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Mary Ann P. Limbos, MD, MPH; Marizen Ramirez, MPH, PhD; Laura S. Park, MPH; Corinne Peek-Asa, MPH, PhD; Jess F. Kraus, PhD

Arch Pediatr Adolesc Med. 2004;158:1057-1061.

Background  Injuries to the head comprise 20% to 39% of all school-related injuries. Head injuries among special education students have not been adequately described.

Objectives  (1) To examine the incidence and characteristics of head injuries in children enrolled in special education and (2) to determine the factors that increase the risk of sustaining a head injury compared with an injury to another part of the body.

Methods  Pupil Accident Reports for 6769 students enrolled in 17 of 18 special education schools in 1 large urban school district during the academic years 1994-1998 were reviewed, and information on the nature of injury, external cause, and activity was abstracted. Head-injured and nonhead-injured cases were identified and compared by race, sex, age, characteristics of injury, and disability category.

Results  Six hundred ninety-seven injury events were reported during the 4-year study period. The overall injury rate was 4.7 injuries per 100 student-years. Two hundred five children (29.4%) sustained injuries to the head, and the rate of head injury was 1.3 injuries per 100 student-years. Falls were the leading cause of injury. Head injuries were most commonly associated with physical education and unstructured play and usually occurred on the playground. Disproportionately more head than nonhead injuries were sustained in the classroom (12% vs 8%) and the bathroom (9% vs 3%). Compared with children with emotional/mental disabilities, children with multiple disabilities had the highest risk of a head injury (incidence density ratio, 2.4 [95% confidence interval, 1.6-3.5]), followed by children with physical disabilities (incidence density ratio, 1.8 [95% confidence interval, 1.1-3.1]). There appeared to be no significant difference in the rate of head injury by sex and age.

Conclusions  Modifications of the classroom, bathroom, and playground environments might reduce the risk of head injuries in children enrolled in special education. Special modifications and increased supervision may, in particular, reduce the risk of head injury for children with physical and multiple disabilities.

Author Affiliations: Division of General Pediatrics (Dr Limbos), Division of Children, Youth, and Families (Dr Ramirez), Childrens Hospital Los Angeles, and Southern California Injury Prevention Research Center, Department of Epidemiology, University of California Los Angeles School of Public Health (Drs Ramirez and Kraus and Ms Park), Los Angeles, Calif; and the Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City (Dr Peek-Asa).

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