Parameters correlating to injury severity score in playground-related fall accidents

Abstract

PROBLEM DEFINITION The lack of published information on parameters influencing injury severity in playground-related fall accidents hinders the preparation of revised European playground standards.

OBJECTIVE The objective of this investigation was to examine the impact of the ‘head injury criterio’(HIC), peakg(g_n), height of fall, type of ground and age of the child on the injury severity score(ISS) in playground equipment-related fall accidents.

PATIENTS AND METHODS We examined 20 playground accidents which occurred on public playgrounds in the city of Graz within the last 2 years. In a questionnaire, all parents of children injured in these accidents provided detailed information on the nature, circumstances, site and height of fall. We reconstructed the accidents on a day with sunny weather and measured HIC and peak g(g_n) 3 times at every site using the height of fall measured according to the description given by the parents in the questionnaire. Three playgrounds had to be excluded due to changes in playground equipment. Data are presented as median(range).

RESULTS The age of 17 children was 5(2-8) years. The type of ground at the impact site was bare earth/sandy earth on 6 playgrounds, concrete/asphalt on 5, lawn on 3, sand on 2 and wood chips on 1. Five children sustained fractures of the extremities (ISS:4-9), 3 cerebral concussions (ISS:4) and 8 contusions or skin wounds of the head (ISS:i). Peak g measured on concrete/asphalt surfaces exceeded 5O0g, even at minimal fall heights. The median peak g in fall accidents from 1.5 meters measured on sand surfaces (i8og[I20-233g]) and bare earth/sandy earth (I7Ig[I44-266g]) was higher than the peak g on Iawn(I55g[95-I76g]] and wood chips (Ioog[98-IoIg]). The median HIC-value in falls from 1.5 meters was also higher on bare earth/sandy earth (934[720-1779]) or sand (9O4[449-i404]) when compared to lawn (744I355-949] or wood chips (363IJ45-375]). On playgrounds with surfaces other than concrete/asphalt, HIC and peak g correlated negatively (n.s.) with ISS. The product of the formula: height of fall(m) x age of child(years) correlated positively with ISS (p<0.05)

CONCLUSION Due to bad impact absorbing qualities, concrete, stone or asphalt surfaces should not be used on playgrounds. In our limited study the result of the formula: height of fall(m) x age of child(years) correlated positively with the injury severity score and therefore makes possible the prediction of injury severity in playground-related fall accidents in children aged between 2 and 8 years of age. The most promising intervention strategy to reduce injury severity in playground-related fall accidents is the reduction of the maximal height of playground equipment.

Keywords:

• Injury severity score
• playground
• accident
• accident prevention
• falling
• children

Additional information

Notes on contributors

Johannes Mayr

Correspondence to: J Mayr, M.D. Dept. Pediatric Surgery, Univ. Graz, Auenbruggerplatz 34, A-8036 Graz, Austria, Tel: [phone], Fax. [phone]