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Unintentional injuries in school-aged children and adolescents: lessons from a systematic review of cohort studies
  1. J Mytton1,
  2. E Towner1,
  3. M Brussoni2,
  4. S Gray3
  1. 1
    Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
  2. 2
    Centre for Community Child Health Research, University of British Columbia, Vancouver, Canada
  3. 3
    Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
  1. Dr J Mytton, Centre for Child and Adolescent Health, Hampton House, Cotham Hill, Bristol BS6 6JS, UK; Julie.Mytton{at}


Objectives: To critically synthesise current knowledge of the patterns of injuries and risk factors for injury in school-aged children, to summarise the evidence and support effective child injury prevention initiatives.

Design: Systematic review.

Selection criteria and methods: Prospective cohort studies reporting unintentional injuries in healthy children aged 5–18 years were identified by searching 15 electronic databases and additional grey literature sources. A narrative synthesis was conducted of papers meeting quality criteria, with risk factors analysed at individual, family and environmental levels. Limitations of existing evidence were considered.

Results: 44 papers from 18 different cohort studies met the inclusion criteria. There were broad and consistent patterns of injury across time and place. Male sex, psychological, behavioural and risk-taking behaviour problems, having a large number of siblings, and a young mother were all associated with increased injury occurrence across more than one cohort and setting.

Conclusions: Descriptive epidemiology and risk factors for injury were derived from prospective cohort studies, but few studies used the full potential of their design. Opportunities to use repeated measures to assess temporal changes in injury occurrence, and the exploration of risk factors, particularly those related to the child’s environment, have rarely been undertaken. Few studies were conducted in low/middle-income countries where the burden of injury is greatest. These findings should be considered when planning future research and prevention initiatives.

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  • Contributors: All authors of this paper fulfil the criteria for authorship, and there are no other people who fulfil the criteria but have not been listed as authors. All authors were involved in the conception and design of the review. JM developed and conducted the searches and identified the included studies. JM, ET and MB conducted the data extraction and critical appraisal. JM conducted the analyses and prepared the drafts with critical support from ET, MB and SG. JM is the guarantor.

  • Funding: None.

  • Competing interests: None.