[School accidents--an epidemiological assessment of injury types and treatment effort]

Adolescent school injuries and classroom sex compositions in German secondary schools

BACKGROUND

School injuries are an important adolescent health problem. Previous research suggests that relevant risk behaviors for school injuries, risk-taking and aggression, are highly susceptible to peer effects. Specifically, evidence suggests that the ratio of men and women in peer groups (sex ratio) affects individuals' propensity for aggression and risk-taking. However, potential associations of classroom sex ratios with adolescent school injury risks have not been studied so far. The purpose of this paper is to investigate the association of classroom sex compositions with adolescent school injuries.

METHODS

We investigate the association of classroom sex ratios with school injuries in a longitudinal survey dataset containing 13,131 observations from 9,204 adolescent students (ages 13-16) from secondary schools in Germany. The data also allow us to identify injuries due to aggressive behavior and analyze these injuries in detail. We use multilevel logistic regression models to analyze risks of both overall and aggression-related school injuries.

RESULTS

Adolescent students' risk for school injuries is significantly and positively associated with male-skewed classroom sex ratios (OR = 1.012, p=0.012). Specifically, the risk of sustaining a school injury increases by 33.5 percent when moving from the 10th to the 90th classroom sex ratio percentile. Moreover, we find an even stronger positive association between male-dominated classrooms and aggression-related injury risks (OR = 1.022, p=0.010). Compared to classroom sex ratios at the 10th percentile, the risk of an aggression-related injury is 78 percent higher in classrooms with a sex ratio at the 90th percentile. Finally, we find that both boys' and girls' injury risks equally increase with a higher proportion of male students in their classroom.

CONCLUSIONS

Our findings indicate that sex composition of classrooms is an important contextual factor for adolescent school injuries, in particular school injuries resulting from aggression. These findings illustrate the need to integrate a contextual perspective on school injuries among adolescent students both into research and into intervention planning.

School environment and school injuries

Background: Although injuries at school are an important issue in public health, environmental factors in schools and school yards have seldom been the focus of school injury research. The goal of our investigation was to examine the effect of environmental factors on school injuries.

Methods: Nine comprehensive Finnish schools registered school injuries over a period of two school years. Injuries were classified as being associated with environmental factors, suspected environmental factors, and others. The consensus between two independent classifiers was 81%.

Results: A total of 722 injuries were classified. In 11.6% of these injuries, the physical environment factor was evident, and in 28.1% of the injuries, physical environment was suspected of being a contributory risk factor. Thus the physical environment of the school was a contributing factor in over a third (39.7%) of injuries occurring in the school, on the school yard or during the journey to, or from school. In this study, conducted in Finland, ice on the ground was mentioned most frequently as an environmental risk factor.

Conclusion: In Finland, the Nordic weather conditions are not taken into account in the school yard and playground plans as they ought to from the safety point of view. An initiative has been launched on a mandatory wintertime master plan for every school yard.

School accidents in Austria

The aim of this study was to obtain information about the mechanisms and types of injuries in school in Austria. Children between 0 and 18 years of age presenting with injuries at the trauma outpatient in the Department of Pediatric Surgery in Graz and six participating hospitals in Austria were evaluated over a 2-year prospective survey. A total of 28,983 pediatric trauma cases were registered. Personal data, site of the accident, circumstances and mechanisms of accident and the related diagnosis were evaluated. At the Department of Pediatric Surgery in Graz 21,582 questionnaires were completed, out of which 2,148 children had school accidents (10%). The remaining 7,401 questionnaires from peripheral hospitals included 890 school accidents (12%). The male/female ratio was 3:2. In general, sport injuries were a predominant cause of severe trauma (42% severe injuries), compared with other activities in and outside of the school building (26% severe injuries). Injuries during ball-sports contributed to 44% of severe injuries. The upper extremity was most frequently injured (34%), followed by lower extremity (32%), head and neck area (26%) and injuries to thorax and abdomen (8%). Half of all school related injuries occur in children between 10 and 13 years of age. There are typical gender related mechanisms of accident: Boys get frequently injured during soccer, violence, and collisions in and outside of the school building and during craft work. Girls have the highest risk of injuries at ball sports other than soccer.