Research Article: Are active children and young people at increased risk of injuries resulting in hospital admission or accident and emergency department attendance? Analysis of linked cohort and electronic hospital records in Wales and Scotland

Date Published: April 10, 2019

Publisher: Public Library of Science

Author(s): Lucy J. Griffiths, Mario Cortina-Borja, Karen Tingay, Amrita Bandyopadhyay, Ashley Akbari, Bianca L. DeStavola, Helen Bedford, Ronan A. Lyons, Carol Dezateux, Anne Vuillemin.


Children and young people (CYP) are encouraged to increase time spent being physically active, especially in moderate and vigorous intensity pursuits. However, there is limited evidence on the prospective association of activity levels with injuries resulting in use of hospital services. We examined the relationship between objectively-measured physical activity (PA) and subsequent injuries resulting in hospital admissions or accident and emergency department (A&E) attendances, using linked electronic hospital records (EHR) from a nationally representative prospective cohort of CYP in Wales and Scotland.

We analysed accelerometer-based estimates of moderate to vigorous (MVPA) and vigorous PA (VPA) from 1,585 (777 [46%] boys) seven-year-old Millennium Cohort Study members, living in Wales or Scotland, whose parents consented to linkage of cohort records to EHRs up until their 14th birthday. Negative binomial regression models adjusted by potential individual, household and area-level confounders, were fitted to estimate associations between average daily minutes of MVPA, and VPA (in 10-minute increments), and number of injury-related hospital admissions and/or A&E attendances from age nine to 14 years.

CYP spent a median of 59.5 and 18.1 minutes in MVPA and VPA/day respectively, with boys significantly more active than girls; 47.3% of children experienced at least one injury-related admission or A&E attendance during the study period. Rates of injury-related hospital admission and/or A&E attendance were positively associated with MVPA and VPA in boys but not in girls: respective adjusted incidence rate ratios (95% CI) for boys: 1.09 (1.01, 1.17) and 1.16 (1.00, 1.34), and for girls: 0.94 (0.86, 1.03) and 0.85 (0.69, 1.04).

Boys but not girls who engage in more intense PA at age seven years are at higher risk of injury-related hospital admission or A&E attendance when aged nine to 14 years than their less active peers. This may reflect gender differences in the type and associated risks of activities undertaken. EHRs can make a useful contribution to injury surveillance and prevention if routinely augmented with information on context and setting of the injuries sustained. Injury prevention initiatives should not discourage engagement in PA and outdoor play given their over-riding health and social benefits.

Partial Text

The promotion of physical activity (PA) among children and young people (CYP) remains high on the agenda for policy makers and health professionals; however, despite public health efforts, many are insufficiently active with only half of 7-year-old children in the UK achieving the recommended 60 minutes of daily moderate to vigorous intensity PA (MVPA).[1] Girls are significantly less active than boys,[1] and activity levels decline during adolescence: nationally, only 19.7% of 13–15 year olds meet this daily MVPA guideline.[2]

Moderate and vigorous PA is associated with increased risk of injury-related AEAs amongst boys, but not girls, living in Wales and Scotland, possibly reflecting gender differences in activities undertaken, associated risks and their settings, as well as the likelihood of being taken to hospital for an injury. Strategies are needed to prevent serious injury in CYP, while promoting their engagement in organised PA or play, and in the recognition and management of associated risks in order to ensure that the social and health benefits of being physically active outweigh the disbenefits occasioned through injury. Improvements in injury surveillance systems and further linkage studies using EHRs are needed to replicate our findings and to understand more about the context and severity of injuries sustained.




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