title: Association between severity of musculoskeletal injury and risk of subsequent injury in children and adolescents on the basis of parental recall.
abstract: OBJECTIVE
  To describe the frequency of subsequent injuries in children who were seen at an emergency department (ED) for a musculoskeletal injury and to explore factors associated with sustaining a subsequent injury within a year.
  
  
  METHODS
  This was a prospective cohort study of children aged 1 through 17 years who sought care at an ED for an injury. Subsequent injuries were assessed through telephone interviews.
  
  
  METHODS
  Subjects were recruited from a national database of childhood injury after they presented to a hospital ED at 1 of the 2 pediatric trauma centers in Montreal, Quebec. PATIENTS/ PARTICIPANTS: A consecutive sample of 7640 children aged 1 through 17 years who sought care for a fracture or a soft-tissue injury to an arm or a leg; 6182 completed both telephone interviews (80.9% response rate). Main Exposure Having a more severe injury was defined in 2 ways: (1) fracture of a limb or (2) injury that required follow-up or admission. Main Outcome Measure Having a subsequent injury during 12-month follow-up.
  
  
  RESULTS
  Subjects with an index fracture were at lower risk of subsequent injury than were those with a soft-tissue injury (13.5% compared with 17.7%; adjusted odds ratio, 0.74; 95% confidence interval, 0.63-0.87). Subjects whose injury needed a follow-up were also at lower risk of subsequent injury than those whose injury was treated only in the ED (17.7% compared with 14.3%; adjusted odds ratio, 0.79; 95% confidence interval, 0.67-0.93) as were those who were admitted (17.7% compared with 8.7%; adjusted odds ratio, 0.51; 95% confidence interval, 0.26-0.99).
  
  
  CONCLUSIONS
  Having had a severe musculoskeletal injury may be associated with a decreased risk of subsequent injury in children and adolescents. A possible explanation could be reduced exposure to risk.
authors.affiliation: School of Public Health and Faculty of Medicine, Physiotherapy Program, University of Montreal, Quebec.
authors.forename: Glenn
authors.initials: G
authors.lastname: Keays
authors.forename: Bonnie
authors.initials: B
authors.lastname: Swaine
authors.forename: Debbie
authors.initials: D
authors.lastname: Ehrmann-Feldman
mesh_terms: D000057:Accident Proneness; D000059:Accidents / Q000706:statistics & numerical data; D000293:Adolescent; D001134:Arm Injuries / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007869:Leg Injuries / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009141:Musculoskeletal System / Q000293:injuries*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013180:Sprains and Strains / Q000453:epidemiology*