Advertisement

Trends and Patterns of Playground Injuries in United States Children and Adolescents

      Objective.—To determine the prevalence, trends, and severity of injuries attributable to playground falls relative to other common unintentional mechanisms that resulted in an emergency department (ED) visit in the United States.
      Design and Setting.—Data from the emergency subset of the National Hospital Ambulatory Medical Care Survey collected from 1992 to 1997 for children <20 years.
      Methods.—Injury rates and 95% confidence intervals (CIs) were estimated and injury severity scores were computed.
      Results.—There were 920 551 (95% CI: 540 803 to 1 300 299) ED visits over the 6-year study period by children and adolescents that were attributable to falls from playground equipment. The annual incidence of visits for playground injuries did not significantly decrease over the course of the study (187 000 to 98 000, P = .053). Injury visits for playground falls were twice as prevalent as pedestrian mechanisms, but they were less prevalent than visits for motor vehicle– and bicycle-related injuries. A larger proportion of playground falls resulted in “moderate-to-severe” injury than did bicycle or motor vehicle injuries. Children aged 5 to 9 years had the highest number of playground falls (P = .0014). Playground falls were most likely to occur at school compared to home, public, and other locations (P = .0016).
      Conclusions.—Playground injury emergency visits have not significantly declined and remain a common unintentional mechanism of injury. Injury visits for playground falls were proportionally more severe than injury visits attributable to other common unintentional mechanisms. Interventions targeting schools and 5- to 9-year-old children may have the greatest impact in reducing emergency visits for playground injuries.

      KEY WORDS

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Bijur PE
        • Trumble A
        • Harel Y
        • et al.
        Sports and recreation injuries in US children and adolescents.
        Arch Pediatr Adolesc Med. 1995; 149: 1009-1016
        • Di Scala C
        • Gallagher SS
        • Schneps SE
        Causes and outcomes of pediatric injuries occurring at school.
        J School Health. 1997; 67: 384-389
        • Warner M
        • Barnes B
        • Fingerhut L
        Injury and Poisoning Episodes and Conditions; National Health Interview Survey, 1997. Centers for Disease Control/National Center for Health Statistics, Hyattsville, Md2000
      1. Playground-related injuries in preschool-aged children—United States, 1983–1987.
        Morbid Mortal Wkly Rep. 1988; 37: 629-632
      2. Playground safety—United States, 1998–1999.
        Morbid Mortal Wkly Rep. 1999; 48: 329-332
        • Mack M
        • Thompson D
        • Hudson S
        Playground injuries in the 90's.
        Playground Recreation. 1998; : 81-94
        • Drago DA
        • Winston FK
        • Baker SP
        Clothing drawstring entrapment in playground slides and school buses. Contributing factors and potential interventions.
        Arch Pediatr Adolesc Med. 1997; 151: 72-77
        • Sacks JJ
        • Smith JD
        • Kaplan KM
        • et al.
        The epidemiology of injuries in Atlanta day-care centers.
        JAMA. 1989; 262: 1641-1645
        • Anonymous
        Playground injuries.
        NY State J Med. 1988; 88: 667-668
        • Mack MG
        • Hudson S
        • Thompson D
        A descriptive analysis of children's playground injuries in the United States 1990–4.
        Inj Prev. 1997; 3: 100-103
        • Sacks JJ
        • Brantley MD
        • Holmgreen P
        • Rochat RW
        Evaluation of an intervention to reduce playground hazards in Atlanta child-care centers.
        Am J Public Health. 1992; 82: 429-431
        • McCaig LF
        • McLemore T
        Plan and operation of the National Hospital Ambulatory Medical Care Survey. National Center for Health Statistics.
        Vital Health Stat. 1994; 1: 1-79
      3. The Abbreviated Injury Scale. Update 98. Association for the Advancement of Automotive Medicine, Des Plaines, Ill1990
        • Osler T
        • Baker SP
        • Long W
        A modification of the injury severity score that both improves accuracy and simplifies scoring.
        J Trauma Inj Infect Crit Care. 1997; 43: 922-926
        • Sacco W
        • MacKenzie E
        • Champion H
        • et al.
        Comparison of alternative methods for assessing injury severity based on anatomic descriptors.
        J Trauma Inj Infect Crit Care. 1999; 47: 441-447
        • Marganitt B
        • MacKenzie EJ
        • Deshpande J
        • et al.
        Hospitalizations for traumatic injuries among children in Maryland—trends in incidence and severity 1979 through 1988.
        Pediatrics. 1992; 89: 608-613
        • Baker S
        • O'Neill B
        • Haddon W
        • Long WB
        The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.
        Trauma. 1974; 14: 187-196
        • Wan G
        • Neffsmith M
        The impact of demographics, injury severity, and trauma type on the likelihood of survival in child and adolescent trauma patients.
        J Trauma. 1996; 40: 412-416
      4. Tri-Analytics I ICDMAP-90 Bel Air, Md; 1998

        • MacKenzie E
        • Steinwachs D
        • Shankar B
        Classifying severity of trauma based on hospital discharge diagnoses: validation of an ICD-9CM to AIS-85 conversion table.
        Med Care. 1989; 27: 412-422
        • MacKenzie E
        • Morris J
        • Smith G
        • Fahey M
        Acute hospital costs of trauma in the United States: implications for regionalized systems of care.
        J Trauma. 1990; 30: 1096-1103
        • Shah B
        • Barnwell BG
        • Bieler GS
        SUDAAN User's Manual, Release 7.5. Research Triangle Institute, Research Triangle Park, NC1997
        • Burt C
        • Fingerhut L
        Injury Visits to Hospital Emergency Departments: United States, 1992–95. National Center for Health Statistics. Vital Health Statistics, Hyattsville, Md1998
        • Fleiss J
        Statistical Methods for Rates and Proportions. 2nd ed. John Wiley & Sons, New York1981
        • Macarthur C
        • Hu X
        • Wesson D
        • Parkin P
        Risk factors for severe injuries associated with falls from playground equipment.
        Accid Anal Prev. 2000; 32: 377-382
        • Durbin D
        • Winston F
        • Applegate S
        • et al.
        Development and validation of the injury severity assessment survey/parent report.
        Arch Pediatr Adolesc Med. 1999; 153: 404-408
        • Hoff W
        • Tinkoff GH
        • Lucke JF
        • Lehr S
        Impact of minimal injuries on a level I trauma center.
        J Trauma. 1992; 33: 408-412
        • Robertson L
        Injury Epidemiology. 2nd ed. Oxford University Press, Oxford1998
        • Rivara F
        • Grossman DC
        Prevention of traumatic deaths to children in the United States: how far have we come and where do we need to go?.
        Pediatrics. 1996; 97: 791-797
        • Sibert J
        • Mott A
        • Rolfe K
        • et al.
        Preventing injuries in public playgrounds through partnership between health services and local authority: community intervention study.
        BMJ. 1999; 318: 1595
        • Laraque D
        • Barlow B
        • Durkin M
        • Heagarty M
        Injury prevention in an urban setting: challenges and successes.
        Bull NY Acad Med. 1995; 72: 16-30
        • Chalmers DJ
        • Marshall SW
        • Langley JD
        • et al.
        Height and surfacing as risk factors for injury in falls from playground equipment: a case-control study.
        Inj Prev. 1996; 2: 98-104
        • Briss PA
        • Sacks JJ
        • Addiss DG
        • et al.
        A nationwide study of the risk of injury associated with day care center attendance.
        Pediatrics. 1994; 93: 364-368
        • Sacks JJ
        • Holt KW
        • Holmgreen P
        • et al.
        Playground hazards in Atlanta child care centers.
        Am J Public Health. 1990; 80: 986-988
        • Alkon A
        • Genevro JL
        • Tschann JM
        • et al.
        The epidemiology of injuries in 4 child care centers.
        Arch Pediatr Adolesc Med. 1999; 153: 1248-1254
        • Mott A
        • Evans R
        • Rolfe K
        • et al.
        Patterns of injuries to children on public playgrounds.
        Arch Dis Child. 1994; 71: 328-330
        • Coppens N
        • Gentry L
        Video analysis of playground injury-risk situations.
        Res Nursing Health. 1991; 14: 129-136
        • Pellegrini AD
        • Davis PD
        Relations between children's playground and classroom behaviour.
        Br J Educ Psychol. 1993; 63: 88-95
        • Laraque D
        • Barlow B
        • Davidson L
        • Welborn C
        The Central Harlem playground injury prevention project: a model for change.
        Am J Public Health. 1994; 84: 1691-1692
        • Davidson L
        • Durkin M
        • Kuhn L
        • et al.
        The impact of the Safe Kids/Healthy Neighborhoods Injury Prevention Program in Harlem, 1988 through 1991.
        Am J Public Health. 1994; 84: 580-586
        • von Kries R
        • Kohne C
        • Bohm O
        • von Voss H
        Road injuries in school age children: relation to environmental factors amenable to interventions.
        Inj Prev. 1998; 4: 103-105
        • Mott A
        • Rolfe K
        • James R
        • et al.
        Safety of surfaces and equipment for children in playgrounds.
        Lancet. 1997; 349: 1874-1876
        • Mowat DL
        • Wang F
        • Pickett W
        • Brison RJ
        A case-control study of risk factors for playground injuries among children in Kingston and area.
        Inj Prev. 1998; 4: 39-43
        • Waltzman ML
        • Shannon M
        • Bowen AP
        • Bailey MC
        Monkeybar injuries: complications of play.
        Pediatrics. 1999; 103: e58