Trampolines versus Playgrounds - A Comparative Assessment of Pediatric Fractures Sustained from Recreational Play

Background: A recent body of literature has emerged highlighting the rising frequency and severity of pediatric trampoline-related injuries. However, to date, little is known about the spectrum and severity of these injuries as compared to other recreational mechanisms. Using the Pediatric Health Information System (PHIS), we sought to compare the characteristics of children sustaining fractures from trampolines or other playground equipment. We hypothesized that trampoline fractures would be more severe than playground-associated injuries after adjustment for confounding.

Methods: Pediatric patients (≤18yo) presenting between 1/2009 and 12/2019 with fractures associated with trampolines or playground equipment were identified using the PHIS database. We adjusted the effect of fracture mechanism (trampoline vs. playground) for hospital, year of injury, patient gender, age, and race, and the patient’s zip code’s median household income and geographic location through propensity score weighting. We considered four proxies for injury severity: operative management, length of stay, administrative severity (an internally-coded value by PHIS), and the presence of any complications.

Results: Review of PHIS identified 144,145 patients with fractures sustained from trampolines or playground equipment. Before adjustment, we noted significant differences existed between children injured by trampolines and other playground equipment for all demographic characteristics (max p<0.001). We also noted that children injured by trampolines had a longer length of stay (exp(B)=1.03 95% CI [1.01, 1.05]), a higher administrative severity (Odds Ratio=1.14 [1.01, 1.27]), and a higher risk of complications (OR=1.20 [1.02, 1.41]). After adjustment, there was no significant effect of fracture mechanism on operative management, length of stay, administrative severity, or complication risk.

Conclusion: Children with fractures from a trampoline compared to other playground equipment have a greater length of stay, present with more severe injuries, and are more likely to face complications. However, these differences disappear after including patient characteristics in the model. Therefore, although fractures from trampolines tend to be more severe than those from other playground equipment, these differences are potentially due to the children that participate in these activities.