Pediatric Head Injuries in Summer Camps

Background: Over 14 million children attend summer camps yearly and actively participate in outdoor and sports activities. Summer camps also have a unique supervisory environment different from home and school that may lead to increased injury risk. While the incidence of pediatric traumatic brain injuries (TBI) has been increasing, with nearly half a million children visiting the emergency department for TBI yearly, the epidemiology of head injuries in summer camp settings remains unclear. Objectives: To assess the current epidemiology of head injuries among summer campers nationally using a camp-specific electronic health record (EHR) system. Methods: We partnered with CampDoc.com, a national web-based EHR system that manages health data for summer camps. Head injury report, filed by camp nurses occurring in the year 2016, were obtained from 197 summer camps representing 36 states, Washington DC, and Ontario, Canada. Head injuries were categorized by injury severity, concussion status (Figure 1) cause of injury, and hospitalization status. Injury notes were reviewed independently by two researchers. Campers >20 years of age were excluded. Data were analyzed using descriptive statistics. Results: Of the 4,626 possible camp head injury reports available, 4,257 (92%) were coded as definite head injuries. Among campers with head injuries, 49% were female and median camper age was 10 years old. Head injury severity were categorized as mild (94%, n=4011); moderate (6%, n=244) and severe (<1%, n=2). Only 3% (n=126) of injured campers were taken to the hospital or doctor following their injury. Of head injuries, 29% (n=1221) were sports-related. 1315 head injuries occurred during sports and other outdoor activities (Figure 2). Based on available head injury symptom reports, 3% (n=135) of head injuries were coded as definite concussions, 12% (n=565) were coded as possible concussions. Of definite and probable concussions, 40% (n=277) were sports-related, and 59% (n=79) of definite concussions were incurred by female campers. Conclusion: Summer camps, while an important location of head injury risk for children, appear to be a safe environment for children and adolescents. Improving active supervision strategies throughout all areas of the camp, increasing training for summer camp workers, and incorporating strategies to reduce risky behavior may be ways to further decrease the incidence of head injuries in camp settings.