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

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.