Preplanned Studies: Characteristics of Injury Diagnosis among Primary and Secondary School Students — China, 2018

Child injury has become a public health issue attracting widespread concern in the world (1). In China, injury is also an important threat to children’s health and safety, particularly for those in schools (2). This study uses data from the National Injury Surveillance System (NISS) in China to depict the characteristics of primary and secondary school students with injury diagnosis in 2018 in order to provide evidence for better formulation of relevant strategies and measures towards primary and secondary school student-related injury prevention and control.

In the world, more than 95% of child injury deaths occur in low- and middle-income countries every year (1). In developed countries, the absolute number of child injury mortality is relatively low, but injury is still the main cause of death among children, accounting for about 40% of child deaths (2). In China, about 42 million primary and secondary school students suffer from various injuries every year, of which about 400,000 are disabled (3).

At present, the epidemiological characteristics of primary and secondary school student-related injury were usually reported from school-based population surveys conducted in developed regions of China, such as Beijing, Shanghai, Guangdong Province, and Zhejiang Province (4–5). However, data derived from medical and health institutions are rarely adopted to explore typical patterns of injuries among primary and secondary school students in China.

The NISS was established and operated by the National Center for Chronic and Noncommunicable Disease Control and Prevention of the Chinese Center for Disease Control and Prevention (NCNCD, China CDC) in 2006. Currently, it covers 84 counties and districts in 31 provincial level administrative divisions (PLADs), including 252 medical and health institutions (6). This study used NISS 2018 data to descriptively analyze the characteristics of injury event and injury-induced clinical outcome of primary and secondary school students.

All data in this study were from NISS in 2018. The working mechanism, data collection process, quality control, and report card data domains and other detailed information of NISS can be found in published articles (6–7). In this study, patients who met all following criteria will be considered as primary and secondary school students and included in the final analysis: 1) aged between 6 and 18 years old (8); 2) education level was self-reported or reported by other guardians as primary school, junior high school, or senior high school (equivalent to high school); 3) the occupation was self-reported or reported by other guardians as student. Software Stata (version 15.1; College Station, TX, USA), was adopted to perform the analysis in this study.

In 2018, there were 147,018 cases in line with the definition of primary and secondary school students in the NISS, accounting for 10.61% of all injury cases including 100,104 male students and 46,914 female students, and 72,616, 34,202, and 40,200 cases for primary, junior, and senior high school students, respectively. There were more male students than females in each education level.

Among cases with different levels of education, injuries mainly occurred in the year from March to June and in a day at noon. As for injury cause, the top three causes in primary school students were fall (52.21%), animal injury (14.06%), and blunt injury (11.09%). In junior high school students, the three causes were fall (52.42%), blunt injury (12.36%), and animal injury (10.16%). In senior high school students, these causes were fall (45.46%), blunt injury (14.25%), and road traffic injury (12.06%). As for location of injury, the top three locations in primary school students were home (33.28%), school and school-related public places (28.96%), and roads/streets (17.27%). In junior high school students, the top three locations were school and school-related public places (35.99%), home (23.85%), and road/street (19.46%), respectively. In senior high school students, these locations were schools and school-related public places (34.71%), roads/streets (22.00%), and homes (20.91%). (Table 1)

As for activity at the time of injury, the top three activities in primary school students were leisure activities (49.75%), sports activities (11.67%), and life activities (11.03%). In junior high school students, the top three activities were leisure activities (39.55%), sports activities (18.83%), and life activities (10.03%). The three activities in senior high school students when injuries occurred were leisure activities (36.80%), sports activities (18.95%), and driving/riding vehicles (11.11%). More than 90% of the cases with different education levels were unintentional injuries. For intentional injury, the proportion of self-harm/suicide was highest in senior high school students (0.60%), followed by junior high school students (0.32%), and primary school students (0.08%). The proportion of other intentional injuries in senior high school students was 6.41%, which is more than that in junior high school students (4.59%), and primary school students (2.13%).

The characteristics of clinical outcomes in cases with different levels of education are very similar. More than 80% of injury cases were mild at each education level. The major body part injured is limbs and head. The most common nature of injury is contusions/bruises. More than 90% of injury cases can be discharged after medical treatment. There were only 44 injury-related deaths among primary and secondary school students in NISS, but the proportion of death in senior high school students was more than twice as high as that in junior high school and primary school students.