Children acquire many of the academic and social skills they need for their adult lives at school. Excessive absence from school is associated with educational failure, particularly when children miss more than 11% of school days.1 Each year, one in three British children goes to an emergency department for treatment, predominantly with minor injuries, but the effect on school attendances has not been quantified.2
This study was designed to investigate the number of days missed from school after children attended one of three local emergency departments with minor injuries. We defined minor injuries as those not requiring admission to hospital and not affecting mobility or the ability of the child to care for himself or herself.
Method and results
This case-control study involved children resident in, and attending school full time in, the Welsh counties of Swansea and Neath Port Talbot during the autumn school term of 1999. A case was defined as a child who attended the local emergency department on a Sunday preceding a school week with an injury that should not prevent school attendance. The children and their families were not informed of inclusion in the study. The next child of the same sex on the class register was chosen as a matched control. Ethical approval was obtained from Morgannwg Local Research Ethics Committee.
For each case, we obtained the age, sex, home postcode, school attended, and nature of the injury from the emergency department's records. School attendance for each half day in the week that followed the injury was recorded from the school register for the case pupil and the matched control (along with the control pupil's home postcode). For a randomly chosen sample of 100 pairs, we recorded the school attendance for each half day in the school week that preceded the minor injury.
Differences in school attendance between the matched pairs were analysed by using the one sample t test and Wilcoxon's matched pairs signed ranking test. A Townsend small area deprivation score was calculated for each child, and the children's attendances were analysed in relation to these scores.3
Overall, 422 case-control pairs were identified in 130 schools; 251 (59%) pairs comprised boys. Ages ranged from 4 to 16 years (mean 10.6 years). The type and frequency of injury were recorded along with the mean number of half days present in school for each injury type (table).
We excluded 57 minor fractures and one haemarthrosis from further analysis as they could be argued to be more serious injuries. We analysed attendance for the remaining 364 case-control pairs only.
Case children attended significantly fewer half days in school after injury than control children (7.38 v 9.40, P<0.001). Deprivation scores for matched pairs did not differ significantly, and there was no association between missed time at school and deprivation score. Mean half day attendance in the week preceding injury did not differ significantly between case children and control children (9.25 v 9.59, P>0.1).
Comment
On average, one full school day was missed unnecessarily after children presented to hospital emergency departments with minor injuries. As children with and without injuries had similar previous school attendance, the resulting loss could be attributed to the injury. The cumulative loss was great given the high frequency of such injuries. Repeated absences of this type could contribute to educational difficulties, especially in children whose attendance is already suboptimal for other reasons.
We propose that health professionals are more proactive in stressing the importance of children attending school after minor injury when there is no medical reason to prevent attendance. Improved liaison between emergency departments, school health services, and local education authorities might help to reduce the unnecessary burden of minor injury.
Table.
Relation between minor injuries and subsequent school attendance in pupils in full time education in two Welsh counties
| Injury | Number (%) of injuries | Mean (range) number of half days |
|---|---|---|
| Bruise | 115 (27) | 7.9 (0-10) |
| Sprain | 110 (26) | 7.1 (0-10) |
| Laceration | 66 (16) | 6.7 (0-10) |
| Fracture | 57 (14) | 5.5 (0-10) |
| Head injury | 28 (7) | 7.8 (0-10) |
| Puncture wound | 9 (2) | 7.3 (0-10) |
| Bite | 8 (2) | 6.9 (0-10) |
| Abrasion | 7 (2) | 8.0 (2-10) |
| Nasal injury | 7 (2) | 6.9 (1-10) |
| Eye injury | 6 (1) | 8.7 (4-10) |
| Burn/scald | 5 (1) | 6.0 (0-10) |
| Foreign body* | 3 (1) | 9.3 (8-10) |
| Haemarthrosis | 1 (<1) | 0 |
| All | 422 | 7.4 (0-10) |
Tissue injury such as from a splinter or metal fragment.
Acknowledgments
We are grateful for the valuable assistance of the emergency department staff, all participating schools, and Mrs Lisa Webb for her secretarial help.
Footnotes
Funding: None.
Competing interests: None declared.
References
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