Intentional injuries leading to ED visits often occur at school

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1. Intentional injuries suffered at school are more likely to lead to an emergency department visit (EDV) than intentional injuries suffered outside of the school setting.

2. Demographic risk factors for intentional injury-related EDVs in the school setting compared to unintentional injuries included: male gender, 10- to 14-year age group, and black, American Indian, and Hispanic race.

Evidence Rating Level: 2 (Good)

Study Rundown: It is estimated that up to one quarter of all childhood injuries occur in the school setting, with nearly a fifth due to intentional violence. Bullying affects 30% of youth and carries significant health-related, psychosocial, and academic consequences.1 This study sought to address the gap in the research surrounding intentional in-school injuries by comparing emergency department visits (EDVs) for intentional injuries sustained at school to EDVs for those occurring outside of school. Results indicated that students had nearly 2 times the odds of having an EDV due to intentional injuries at school than outside of school. Furthermore, demographic risk factors for intentional injury-related EDVs in the school setting compared to unintentional injuries were found to be: male gender, 10- to 14-year age group, and black, American Indian, and Hispanic race. Limitations to this study included a lack of information regarding the demographic background of perpetrators and the specific circumstances (e.g. environment, presence of supervision, etc.) under which the injuries occurred. Additionally, schools may be more likely to request an EDV after an injury. These findings have implications for the development of targeted bullying interventions and prevention strategies in the school setting.

Click to read the study published today in Pediatrics

Relevant Reading: Bullies, Gangs, Drugs, and School: Understanding the Overlap and Role of Ethnicity and Urbanicity

Study Author, Dr. Siraj Amanullah, MD, MPH, talks to 2 Minute Medicine: Assistant Professor of Emergency Medicine, Bio-Med Emergency Medicine, Alpert Medical School, Brown University. 

“The current study is a follow up to our earlier study of injuries at school resulting in an ED visit. In the present study, we specifically examined injuries from interpersonal violence and bullying occurring at school that were evaluated in an ED.  It’s important to keep in mind that such injuries lead not only to a physical burden but there is also an associated mental health impact. Despite the emphasis on safety at school, there have been substantial numbers of intentional injury-related emergency department visits from 2001-2008 from US schools with age, gender and racial/ethnic disparities, suggesting the need for further, culturally tailored preventive strategies. These preventive efforts can be addressed by physicians at various patient encounters especially when pediatric patients are seen for their regular physical examinations.”

In-Depth [retrospective cohort study]: Authors analyzed data from the National Electronic Injury Surveillance System – All Injury Program, a database of EDVs for injury reported by 66 hospitals throughout the United States. A total of 44 721 462 injury-related EDVs for youth ages 5 to 19 were identified from January 1, 2001 to December 31, 2008 with 7 397 301(12.5%) of these injuries occurring at school. The percentage of EDVs from intentional injuries that occurred at school was higher than the percentage of those occurring outside of school (10.7% vs. 6.4% in 2001-2002 to 8.5% vs. 5.7% in 2007-2008). Univariate analysis revealed the odds of an EDV due to an intentional injury at school compared to outside of school to be 1.76 (95% CI: 1.45-2.12). Demographic risk factors for intentional injury-related EDVs compared to unintentional injuries in the school setting were: male gender (OR: 1.0), 10- to 14-year age group (OR: 1.58; 95% CI: 1.10-2.27)), and black (OR: 4.14; 95% CI: 2.94-5.83), American Indian (OR: 2.48; 95% CI: 2.06-2.99), and Hispanic race (OR: 3.67; 95% CI: 2.02-6.69).  Middle school-aged children (10 to 14 years) experienced most of their intentional injury-related EDVs at school, compared to outside of school for high school-aged students (15 to 19 years).

By Cordelia Y. Ross and Leah H. Carr
Reviewed by William V. Raszka, MD

1 Nansel TR, Overpeck M, Pilla RS, Ruan WJ, Simons-Morton B, Scheidt P. Bullying behaviors among US youth: prevalence and association with psychosocial adjustment. JAMA. 2001;285(16):2094.

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