The effect of safer play equipment on playground injury rates among school children

Background: Changes to Canadian Standards Association ( CSA) standards for playground equipment prompted the removal of hazardous equipment from 136 elementary schools in Toronto. We conducted a study to determine whether applying these new standards and replacing unsafe playground equipment with safe equipment reduced the number of school playground injuries. Methods: A total of 86 of the 136 schools with hazardous play equipment had the equipment removed and replaced with safer equipment within the study period ( intervention schools). Playground injury rates before and after equipment replacement were compared in intervention schools. A database of incident reports from the Ontario School Board Insurance Exchange was used to identify injury events. There were 225 schools whose equipment did not require replacement ( nonintervention schools); these schools served as a natural control group for background injury rates during the study period. Injury rates per 1000 students per month, relative risks ( RRs) and 95% confidence intervals ( CIs) were calculated, adjusting for clustering within schools. Results: The rate of injury in intervention schools decreased from 2.61 ( 95% CI 1.93 - 3.29) per 1000 students per month before unsafe equipment was removed to 1.68 ( 95% CI 1.31 - 2.05) after it was replaced ( RR 0.70, 95% CI 0.62 - 0.78). This translated into 550 injuries avoided in the post- intervention period. In nonintervention schools, the rate of injury increased from 1.44 ( 95% CI 1.07 - 1.81) to 1.81 ( 95% CI 1.07 - 2.53) during the study period ( RR 1.40, 95% CI 1.29 - 1.52). Interpretation: The CSA standards were an effective tool in identifying hazardous playground equipment. Removing and replacing unsafe equipment is an effective strategy for preventing playground injuries.