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PEDIATRICS Vol. 103 No. 5 May 1999, pp. 1053-1056
AMERICAN ACADEMY OF PEDIATRICS:
Trampolines at Home, School, and Recreational Centers
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ABSTRACT |
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Abstract
Conclusion
Recommendation
References
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The latest available data indicate that an estimated 83 400 trampoline-related injuries occurred in 1996 in the United States. This represents an annual rate 140% higher than was reported in 1990. Most injuries were sustained on home trampolines. In addition, 30% of trampoline-related injuries treated in an emergency department were fractures often resulting in hospitalization and surgery. These data support the American Academy of Pediatrics' reaffirmation of its recommendation that trampolines should never be used in the home environment, in routine physical education classes, or in outdoor playgrounds. Design and behavioral recommendations are made for the limited use of trampolines in supervised training programs.
Review of the literature and the previous policy statements
by the American Academy of Pediatrics Access to accurate longitudinal data about the incidence and severity
of injuries resulting from trampoline use is critical in making sound
policy recommendations. Although a variety of articles about
trampoline-related injuries have been published,4-16 many
lack consistent data sources, overlap in reporting of case series, lack
an accurate measure of exposure to trampolines, and often lack detail
on the circumstances of injury. Two data sources are available to help
guide the present policy statement: 1) the Consumer Product Safety
Commission (CPSC) National Electronic Injury Surveillance System
(NEISS) and other files of product-related incidents; and 2) the
National Pediatric Trauma Registry (NPTR).
In 1996, an estimated 83 400 trampoline-related injuries were
treated in US hospital emergency departments, a rate of 31.5 injuries
per 100 000 population (Tables 1 and
2).3 The figures represent a
140% increase over the 1990 rate of injury (13/100 000). The NEISS
data showed that for all years (1991-1996), incidents were about
evenly divided between boys and girls. In 1996, more than 66% of
victims were ages 5 through 14 years; about 16% were 15 through 24 years; and about 10% were 4 years or younger (Table 2). Children
younger than 5 years had the second highest rate of injury.
Strain/sprain was the most common diagnosis, and was involved in 40%
of the injuries. Fractures accounted for 30% of injuries;
contusions/abrasions, 13%; lacerations, 11%; and other, 6%. Of the
estimated injuries, 45% occurred to the lower extremity (leg or foot)
and 30% to the upper extremity (arm or hand); 14% were head or face
injuries. The majority of injuries to the leg or foot were strains or
sprains (58%), whereas the majority of injuries to the arm or hand
were fractures (58%). Most injuries to the head or face were
lacerations (61%). Fractures, concussions, and internal injuries to
the head accounted for about 15% of all head injuries. For the most
severe injuries resulting in hospitalization, fractures (most
frequently to the arm and leg) were diagnosed in almost 90%. Two
percent of trampoline-related injuries treated in the emergency
department resulted in hospitalization, compared with 4% for other
product-related injuries reported to NEISS. Table 1 summarizes the
number of cases of trampoline-related injuries, the number of
hospitalizations, and the number of head and neck injuries for the
years 1991 through 1996. The CPSC data indicate that in 1996, head
(excluding face) and neck injuries accounted for 9.8% of
trampoline-related injuries, 7.2% of skateboard-related injuries,
and 4.9% of in-line skating-related injuries.3
TABLE 1 TABLE 2
"Trampolines" and
"Trampolines II"were critical in placing the currently available
data on trampoline-related injuries and deaths in
perspective.1,2 Injuries have been reported on trampolines
ranging from 3 feet in diameter to running or tumbling trampolines that
may be as long as 30 feet.3 Previous data have shown that
injuries are likely to occur equally on large or small
trampolines.4
TRAMPOLINE INJURIES
Trampoline-Related Injuries*
Estimated Injuries and Injury Rates From Trampolines, by Age of Victim
(1996)*
Most trampoline-related injuries have occurred on home trampolines (Table 3). The proportion of injuries for which the location was unknown increased from 1991 to 1996 and deserves further study. Review of NEISS 1996 descriptive comments showed that victims were injured when they landed incorrectly while jumping or while performing stunts. Other injuries occurred when the victims fell from the trampoline to the surface below or collided with another person on the equipment. Victims also were injured when they contacted the frame and/or springs while near the edge of the jumping surface. A limited NEISS in-depth study of people in hospital emergency departments in September 1995 revealed that in 57% of cases, the victims were on the trampoline with one or more other persons when they were injured.3 Many of these multiple-user incidents seemed to result from contact with another user. Most injuries involved relatively new full-size trampolines in residential yards. Most trampolines were at least 2 feet high.
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The NPTR is a database of trauma cases treated in a set of pediatric trauma centers or in children's hospitals with a pediatric trauma unit. In October 1996, there were 78 participating hospitals. During the period July 13, 1988, to June 30, 1996, 149 trampoline-related injuries were reported to the NPTR (unpublished data, 1996). About 50% of these patients were transported directly to the operating room. The leading diagnosis was fracture of an extremity. In 16% of cases, the head and neck were involved. One spinal cord lesion without vertebral injury was reported, and one fracture of the vertebral column occurred without spinal cord injury. The majority of head and neck injuries were skull fractures with intracranial injury or concussion.
A recent epidemiologic study of trampoline-related injuries in New Zealand, during a 10-year period 1979 through 1988, revealed an increase in incidence of hospitalization rate from 3.1 to 9.3 per 100 000.4 Of hospitalized victims, 71% were injured on home trampolines, and in contrast to other studies, 80% fell from the trampoline to the surrounding surface. Fractures were the most common type of injury, and the incidence of severe head and neck injuries was low. Two deaths and 2098 hospitalizations occurred. Most injuries occurred when the victims fell from the trampoline and sustained injury on impact with the surface below.
A recent review of trampoline-related injuries to children in the United States from 1990 through 1995 provided a retrospective analysis of data from the NEISS. The data indicated that an estimated 1400 children, or 2.0 per 100 000, required hospital admission or interhospital transfer because of a trampoline-related injury. This represented 3.3% of all children with a trampoline-related injury.16
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TRAMPOLINE DEATHS |
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Since 1990, the CPSC has received reports of six deaths involving trampolines. Victims ranged in age from 3 years through 21 years, although the 21-year-old died 6 years after being injured on a trampoline. Most deaths occurred when victims fell from the trampolines, and most involved the cervical spinal cord.
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CONCLUSIONS |
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Abstract
Conclusion
Recommendation
References
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The following conclusions may be drawn from the data and literature review:
- In the United States, the largest proportion of trampoline-related injuries has occurred on home trampolines.
- Most trampoline-related injuries occur from falls sustained on and off the trampoline.
- Many trampoline-related injuries occur when there are simultaneous multiple users.
- The most likely injuries resulting in hospitalization sustained while using a trampoline are fractures to the upper and lower extremities; these injuries may be severe, often resulting in surgery.
- Catastrophic cervical spine injuries are rare. However, head and neck injuries constitute a notable number of the more serious injuries requiring hospitalization.
- More data are needed about the incidence, circumstances, and mechanism of catastrophic injuries, such as those to the cervical spine.
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RECOMMENDATIONS |
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Abstract
Conclusion
Recommendation
References
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Despite all currently available measures to prevent injury, the potential for serious injury while using a trampoline remains. The need for supervision and trained personnel at all times makes home use extremely unwise.
- The trampoline should not be used at home, inside or outside. During anticipatory guidance, pediatricians should advise parents never to purchase a home trampoline or allow children to use home trampolines.
- The trampoline should not be part of routine physical education classes in schools.
- The trampoline has no place in outdoor playgrounds and should never be regarded as play equipment.
The limited use of trampolines under direct supervision of physical therapists, athletic trainers, or other appropriately trained individuals for specific medical conditions, including conditioning and/or rehabilitation of injuries, is not addressed in this statement. The limited use of trampolines in supervised training programs (eg, gymnastics, diving, and other competitive sports), should include the design and behavioral recommendations that follow.
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DESIGN |
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- A safety pad should cover all portions of the steel frame and springs.
- The surface around the trampoline should have an impact-absorbing safety surface material.17
- The condition of the trampoline should be regularly checked for tears, rust, and detachments.
- Safety harnesses and spotting belts, when appropriately used, may offer added protection for athletes learning or practicing more challenging skills on the trampoline.
- Setting the trampoline in a pit so the mat is at ground level should be considered.
- Ladders may provide unintended access to the trampoline by small children and should not be used.
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BEHAVIOR |
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- Only one person should use the trampoline at a time.
- In supervised settings, the user of the trampoline should be at the center of the mat. The user of the trampoline should not attempt maneuvers beyond capability or training, thereby putting them at risk for injury.
- Personnel trained in trampoline safety and competent spotters should be present whenever the trampoline is in use.
- Even in supervised training programs, the use of trampolines for children younger than 6 years of age should be prohibited.18
- The trampoline must be secured and not accessible when not in use.
COMMITTEE ON INJURY AND POISON PREVENTION,
1998-1999
Murray L. Katcher, MD, PhD, Chairperson
Phyllis Agran, MD, MPH
Danielle Laraque, MD
Susan H. Pollack, MD
Barbara L. Smith, MD
Gary A. Smith, MD, DrPH
Howard R. Spivak, MD
Milton Tenenbein, MD
Susan B. Tully, MD
LIAISON REPRESENTATIVES
Ruth A. Brenner, MD, MPH
National Institute for Child Health and Development
Stephanie Bryn, MPH
Maternal and Child Health Bureau
Cheryl Neverman, MS
National Highway Traffic Safety Administration
Richard A. Schieber, MD, MPH Centers for Disease Control and
Prevention
Richard Stanwick, MD
Canadian Paediatric Society
Deborah Tinsworth
United States Consumer Product Safety Commission
William P. Tully, MD
Pediatric Orthopaedic Society of North America
SECTION LIAISONS
Marilyn Bull, MD
Section on Injury and Poison Prevention
Victor Garcia, MD
Section on Surgery
COMMITTEE ON SPORTS MEDICINE AND FITNESS, 1998-1999
Steven J. Anderson, MD, Chairperson
Bernard A. Griesemer, MD
Miriam D. Johnson, MD
Thomas J. Martin, MD
Larry G. McLain, MD
Thomas W. Rowland, MD
Eric Small, MD
LIAISON REPRESENTATIVES
Claire LeBlanc, MD
Canadian Paediatric Society
Carl Krein, ATC, PT
National Athletic Trainers Association
Judith C. Young, PhD
National Association for Sport and Physical Education
SECTION LIAISONS
Frederick E. Reed, MD
Section on Orthopaedics
Reginald L. Washington, MD
Section on Cardiology
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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CPSC, Consumer Product Safety Commission; NEISS, National Electronic Injury Surveillance System; NPTR, National Pediatric Trauma Registry.
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REFERENCES |
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Abstract
Conclusion
Recommendation
References
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- American Academy of Pediatrics, Committee on Accident and Poison Prevention. Trampolines. News and Comment. September 1977
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American Academy of Pediatrics, Committee on Accident and Poison Prevention and Committee on Pediatric Aspects of Physical Fitness, Recreation and Sports
Trampolines II.
Pediatrics.
1981;
67:438-439
[Abstract/Free Full Text] - Cassidy SP. United States Consumer Product Safety Commission (US CPSC). Trampolines. Memorandum, May 15, 1996, and National Electronic Injury Surveillance System (NEISS) data, 1991-1995; 1996
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Chalmers DJ,
Hume P,
Wilson FD
Trampolines in New Zealand: a decade of injuries.
Br J Sports Med.
1994;
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Torg JS,
Das M
Trampoline-related quadriplegia: review of the literature and reflections on the American Academy of Pediatrics' position statement.
Pediatrics.
1984;
74:804-812
[Abstract/Free Full Text] -
Hume PA,
Chalmers DJ,
Wilson BD
Trampoline injury in New Zealand: emergency care.
Br J Sports Med.
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30:327-330
[Abstract/Free Full Text] - Torg JS Trampoline-induced quadriplegia. Clin Sports Med. 1987; 6:73-85 [Medline]
- Torg JS Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine. Med Sci Sports Exerc. 1985; 17:295-303 [Medline]
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Silver JR
Spinal injuries in sports in the UK.
Br J Sports Med.
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27:115-120
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Woodward GA,
Furnival R,
Schunk JE
Trampolines revisited: a review of 114 pediatric recreational trampoline injuries.
Pediatrics.
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89:849-854
[Abstract/Free Full Text] -
Larson BJ,
Davis JW
Trampoline-related injuries.
J Bone Joint Surg Am.
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77:1174-1178
[Abstract/Free Full Text] -
Hammer A,
Schwartzbach AL,
Paulev PH
Some risk factors in trampolining illustrated by six serious injuries.
Br J Sports Med.
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16:27-32
[Abstract/Free Full Text] -
Hammer A,
Schwartzbach AL,
Paulev PH
Trampoline training injuries: one hundred and ninety-five cases.
Br J Sports Med.
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15:151-158
[Abstract/Free Full Text] - Routley V Trampoline injuries. Hazard. 1992; 13:1
- Clarke KS A survey of sports-related spinal cord injuries in schools and colleges, 1973-1975. J Safety Res. 1977; 9:140-146
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Smith GA
Injuries to children in the United States related to trampolines, 1990-1995: a national epidemic.
Pediatrics.
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101:406-412
[Abstract/Free Full Text] - American Society for Testing and Materials, ASTM Subcommittee F15-29. F1487-95 Standard Consumer Safety Performance Specification for Playground Equipment for Public Use. West Conshohocken, PA; 1997
- Consumer Product Safety Alert. Trampoline Safety Alert. Washington, DC: US Consumer Product Safety Commission; June 1997
Pediatrics (ISSN 0031 4005). Copyright ©1999 by the American Academy of Pediatrics
Statement of reaffirmation:
- AAP Publications Retired and Reaffirmed
- American Academy of Pediatrics
Pediatrics 2006 117: 1846-1847.[Extract] [Full Text] [PDF]
The following policy statement has been revised:
- Trampolines II
- H. James Holroyd, Lorne K. Garrettson, Joseph Greensher, Matilda S. McIntire, Leonard S. Krassner, Raymond Chi Wing Ng, Avrin M. Overbach, Barry H. Rumack, Mark D. Widome, George D. Armstrong, Diane Imhulse, Andre l'Archeveque, H. Biemann Othersen, Jr, Thomas G. Flynn, John H. Kennell, Robert N. McLeod, Jr, Thomas E. Shaffer, William B. Strong, Melvin L. Thornton, Clemens W. Van Rooy, Lucille Burkett, Fred W. Baker, and Richard Malacrea
Pediatrics 1981 67: 438.[Abstract] [PDF]
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