School-injury determinants and characteristics: developing an investigation instrument from a literature review

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Abstract

The school constitutes an environment of public-health concern since it is the location of occurrence of a major proportion of injuries sustained by children. This paper reviews a total of 42 empirical studies dealing with the determinants and characteristics of injuries to school pupils. On the basis of the review, a proposal is made for a specialized instrument (SIIR) dedicated to the analysis and registration of injuries and incidents at school. It addresses the `who?', `where?' and `what?' questions usually posed in traditional instruments for injury surveillance but places far greater emphasis on the `how?' and `why?' questions of injury. SIIR enables the injury phenomenon to be subjected to greater scrutiny, and is designed to support preventive work at school level. For one school-year, it is also being employed for the creation of a data register for research and development purposes.

Introduction

The school constitutes an environment of public-health concern since it accounts for an important proportion of injuries sustained by children. Since 1991, Sweden has approached the issue of school-related health by stipulating in its labor legislation that all pupils (aged six and over) are covered by the provisions of the Work Environment Act in the same way as adult workers. The promotion and development of safe and healthy `work' conditions even at school has been regarded as of great importance.

As a result, with their 1.2 million pupils, Swedish schools have collectively become one of Sweden's biggest workplaces, and the prevention of school-injuries has been placed on the occupational research agenda (Menckel, 1994). Accordingly, a review of the literature has been undertaken to identify the injury determinants and characteristics particular to the school environment and pupils to which attention has already been drawn in the literature (both those upon which there is general agreement and those less sparsely investigated). The review has served as a basis for the elaboration of a pupil-injury analysis instrument designed to support preventive work at school level, and also to assess surveillance and research needs.

This paper presents the results of the review and describes the instrument elaborated.

Section snippets

Framework for the review

The analytic framework within which the review was conducted is presented in Fig. 1. It distinguishes an injury from the accident sequence that precedes it, and highlights the types of factors that may initiate/trigger harmful sequences of this kind (injury determinants). The framework is based on the conception that accident sequences result from interactions between pupils, the school environment and the community as a whole. Its general perspective is inspired by what has become virtually a

Literature search and selection

The relevant scientific literature of the past four decades was gathered together through searches in a variety of databases, and through scrutiny of reference lists and lists of publications. Searches were made in the international databases NIOSHTIC, MEDLINE, PSYCH INFO, SPRILINE and Eric, and in the Swedish databases ARBLINE and SWEMED. The key words employed for all searches were `accident/injury' in combination with `school/student/pupil/playground/athletics/sports'.

A preliminary review of

Results of the review

A total of 42 studies were scrutinized in detail. They are grouped in Table 1, according to their object of study, in the following categories: (1) injury epidemiology, all school grades considered, community-based (18 articles, of which 16 are reviewed in Laflamme and Menckel, 1997); (2) injury epidemiology, particular levels or courses (6 articles); (3) sports-related injuries (10 articles); (4) injuries in the schoolyard (3 articles); (5) individual factors as injury determinants (6

Knowledge accumulated so far

The material accumulated so far on school-injury characteristics and determinants indicates that injury rate and injury severity tend to vary considerably from school to school, but the reasons for this have been only sparsely investigated. The evidence suggests, however, that injury frequency varies with school level/grade, that playground injuries are more common among young pupils, and that injuries in organized gymnastics and sports tend to become more important as age increases. Injury

Conclusions

The epidemiology of school-injuries has been the concern of a number of empirical studies over the years. The findings so far largely focus on individual characteristics and school activities and locations as injury determinants. Regarding the school as the work environment of pupils, however, has prompted the conception of an analytic frame that encompasses wider aspects of school-injury genesis, looked at jointly in a systemic perspective. Taken as a whole, the knowledge already available has

Acknowledgements

This work was sponsored in part by Sweden's National Institute of Public Health and by the Swedish Council for Working Life. The authors are grateful to Associate Professor Lothar Schelp for his creative suggestions regarding the injury-surveillance form.

References (56)

  • T. Boyce et al.

    Playground equipment injuries in a large, urban school district

    American Journal of Public Health

    (1984)
  • T. Boyce et al.

    Epidemiology of injuries in a large, urban school district

    Pediatrics

    (1984)
  • S. Bremberg et al.

    Injuries at school, influence of schoolmate interaction

    Acta Paediatrica Scandinavia

    (1988)
  • R.B. Chambers

    Orthopaedic injuries in athletes (ages 6 to 17). Comparison of injuries occurring in six sports

    American Journal of Sports Medicine

    (1979)
  • K.S. Clarke et al.

    Women's injuries in collegiate sports. A preliminary comparative overview of three seasons

    American Journal of Sports Medicine

    (1980)
  • S.C. Clarke

    A survey of sports-related spinal injuries in schools and colleges, 1973–1975

    Journal of Safety Research

    (1977)
  • N.M. Coppens et al.

    Video analysis of playground injury-risk situations

    Research in Nursing and Health

    (1991)
  • M. Dale et al.

    Are schools safe? Analysis of 409 student accidents in elementary schools

    Clinical Pediatrics

    (1969)
  • S. Declich et al.

    Public health surveillance: historical origins, methods and evaluation

    Bulletin of the World Health Organization

    (1994)
  • M. de Loës et al.

    Risk exposure and incidence of injuries in school physical education at different activity levels

    Canadian Journal of Sport Science

    (1990)
  • W. Feldman et al.

    Prospective study of school injuries: incidence, types, related factors and initial management

    Canadian Medical Association Journal

    (1983)
  • J. Fortin

    Les accidents à l'école maternelle. Étude épidémiologique et perspective de prévention

    Revue de Pédiatrie

    (1984)
  • J.G. Garrick et al.

    Injuries in high school sports

    Pediatrics

    (1978)
  • I. Goldie et al.

    Störst risk för inaktiva elever att skadas i skolidrotten

    Läkartidningen

    (1990)
  • Graitcer, P. L. (1992) Injury surveillance. In Halperin, W. and Baker, E. Jr (eds), Public Health Surveillance, pp....
  • W. Halperin

    Occupational health surveillance

    Health and Environmental Digest

    (1993)
  • A. Hammarström et al.

    Epidemiology of school injuries in the northern part of Sweden

    Scandanavian Journal of Medicine

    (1994)
  • A. Hammer et al.

    Children injured during physical education lessons. Nine hundred and eighteen cases

    Journal of Sports Medicine

    (1981)
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