Abstract
Background
To prevent school injuries, thorough epidemiological data is an essential foundation. We aimed to investigate the characteristics of school injuries in Asia and explore risk factors for major trauma.
Methods
This retrospective study was conducted in the participating centers of the Pan-Asian Trauma Outcome Study from October 2015 to December 2020. Subjects who reported “school” as the site of injury were included. Major trauma was defined as an Injury Severity Score (ISS) value of ≥16.
Results
In total, 1305 injury cases (1.0% of 127,715 events) occurred at schools. Among these, 68.2% were children. Unintentional injuries were the leading cause and intentional injuries comprised 7.5% of the cohort. Major trauma accounted for 7.1% of those with documented ISS values. Multivariable regression revealed associations between major trauma and factors, including age, intention of injury (self-harm), type of injury (traffic injuries, falls), and body part injured (head, thorax, and abdomen). Twenty-two (1.7%) died, with six deaths related to self-harm. Females represented 28.4% of injuries but accounted for 40.9% of all deaths.
Conclusions
In Asia, injuries at schools affect a significant number of children. Although the incidence of injuries was higher in males, self-inflicted injuries and mortality cases were relatively higher in females.
Impact
-
Epidemiological data and risk factors for major trauma resulting from school injuries in Asia are lacking.
-
This study identified significant risk factors for major trauma occurring at schools, including age, intention of injury (self-harm), injury type (traffic injuries, falls), and body part injured (head, thoracic, and abdominal injuries).
-
Although the incidence of injuries was higher in males, the incidence of self-harm injuries and mortality rates were higher in females.
-
The results of this would make a significant contribution to the development of prevention strategies and relative policies concerning school injuries.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 14 print issues and online access
$259.00 per year
only $18.50 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
Data availability
The datasets analyzed during the current study are not publicly available due the regulations of PATOS organizations but are available from the corresponding author on reasonable request approved by the PATOS EXCO meeting mainly composed of data-contributing principal investigators. The contact of the PATOS coordination center is listed below. Ms. Suhee Agnes KIM, MPH. Laboratory of Emergency Medical Services, Biomedical Research Institute. Seoul National University Hospital, Seoul, South Korea. Tel: +2 2072 4683; Mobile: +82 10 8572 7715; http://lems.re.kr/ E-mail: suheekimsnuh@gmail.com.
References
F. Howard, editors. Safe and Healthy School Environments. New York, 2006; online edn, Oxford Academic, 2009.
Joseph, N. et al. Awareness, attitudes and practices of first aid among school teachers in Mangalore, south India. J. Prim. Health Care 7, 274–281 (2015).
Olympia, R. P., Wan, E. & Avner, J. R. The preparedness of schools to respond to emergencies in children: a national survey of school nurses. Pediatrics 116, e738–e745 (2005).
Linakis, J. G., Amanullah, S. & Mello, M. J. Emergency department visits for injury in school-aged children in the United States: a comparison of nonfatal injuries occurring within and outside of the school environment. Acad. Emerg. Med. 13, 567–570 (2006).
Yang, C. Y., Yeh, Y. C., Cheng, M. F. & Lin, M. C. The incidence of school-related injuries among adolescents in Kaohsiung, Taiwan. Am. J. Prev. Med. 15, 172–177 (1998).
Al-Hajj, S., Nehme, R., Hatoum, F., Zheng, A. & Pike, I. Child school injury in Lebanon: A study to assess injury incidence, severity and risk factors. PLoS One 15, e0233465 (2020).
Park, H. A. et al. Epidemiologic characteristics of injured school-age patients transported via emergency medical services in Korea. J. Korean Med. Sci. 33, e73 (2018).
Wickramasinghe, S. et al. Serious non-fatal unintentional injuries among in-school adolescents in Sri Lanka: results from the 2016 Sri Lankan global school-based health survey. BMC Public Health 20, 1697 (2020).
Bremberg, S. Is school-based reporting of injuries at school reliable? A literature review and an empirical study. Accid. Anal. Prev. 21, 183–189 (1989).
Al Zeedi, M. A. S., Al Waaili, L. H., Al Hakmani, F. M. & Al Busaidi, A. M. Incidence of school-related injuries among students in A’Dakhiliyah Governorate Schools, Oman. Oman Med. J. 35, 127 (2020).
Khan, U. R., Bhatti, J. A., Zia, N. & Farooq, U. School-based injury outcomes in children from a low-income setting: results from the pilot injury surveillance in Rawalpindi city, Pakistan. BMC Res. Notes 6, 86 (2013).
Gratz, R. R. School injuries: what we know, what we need. J. Pediatr. Health Care 6, 256–262 (1992).
Sun, K. M. et al. Comparison of emergency medical services and trauma care systems among Pan-Asian countries: An international, multicenter, population-based survey. Prehosp. Emerg. Care 21, 242–251 (2017).
Kong, S. Y. et al. Pan-Asian trauma outcomes study (PATOS): Rationale and methodology of an international and multicenter trauma registry. Prehosp. Emerg. Care 22, 58–83 (2018).
Lee, M. C. et al. PATOS clinical research network. epidemiology and prehospital care of pediatric unintentional injuries among countries with different economic status in Asia: A cross-national, multi-center observational study. Prehosp. Emerg. Care 27, 227–237 (2023).
Wang, P. Y. et al. PATOS clinical research network. Characteristics of non-accidental injuries in children and adolescents in Asia: a cross-national, multicenter cohort study. Sci. Rep. 13, 6602 (2023).
van der Staay, L. U., Koestner, C. & Dietz, P. Differences in work and commuting accidents between employees and students at higher education institutions in Rhineland-Palatinate, Germany, from December 2014 to December 2019. Int J. Environ. Res Public Health 20, 2462 (2023).
Josse, J. M., MacKay, M., Osmond, M. H. & MacPherson, A. K. School injury among Ottawa-area children: a population-based study. J. Sch. Health 79, 45–50 (2009).
Goldstick, J. E., Cunningham, R. M. & Carter, P. M. Current causes of death in children and adolescents in the United States. N. Engl. J. Med 386, 1955–1956 (2022).
Ou, Z. et al. Global burden and trends of firearm violence in 204 countries/territories from 1990 to 2019. Front Public Health 10, 966507 (2022).
Kucera, K. L. et al. Incidence of sport-related internal organ injuries due to direct-contact mechanisms among high school and collegiate athletes across 3 national surveillance systems. J. Athl. Train. 54, 152–164 (2019).
Wasserman, D., Carli, V., Iosue, M., Javed, A. & Herrman, H. Suicide prevention in childhood and adolescence: a narrative review of current knowledge on risk and protective factors and effectiveness of interventions. Asia Pac. Psychiatry 13, e12452 (2021).
Walsh, E. H., McMahon, J. & Herring, M. P. Research Review: The effect of school-based suicide prevention on suicidal ideation and suicide attempts and the role of intervention and contextual factors among adolescents: a meta-analysis and meta-regression. J. Child Psychol. Psychiatry 63, 836–845 (2022).
Dowd, M. D., Keenan, H. T. & Bratton, S. L. Epidemiology and prevention of childhood injuries. Crit. Care Med. 30, S385–S392 (2002).
Fadel, S. A. et al. Trends in cause-specific mortality among children aged 5–14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies. Lancet 393, 1119–1127 (2019).
Özdemir, S., Akça, H. Ş., Algın, A., Kokulu, K. & Özkan, A. Characteristics of school injuries presenting to the emergency department. Avicenna J. Med. 12, 61–66 (2022).
Hawton, K. et al. Clustering of suicides in children and adolescents. Lancet Child Adolesc. Health 4, 58–67 (2020).
Gore, G. C., Magdalinos, H. & Pless, I. B. School injuries and preventive policies and programs. Can. J. Public Health 95, 424–428 (2004).
Barber, C. W. & Miller, M. J. Reducing a suicidal person’s access to lethal means of suicide: a research agenda. Am. J. Prev. Med. 47, S264–S272 (2014).
Acknowledgements
We acknowledge all participating PATOS sites for excellent collaboration as well as the data quality assurance of the PATOS coordination center at Seoul National University Hospital to improve prehospital and in-hospital care for trauma patients in Asia. The authors also thank Yu-Yun Wu, Su-Mei Wang, and Chin-Hao Chang, staff of the National Taiwan University Hospital Statistical Consulting Unit for their help with the statistical consultation.
Funding
This study was supported by grants from Taiwan Ministry of Science and Technology (MOST) (MOST 106-2314-B-002-208-MY1, MOST 107-2314-B-002-011, MOST 108-2314-B-002-130-MY3, MOST 105-2314-B-002-200-MY3, MOST 109-2314-B-002-154-MY2) and National Taiwan University Hospital Yun-Lin Branch (NTUHYL.111.S017).
Author information
Authors and Affiliations
Consortia
Contributions
S.-H.C.: Writing—Original Draft, Formal analysis, Visualization. M.-C.L.: Writing—Review & Editing. P-.-Y.W.: Writing—Review & Editing. W-.-C.T.: Conceptualization, Writing—Original Draft, Formal analysis, Writing—Review & Editing. W.-C.C.: Conceptualization, Writing—Review & Editing, Supervision. M-.H.-M.M.: Writing—Review & Editing, Supervision. S-.D.S.: Methodology, Validation, Resources, Project administration. J.-T.S.: Methodology, Validation, Resources, Project administration. S.F.J.: Methodology, Validation, Resources, Project administration. H.T.: Methodology, Validation, Resources, Project administration. D.N.S.: Methodology, Validation, Resources, Project administration. K.J.H.: Methodology, Validation, Resources, Project administration.
Corresponding authors
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval and consent to participate
All methods were carried out in accordance with relevant guidelines and regulations. This research did not involve human embryos, gametes, and stem cells. Ethical approval was obtained from the coordinating center of the Institutional Review Board of the National Taiwan University Hospital (NTUH-202111004RIND), and all centers involved in the PATOS collaboration had local ethical approval. Written inform consent was waived by National Taiwan University Hospital Ethic committee because the designs of retrospective, and data were anonymous and de-identified to the analyzer.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Chen, SH., Lee, MC., Wang, PY. et al. Characteristic of school injuries in Asia: a cross-national, multi-center observational study. Pediatr Res 95, 1080–1087 (2024). https://doi.org/10.1038/s41390-023-02884-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41390-023-02884-9
