A population based investigation of head injuries and symptoms of concussion of children and adolescents in schools

OBJECTIVE: To examine the incidence of head injury and symptoms of concussion among children at school and to determine the relationship of age, gender, and cause to incidence rates. DESIGN: Incident reports involving head injury for schools in the Province of Ontario, Canada during the year 2000 were evaluated. PARTICIPANTS: The population base for the schools represented was 1 372 979 children aged 6 to 16. SETTING: 95% of schools in the province of Ontario, Canada participated in the injury reporting system. MAIN OUTCOME MEASURES: A head injury was defined as any injury to the head that came to the attention of a school official. Head injuries accompanied by symptoms of concussion became a secondary outcome measure. RESULTS: There were 11 068 unduplicated head injury reports for the year 2000 of which 1861 qualified as producing signs or symptoms of concussion. Young children were more likely to have a head injury than older children, but slightly less likely to experience concussive symptoms. The primary cause of injury to young children was falls. Older children were more likely to receive head injuries and symptoms of concussion from sports activities. CONCLUSIONS: Overall rate of injury (3.98 per 100 children) was consistent with previous studies using prospective injury reporting systems. Probability of a head injury with symptoms of concussion among schoolchildren was only 1.9% for boys and <1% for girls during the course of their school years. There is ample justification for prevention efforts in schools.