COLUMBUS, Ohio -- An estimated 17,000 school-age kids are treated in emergency departments for bus-related injuries annually, twice the number cited by previous estimates based on highway safety data.
COLUMBUS, Ohio, Nov. 6 -- School bus crashes and other mishaps account for many more non-fatal injuries to children than previously reported.
A review of a national injury database revealed that an estimated 17,000 children are treated in emergency departments for bus-related injuries annually, twice the toll cited previously by the National Highway Traffic Safety Administration, found Jennifer McGeehan, M.P.H., of Children's Hospital here, and other centers.
Those most at risk for school-bus related injuries are 10- to 14-year-olds, and children in this age group should be specially targeted for safety interventions, the investigators recommended in the November issue of Pediatrics.
The authors recommended seat-belt use in school buses, a position that has been held by the American Academy of Pediatrics for a decade.
Older children (ages 10 to 19) tended to suffer more lower-extremity injuries, while more than half of all kids under age 10 suffered head injuries, the authors found.
Children in 10-to-14 age group "may be more likely to ride the bus, because they are more independent than younger children, and their parents may not feel that they need to be transported by car," they wrote. "In addition, children 16 or older may be more likely to drive themselves to school or ride with a friend who drives. Therefore, school bus safety messages may need to especially reach and affect children 10 to 14 years of age."
Injuries to the head accounted for 30% of the total, followed by injuries to the lower extremities (21%), trunk (17%), upper extremities (15%), neck (14%), and other/not stated (3%).
Injuries occurred most frequently in September and October, and about 42% were caused when a car collided with a bus that child was riding. About one-fourth of all injuries occurred as the children were either boarding or getting off the bus.
"The findings from this study indicate that motor vehicle crashes are the leading mechanism of nonfatal school bus-related injury for children in the U.S.," the authors wrote. "In addition, this study identified several other important mechanisms of school bus-related injury. Further research is needed to determine the relative contributions of structural and operational components of the school bus, supervision, and rider behavior to the occurrence of these injuries and the effectiveness of occupant restraint systems and other strategies to prevent these types of injuries."
The National Highway Traffic Safety Administration had estimated that 8,500 children annually are injured in school-bus related accidents. The injuries were estimated to be minor in 86% of the case, moderate in 10%, and severe in 4%, the investigators noted.
But the estimates are based primarily on motor-vehicle crash data, and don't take into account other possible mechanisms of injuries, such as slips and falls.
To get a better handle on the epidemiology of school-bus related injuries among children and teens, the authors extracted nationally representative data from the National Electronic Injury Surveillance System All-Injury Program, which is operated by the U.S. Consumer Product Safety Commission.
Cases included all of the patients in the database who had been treated in a hospital emergency department for a nonfatal school bus-related injury from 2001 to 2003.
The investigators identified an estimated 51,100 school bus-related injuries over the study period, for an average annual incidence of 17,000 injuries, and a rate of 21 per 100,000 population. In the overwhelming majority of cases (97%), the children were treated and released.
In all, 43% of injuries occurred among 10- to 14-year-olds, an annual rate of 34.7/100,000, followed by five- to nine-year olds, who accounted for 27.3% of injuries (rate 23.3/100,000), teens 15 to 19, who had 25.6% of injuries (rate 21.4/100,000), and the toddler set (0-4) who had 4.1% of the injuries (rate not provided, due to data uncertainty).
Car-bus collisions were responsible for 42.3% of all injuries, while 23.8% occurred when the child was either getting on or off of the bus, or approaching it.
Slightly more than half (52.1%) of all injuries in kids under 10 were head injuries. In contrast, among 10- to 19-year-olds, lower-extremity injuries were most common, occurring in 25.5% of cases in this age group.
One third of all injuries (33.4%) were sprains and/or strains, followed by contusions and abrasions in 28.3%, and lacerations in 14.9%; more than three-fourths of lacerations (77.7%) were to the head.
The authors recommend a combination of seat-belt use, improved rider behavior, better supervision of children, and fewer distractions for bus drivers as a means of reducing school bus-related injuries.