Intended for healthcare professionals


Unnecessary school absence after minor injury: case-control study

BMJ 2001; 323 doi: (Published 03 November 2001) Cite this as: BMJ 2001;323:1034
  1. Peter M Barnes, specialist registrara,
  2. Lorna Price, staff grade doctora,
  3. Alison Maddocks, consultant (alison.maddocks{at},
  4. Ronan A Lyons, senior lecturerb,
  5. Pam Nash, consultantc,
  6. Michael McCabe, consultantd
  1. a Department of Community Child Health, Swansea NHS Trust, Central Clinic, Swansea SA1 1LT
  2. b Department of Public Health, Iechyd Morgannwg Health Authority, Swansea SA1 1LT
  3. c Local Accident Centre, Neath General Hospital, Neath SA11 2LQ
  4. d Accident and Emergency Department, Swansea NHS Trust, Morriston Hospital, Swansea SA6 6NL
  1. Correspondence to: A Maddocks
  • Accepted 11 July 2001

Children acquire many of the academic and social skills they need for their adult lives at school. Excessive absence from school is associated with educational failure, particularly when children miss more than 11% of school days.1 Each year, one in three British children goes to an emergency department for treatment, predominantly with minor injuries, but the effect on school attendances has not been quantified.2

This study was designed to investigate the number of days missed from school after children attended one of three local emergency departments with minor injuries. We defined minor injuries as those not requiring admission to hospital and not affecting mobility or the ability of the child to care for himself or herself.

Method and results

This case-control study involved children resident in, and attending school full time in, the Welsh counties of Swansea and Neath Port Talbot during the autumn school term of 1999. A case was defined as a child who attended the local emergency department on a Sunday preceding a school week with an injury that should not prevent school attendance. The children and their families were not informed of inclusion in the study. The next child of the same sex on the class register was chosen as a matched control. Ethical approval was obtained from Morgannwg Local Research Ethics Committee.

For each case, we obtained the age, sex, home postcode, school attended, and nature of the injury from the emergency department's records. School attendance for each half day in the week that followed the injury was recorded from the school register for the case pupil and the matched control (along with the control pupil's home postcode). For a randomly chosen sample of 100 pairs, we recorded the school attendance for each half day in the school week that preceded the minor injury.

Relation between minor injuries and subsequent school attendance in pupils in full time education in two Welsh counties

View this table:

Differences in school attendance between the matched pairs were analysed by using the one sample t test and Wilcoxon's matched pairs signed ranking test. A Townsend small area deprivation score was calculated for each child, and the children's attendances were analysed in relation to these scores.3

Overall, 422 case-control pairs were identified in 130 schools; 251 (59%) pairs comprised boys. Ages ranged from 4 to 16 years (mean 10.6 years). The type and frequency of injury were recorded along with the mean number of half days present in school for each injury type (table).

We excluded 57 minor fractures and one haemarthrosis from further analysis as they could be argued to be more serious injuries. We analysed attendance for the remaining 364 case-control pairs only.

Case children attended significantly fewer half days in school after injury than control children (7.38 v 9.40, P<0.001). Deprivation scores for matched pairs did not differ significantly, and there was no association between missed time at school and deprivation score. Mean half day attendance in the week preceding injury did not differ significantly between case children and control children (9.25 v 9.59, P>0.1).


On average, one full school day was missed unnecessarily after children presented to hospital emergency departments with minor injuries. As children with and without injuries had similar previous school attendance, the resulting loss could be attributed to the injury. The cumulative loss was great given the high frequency of such injuries. Repeated absences of this type could contribute to educational difficulties, especially in children whose attendance is already suboptimal for other reasons.

We propose that health professionals are more proactive in stressing the importance of children attending school after minor injury when there is no medical reason to prevent attendance. Improved liaison between emergency departments, school health services, and local education authorities might help to reduce the unnecessary burden of minor injury.


We are grateful for the valuable assistance of the emergency department staff, all participating schools, and Mrs Lisa Webb for her secretarial help.

Contributors: MM had the original idea for the study and, together with PN, facilitated the collection of data in the accident and emergency departments and drew up definitions for minor injury. AM facilitated the interagency and interdepartmental working, liaised with the education authority, submitted the application to the ethics committee, and is guarantor for the study. PB and LP designed the data collection form, collected the data, established the database, liased with individual schools, and input the data. RL advised on the research method, provided statistical advice, and analysed the data. The paper was written jointly by all authors.


  • Funding None.

  • Competing interests None declared.


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