School-injury determinants and characteristics: developing an investigation instrument from a literature review
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)
A better understanding of occupational accident genesis to improve safety in the workplace
Journal of Occupational Accidents
(1990)- et al.
The epidemiology of school-related injuries: New perspectives
American Journal of Preventative Medicine
(1992) - et al.
School accidents during a three school-years period in a Swedish municipality
Public Health
(1991) - et al.
Two years of school injuries in a Scottish education sub-division
Public Health
(1996) Locomotor skills and school accidents
Pediatrics
(1975)- Arizona Department of Health Services (1983) Final report for a study of the nature, incidence, and consequences of...
- et al.
Injuries in high school physical education classes
American Journal of Diseases of Children
(1980) School accidents
Health Bulletin
(1986)- et al.
School injuries. Epidemiology and clinical features of 307 cases registered at hospital during one school year
Scandanavian Journal of Primary Care
(1991) - et al.
Recurrent injuries in schoolchildren
American Journal of the Diseases of Children
(1989)
Playground equipment injuries in a large, urban school district
American Journal of Public Health
Epidemiology of injuries in a large, urban school district
Pediatrics
Injuries at school, influence of schoolmate interaction
Acta Paediatrica Scandinavia
Orthopaedic injuries in athletes (ages 6 to 17). Comparison of injuries occurring in six sports
American Journal of Sports Medicine
Women's injuries in collegiate sports. A preliminary comparative overview of three seasons
American Journal of Sports Medicine
A survey of sports-related spinal injuries in schools and colleges, 1973–1975
Journal of Safety Research
Video analysis of playground injury-risk situations
Research in Nursing and Health
Are schools safe? Analysis of 409 student accidents in elementary schools
Clinical Pediatrics
Public health surveillance: historical origins, methods and evaluation
Bulletin of the World Health Organization
Risk exposure and incidence of injuries in school physical education at different activity levels
Canadian Journal of Sport Science
Prospective study of school injuries: incidence, types, related factors and initial management
Canadian Medical Association Journal
Les accidents à l'école maternelle. Étude épidémiologique et perspective de prévention
Revue de Pédiatrie
Injuries in high school sports
Pediatrics
Störst risk för inaktiva elever att skadas i skolidrotten
Läkartidningen
Occupational health surveillance
Health and Environmental Digest
Epidemiology of school injuries in the northern part of Sweden
Scandanavian Journal of Medicine
Children injured during physical education lessons. Nine hundred and eighteen cases
Journal of Sports Medicine
Cited by (27)
Quantitative analysis of school safety events in China
2020, Journal of Safety Science and ResilienceUnintentional injuries at school in China - Patterns and risk factors
2006, Accident Analysis and PreventionCitation Excerpt :The injury rate was 7.4 per year per 100 students aged 5 to 19. LaFlamme et al. (1998) reviewed 42 studies related to school injuries and found that injury frequency varied with school level/grade, that playground injuries were more common among young pupils, and that injuries in organized gymnastics and sports tended to become more important as age increased. Injury rate and injury severity tended to vary considerably from school to school, but the reasons for this have been sparsely investigated.
Solving a linear model of nonfatal risk behavior and injuries in school children
2001, Computer Methods and Programs in BiomedicineMultiple attribute entropy classification of school-age injuries
2000, Accident Analysis and PreventionCitation Excerpt :The major proportion of non-fatal childhood injuries is sustained at school. Studies have been conducted in a variety of countries aimed at targeting risk groups for effective preventive programs (Pagano et al., 1987; Bergstrom and Bjornstig, 1991; Lenaway et al., 1992; Sosin et al., 1993; Laflamme and Menckel, 1997; Di Scala et al., 1997; Laflamme et al., 1998). Beside school injuries, injuries in sports and recreation are very common in school-age (Garrick and Requa, 1978; Austin et al., 1980; Zaricznyj et al., 1980; Boyce et al., 1984; De Loes et al., 1990; Sahlin, 1990; Chalmers et al., 1996).
Injuries in Swedish schools during recesses: Distribution and patterns
1999, Safety Science