being mostly fractures in the upper limb. 64.2% were treated with immobilisation only whilst 24.2% required closed manipulation and reduction. 1.2% required admission for treatment of their fractures. The average period of cast immobilisation was 34 days. The average number of consults, including that at the emergency department, was 4 with an average length of follow up of 67.2 days. Based on the above, in our institution, the average cost for outpatient treatment would be about S$680.00 (US$485.71) (US$1.00 = S$1.40; 1/1/2010) per injury. The inpatient cost for non-surgical treatment cost would be S$1000.00 and for surgical stabilisation the average cost would be S$3300.00 (US$2357.14). CONCLUSION Playgrounds are meant for children to play safely. Yet, there appears to be a significant number of injuries sustained. Whilst these fractures are relatively minor, requiring outpatient treatment,there are costs. Besides the financial costs, there are hidden psychological costs of loss of school days and inability to participate in sports. Finally, as with any injury, there can be long-term complications which present further clinical costs. SIGNIFICANCE Most studies on playground injuries tend to concentrate on the equipment and very superficially cover the clinical aspects, less so the costs. This paper looks at the clinical aspects in greater depth and emphasises that there are significant costs, beyond financial, when a child sustains a playground injury. The next thing to do is to examine what playgrounds factors significantly contribute to these injuries and remedy them when planning the construction of playgrounds.
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Affiliation(s)
- Kenneth Wong Pak Leung
- Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
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Composite playground safety measure to correlate the rate of supracondylar humerus fractures with safety: an ecologic study. J Pediatr Orthop 2010; 30:101-5. [PMID: 20179553 DOI: 10.1097/bpo.0b013e3181d07689] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND More than 200,000 children are injured at playgrounds in the United States each year. Our goal was to introduce a composite measure of playground safety and use this instrument to correlate the incidence of supracondylar humerus fractures with playground safety in an ecologic study design. METHODS We used a novel "overall-safety rating," defined as a composite of 3 previously validated instruments (National Program for Playground Safety School score, surface depth compliance, and the use zone compliance) to measure the overall safety of all playgrounds within a region. The regions were rated from most to least safe based on average playground safety as measured by this new method. The incidence of supracondylar fractures was calculated using Hasbro Children's Hospital Emergency Department data and state of Rhode Island Census data from 1998 to 2006. The incidence was then correlated with playground safety as defined by our composite measure. RESULTS Compared with the neighborhood deemed the safest, the least safe district had 4.7 times greater odds of supracondylar humerus fracture. Overall composite safety score of the district was linearly correlated with the injury rate observed in the population at risk (R=0.98; P=0.04). CONCLUSIONS Using our novel composite playground safety score, we found that the incidence of supracondylar humerus fractures was increased in districts with playgrounds with lower scores, suggesting that improvements in playground infrastructure may potentially reduce the incidence of supracondylar humerus fractures, and other injuries, in children. LEVEL OF EVIDENCE Level IV.
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Abstract
BACKGROUND The purpose of this study is to investigate the relationship between children who sustain tibia fractures on a playground slide and the mechanism of injury. METHODS This retrospective review included the chart and radiographs of all children diagnosed with a tibia fracture, over an 11-month period. All patients were originally seen in either the emergency room of a level 1 trauma center or the treating physician's office. RESULTS During the period of study, 58 fractures of the tibia were found. Eight (13.8%) of the tibia fractures were sustained while playing on a playground slide. The 8 fractures identified are the focus of this study. The tibia fractures were nondisplaced, diaphyseal, with an intact fibula. There were 5 female and 6 male children included in the study. The age range of the patients with a tibia fracture sustained while going down a slide was 14 months to 32 months; the average age of the 8 children in this study was 20.6 months. The average age of boys sustaining a tibia fracture on a playground slide was found to be 20.7 months and the average age of girls was found to be 20.6 months. All tibia fractures associated with playing on a slide were sustained while going down the slide on the lap of an adult. None of the 8 children studied went down the slide alone. CONCLUSIONS Children at risk for tibia fractures sustained while going down a playground slide, on the lap of an adult, were found to be less than 32 months of age. Many parents believe they are increasing the safety of their young child by placing the child on their lap while going down a playground slide. Parents should be educated not to go down a slide with a child on their lap. If the child is unable to use the slide independently, another activity would be more appropriate. LEVEL OF EVIDENCE Therapeutic study, level IV.
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Randazzo C, Stolz U, Hodges NL, McKenzie LB. Pediatric tree house-related injuries treated in emergency departments in the United States: 1990-2006. Acad Emerg Med 2009; 16:235-42. [PMID: 19281495 DOI: 10.1111/j.1553-2712.2009.00352.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to describe the epidemiology of tree house-related injuries in the United States among children and adolescents. METHODS The authors conducted a retrospective analysis using data from the National Electronic Injury Surveillance System for patients < or =19 years who were treated in an emergency department (ED) for a tree house-related injury from 1990 through 2006. RESULTS An estimated 47,351 patients < or =19 years of age were treated in EDs for tree house-related injuries over the 17-year study period. Fractures were the most common diagnosis (36.6%), and the upper extremities were the most commonly injured body part (38.8%). The odds of sustaining a head injury were increased for children aged <5 years. Falls were the most common injury mechanism (78.6%) and increased the odds of sustaining a fracture. Falls or jumps from a height > or =10 feet occurred in 29.3% of cases for which height of the fall/jump was recorded. Boys had significantly higher odds of falling or jumping from a height of > or =10 ft than girls, and children 10 to 19 years old also had significantly higher odds of falling or jumping from a height of > or =10 feet, compared to those 9 years old and younger. The odds of hospitalization were tripled if the patient fell or jumped from > or =10 feet and nearly tripled if the patient sustained a fracture. CONCLUSIONS This study examined tree house-related injuries on a national level. Tree house safety deserves special attention because of the potential for serious injury or death due to falls from great heights, as well as the absence of national or regional safety standards. The authors provide safety and prevention recommendations based on the successful standards developed for playground equipment.
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Affiliation(s)
- Charles Randazzo
- College of Medicine, The Ohio State University, Columbus, OH, USA
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Vollman D, Witsaman R, Comstock RD, Smith GA. Epidemiology of playground equipment-related injuries to children in the United States, 1996-2005. Clin Pediatr (Phila) 2009; 48:66-71. [PMID: 18648079 DOI: 10.1177/0009922808321898] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study is to describe the epidemiology of playground equipment-related injuries. This is a retrospective analysis of data for children 18 years old and younger from the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1996 through 2005. There were an estimated 2,136,800 playground equipment-related injuries to children 18 years and younger treated in hospital emergency departments in the United States during the 10-year period. The leading mechanism of injury was falls (75.1%), followed by impact/striking (10.5%), cutting/ pinching/crushing (7.7%), entrapment/ entanglement (1.4%), trip/slip (1.1%), and other/ unknown (4.1%). The leading type of injury sustained by patients was a fracture (35.4%), followed by contusion/ abrasion (19.6%) and laceration (19.6%). The consistency of the large annual number of playground equipment-related injuries to children is evidence that more needs to be done to prevent these injuries. More research should be conducted to develop and implement arm fracture-specific criteria for surface performance.
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Affiliation(s)
- David Vollman
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Chadwick DL, Bertocci G, Castillo E, Frasier L, Guenther E, Hansen K, Herman B, Krous HF. Annual risk of death resulting from short falls among young children: less than 1 in 1 million. Pediatrics 2008; 121:1213-24. [PMID: 18519492 DOI: 10.1542/peds.2007-2281] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of the work was to develop an estimate of the risk of death resulting from short falls of <1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday. METHODS A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed. RESULTS The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers. CONCLUSIONS The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.
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Affiliation(s)
- David L Chadwick
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
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Abstract
BACKGROUND/PURPOSE There have been many different studies of injuries owing to playground equipment but none that have looked in detail using large nationwide databases. It was the purpose of this study to investigate injuries owing to playground equipment using the National Electronic Injury Surveillance System (NEISS) database and further understand their demographics. METHODS Detailed NEISS injury data from 2002 through 2004 for slides, monkey bars, and swings were analyzed. Appropriate statistical analyses were performed; because of the many analyses on this large data set, P < .01 was considered statistically significant. RESULTS There were 22728 emergency department visits owing to playground equipment injuries recorded by NEISS between 2002 and 2004; 83.9% were owing to monkey bars, swings, and slides, and the 5 most common diagnoses were fractures (39.3%), contusions/abrasions (20.6%), lacerations (16.6%), strains/sprains (9.9%), and traumatic brain injuries (TBI) (8.5%). There were 9487 boys (54.3%) and 7995 girls (45.7%). The average age was 6.5 +/- 3.0 years. The injuries occurred at school in 38.9%; at a recreation/sporting facility, in 35.5%; and at home, in 25.6%. Most were treated and released (94.4%). Amerindian children were 2 times more likely than blacks to be admitted; compared to contusions, fractures were 9.8 times, and TBIs, 4.7 times more likely to be admitted. Injuries on monkey bars were 1.2 times more likely to be admitted than those on swings or slides. Fractures were 1.9 times more likely to occur on a monkey bar compared with swings or slides. Traumatic brain injuries were 1.4 times more likely to occur on a swing compared to slides or monkey bars. CONCLUSION Swings at school are the most common mechanism of injury for TBIs, and the seasonal data would suggest that increased supervision of children using swings during school hours might reduce the occurrence of TBIs. Monkey bars are the most common cause of fracture, and fracture is the most common cause of admission. Prevention strategies to reduce the number of fractures should be directed at monkey bar equipment and landing surfaces. The trend in playground equipment injury also indicates that monkey bars are problematic because the number of injuries per year per capita owing to monkey bars is stable, whereas those from swings and slides is decreasing.
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Affiliation(s)
- Randall T Loder
- Department of Orthopaedic Surgery, Indiana School of Medicine, Indiana University, IN 46202, USA.
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Bayreuther J, Maconochie I. The evidenced-based care behind the early management of head injured children. TRAUMA-ENGLAND 2008. [DOI: 10.1177/1460408608088770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Trauma remains the highest cause of death in children over the age of 1. Head injury accounts for the highest mortality. There is much information on the treatment of head injuries and indications for CT scanning. This review aims to summarise the key differences between paediatric and adult victims of trauma and outline the key steps in management of head injured children, from prevention through to who should have a CT scan and initial management in the emergency department (ED) if transfer is required to a PICU or neurosurgical unit. Information is also provided on recommendations for follow up of children who do not require PICU or neurosurgical care.
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Affiliation(s)
- Jane Bayreuther
- Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK,
| | - Ian Maconochie
- St Marys Paddington, St Mary's NHS Trust, Praed Street, London W2 1NY, UK
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Khambalia A, Joshi P, Brussoni M, Raina P, Morrongiello B, Macarthur C. Risk factors for unintentional injuries due to falls in children aged 0-6 years: a systematic review. Inj Prev 2007; 12:378-81. [PMID: 17170185 PMCID: PMC2564414 DOI: 10.1136/ip.2006.012161] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify risk factors for unintentional injuries due to falls in children aged 0-6 years. DESIGN A systematic review of the literature. METHODS Electronic databases from 1966 to March 2005 were comprehensively searched to identify empirical research that evaluated risk factors for unintentional injuries due to falls in children aged 0-6 years and included a comparison group. RESULTS 14 studies met the inclusion criteria. Studies varied by the type of fall injury that was considered (ie, bunk bed, stairway, playground or infant walker) and with respect to the quality of evidence. In general, major risk factors for the incidence or severity of injuries due to falls in children included age of the child, sex, height of the fall, type of surface, mechanism (dropped, stairway or using a walker), setting (day care v home care) and socioeconomic status. CONCLUSION Despite a high burden, few controlled studies have examined the risk and protective factors for injuries due to falls in children aged 0-6 years. The only study to examine falls from a population health perspective suggests that age, sex and poverty are independent risk factors for injuries due to falls in children.
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Affiliation(s)
- A Khambalia
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
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Tan NC, Ang A, Heng D, Chen J, Wong HB. Evaluation of playground injuries based on ICD, E codes, international classification of external cause of injury codes (ICECI), and abbreviated injury scale coding systems. Asia Pac J Public Health 2007; 19:18-27. [PMID: 17784655 DOI: 10.1177/10105395070190010501] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The survey is aimed to describe the epidemiology of playground related injuries in Singapore based on the ICD-9, AIS/ ISS and PTS scoring systems, and mechanisms and causes of such injuries according to E codes and ICECI codes. A cross-sectional questionnaire survey examined children (< 16 years old), who sought treatment for or died of unintentional injuries in the ED of three hospitals, two primary care centers and the sole Forensic Medicine Department of Singapore. A data dictionary was compiled using guidelines from CDC/WHO. The ISS, AIS and PTS, ICD-9, ICECI v1 and E codes were used to describe the details of the injuries. 19,094 childhood injuries were recorded in the database, of which 1617 were playground injuries (8.5%). The injured children (mean age=6.8 years, SD 2.9 years) were predo-minantly male (M:F ratio = 1.71:1). Falls were the most frequent in-juries (70.7%) using ICECI. 25.0% of injuries involved radial and ulnar fractures (ICD-9 code). 99.4% of these injuries were minor, with PTS scores of 9-12. Children aged 6-10 years, were prone to upper limb injuries (71.1%) based on AIS. The use of international coding systems in injury surveillance facilitated standardisation of description and comparison of playground injuries.
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Affiliation(s)
- N C Tan
- SingHealth Polyclinics, Singapore.
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Jandrić S. Effects of physical therapy in the treatment of the posttraumatic elbow contractures in the children. Bosn J Basic Med Sci 2007; 7:29-32. [PMID: 17489764 PMCID: PMC5802282 DOI: 10.17305/bjbms.2007.3085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pediatric post-traumatic elbow contracture can occur as result of the various injuries of area of the elbow joint. The aim of the study was to investigate the effect of the physical therapy and rehabilitation on the range of the motion of the elbow joint in the post-traumatic elbow contractures in the childhood. We analyzed in this research 54 children (average age 9,4+/-3,15 years) that were treated because of posttraumatic elbow contractures. Kinesitherapy, occupational therapy and other procedures physical therapy are used in the management. Range of the motion of the elbow was measured at the beginning and the end of the therapy for every child. Functional outcome was presented in degree from 1 to 3 (Flynn). Satisfied result of the therapy at the discharge was in the 94, 45% of the children and 74, 07 % of the children had excellent result The difference in the grade at the beginning and the end of the therapy is statistically significant (t= 13,72, p<0,001). Significant improvement of the range of the motion in the elbow joint in the children with post-traumatic elbow contracture is attained by physical therapy.
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Affiliation(s)
- Slavica Jandrić
- Institute for rehabilitation Dr Miroslav Zotović, M. Kraljevića 20, 78 000 Banjaluka, RS, Bosnia and Herzegovina
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Rubie-Davies CM, Townsend MAR. Fractures in New Zealand elementary school settings. THE JOURNAL OF SCHOOL HEALTH 2007; 77:36-40. [PMID: 17212758 DOI: 10.1111/j.1746-1561.2007.00160.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is a need for greater international understanding of student safety in schools. This New Zealand study investigated the causes and school location of fractures sustained by students attending elementary school, with special emphasis on the types of fractures sustained following falls from playground equipment of various heights. METHODS Over a 1-year period, 76 participating schools (with a combined roll of over 25,000 students) completed a questionnaire about the nature and circumstances of student fractures sustained during regular school hours. RESULTS Some 118 students sustained a total of 131 fractures. Injuries from playground equipment were no more frequent than those from general activities at school, and most were sustained in falls from heights less than 59 inches. Most fractures were to the upper limbs. Fractures were found to vary by gender and school size. CONCLUSIONS The results are discussed in terms of the conditions and policies present in local schools, and the tension that exists in maintaining safety while offering appropriate challenges to students. Improvements in school safety may be more likely to result from a greater focus on the way that students interact at school, rather than on modifications to playground equipment.
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Sharp D. Child's play: striking a balance. J Urban Health 2005; 82:350-2. [PMID: 16033930 PMCID: PMC3456047 DOI: 10.1093/jurban/jti098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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