Children riding school buses suffer more injuries than previous public data have suggested, according to a report in the November issue of Pediatrics that examined a national database of emergency room visits.
The vast majority of the children injured—97 percent—are treated and released from the hospital on the same day. But the study suggests that the data sources may be underestimating the number of children injured on school buses because those sources focus only on more serious accidents, or on those that take place during transportation to and from school during the school year.
The study in the journal, published by the American Academy of Pediatrics, examined injuries that occur at any time, regardless of severity. However, the study did not examine accidents that resulted in fatalities.
“It’s good to make your focus bidirectional and look at injuries that are causing emergency room visits as well as fatalities,” said Jennifer McGeehan, the lead author of the study and a project-team leader for the Center for Innovation and Pediatric Practice, based at Columbus Children’s Hospital in Ohio.
The study drew its conclusions from the National Electronic Injury Surveillance System, which is operated by the U.S. Consumer Product Safety Commission. The injury-reporting system, established in 1978, was intended to study consumer-product-related injuries by gathering information from a nationally representative group of 99 hospitals that provide 24-hour emergency care.
Since 2000, the federal agency has expanded its information-gathering efforts, collecting injury information of all kinds from a sample of 66 of the 99 hospitals. The Pediatrics study used the commission’s data to examine school bus accidents that resulted in emergency room visits from 2001 to 2003.
In that time, the database recorded 939 emergency room visits by children from infancy to age 19 that were in some way related to school buses, excluding cases in which a child was struck by a bus or was a passenger in another vehicle involved in a collision with a bus. The researchers’ data included injuries that didn’t stem from a crash, such as those occurring when a driver braked suddenly or made a sharp turn.
Based on that sample, gathered from the 66 hospitals monitored for injuries of all kinds, the researchers extrapolated that an average of 17,000 children per year were treated in emergency rooms all over the country for school-bus-related accidents in the three years studied.
Ten- to 14-year-olds had the highest proportion of such visits to an emergency room, at 43 percent of all the children with such visits in those three years. Children ages 5 to 9 represented the second-largest group, at 27.3 percent of emergency room visits. Strains and sprains accounted for the most injuries, at 33.4 percent, followed by contusions or abrasions, at 28.3 percent.
Most of the emergency room visits that occurred were in the two-month time period of September and October. The researchers hypothesized that back-to-school “anxiety and excitement,” coupled with new bus drivers, could lead to more accidents during that period.
The researchers’ numbers are much higher than those compiled by the Transportation Research Board, a division of the National Research Council, which provides independent research to the federal government. The board has estimated that there are 5,500 school-bus-related injuries to children as passengers per year.
ER for All?
Michael J. Martin, the executive director of the National Association for Pupil Transportation, in Albany, N.Y., said he had not seen the study, but he suggested a high number of emergency room visits may reflect standard practice in some districts that call for taking all children to the hospital after a school bus accident, regardless of the accident’s severity.
“In the best school district operations, any time there’s a crash, the children are brought someplace where there can be some evaluation,” Mr. Martin said.
Ms. McGeehan suggested several reasons why her research came up with a larger number: The Transportation Research Board’s information comes from a database that gathers information only on accidents that result in property damage, injury, or death, while the CSPC’s injury-surveillance system casts a wider net. Also, the board collects only information on accidents that occur during traditional school transportation hours—from 6 a.m. to 8:59 a.m. and 2 p.m. to 4:59 p.m., Monday through Friday, from September to June.
Ms. McGeehan said that since some injuries apparently occur when children are moving around on a bus, lap-and-shoulder seat belts could possibly prevent some injuries. More adult supervision may also improve safety, she said.
