Section 6: Healthy settings for young people in Canada – Injury and physical trauma
6 Injury and Physical Trauma
by William Pickett
What is injury?
Injury is defined as any physical harm to the body caused typically by an external force. Causes of injury include physical forces, such as motor vehicles or collisions, and chemical and thermal forces that lead to burns, such as fire or hot substances.
Physical trauma refers to injuries with a certain threshold of severity. Thresholds used by researchers to rate the seriousness of youth injury include need for medical treatment, admission to hospital overnight, and – most dramatically – death. Doctors often talk about “trauma systems” when referring to extensive hospital-based medical care for major injuries in young people.
In Canada, once children survive through their infant years, injury becomes the number one threat to their health and well-being.
There are few young people in our world who do not feel the impact of injuries in their lives. Injuries that happen to young people can lead to a great deal of pain and suffering and, worse, to permanent disability and even death. Injuries are also costly to society in terms of health care expenditures and time lost from productive activities for both adolescents and their caregivers.
A serious physical injury is defined by the HBSC study as one requiring significant medical treatment, specifically casting, stitches, surgery, or hospital admission.
The 2006 survey asked every participating student about the occurrence of one or more physical injuries requiring medical attention during the past 12 months. One year represents the standard time period over which it is believed young people can recall their experiences fairly accurately.
Detailed descriptions were also collected about the most serious injury reported by each young person, including physical environment (where the injury happened), activity (how it happened), whether the activity was with an organized league or club, medical treatment (where the injury was treated and whether significant treatment was required), and missed days of school.
The HBSC survey did not include a question specifically about physical trauma cases. Instead, young people were asked about injuries that required a cast, stitches, surgery, or staying in a hospital overnight. These more significant forms of medical treatment were used to signal “serious” injuries.
In this chapter, we report on the percentage of students who experience at least one injury in a year, on those who experience multiple injuries, and on the seriousness of injuries. Time lost at school or for other productive activities is also reported, including data from three previous survey cycles, as well as total number of days missed in 12 months per 1000 students. We also indicate the activities during which injuries occurred, the percentage of injuries occurring during organized vs. informal activities, and locations of injury, as well as location and significance of any treatment received.
We examine injury in relation to the seven social context measures: living with both parents, parent trust and communication, academic achievement, attitude towards school, communication with friends, pro-social attitudes of friends, and family affluence.
Figure 6.1 shows the overall proportions of students who report at least one injury. Across the grades, 44 to 48% of boys are likely to experience at least one injury requiring medical treatment, compared to 31 to 41% of girls. In every grade, boys consistently report more injuries than girls. The proportion of boys reporting injuries is fairly similar across the five grades, while there is a clear increase in the proportion of injured girls as they get older.
Some young people experience more than one injury over the course of a year, and this is shown in Figure 6.2. Reports of multiple injuries range from 20 to 25% for boys and 14 to 19% for girls. In general, the percentages are slightly higher in the older grades for both boys and girls.
Figure 6.3 shows that 18 to 22% of boys report one or more serious forms of injury requiring placement of a cast, stitches, surgery, or overnight admission to hospital in the past 12 months, compared with 10 to 13% of girls.
The impact of students’ injuries extends beyond their immediate physical consequences. Based on the HBSC survey data, about 1 in 5 students typically miss one or more days in school or other usual activities due to an injury, with higher percentages in the older grades (Figure 6.4).
Between 3 and 10% of students report missing more than a week of school or usual activities due to an injury (Figure 6.5).
Trends in the occurrence of injuries that result in students missing a week or more from school or usual activities are summarized in Figure 6.6. Among boys, there appear to be slight increases in the occurrence of these types of injury in more recent survey years. For example, the percentages of boys reporting these injuries in Grade 10 are 9% (for 1994), 8% (for 1998), 12% (for 2002), and 10% (for 2006). Similar patterns are observed among girls in Grades 8 and 10, but not among Grade 6 girls. These more serious injuries tend to occur more frequently with advancing grade in both genders.
Cumulatively, these injury events result in an enormous amount of lost time to students in all grades (Figure 6.7). Injuries also affect the lives of parents and other family members who need to seek emergency medical care on behalf of these young people, as well as to provide time and care for various stages of rehabilitation.
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