Page 16 - Delaware Medical Journal - February 2018

RESULTS
There were a total of 666 playground equipment injuries to children 18 years into the trauma registry at this Level
1 Pediatric Trauma Center during the study period between 2009 and 2016. The year 2012 yielded the highest volume of patients (n = 103), with increases also seen in 2010 and 2015. The months of May and September were the highest volume months, with January and December showing the fewest playground injuries. Of the 666 patients, 94.3 percent were admitted to the hospital with
nearly 75 percent of those admitted to
the orthopedic service. All patients were alive at discharge from the hospital.
The average age of these children was 6.36 years (± 2.84), with the highest rate of injury occurring in those aged 5 to 9 years (64.3 percent). Patients aged 0 to 4 constituted about a quarter of this study population, followed by around 10 percent aged 10 to 14 years, and 2 percent aged 15 to 18 years. Injury severity score ranged from 1 to 17, with an average of 5.74 (± 2.70). The location of these incidents varied, with nearly half of all injuries occurring at a place of recreation (46.4
percent), a public building such as school (24.9 percent), home (19.2 percent), and were injured slightly more frequently than females (52.4 percent and 47.3 percent, respectively), and 0.3 percent of patient sex information was unknown.
As for the playground equipment involved (Figure 1), the majority of children were injured on the monkey bars, followed by the swings, other/unknown, trampoline, slide, and jungle gym. Of these injuries, over 88 percent of patients were diagnosed with fracture. Approximately 4 percent presented to the hospital with a concussion. Of the patients with fractures, over half were diagnosed with a supracondylar fracture, making up 46.1 percent of the total injuries (Figure 2). Overall, nearly
80 percent of the injuries were to the upper extremity, followed by lower extremity, head, neck/torso, other, and face/mouth.
Not only were the monkey bars the most common equipment relating to injury,
but they also resulted in increased injury severity scores, with the majority of both mild and moderate injuries occurring in these patients (Figure 3). Also, when comparing patient characteristics with the playground equipment (Table 1), there was a high percentage of fractures and
upper extremity injuries in those who were injured on the monkey bars. Regarding sex, females had a higher incidence of injury rate on trampolines than males (62 percent and 39 percent, respectively) but incidence remained equal for injuries on the monkey bars. When comparing age to playground equipment type, patients aged 0 to 9 years were most frequently injured on the monkey bars, while patients aged 10 to 18 were injured most on trampolines (Figure 4).
DISCUSSION
This study was consistent with others performed within pediatric trauma centers, as many injuries are associated with monkey bars and often occur in elementary-school-aged children. A study performed by Keays and Skinner found that approximately 84 percent of injuries occurred in a public setting, which was 8 This suggests that public playgrounds may need updates or guidelines that ensure that the equipment is safe. We also found that within this study population, fracture rate was high, constituting 88 percent of the trauma patients. This association was especially high within patients injured on the monkey bars, which may again indicate a need
to lower this equipment or possibly even change the landing surfaces. In previous research performed by Laforest et al.,
it was suggested that equipment height should remain under two meters, and that effective surfaces include rubber, sand, and wood chips.9 Also, within the subset of fracture diagnoses, nearly half of these patients were diagnosed with
a supracondylar fracture. This is cause for concern, as these typically occur when a child falls from a great height
and often require surgery and may lead
to complications.10 With the continued high number of injuries seen at N/AIDHC associated with a fall at a playground, it is clear that change is necessary in this area.
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Del Med J | February 2018 | Vol. 90 | No. 2