Interpretation
The results of this study show that the CSA standards
were effective in identifying schools with unsafe playground
equipment. Removing unsafe equipment and replacing
it with equipment compliant with safety standards
reduced the rate of playground injuries.
Other studies have evaluated interventions to facilitate
safe playground environments.15–18 In general, these interventions
have involved a variety of assessments of playground
hazards followed by educational programs. None evaluated
the effects of a large-scale intervention on a population of
children. Our data allowed us to compare injury rates in the
intervention schools and in the nonintervention schools and
to assess trends in playground injuries over time.
Why did the injury rates fall in the intervention schools
and rise in the nonintervention schools? Possible explanations
include changes in the physical environment, in exposure,
in supervision or in reporting. We believe that the
change in physical environment is the best explanation.
The physical environment improved in the intervention
schools, where injury rates dropped. It was possibly deteriorating
in nonintervention schools, where injury rates increased.
A reduction in injuries not recorded as being
“equipment related” is explained by the fact that the entire
outdoor environment was addressed in those schools undergoing
equipment removal and replacement. Additional
dangers such as fragmented asphalt, poorly drained and icy
areas, steep embankments and degraded borders were repaired
or safely landscaped during equipment replacement.
There are limitations to our study. First, we could not assess the amount of exposure to equipment or nonequipment
play. However, we suspect that, if anything, the novelty
of new equipment would increase exposure, which
would thereby strengthen our findings. This may explain
why the number of equipment-related injuries was still
slightly higher in the intervention schools than in the nonintervention
schools after the intervention. Second, we did
not measure supervision, which may have changed. However,
to have an effect on injury rates, supervision would
need to have increased in the intervention schools yet decreased
in the nonintervention schools, and we think this
is unlikely. Third, information on injuries was obtained
from reports of teachers and other school employees,
whose thresholds for recording and reporting injuries may
have changed during the study. It is difficult to imagine
how equipment type would systematically influence the
likelihood of reporting injuries. If the intervention sensitized
school employees to playground safety, we would expect
increased reporting at the intervention schools, which
would not explain the observations.
The CSA standards were an effective tool in identifying
hazardous playground equipment. Removal and replacement
of unsafe equipment is an effective strategy for preventing
playground injuries.