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Are more kids suffering from playground-related head injuries?

A closer look at a new study that finds more children seen in emergency departments for traumatic brain injuries from the playground.

The average number of children – from birth to 14-years-old – treated yearly for playground-related traumatic brain injuries in hospital emergency departments has gone up markedly, found a Pediatrics study released online today.

From 2001 to 2013, an average of about 21,100 children were seen in ERs for TBI. The numbers from year to year averaged as low as 13,720 in 2005 to highs of 32,020 in 2012 and 29,410 in 2013. Monkey bars or playground gyms (28 percent) and swings (28 percent) were the most frequently associated with TBI, but equipment usage varied by age.

This seems very troubling since playgrounds are now much safer in general than in the past – they're paved with softer surfaces and built with less risky equipment. But before you start worrying about playgrounds, let's take a closer look at the study's data.

Researchers looked at injuries taken from a national injury surveillance system that uses discharges from EDs. The increase in cases may have occurred for reasons other than more playground falls on the head:

1. ED discharge data has gotten more specific over time due to government regulations and insurance reimbursements. EDs have become much more careful about discharge coding, so what may have "fall" or "head injury" now is "playground associated fall resulting in head injury." I know my office and hospital coding has gotten much more detailed.

2. The general population is much more concerned about falls in general and more specifically, head injuries.  This is due to the revelations about the long- and short-term consequences of head injuries and the increased awareness of chronic traumatic encephalopathy, in the press and even in popular movies such as Concussion. The rate of calls from parents to doctors' offices and visits to the EDs for head injuries has gone up. Visits have also gone up even more from schools requiring the child to be seen before returning to school.

So the increase in EDs seeing head injuries may not mean more head injuries.

In fact, 96 percent of cases were treated and released. During the 13 year study period, an average of 550 or 2.6 percent children with playground head injuries were hospitalized or transferred for further care. This is a rate of about one for every 300 children seen that needed additional care. We have to drill deeper into the data to see if there is actually a significant change in seriously injured children over the period of the investigation. The data could be true when we find a way to research it more accurately.

My objection to the study is in some of its conclusions.The researchers recommend improvements in playground design, maintenance and surfacing. It's hard to object to those ideas. But having had grandchildren in Europe for many years, I can attest that European playgrounds I have seen are much more dangerous than new American ones. They also are more heavily used, since outdoor play is emphasized in Europe to improve health and coordination. In my experience, parents there are more accepting of the fact that children do occasionally get hurt, and this is not a reason to avoid active play.

The study also states that "appropriate supervision and child behavior modification" are needed. I agree strongly if they mean parents should get off their cell phones and actually interact with their children. But a balance needs to be struck – supervising too closely is probably not good for a child's long-term development. Also, children need to learn to play by themselves and with other children, and the playground is a good place for them to work on these skills.

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