Association between severity of musculoskeletal injury and risk of subsequent injury in children and adolescents on the basis of parental recall

Abstract

Objectives: To describe the frequency of subsequent injuries in children who were seen at an emergency department (ED) for a musculoskeletal injury and to explore factors associated with sustaining a subsequent injury within a year.

Design: This was a prospective cohort study of children aged 1 through 17 years who sought care at an ED for an injury. Subsequent injuries were assessed through telephone interviews.

Setting: Subjects were recruited from a national database of childhood injury after they presented to a hospital ED at 1 of the 2 pediatric trauma centers in Montreal, Quebec. PATIENTS/ PARTICIPANTS: A consecutive sample of 7640 children aged 1 through 17 years who sought care for a fracture or a soft-tissue injury to an arm or a leg; 6182 completed both telephone interviews (80.9% response rate). Main Exposure Having a more severe injury was defined in 2 ways: (1) fracture of a limb or (2) injury that required follow-up or admission. Main Outcome Measure Having a subsequent injury during 12-month follow-up.

Results: Subjects with an index fracture were at lower risk of subsequent injury than were those with a soft-tissue injury (13.5% compared with 17.7%; adjusted odds ratio, 0.74; 95% confidence interval, 0.63-0.87). Subjects whose injury needed a follow-up were also at lower risk of subsequent injury than those whose injury was treated only in the ED (17.7% compared with 14.3%; adjusted odds ratio, 0.79; 95% confidence interval, 0.67-0.93) as were those who were admitted (17.7% compared with 8.7%; adjusted odds ratio, 0.51; 95% confidence interval, 0.26-0.99).

Conclusions: Having had a severe musculoskeletal injury may be associated with a decreased risk of subsequent injury in children and adolescents. A possible explanation could be reduced exposure to risk.