PEDIATRICS Vol. 106 No. 1
July 2000,
pp. 10-13
Injuries Sustained by Students in Shop Class
Stacey Knight, MStat*,
Edward P. Junkins,
Jr, MD*, 
,
Amy C. Lightfoot, BS*,
Calvert F. Cazier, MPH§, and
Lenora M. Olson, MA*
From * Intermountain Injury Control Research Center, Department
of Pediatrics, University of Utah School of Medicine, Salt Lake City,
Utah; Department of Pediatrics, Division of Pediatric Emergency
Medicine, Primary Children's Medical Center, University of Utah School
of Medicine, Salt Lake City, Utah; and § Utah Department of Health,
Violence and Injury Prevention Program, Division of Community and
Family Health Services, Salt Lake City, Utah.
 |
ABSTRACT |
Objective. Injuries in the school
environment are a serious public health problem. Injuries occurring
within the school shop class are a part of this problem that has
received little to no attention. The purpose of our study was to
describe the epidemiology of shop class injuries in Utah public schools
for the years 1992-1996.
Methods. Utah statewide grades 7 through 12 school injury
data for 1992-1996 were used. The data were generated from a
standardized Student Injury Report form completed by school personnel
immediately after the occurrence of an injury on school premises that:
1) caused loss of at least one half of a day of school; and/or 2) warranted medical attention and treatment. Shop injuries were defined
as injuries that occurred in industrial art classes, vocational educational classes, or automotive classes. To determine the medical outcome and hospital charges associated with shop class injuries, we
linked the Student Injury Report database to Utah statewide emergency department (ED) records (available for 1996 only), and to
Utah statewide hospital inpatient discharge records (1992-1996).
Results. During 1992-1996, 14 133 students in grades 7 through 12 were injured at school, of which 1008 (7.1%) were injured
during a shop class. The majority (88.4%) of shop injuries involved
equipment use. Equipment was misused in 37.9% and malfunctioned in
3.5% of the incidents. The leading injuries reported for shop
equipment were lacerations (70.9%), burns (6.0%), and abrasions
(4.6%), whereas the leading for nonequipment injuries were lacerations (45.4%), fractures (9.2%), and pain/tenderness (6.7%). In 1996, 167 students were injured in a shop class and 45 (26.9%)
visited an ED as a result of the shop injury. Equipment was a factor in
88.9% of the shop injuries admitted to the ED. Table saws (15.0%),
other saws (15.0%), and band saws (12.5%) were involved in nearly one
half of the equipment injuries. Equipment was misused in 44.7% and
malfunctioned in 10.5% of the incidents resulting in an ED visit. The
majority (64.4%) of students sustained an open wound injury. The total
ED charges were $16 571. For 1992-1996, 1008 students were injured in a shop class, 7 (.7%)
required inpatient hospital care. Six of the students were injured
using a table saw and 1 sustained injuries attributable to automotive
cleaning fluid. Equipment was used improperly in 4 of the table saw
injuries. Six of the students sustained hand injuries, with 3 suffering
a traumatic amputation of a finger or thumb. The total inpatient
charges were $26 747.
Conclusion. School shop injuries have a great impact on
students, their families, and schools because of the loss of
productivity for the student and the financial impact. Many of the
injuries are preventable. These findings stress the need for school
administrators, teachers, and students to develop and improve safety
policies and practices in school shop classes. In addition, the
findings may provide useful information to pediatricians and enable
them to better inform patients of risks in school shop
classes.
Key words:
school health,
equipment injuries,
shop class
injuries,
financial outcomes,
medical outcomes,
prevention.
Injuries in the school environment are a serious public
health problem. It is estimated that 20% of injuries to school-aged children occur on school premises.1 School injuries result in an estimated $3.2 billion in medical spending and $115 billion in
good health lost each year.2 Although injuries occurring on school playgrounds and during sporting events have been studied, injuries occurring within the classroom have received little to no
attention, especially injuries occurring in shop
classes.3-11 The seriousness of injuries in a shop class
is illustrated in the following account. An 11th-grade female shop
student sustained a hand injury attributable to a table saw. After the
machine was turned off, the free-spinning blade drew her fingers across
the blade as she reached for the wood scrap. She partially severed 2 fingers. These injuries required surgery and a hospital stay. She
missed 4 days of school and was restricted from activity on return to
school.
Federal policies carefully regulate the workplace regarding safety
issues involving minors. As part of these regulations, children <18
years of age are prohibited from working with equipment such as
power-driven woodworking tools, metal-forming or punching machines,
circular saws, and band saws.12 Often these same tools are
used by students in shop class, where there are few or no restrictions
for use of the equipment. This equipment is not only designed for
adults but also has great potential for serious injury.
The purpose of our study was to describe the epidemiology of shop class
injuries in Utah public schools for the years 1992-1996. To assess the
medical and financial outcome of shop class injuries, we used a
statewide school injury database linked to emergency department (ED)
records and hospital inpatient records. The findings from this study
may help school administrators, teachers, and students develop and
improve safety policies and practices in school shop classes. In
addition, the findings may provide useful information to pediatricians
and enable them to better inform patients of risks in school shop
classes.
| |
METHODS |
Data collected by the Utah Department of Health Violence and
Injury Prevention Program from 1992-1996 were used. The data were
generated from a standardized Student Injury Report (SIR) form
completed by school personnel (ie, secretary, school nurse, counselor,
coach, teacher, etc) immediately after the occurrence of an injury on
school premises that: 1) caused loss of at least one half of a day of
school; and/or 2) warranted medical attention and treatment (ie, school
nurse, physician, other health care provider, or evaluation in a health
care facility). The SIR forms are used in all school districts in Utah.
A technician reviews each form before it is entered into the database,
communicates with schools regarding the consistency of reporting, and
provides training to improve the accuracy of reporting. Use of these
forms is voluntary; however, compliance has been consistent from year to year, and this form is the only means used to report student injuries to the health department. Items on the form include: student
demographics, time and date of injury, place (school and district),
number of missed days, action taken (ie, first aid, called 911, taken
to a physician), nature of injury, body area affected, contributing
factor, school setting, location (ie, athletic event, classroom,
gymnasium, shop class, laboratory, etc.), activity during which injury
occurred, equipment involved, malfunction of equipment, and equipment
misuse.
We analyzed injuries that occurred to students in grades 7 through 12. A shop injury was defined as an injury where shop was coded for the
location. Shop is recorded for industrial art classes, vocational
educational classes, or automotive classes.
To determine the medical outcome and hospital charges associated with
shop class injuries, we linked the SIR database to Utah statewide ED
records (available for 1996 only), and to Utah statewide hospital
inpatient discharge records (1992-1996). These records were acquired
from the Utah Health Data Committee, Office of Health Data Analysis.
Reporting by hospitals is mandated by Utah law. Both databases contain
International Classification of Disease, Ninth Revision
codes, E-codes, demographic information (birth date, sex, and grade),
billing information, and charges (excluding physician fees). ED records
contain patients seen only in the ED, and not admitted as inpatients;
thus, there is no overlap between the databases.
The methodology of probabilistic linkage has been previously validated
and described.13,14 Briefly, probabilistic record linkage
uses statistical properties of variables that are common in 2 databases
to determine whether a pair of records refers to the same person and
event. We used Automatch 4.1 (Matchware Techologies, Inc, Silver
Spring, MD) to probabilistically link the SIR database to the ED and
inpatient files.
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RESULTS |
SIR Database
From 1992 to 1996, 14 133 students in grades 7 through 12 were
injured at school. Of these, 1008 (7.1%) were injured during a shop
class. Nearly one half of the shop injuries (42.1%) occurred to
students in grades 8 and 9, and 87.3% were male. The predominant hour
for shop injuries was 10:00 AM. Teachers completed 62.5% of the injury reports. The average missed school time for a shop injury
was one half of a day (range: 0-36 days).
Equipment use accounted for 88.4% of the shop injuries. Nonequipment
injuries included collision with an object or person and foreign
body/object. Band saws (11.9%), table saws (11.6%), and
sander/buffers (7.4%) were involved in nearly one third of the
equipment-related injuries. Other types of equipment included other
saws (7.2%), cutting equipment (6.4%), drills (3.8%), welders (3.7%), and routers (2.8%). Improper use of equipment was reported in
37.9% of the equipment-related incidents, and malfunction of equipment
was reported for 3.5% of the equipment-related incidents. The type of
injury and primary injured area, reported on the SIR form, varied for
equipment and nonequipment injuries. Lacerations (70.9%), burns
(6.0%), and abrasions (4.6%) were reported for equipment injuries,
whereas lacerations (45.4%), fractures (9.2%), and pain/tenderness
(6.7%) were reported for nonequipment injuries. The primary injured
areas reported for equipment injuries were finger/thumb (64.0%),
hand/wrist (12.8%), and eye (5.6%), whereas the primary injured areas
reported for nonequipment injuries were eye (19.3%), finger/thumb
(17.6%), and hand/wrist (10.9%).
ED Linkage
In 1996, 2951 students in grades 7 through 12 were injured at
school and 713 (24.2%) visited an ED as a result of the injury. That
same year 167 students were injured in a shop class and 45 (26.9%)
visited an ED as a result of the shop class injury. Over one half
(57.7%) of the students who visited the ED for a shop injury were in
grades 11 and 12, and 91.1% were male. The average missed school time
for the students admitted to ED was 1 day (range: 0-10 days). Three
students were restricted from activity for 4, 10, and 20 days.
Equipment was a factor in 88.9% of the shop injuries admitted to the
ED. Table saws (15.0%), other saws (15.0%), and band saws (12.5%)
were involved in nearly one half of the equipment injuries seen in the
ED. Equipment was used improperly in 44.7% of the equipment-related
incidents and malfunctioned in 10.5% of the equipment-related
incidents. The majority (68.9%) of the students experienced a
hand/wrist injury. The leading injuries sustained were open wounds
(64.4%), followed by contusions (13.3%), fractures (8.9%), and 2 students sustained traumatic amputation of a finger. The total ED
charges for shop injuries were $16 571 or ~$368 per injury.
Inpatient Linkage
For 1992-1996, 14 133 students were injured at school and 146 (1.0%) required inpatient hospital care as a result of the injury. Of
the 1008 students injured in a shop class, 7 (.7%) required inpatient
hospital care. All of these students were in grades 9 to 12, and 4 (57.1%) were male. The students missed an average of 6 days of school,
with 1 student missing 36 days. Six of the students were injured using
a table saw and 1 sustained injuries attributable to automotive
cleaning fluid. Equipment was used improperly in 4 of the table saw
injuries, whereas equipment malfunction was not reported as
contributing to any of the injuries. Two students sustained an
open-wound hand injury involving a tendon, 2 sustained traumatic
amputation of a finger, 1 suffered a traumatic amputation of a thumb, 1 suffered an open fracture to a finger sustaining nerve and tendon
damage, and 1 sustained second degree burns on face and upper limb. The
total inpatient hospital charges for shop injuries were $26 767 with
an average charge of $3821, and the average length of stay was 1.4 days. All 7 patients were discharged to home from the hospital.
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DISCUSSION |
While using a sander, a 12th-grade male shop student sustained a
deep finger laceration. The injury required 8 stitches and resulted in
an ED charge of $150. This incident is typical for most shop class
injuries. In fact, we found the vast majority of shop injuries involved
equipment use. In addition, equipment misuse or malfunction was a
significant contributor to shop injuries. The morbidity associated with
shop injuries can be devastating and life lasting; for example, some
students partially or completely severed fingers or thumbs. Other
studies have shown equipment like those used in shop classes have the
potential to cause serious injuries.15-17 These
tools may be particularly dangerous for school-aged children because of
the children's musculoskeletal development. Adolescents commonly
experience disproportional growth patterns, causing limited and
uncoordinated range of motion, and resulting in an increased risk for
injury. Furthermore, shop equipment designed for adults may be
unsuitable in size and dimension for school-aged children, which may
put them at increased risk for injury.12 These findings
stress the need for school administrators, teachers, and students to
develop and improve safety policies and practices in school shop
classes. In addition, pediatricians need to be cognizant of these
hazards and inform patients of risks in school shop classes.
We found that power saws accounted for approximately one quarter of the
equipment-related injuries. This finding is particularly troubling
because the use of power saws by minors is regulated in the workplace.
No such regulations exist for students in the shop class environment. A
study of amateur and professional woodworkers found that although the
largest percentage of serious equipment-related injuries involved a
table saw, the table saw had the lowest rate per hour of use for a
first time injury incident (.7 incidence per 1000 person
hours).16 Although this particular study was not
restricted to students in shop classes, it may indicate that although
shop equipment-injuries often involve table saws, other shop equipment
may be more dangerous per hour of use. In our study, we were unable to
obtain usage rates of shop equipment, thus preventing us from
determining the risk of an injury for specific shop equipment. However,
by identifying which equipment contributed to shop injuries, we were
able to better determine which equipment may need increased attention.
Shop class instructors and school administrators should ensure that
shop class power saws and other equipment are well-maintained and
include all available safety features. In addition, it is important
that individual students are not allowed to use power saws
inappropriate for their stature.
Another important finding was that many of the equipment-related
injuries were coded as equipment misuse. Shop class curriculum in Utah
public schools includes equipment training and instructions on shop
safety practices and procedures, yet students continue to be injured by
improper use of equipment. This may indicate that safety instructions
need greater emphasis or perhaps that safety policy enforcement is
lacking. In the occupational literature, proper training on the safe
use of equipment and improved supervision of workers have been shown to
reduce injuries and decrease inappropriate behaviors.12,18
The use of occupational training material and supervision techniques
may help increase safety practices in shop classes.
A 12th-grade male shop student cut the end of his thumb while using a
malfunctioning paper cutter. He sustained a laceration when the slicing
arm of the apparatus failed to remain in an upright position. The
injury did not result in stitches, but resulted in an ED visit and $105
in ED charges. Injuries resulting from the malfunction of equipment are
costly and unnecessary. These injuries are costly because they may
result in litigation for the school (not to mention the medical cost of
the injury), and are also unnecessary because most are preventable.
Injuries resulting from malfunction of equipment indicate a need for
school administrators and shop instructors to ensure that equipment is
maintained properly and old equipment is updated or replaced. One
suggestion for decreasing shop injuries is to take a workplace
approach. For example, Padham19 suggests that schools
invite outside agencies, such as the Occupational Safety and Health
Administration, into shop facilities to conduct safety audits.
While reaching for a wood scrap, a female in grade 10 severed 3 fingers, when she came in contact with the table saw blade. She missed
36 days of school, required several surgeries, and incurred over $6100
in inpatient hospital charges. The morbidity associated with shop
injuries can be devastating and life lasting, as evidenced by the
previous example. In our study, one quarter of students injured in shop
class required an ED evaluation or hospital inpatient care. The
majority of the hospital and ED injuries were to the hand. In fact, 5 students sustained traumatic amputations to a finger or thumb. Other
studies have documented that hand injuries cause serious morbidity. A
study of injuries among carpenters found equipment-related hand
injuries cost an average of $12 000 and resulted in an average of 20 days of total or partial disability.17 Another study,
which examined hand injuries treated in a hospital, reported that 6 weeks after treatment 26% of outpatients and 44% of inpatients
reported pain and discomfort, and 18% had problems writing or
typing.20 Hand injuries to shop class students, especially
those that sustain traumatic amputations, impact the students and their
families in terms of financial burdens because of rehabilitation cost,
missed school days, and loss of productivity.
Our study has several strengths. First, to our knowledge, this is the
largest school shop injury study to date. The use of the Utah SIR
database enabled us to conduct a population-based study of shop
injuries. Second, the SIR database contained useful equipment-related
injury information that is important in determining possible areas for
prevention of shop injuries. Third, the use of probabilistic linkage
allowed us to determine the severity of injuries and determine hospital
charges that enabled us to associate the injuries with actual financial
impact without using estimates.
Limitations of our study include possibly underestimating of school
injuries because of the voluntary nature of the reporting. The SIR form
has been in place for >10 years. Although it is voluntary, it is the
only form schools use to report injuries to the health department, and
compliance has been consistent from year to year. A second limitation
is the fact that forms are completed by shop teachers and other school
personnel, not by safety professionals trained in accident
investigation. Another limitation is our data contain hospital charges,
which do not include physician fees or rehabilitation charges and do
not accurately contain cost or payment information. In addition, our
data lacked cost associated with litigation. Thus, the financial impact
of shop injuries is probably underestimated. Further limitations
include the lack of student enrollment rates for shop classes, the lack
of specific shop equipment usage rates, the inability to determine
maintenance of specific equipment, and the lack of information
regarding supervision. These limitations should be addressed as part of
future studies.
Despite these limitations, we have shown that shop injuries are an
important component of school health. In our study, we found that shop
injuries were most often equipment-related, were a result of equipment
misuse or malfunction, and can cause serious injury. These injuries
have a great impact on students, their families, and schools because of
the loss of productivity of the student and the financial impact. Many
of the injuries are preventable. These findings stress the need for
school administrators, teachers, and students to develop and improve
safety policies and practices in school shop classes and in school
health in general. Pediatricians and other physicians need to ask
teen-aged patients whether they are enrolled in shop class and to
caution them about equipment use, especially power saws.
| |
ACKNOWLEDGMENT |
This project was supported in part by Cooperative Agreement
MCH-494003-03-0 from Maternal and Child Health Bureau, Health Resource and Services Administration, Public Health Services, United
States Department of Health and Human Services.
| |
FOOTNOTES |
Received for publication Jul 22, 1999; accepted Nov 16, 1999.
Reprint requests to (S.K.) University of Utah, 410 Chipeta Way,
Suite 222, Salt Lake City, UT 84108. E-mail:
stacey.knight{at}hsc.utah.edu
| |
ABBREVIATIONS |
ED, emergency department;
SIR, Student Injury
Report.
| |
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Pediatrics (ISSN 0031 4005). Copyright ©2000 by the American Academy of Pediatrics
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Abstract
Methods
