Siraj Amanullah, MD, MPH, an emergency medicine attending physician at Hasbro Children’s Hospital, recently led a study that found children between the ages of five and 19 still experience a substantial number of intentional injuries while at school. The study, titled “Emergency Department Visits Resulting from Intentional Injury In and Out of School,” has been published online ahead of print in the journal Pediatrics.
Amanullah’s team analyzed data from the National Electronic Injury Surveillance System All Injury Program from 2001 to 2008 to assess emergency department (ED) visits after an intentional injury. Of an estimated 7.39 million emergency department visits due to injuries occurring at school, approximately 736,014 (10 percent) were reported as intentional, such as those from bullying and peer-to-peer violence.
“This study is the first of its kind to report such a national estimate,” said Amanullah. “The 10 percent number may not seem large, but it is alarmingly high when you consider that such a significant number of intentional injuries are occurring in the school setting, where safety measures meant to prevent these sorts of injuries, are already in place.”
The study also identified gender and age disparities. Boys were most likely to be identified as at risk for intentional injury-related ED visits from within the school setting, along with all students in the 10- to 14-year age group; whereas girls were most at risk for intentional injury-related ED visits from outside of the school setting, along with the 15- to 19-year age group.
Additionally, both African-American and Hispanic ethnicities were found to be associated with higher risks for intentional injury in the school setting compared to outside school. “The important point about these disparities related to specific ethnicities and specific age groups is that the findings suggest that preventive safety efforts in the school setting may need to be tailored for the groups that carry much of this injury burden,” said Amanullah.
James Linakis, MD, PhD, associate director of pediatric emergency medicine at Hasbro Children's Hospital and co-author of the study, added, “We know that the risk of hospitalization was found to be higher from intentional injury-related ED visits versus unintentional injuries.” Linakis continued, “In supervised environments such as schools, we have a great opportunity to implement additional prevention strategies and reduce the number of seriously injured children who we are seeing in emergency departments nationwide.”
The study highlights the continued public health impact of bullying and peer-to-peer violence. While there are substantial numbers of emergency department visits due to intentional injuries occurring in U.S. schools, there are still likely many others that do not result in ED visits.
Michael Mello, MD, MPH, director of the Injury Prevention Center at Hasbro Children’s Hospital who also contributed to the study, added a reminder that these injuries not only affect the physical health, but also the emotional health of children, families and both victim and perpetrator. “As parents, guardians and physicians we need to keep talking to our children and patients about this physical and mental health burden. It is our responsibility to address the issue of violence and bullying, both in and out of school, just like prevention efforts for any other medical illness,” said Mello.