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  1. L. M. Ryan,
  2. J. L. Wright
  1. Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC


Background More than 200,000 children less than 15 years of age are treated per year in US emergency departments (ED) for playground-related injuries. The majority of such injuries occur on public playgrounds; most occur at schools. Most injuries occur when children fall from equipment onto the ground. Cost of care is estimated at $7.5 billion annually.

Objective To characterize the epidemiology of ED-evaluated playground injuries occurring in an urban public school system.

Design/Methods All 168 schools in the 65,000 pupil District of Columbia public school system are supported by an on-site registered nurse. Clinical practice policy mandates that school nurses prenotify the ED at Children's National Medical Center (CNMC) for all students requiring emergency referral. Since 2003, referrals and associated ED treatment records are incorporated into a database to facilitate illness and injury surveillance and tracking. Injury data were analyzed for school year 2003-2004 to identify cases of playground injury. Descriptive epidemiologic and bivariate analysis was conducted.

Results During this period, 161 students, ages 3-19, were referred by a school nurse and evaluated at CNMC ED. Seventy-nine (49.1%) referrals were due to injury. Of injured students, 13 (16.4%) were playground related. The most common mechanism of injury was a fall from playground equipment (69.2%). Fractures (46.1%) and lacerations (30.7%) were the most common types of injury. All playground-related fractures were due to falls from monkey bars. The rate of fracture for playground-injured students (556/1,000 student-years) was significantly higher than the rates of fracture for all injured patients in the same age range seen in the CNMC ED during calendar year 2003 (134/1,000 patient-years, RR = 4.15, 95% CI 3.51-4.90).

Conclusion Fractures are overrepresented as an outcome of school playground injuries and are predominantly the result of falls from equipment. Opportunities for intervention should include further evaluation of urban school playground safety, including playground maintenance and injury patterns.

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