Descriptive Epidemiology of Unintentional Injuries in School-Aged Children: a Systematic

SUPPLEMENTARY MATERIAL

Supplementary Box 1: Medline search history

1 (cohort adj1 stud$).mp. [mp=title, original title, abstract, name of substance word, subject heading word] 2 (longitudinal adj1 stud$).mp. [mp=title, original title, abstract, name of substance word, subject heading word] 3 exp Cohort Studies/ 4 1 or 2 or 3 5 exp Adolescent/, or exp Adolescent Hospitalized/ or exp Adolescent Institutionalized/ 6 exp Child/ or exp Child, Hospitalized/ or exp Child, Institutionalized 7 exp Pediatrics/ 8 exp Disabled Children/ 9 youth$.mp. [mp=title, original title, abstract, name of substance word, subject heading word] 10 teen.mp. [mp=title, original title, abstract, name of substance word, subject heading word] 11 5 or 6 or 7 or 8 or 9 or 10 12 exp accident prevention/ or exp accidental falls/ or exp accidents, home/ or exp accidents, traffic/ or exp drowning/ 13 exp “Wounds and Injuries”/ep [Epidemiology] 14 12 or 13 15 4 and 11 and 14

Supplementary Box 2: Electronic databases searched

No. Database Dates searched 1 Medline 1950 to January Week 3 2006 2 Cochrane Library 2006 Issue 1 3 Embase 1980 to Week 4 2006 4 CINAHL 1982 to Dec Wk 2 2005 5 BNI (British Nursing Index) 1985 to Jan 2006 6 PsycINFO 1806 to Wk 5 Jan 2006 7 HMIC (Health Management Information January 2006 Consortium) 8 AMED (Allied and Alternative Medicine 1985 to Jan 2006 Database) 9 SportDiscus 1830 to Jan 2006 10 ChildData 1989 to 2006 11 Index to Theses 1716 to 17.01.06 12 ISI Proceedings 1990 to 27.01.06 13 Zetoc 1993 to 2.2.06 14 NRR (National Research Register) 2000 to 02.02.06 15 ReFeR (Research Findings Electronic 02.02.06 Register)

Unintentional injuries in school-aged children: Page 1 of 11 Supplementary Table 1: Summary of descriptive reporting of injuries from papers included in the review

Primary study name, Country, Author, year Any injury Repeat Type of Mechanism of Part of Severity of Conseque Location of Year of recruitment injuries injury injury body injury nces injury event injured Cohort from Baise City, China, Chen, 2005a        2002 Chen, 2005b  Cohort from Maanshan City, Peng, 2003 China, 2001    Cohort from Kaohsiung, Taiwan, Yang, 1998 1995      West of Scotland 11-16 Study, West P, 2004 UK, 1994     National Longitudinal Survey of Soubhi, 2004a  Children & Youth, Canada, 1994 Soubhi, 2004b Add Health Study (aka National Hammig, 2001 Longitudinal Study of Adolescent Health), USA, 1994  Cohort from Kamphaeng Phet Kozik, 1999 Province Vaccination Study, Thailand, 1991      Adolescent Injury Control Study, Anderson, 1994 USA, 1990   Cohort from Eastern Shore Alexander, 1992 Maryland, USA, 1986  Carolina Longitudinal Study, Cobb, 1995 USA, 1981     Christchurch Child Development Horwood, 1989   Study, New Zealand, 1977 Fergusson, 1995  McKinlay, 2002     Cohort from Seattle, USA, 1975 Padilla, 1976

Dunedin Multidisciplinary Child Langley, 1981         Development Study, New Langley, 1985        Zealand, 1975 Langley, 1987a       Langley, 1987b  Chalmers, 1989         Lodge, 1990         Begg, 1990     Begg, 1991       Begg, 1992   Jones, 2002   Jones, 2004  Cohort from South Wales, UK, Davidson, 1987  1972 Davidson, 1988     Child Health & Education Study Bijur, 1988a     (aka British Births Study 1970), Bijur, 1988b    UK, 1970 Bijur, 1988c    Bijur, 1990    Beattie, 1999      Cambridge Study of Delinquent West, 1977    Development, UK, 1961 Shepherd, 2002    Shepherd, 2004   National Child Development Peckham, 1973    Study (aka 1958 British Birth Peckham, 1976   Cohort Study), UK, 1958 Pless, 1989     Bijur, 1991    Cumberland, 2004   Rahi, 2006 Newcastle Thousand Families Miller, 1974 Study, UK, 1947       Note: Padilla 1976 did not report descriptive data for the whole study cohort. Soubhi 2004b and Rahi 2006 reported only analysis of risk factors for injury and did not report descriptive injury data

Unintentional injuries in school-aged children: Page 2 of 11 Supplementary Table 2: Proportion of boys and girls sustaining any injury or multiple injuries during the period of follow-up.

Cohort, Country Age of child Proportion (%) of cohort sustaining injury (Period of data (years) collection) Any injury More than one injury

Boys Girls Boys Girls

Primary school age

Cohort from south 5-81 37.2 26.3 12.5 7.1 Wales, UK (1977- 1980)

1970 British Birth 5-102 49 34.8 43.9 31.4 Cohort Study, UK (1975-1980)

1958 British Birth 8-113 4.1 2.1 Cohort, UK (1966- 1969)

Post primary school age

Cohort from Baise 11-184 34.8 30.3 12.2 8.3 City, China (2002- 2003) 13-185 32.6 27.4

West of Scotland 11- 13 6 39.2 28.1 16 study, UK (1994- 1998) 15 6 58.0 40.1

Carolina 14-18 7 53.1 39.0 Longitudinal Study, USA (1981-1986)

1970 British Birth 10-16 8 52 33 Cohort Study, UK (1980-1986)

1958 British Birth 12-163 6.6 3.5 Cohort, UK (1969- 1974) 12-16 9 25.3 11.4 5.3 1.5

11-16 10 30.6 17.3

Combined primary and post-primary school age

Cohort from School entry-16 70.8 60.2 37.9 27.2 Kampaeng Phet 11 Province Vaccination Study, Thailand (1991-1993)

Cohort from 7-13 12 32.1 29.1 9.7 8.4 Maanshan, China (2001-2002) Note: 1958 British Birth Cohort Study paper by Pless 3 reported road traffic injuries only

Unintentional injuries in school-aged children: Page 3 of 11 Supplementary Table 3: Percentage of injuries due to different mechanisms of injury occurrence, by age of children injured

Cohort Age of child Falls Sharp Blunt Motor Non Heat / Airway Other (inclusive % objects object vehicle -MV cold % % years) % % RTI RTI % % % Dunedin 6-713 44 18 10 4 4 2 2 16 Multidisciplinary Child Development 8-914 45 10 25 14 6 Study 10-1115 54 17 9 13 7

12-1316 54 69 3 1

14-1517 39 71 7 2 17

1970 British 10-168 34 26 5 9 26 Cohort Study

Cambridge Study 16-1818-20 14-17 of Delinquent Development

Baise City Cohort 11-184 33 14 20 5 4 2 22

Newcastle 5-1521 >50 Thousand Families Study

Carolina 14-187 7 36 57 Longitudinal Survey

Kamphaeng Phet School entry 12 20 5 6 4 18 12 23 Province -1611 Vaccination Study Note: RTI = Road traffic injury, Non-MV = Non motor vehicle road traffic injury (includes pedestrian, cycle and skateboard injuries). Airway includes suffocation, submersion, airway trauma or foreign body. Percentages may not total 100 due to rounding, partial data reporting and because categories are not used exclusively by all authors.

Unintentional injuries in school-aged children: Page 4 of 11 Supplementary Table 4: Percentage of injuries occurring in different locations, by age of children injured

Cohort Age of child Home Road Leisure, School Work (inclusive years) % % Play, or Sports % % %

Primary school-aged children

Dunedin 6-713 52 11 8 19 Multidisciplinary Child Development 8-914 41 17 10 22 Study 10-1115 28 16 19 28

Post-primary school-aged children

West of Scotland 11-166 32 study

Dunedin 12-1316 22 14 24 29 Multidisciplinary Child Development 14-1517 18 12 31 28 Study

Cambridge Study 16-1818-20 11 18 22 38 of Delinquent Development

Baise City Cohort 11-184 32 10 23 35

Combined primary and post-primary school-aged children

Newcastle 5-1521 26 37 18 19 Thousand Families Study

Carolina 9-187 36 24 5 Longitudinal Survey Note: Percentages may not total 100 due to rounding and partial data reporting.

Unintentional injuries in school-aged children: Page 5 of 11 Supplementary Table 5: Percentage of injuries requiring different forms of healthcare service use, by age of child

Cohort Age of child Admitted to Seen in hospital Seen by primary (years) hospital (%) emergency room or care doctor (%) outpatient setting (%)

Primary school age children

Dunedin Multidisciplinary Child 6-7 9 Development Study, New 13-15 Zealand 8-9 2 24

10-11 2 38 7

Christchurch Child Development 5-6 1 18 16 Study, New Zealand22 6-7 1 13 16

7-8 2 19 20

8-9 1 13 23

9-10 1 16 25

Dunedin Multidisciplinary Child 12-13 4 61 27 Development Study, New 16;17 Zealand 14-15 5 65 33

Combined primary and post-primary school-aged children

Newcastle Thousand Families 5-15 6 53 Study, UK21 Note: Percentages may not total 100 across papers where only partial health service use was reported, and because health care providers are not used exclusively (e.g. a child may be taken to their GP and then attend a hospital). Percentages have been rounded to whole integers.

Unintentional injuries in school-aged children: Page 6 of 11 Supplementary Table 6: Percentage of injuries in different categories of severity, using the Abbreviated Injury Severity score, by age of child

Abbreviated Injury Severity score

Cohort Age of child (years) AIS 1 (minor) AIS 2 (moderate) AIS 3 (severe)

Primary school-aged children

Dunedin 8-914 65 24 5 Multidisciplinary Child Development 10-1115 72 19 3 Study, New Zealand

Dunedin 12-1316 74 23 1 Multidisciplinary Child Development 14-1517 83 15 2 Study, New Zealand

1970 British Cohort 10-168 70 30 0 Study, UK Note: Percentages may not total 100 across papers where incomplete data is reported. Percentages have been rounded to whole integers.

Unintentional injuries in school-aged children: Page 7 of 11 Supplementary Table 7: Author reported statistically significant associations of risk factors and increased injury occurrence, by cohort

Cohort (Country), Year Factors assessed by author Author reported associations with increased risk of injury (p<0.05) of recruitment Individual Family risk Environme- Comparison group Reference group p value risk factors ntal risk factors factors Cohort from Baise,   Boys Girls 0.04 (China), 2002 12,13 Trend for decreasing injury with increasing age <0.01 Minority ethnic group Majority ethnic group 0.02 1 child in family 2 children in family <0.01 Living with father alone Living with mother alone or 0.03 grandparents Father has university education Father has lower level of education <0.01 Mother has university education Mother has lower level of <0.01 education Family monthly income <2000 Yuan Family monthly income >2000 <0.01 Yuan Mean raw scores on parent Mean raw scores on parent <0.01 psychological symptoms checklist psychological symptoms checklist (SCL-90-R) for injured children (for (SCL-90-R) for uninjured children somatisation, obsessive- compulsiveness, interpersonal sensitivity, depression, anxiety, phobia, paranoid ideation and psychoticism) Cohort from Maanshan,   Children with antisocial or neurotic Children without antisocial or 0.000 (China), 2001 14 behaviour problems neurotic behaviour problems West of Scotland 11-16   For boys, increasing trend for any accident or injury at age 15 across social 0.004 Study (UK), 1994 16 class I to V For boys, increasing trend for being injured in an assault at age 15 across 0.000 social class I to V For girls decreasing trend for being injured in sports at age 15 across social 0.001 class I to V   Boys Girls <0.05

Unintentional injuries in school-aged children: Page 8 of 11 Carolina Longitudinal Caucasian females African-American females <0.05 Study, (USA), 1981 23 Adolescents deemed aggressive as Adolescents not considered <0.01 children aggressive as children Risk taking behaviour in boys Risk taking behaviour in girls <0.05 Christchurch Child   Having conduct or oppositional Not having conduct or oppositional <0.01 Development Study, (New defiant disorder defiant disorder Zealand), 1977 26 Dunedin Multidisciplinary   Boys aged 7-11 years Girls aged 7-11 years 0.019 Child Development Study, Children with high personal adversity Children without high personal 0.011 (New Zealand), 1975 35 index (includes behaviour, reading, adversity index (includes IQ, fine and gross motor behaviour, reading, IQ, fine and coordination) gross motor coordination) Cohort from South Wales,   Boys Girls <0.05 (UK), 1972 40 Children with mothers having high or Children with mothers having low 0.001 middle scores for neuroticism scores for neuroticism Child Health & Education    Boys Girls <0.001 Study (CHES), (UK). Boys with high levels of aggression Boys with lower levels of <0.001 1970 42-45 aggression Boys with high levels of overactivity Boys with low levels of <0.001 overactivity Children having 3 or more injuries Children having none or 1-2 <0.001 between 0-5 years injuries between 0-5 years Children having one or more injury Children having no injuries <0.001 requiring hospitalisation between 0-5 requiring hospitalisation between years 0-5 years Children of mothers who are 5 years Children of mothers who were not <0.001 or more younger than other mothers in the youngest age group Children with older siblings Children without older siblings <0.001 Children living in a family with 4+ Children living in a family with <0.001 other children less than 4 children Children occupying a middle birth Children occupying the youngest <0.05 position or the oldest birth position National Child    Boys having hospitalised injuries Girls having hospitalised injuries <0.001 Development Study Boys having injuries requiring Girls having injuries requiring <0.001 (NCDS), (UK), 1958 52,54 ambulatory care ambulatory care

Unintentional injuries in school-aged children: Page 9 of 11 Children drinking more than 4 Children drinking 4 alcoholic <0.001 alcoholic drinks per week at age 15- drinks per week or less at age 15- 16 years 16 years Children with 2 or more house moves Children with 0 or 1 house moves <0.001 Children with high antisocial Children with lower antisocial <0.001 behaviour scores at age 11 behaviour scores at age 11 Children with high overactive Children with lower overactive <0.001 behaviour scores at age 11 behaviour scores at age 11 Newcastle Thousand   Children aged 5-15 years with Children aged 5-15 years with ‘Statistically Families Study, (UK), mothers who have poor coping skills mothers who had adequate coping significant 1947 55 skills difference’, p=NS Children aged 5-15 years with lower Children aged 5-15 years with ‘Statistically intelligence normal intelligence significant difference’, p=NS *Associations failing to reach significance at p<0.05 level, not reported. Effect estimates (OR or RR) reported separately in Tables 2 and 3. NS = Not stated. N/a = Not applicable

Unintentional injuries in school-aged children: Page 10 of 11 Unintentional injuries in school-aged children: Page 11 of 11