Preventing injuries in public playgrounds through partnership between health services and local authority: community intervention study

Pediatric tree house-related injuries treated in emergency departments in the United States: 1990-2006

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.

Attendance for injury at accident and emergency departments in London: a cross-sectional study

OBJECTIVE

In order to set the foundation for the possible development of injury surveillance initiatives in north-west London, data on all presentations during 2002 at the nine accident and emergency departments (AEDs) in the relevant strategic health authority were examined.

STUDY DESIGN

Descriptive, cross-sectional study.

METHODS

A search algorithm was devised to extract records pertaining to injury presentations. The results were validated against a manually checked sample. Descriptive, quantitative analyses were performed.

RESULTS

Only four of the nine hospitals in the study area routinely recorded data in a form useful for research on injury. In these four hospitals, presentations with injury accounted for 29.7% of total attendances at the AED, which is markedly lower than the national average.

CONCLUSIONS

Certain characteristics of London regarding provision of primary care may explain why attendances for injury are proportionately low. However, the unusual pattern also underlines the importance of improving the quality of AED data in order to support adequate local surveillance of injury as the basis of efforts to prevent such incidents and to plan services to deal with injuries.

Efficacy of the North American guidelines for children's agricultural tasks in reducing childhood agricultural injuries

OBJECTIVES

We assessed whether active dissemination of the North American Guidelines for Children's Agricultural Tasks (NAGCAT) reduced childhood agricultural injuries.

METHODS

In this randomized controlled trial, lay educators visited intervention farms to review NAGCAT. New York State farms with resident or working children were randomized. Control farms were visited only to collect baseline data. Data on childhood injuries, tasks, and hours worked were obtained quarterly for 21 months. Injury rates per farm were compared between the treatment and control groups, along with time span to occurrence of an injury and to violation of NAGCAT age guidelines.

RESULTS

Intervention farms were less likely than control farms to violate NAGCAT age guidelines in the areas of all-terrain-vehicle use and tractor and haying operations. Cox proportional hazards regression models showed a significant protective effect of the intervention on preventable injuries after adjustment for important covariates.

CONCLUSIONS

Our results showed that dissemination of NAGCAT reduced rates of work-related childhood agricultural injuries. A comprehensive public health approach is needed to reduce non-work-related childhood injuries.

Poor neighborhoods: safe playgrounds

Although unstructured physical play is helpful to child development and physical activity is important to obesity prevention, up-to-date information about playgrounds and playground hazards in urban areas is limited. Local data are needed to identify problems and target interventions. The aim of this study was to describe the hazards in playgrounds located in low-income (median dollars 28,728-38,915) and very low-income (median dollars 18,266-18,955) Chicago neighborhoods. Using a standardized on-site survey (National Program for Playground Safety), two investigators reviewed seventy-eight public playgrounds for hazards related to playground design, safe surfaces, supervision, and equipment design and maintenance. The design of 56 playgrounds (72%) posed no hazards. One playground lacked protection from motor vehicles, and 21 had minor flaws. One playground had an asphalt surface; all others had protective surfaces, usually wood chips. The chips were too thin in many places, and in 15 playgrounds (19%), at least one concrete footing was exposed. Trash was a common surface hazard (68%). Although most equipment was safe (swings of soft materials and appropriate platform barriers), many pieces needed repairs. Equipment maintenance hazards included gaps (44%) and missing (38%) or broken parts (35%). In 13 of 39 playgrounds (33%) where children were observed playing, one or more were unsupervised. Playgrounds in very low-income neighborhoods more often had trash in the fall zone and exposed footings (P<.01 for each); there were no differences between low and very low-income neighborhoods in playground design or equipment maintenance. We conclude that playgrounds in low-income Chicago neighborhoods are of good design and have appropriate surfaces. Needed improvements include attention to wood chip depth, the removal of trash from the fall zone, and equipment repairs. Greater adult supervision is warranted.

Playground safety and access in Boston neighborhoods

BACKGROUND

Youth physical activity is partly influenced by access to playgrounds and recreational opportunities. Playgrounds in disadvantaged areas may be less safe.

METHODS

Investigators assessed safety at 154 playgrounds in Boston between July 2000 and July 2001. Playgrounds were geocoded and safety scores assigned to census block groups (CBGs). For each of Boston's 591 CBGs, investigators calculated the total number youth and proportions of black residents, adults without a high school degree, and youth living in poverty. Investigators assigned each CBG a safety score, and calculated distance from the CBG centroid to the nearest playground and nearest "safe" playground (top safety quartile). Statistical analyses were completed using SAS PROC GENMOD by October 2002.

RESULTS

In bivariate analysis, playground safety was inversely associated with total CBG youth population (p =0.001) and proportions of black residents (p <0.001), youth in poverty (p =0.003) and residents with no high school degree (p <0.002). The proportion of black residents in the CBG was inversely associated with safety (p =0.013), independent of CBG educational attainment and numbers of youth. The average distance was 417 meters to the nearest playground and 1133 meters to the nearest "safe" playground. Distance to the nearest playground was inversely associated with the proportion of residents with no high school degree (p <0.0001) after controlling for numbers of youth and proportion of black residents. CBGs with more youth had greater distances to the safest playgrounds (p =0.04).

CONCLUSIONS

In Boston, playground safety and access to playgrounds varied according to indicators of small-area socioeconomic and racial/ethnic composition.

Injury and frequency of use of playground equipment in public schools and parks in Brisbane, Australia

OBJECTIVE

The purpose of this study was to determine the frequency of use of play equipment in public schools and parks in Brisbane, Australia, and to estimate an annual rate of injury per use of equipment, overall and for particular types of equipment.

METHODS

Injury data on all children injured from playground equipment and seeking medical attention at the emergency department of either of the two children's hospitals in the City of Brisbane were obtained for the years 1996 and 1997. Children were observed at play on five different pieces of play equipment in a random sample of 16 parks and 16 schools in the City of Brisbane. Children injured in the 16 parks and schools were counted, and rates of injury and use were calculated.

RESULTS

The ranked order for equipment use in the 16 schools was climbing equipment (3762 uses), horizontal ladders (2309 uses), and slides (856 uses). Each horizontal ladder was used 2.6 times more often than each piece of climbing equipment. Each horizontal ladder was used 7.8 times more than each piece of climbing equipment in the sample of public parks. Slides were used 4.6 times more than climbing equipment in parks and 1.2 times more in public schools. The annual injury rate for the 16 schools and 16 parks under observation was 0.59/100 000 and 0.26/100 000 uses of equipment, respectively.

CONCLUSIONS

This study shows that annual number of injuries per standardized number of uses could be used to determine the relative risk of particular pieces of playground equipment. The low overall rate of injuries/100 000 uses of equipment in this study suggests that the benefit of further reduction of injury in this community may be marginal and outweigh the economic costs in addition to reducing challenging play opportunities.

[Playground safety: an introduction to the problem]

This study aims to approach the theme of accident prevention in relation to the use of playground toys, which is little explored in national literature. It is estimated that, annually, more than 200,000 accidents with children happen in playgrounds in the United States of America. Besides discussing this problem, we present some general recommendations about safety in these places and a reflection on the need to alert and educate society about the importance of prevention.

Development and use of a population based injury surveillance system: the all Wales Injury Surveillance System (AWISS)

This report details the development and use of a population based emergency room surveillance system in the UK. Despite some difficulties in accessing high quality data the system has stimulated a considerable number of research and intervention projects. While surveillance systems with high quality data collection and coding parameters remain the gold standard, imperfect systems, particularly if population based, can play a substantial part in stimulating injury prevention initiatives.

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 920551 (95% CI: 540803 to 1300299) 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 (187000 to 98000, 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.

Alliteration in medicine: a puzzling profusion of p's

PROBLEM

Puzzling, progressive profusion of alliterative "p's" in published papers.

PURPOSE

To depict this particular "p" predominance with pinpoint precision. PLAN: Periodic, painstaking perusal of periodicals by a professor of paediatrics.

PROPOSAL

The "p" plethora is positively perplexing and potentially perturbing.