Source:Howard AW, MacArthur C, Willan A, et al. The effect of safer play equipment on playground injury rates among school children.

The effect of playground equipment safety standards and guidelines on injury rates has not been evaluated. Investigators from the Hospital for Sick Children, York University and the Institute for Clinical Evaluative Sciences in Toronto, Ontario, Canada studied injury rates in Toronto elementary schools before and after replacement of substandard playground equipment. The Toronto District School Board and an independent consultant assessed the compliance of playground equipment in all 398 district elementary schools with safety standards established by the Canadian Standards Association (CSA).1 They identified 136 schools with equipment that posed a severe safety hazard and required replacement. All unsafe equipment was removed and, in 86 schools, replacement with safer equipment was completed prior to the study. These 86 schools comprised the intervention group. Schools with equipment that did not require replacement formed a control group (n=225). Playground injuries for 4- to 11-year-old children were identified from an Ontario School Board Insurance Exchange database for the years 1998–2002. The database contained reports by school staff on any injury that occurred during school hours and required medical or dental attention, whether provided by school staff or referred to a health care facility. Injury rates were calculated from the number of injuries, the average yearly enrollment in each school, and the number of months school was in session. The 10-month 1999–2000 school year (pre-intervention) was compared with an equivalent period post-intervention.

In intervention schools, the injury rate decreased from 2.61 per 1000 children per month before intervention to 1.68 after intervention (adjusted RR=0.70; 95% CI, 0.62–0.78). In contrast, in non-intervention schools the injury rate increased from 1.44 to 1.81 during the same period (adjusted RR=1.40; 95% CI, 1.29–1.52). Injuries specifically described as equipment-related similarly decreased in the intervention schools (from 0.58 to 0.44; adjusted RR=0.82; 95% CI, 0.66–1.03) but increased in the non-intervention schools (from 0.25 to 0.32; adjusted RR=1.15; 95% CI, 0.96–1.37). The authors conclude that replacement of playground equipment not meeting CSA standards is an effective strategy for preventing playground injuries.

Dr. Aldous has disclosed no financial relationships relevant to this commentary.

The most effective injury prevention strategies are those that do not require active behavior change on the part of consumers. In this study, the authors demonstrate that adherence to safety standards for elementary school playground equipment can substantially decrease injury rates without requiring voluntary behavior change among students. The standards of the CSA are not available free of charge, making comparison to other standards difficult. However, the authors state that substandard equipment usually posed a risk of falling more than 1.5 meters or onto unsuitable surfacing. The United States Consumer Product Safety Commission (CPSC) has published detailed guidelines for playground safety, which specifically address requirements for raised play platforms and protective playground surfaces.2 Adherence to these standards will likely be similarly effective in reducing injuries due to falls....

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