Abstract
BackgroundDespite updated playground equipment and improved industry standards, playgrounds remain a common source of childhood injury. Fractures account for 35% of all playground injuries presenting to emergency departments (EDs). We aimed to examine the time trends and epidemiologic patterns of playground equipment-related extremity fractures in children in the United States.MethodsWe analyzed data from the National Electronic Injury Surveillance System. Children ≤14 years presenting to US emergency departments from 2006 to 2016 with playground equipment-related injuries were included. We used weighted complex survey analysis to describe the epidemiologic patterns and severity of playground equipment-related extremity fractures and Joinpoint linear weighted regression analysis to determine trends in extremity fractures.ResultsAn annual average of 72,889 children were treated in US EDs for playground equipment-related extremity fractures, yielding a national annual incidence rate of 119.2 per 100,000 children. Playground equipment-related extremity fractures accounted for 33.9% of ED presentations and 78.7% of hospitalizations for playground equipment-related injuries. Of patients with playground equipment-related extremity fractures, 11.2% had severe fractures requiring hospitalization. The annual rate of ED visits due to playground equipment-related extremity fractures remained stable (annual rate of change = 0.74, p = 0.14) from 2006 to 2016. Adjusted for age, injuries on monkey bars or climbing gyms were associated with significantly increased odds of extremity fractures in comparison to injuries from other playground equipment (adjusted odds ratio [aOR]: 2.0; 95% CI: 1.9–2.1). Overall, 49.8% of extremity fractures and 54.7% of severe extremity fractures (i.e. those requiring hospitalization) occurred on monkey bars or climbing gyms.ConclusionsDespite enhanced playground safety standards, national rates of playground equipment-related extremity fractures have remained stable in the US. Extremity fractures remain the most common type of playground injury presenting to EDs and most commonly occur on monkey bars and climbing gyms.
Highlights
Despite updated playground equipment and improved industry standards, playgrounds remain a common source of childhood injury
We aimed to examine the time trends and epidemiologic patterns of playground equipment-related extremity fractures in children seen in United States (US) emergency departments from 2006 to 2016 (ASTM, 2018)
Half of all playground equipment-related extremity fractures occurred in boys (54.3%) and children aged 5–9 years had the highest rates of playground equipment-related extremity fractures and other playground equipment-related injuries
Summary
Despite updated playground equipment and improved industry standards, playgrounds remain a common source of childhood injury. Fractures account for 35% of all playground injuries presenting to emergency departments (EDs). While most fractures can be evaluated and treated in the ED, extremity fractures are the most common reason children presenting to EDs for playground-related injuries require hospital admission (Tinsworth et al 2001; Adelson et al 2018). Some fracture types, such as supracondylar fractures of the humerus, may require anesthesia, reduction, and hospitalization (Farnsworth et al 1998)
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