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Comparative surgical risk between type of trampoline (size and place) and type of patients (age and sex) in trampoline related injury: a systematic review and indirect meta-analysis

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Background: Despite its high risk of injury, many people are still favor trampolining. However, currently there is no consensus as to which type of trampoline and which type of participant is more likely to have a trampoline related injury that will require surgical management. Methods: This systematic review and meta-analysis aims to assess and compare the factors that cause trampoline injuries requiring surgical treatment. These include the place of the trampoline (park versus home), size of the trampoline (full versus mini), the age of the participant (child versus adult) and the sex of the participant (male versus female). The clinical outcomes measured are surgical management after trampoline injury. This systematic review was conducted according to the PRISMA guidelines. Results: Relevant studies that reported surgery after trampoline injury of either group were identified from Medline and Scopus from inception to May 14, 2019. Sixteen studies were included for the analysis of surgery after trampoline injury; a total of 4491 and 1121 patients were treated conservatively and surgically. The total surgery rate per patient was 31% (95% CI: 16, 46%) in all patients. The surgery rate was 0.3 (95% CI: 0.03, 0.58) and 0.06 (95% CI: 0.04, 0.09) in the full and mini size trampoline groups. There were 0.36 (95% CI: 0.06, 0.67) and 0.11 (95% CI: 0.0, 0.22) in the park and home trampoline groups. The surgery rates were 0.33 (95% CI: 0.14, 0.53), 0.24 (95% CI: 0.07, 0.11), 0.49 (95% CI: 0.47, 0.51) and 0.38 (95% CI: 0.22, 0.53) in children, adults, females and males respectively. Indirect meta-analysis shows that full size trampolines provided a 6.0 times higher risk of surgery (95% CI: 3.7, 9.7) when compared to mini size trampolines. Park trampolines had a higher risk of surgery of 2.17 (95% CI: 1.70, 2.78) when compared to home trampolines. In terms of age and sex of participants, there value was significantly higher at 1.65 (95% CI: 1.35, 2.01) and 1.54 (95% CI: 1.36, 1.74) in children compared to adults and females compared to males. From all the statistical data we summarized that the full size trampoline injuries have a 6 times higher risk of requiring surgery when compared to mini size trampoline injuries. Park trampoline use carries a 2 times higher risk of requiring surgery when compared to home trampoline use. In terms of age and sex of the participant, there is a 1.5 times significantly higher risk of injury in children compared to adults, and females when compared to males. Conclusion: In trampoline related injuries, full size, park trampoline, children and females had higher surgery rates when compared to mini size, home trampoline, adult and male majority in indirect meta-analysis methods.
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R E S E A R C H A R T I C L E Open Access
Comparative surgical risk between type of
trampoline (size and place) and type of
patients (age and sex) in trampoline related
injury: a systematic review and indirect
meta-analysis
Janisa Andrea Muljadi
1
, Kornkit Chaijenkij
2
, Alisara Arirachakaran
3
and Jatupon Kongtharvonskul
4*
Abstract
Background: Despite its high risk of injury, many people are still favor trampolining. However, currently there is no
consensus as to which type of trampoline and which type of participant is more likely to have a trampoline related
injury that will require surgical management.
Methods: This systematic review and meta-analysis aims to assess and compare the factors that cause trampoline
injuries requiring surgical treatment. These include the place of the trampoline (park versus home), size of the
trampoline (full versus mini), the age of the participant (child versus adult) and the sex of the participant (male
versus female). The clinical outcomes measured are surgical management after trampoline injury. This systematic
review was conducted according to the PRISMA guidelines.
Results: Relevant studies that reported surgery after trampoline injury of either group were identified from Medline
and Scopus from inception to May 14, 2019. Sixteen studies were included for the analysis of surgery after
trampoline injury; a total of 4491 and 1121 patients were treated conservatively and surgically. The total surgery
rate per patient was 31% (95% CI: 16, 46%) in all patients. The surgery rate was 0.3 (95% CI: 0.03, 0.58) and 0.06 (95%
CI: 0.04, 0.09) in the full and mini size trampoline groups. There were 0.36 (95% CI: 0.06, 0.67) and 0.11 (95% CI: 0.0,
0.22) in the park and home trampoline groups. The surgery rates were 0.33 (95% CI: 0.14, 0.53), 0.24 (95% CI: 0.07,
0.11), 0.49 (95% CI: 0.47, 0.51) and 0.38 (95% CI: 0.22, 0.53) in children, adults, females and males respectively.
Indirect meta-analysis shows that full size trampolines provided a 6.0 times higher risk of surgery (95% CI: 3.7, 9.7)
when compared to mini size trampolines. Park trampolines had a higher risk of surgery of 2.17 (95% CI: 1.70, 2.78)
when compared to home trampolines. In terms of age and sex of participants, there value was significantly higher
at 1.65 (95% CI: 1.35, 2.01) and 1.54 (95% CI: 1.36, 1.74) in children compared to adults and females compared to
males. From all the statistical data we summarized that the full size trampoline injuries have a 6 times higher risk of
(Continued on next page)
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data made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: Jatupon_kong@hotmail.com
4
Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine
Ramathibodi Hospital and Orthopedic department, Payathai3 Hospital,
Bangkok, Thailand
Full list of author information is available at the end of the article
Muljadi et al. BMC Sports Science, Medicine and Rehabilitation (2020) 12:37
https://doi.org/10.1186/s13102-020-00185-w
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(Continued from previous page)
requiring surgery when compared to mini size trampoline injuries. Park trampoline use carries a 2 times higher risk
of requiring surgery when compared to home trampoline use. In terms of age and sex of the participant, there is a
1.5 times significantly higher risk of injury in children compared to adults, and females when compared to males.
Conclusion: In trampoline related injuries, full size, park trampoline, children and females had higher surgery rates
when compared to mini size, home trampoline, adult and male majority in indirect meta-analysis methods.
Keywords: Trampoline, Trampoline related injury, Full or mini trampoline, Park or home, Surgery, Systematic review,
Meta-analysis
Background
The first trampoline related injuries were reported in
1956 by Zimmerman [1] and in 1960 by Ellis et al. [2].
Spinal cord injuries are among the most severe injury as-
sociated with trampolines. Most of these injuries involve
the cervical spine and result in quadriplegia [35]. The
growing popularity of trampolines has caused significant
increases in the number of injuries associated with their
use [6]. During the period of 20002005, trampoline in-
jury cases went up sharply at the rate of 113% compared
to the past 5 years average [79]. Trampolines are very
popular among children. The majority of trampoline in-
jury patients are children, whereas the adult patients are
less than 1 to 25%. Most of the injuries occurred on full-
sized trampolines, but home trampolines are should be
commonly involved. The causes of trampoline injuries
that frequently happen are collision with another person
on trampoline, awkward landing and falling off from the
trampoline to the ground surface or building structure.
Only two previous studies [10,11] explored the epidemi-
ology risk factors associated with trampoline related in-
juries. First study [10] compared park with domestic
trampoline injuries and the results was reported that
jump parks trampoline-related injury had higher risk of
fractures or dislocations and surgical interventions when
compared to home trampolines. Another study [11] has
reported results of mini-trampolines compared with full-
sized trampolines, children compared with adults. The
result shows that the use of full-sized trampolines had
lower risk of injury than mini-size and young children
had higher risk of injury than older. However, both stud-
ies have a small number of patients that may not be rep-
resentative of trampoline-related injuries and severity of
patients was determined by admission rate which is not
appropriate [10,11]. Moreover there still no information
about other epidemiology risk factor associated of tram-
poline related injuries. Therefore, this systematic review
and meta-analysis aims to assess and compare risk of
surgery related after trampoline injury between place of
trampoline (park versus home), size of trampoline (full
versus mini), age of participant (children versus adult)
and sex of participant (male versus female majority).
This information may lead to increased public awareness
of the potential for serious injuries and permanently
disabling outcomes for those who participate in recre-
ational trampoline use.
Methods
Medline and Scopus databases were used to identify
relevant studies published in English since the date of in-
ception to May 14, 2019. The PubMed and Scopus
search engines were used to locate studies with the
following search terms: Trampoline related injury. Refer-
ences from the reference lists of included trials and pre-
vious systematic reviews were also explored. The review
protocol has been registered at the international pro-
spective register of systematic review (PROSPERO ID:
147234).
Inclusion criteria
Clinical studies (e.g., observational, cross-sectional, co-
hort or randomized controlled trial (RCT)) that reported
the type of treatment, whether conservative or surgical,
after trampoline-related injury were eligible if they met
the following criteria:
Reported treatment conservatively or surgically after
trampoline-related injury.
Had sufficient data to extract and pool, i.e. the
reported mean, standard deviation (SD), the number
of subjects according to treatments for continuous
outcomes, and the number of patients according to
treatment for dichotomous outcomes.
Exclusion criteria
The reference lists of the retrieved articles were also
reviewed to identify publications on the same topic.
Where there were multiple publications from the
same study group on the same population, the most
complete and recent results were used.
Non-English studies were excluded.
Data extraction
Two reviewers (J.M. and J.K.) independently performed
data extraction using standardized data extraction forms.
Muljadi et al. BMC Sports Science, Medicine and Rehabilitation (2020) 12:37 Page 2 of 10
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General characteristics of the study (i.e. mean age,
gender, body mass, location of injury, size of trampo-
lines, mechanism of injury (fall, collision, fell off, contact
with structure, unknown), type of injury (sprain, fracture,
dislocation, concussion, other), region of injury (spine,
upper extremity, head, trunk, lower extremity, other), and
length of hospital stay were extracted. All dichotomous
outcomes (any type of surgery) were also extracted. Any
disagreements were resolved by discussion and consensus
with a third party (A.A.).
Outcomes of interest
The outcomes of interest included surgery or conserva-
tive treatment after trampoline injury. These outcomes
were measured as reported in the original studies which
were surgical (Fixation of extremity fracture, spine sur-
gery, head and neck surgery, thoracic and abdominal
surgery) and conservative (medication, casting, splint,
observation) treatment which included patients who
were outpatients and inpatients.
Statistical analysis
For dichotomous outcomes (surgery), the prevalence
was pooled and calculated using the Mantel-Haenszel
analysis method. Heterogeneity of mean differences was
checked using the Q statistic and the degree of hetero-
geneity was also quantified using the I
2
statistic [12]. If
heterogeneity was significant or I
2
> 25%, the pooled
prevalence was estimated using a random effects model,
otherwise a fixed effects model was applied. Meta-
regression analysis was then applied to explore causes of
heterogeneity [12,13]. Coverable parameters i.e. mean
age, gender, body mass, location of injury, size of tram-
polines, mechanism of injury (fall, collision, fell off, con-
tact with structure, unknown), type of injury (sprain,
fracture, dislocation, concussion, other), region of injury
(spine, upper extremity, head, trunk, lower extremity,
other), and length of hospital stay were considered in
the meta-regression model. Power of the test for meta-
regression was also assessed [14]. The odds ratio (OR)
were estimated by indirect meta-analysis using a random
effects model, If heterogeneity was significant or I2 >
25%, otherwise a fixed effects model was applied otherwise
a fixed effects model was applied. All analyses were per-
formed using STATA version 15.0 [15]. A p-value < 0.05
was considered statistically significant, except for the test
of heterogeneity where < 0.10 was used.
Results
Seventy three and 83 studies were identified from Medline
and Scopus respectively, as described in Fig. 1. Sixty-nine
studies were duplicates, leaving 87 studies for review of
titles and abstracts. Of these, 16 articles [10,11,1629]
were relevant and the full papers were retrieved.
Characteristics of these studies are described in Table 1.
Seventy-one studies were deleted under exclusion criteria;
3, 14, 6, 5, 37 and 6 studies were other intervention, no out-
comes, biomechanics, review, other injuries and no English
language, respectively. Sixteen studies were included for the
analysis of trampoline-related injury; 14 studies [1629]
were retrospective cohort and 2 studies [10,11]werecom-
parative cohort studies. All 14 studies reported conservative
andsurgicalmanagement.Fourstudies,2,2,2,1,1,1,1,1
and 1 study were reported from America, Australia, Ireland,
Korea, Denmark, Hong Kong, Canada, Austria, Finland and
United Kingdom, respectively. Six and two studies were in-
cluded for the analysis of full and mini size trampolines.
Four studies each were included for analysis of park versus
home trampolines. Thirteen studies included mostly chil-
dren, and another three studies included mostly adults.
Seven studies were mostly male, while 6 studies were
mostly female. The lower extremities were the most com-
mon sites of injury (42%) whereas the spine was the least
commonsiteofinjury(4%).Themostcommonmechanism
of injury was falling on the trampoline (30%). Fractures
were the most common injury (40%) while dislocation was
the least common injury (4%). Mean age and percentages
of male patients varied from 5.25 to 25 years and 37 to 71%
(Table 1).
Pooled prevalence of treatment (conservative and
surgery) related trampoline injury
Overall, there were 5622 patients (4233 in the conserva-
tive group and 1379 in the surgery group). The total sur-
gical rate per patient was 0.69% (95% CI: 0.54, 0.84%)
and 0.31% (95% CI: 0.16, 0.46%) in all patients (Table 2).
Full versus mini size trampoline
There were a total of 739 and 402 patients in full and
mini size trampoline studies. There were 187 patients in
the full size group and 17 patients in the mini size group
that had undergone surgery for trampoline injuries. The
surgery rates per patient with injuries from full versus
mini size trampolines were 0.3% (95% CI: 0.03, 0.58%)
and 0.06% (95% CI: 0.04, 0.09) (Table 3). By indirect
meta-analysis, the full sized trampoline had a higher risk
of requiring surgery by 6.0 (95% CI: 3.7, 9.7) when com-
pared to the mini sized trampoline (Fig. 2and Table 4).
Park versus home trampoline
There were a total of 3534 and 746 patients in park and
home trampoline studies, with 648 patients in the park
group and 63 patients in the home group who had
undergone surgery for trampoline injury. The surgery
rate per patient of park and home trampolines were
0.36% (95% CI: 0.06, 0.67%) and 0.11% (95% CI: 0.0,
0.22) (Table 3). By indirect meta-analysis, park trampo-
lines had a higher risk of requiring surgery by 2.17 (95%
Muljadi et al. BMC Sports Science, Medicine and Rehabilitation (2020) 12:37 Page 3 of 10
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CI: 1.70, 2.78) when compared to home trampolines
(Fig. 2and Table 4).
Age and sex associated surgery
There were a total of 4916 patients in the age group
lower than 15 years of age (children) and 706 patients in
the age group more than 15 years of age (adults), with
978 patients in the female group and 4009 patients in
the male group. One thousand thirty-one patients in the
children group and 90 patients in the adult group had
undergone surgery in the trampoline injury patients. For
sex, 258 patients in the male group and 687 patients in
the female group had undergone surgery for trampoline-
related injury.
The surgery rate per patient of for children, adult, fe-
male and male groups were 0.33% (95% CI: 0.14, 0.53%),
0.24% (95% CI: 0.07, 0.11), 0.49 (95% CI: 0.47, 0.51) and
0.38 (95% CI: 0.22, 0.53) (Table 3). By indirect meta-
analysis, children and females had a higher risk of re-
quiring surgery by 1.65 (95% CI: 1.35, 2.01) and 1.54
(95% CI: 1.36, 1.74) when compared to adult and males
(Fig. 2and Table 4).
Sources of heterogeneity
Meta-regression was applied for exploring the cause of
heterogeneity by fitting a co-variable (i.e., age, percentage
of female patients, mechanism of injury, site of injury, size
of trampoline and place of injury), and meta-regression
was applied to assess this. None of the co-variables could
explain the heterogeneity.
Discussion
From the current available evidence, this systematic re-
view and meta-analysis has shown the following: full size
trampoline injuries have a 6 times higher risk of requir-
ing surgery when compared to mini size trampoline in-
juries. Park trampoline use carries a 2 times higher risk
of requiring surgery when compared to home trampo-
line use. In terms of age and sex of the participant, there
is a 1.5 times significantly higher risk of injury in chil-
dren compared to adults, and females when compared
to males.
From previous published studies [9,11,23,25,26,30,
31], the American Academy of Pediatrics (AAP) issued a
policy statement in 1977 recommending that trampo-
lines be banned from use as part of the physical
Fig. 1 Flow of the study
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Table 1 Characteristics of included studies
Author Years Nationality Patients
(N)
Age
(Years)
Male
(%)
Trampoline size Place Mechanism of injury Injury region
Full
(%)
Mini
(%)
Park
(%)
Home
(%)
Other
(%)
Fall Collision Fell of tram Contact with
structure
Other Head Spine Upper
extremities
Trunk Lower
extremities
Doty J 2019 America 150 20.5 78 ––1––111 7 12 20 ––316 64
Doty Y 2019 America 289 21.5 157 –– –1171 43 46 29 ––62 97 130
Cho MJ 2019 Korea 178 –––– 41 32 10 13 92 26 34 8 111
Choi ES 2018 Korea 2799 5.25 1526 –– 0.76 0.17 0.07 754 542 364 356 783 679 55 678 68 1318
Thi Huynh AN 2018 Denmark 113 7.5 –– – – 31856 1 43
Yule MS 2016 Hong Kong 344 7 –– – – 2 239 41 64
Arora V 2016 Australia 50 25 35 ––– 20 1 35
Sandler G 2011 Australia 383 7 193 –– –0.90 0.1 294 32 –– 57 81 5 25 41
Leonard H 2009 Canada 7 11.6 5 –– –2–– 417––
Eberl R, 2009 Austria 265 7.85 122 0.38 0.62 –– 102 56 36 32 39 24 76 29 136
Rattya J 2008 Finland 76 7.65 35 0.97 0.01 0.88 0.12 25 8 25 5 3 545 28
Hurson C 2007 Ireland 101 8.45 41 0.98 0.02 0.05 0.95 23 13 31 9 15 8 38 4 36
Mcdermott C 2006 Ireland 88 8.75 33 1 0.57 0.38 0.05 34 34 13 6 1 –– 61 27
Shankar A 2006 UK 168 9.8 64 –– – 26 14 71 42 41
Shields BJ 2005 America 137 13.9 51 1 0.30 0.58 0.12 64 23 23 27 34 4 25 14 60
Shields BJ 2005 America 143 11 70 1 0.03 0.89 0.08 65 27 4 47 20 12 36 15 60
Larson BJ 1995 America 217 16.6 109 1 ––123 63 31 46 79 19 73
Woodward GA 1992 America 114 8.25 63 0.98 0.02 0.57 0.42 0.01 43 13 33 6 19 28 16 36 27
Muljadi et al. BMC Sports Science, Medicine and Rehabilitation (2020) 12:37 Page 5 of 10
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education programs in grammar schools, high schools,
and colleges, and also be abolished as a competitive
sport.[31] Only three studies have reported risk factors
associated with trampoline injury, with the first study
reported in 2005 by Shield et al. [11], in which they
reported the injury patterns were similar for mini and
full sized trampolines, although mini trampoline-related
injuries were less likely to require admission to the
hospital. Whereas this current study has a significantly
lower amount of injuries in mini-trampoline when com-
pared to full size due to the sufficient sample size to
correct the type 2 error and use conservative or surgical
management to separate patients in two groups by
severity of their injury (low and high severity injury) in-
stead of admission. The second study is by Choi et al.,
which reported a higher number of pediatric trampoline
injuries and trampoline park injuries, while ages at injury
have tended to be lower, which are results that corres-
pond with this study. Today, the widespread use of
trampolines has led to a significant increase of related
trauma. There, we suggest modify or additional recom-
mendation in the policies to prevent trampoline injuries
according to the results of previous published studies
and this meta-analysis. Firstly, all full size and mini
trampolines use should follow the policy recommenda-
tions of the American Academy of Pediatrics (AAP). Use
of the mini trampoline could lower the risk of injury
when compared to using full sized trampolines. Sec-
ondly, children who are aged below 15 years should be
under adult supervision and always wear protection (e.g.,
knee pad, wrist pad and elbow pad protector) of the
lower and upper extremities to prevent fracture or dis-
location [9], which is the most common cause of injury
requiring surgery in this study. Thirdly, jump park tram-
polines should be banned to lower the risk of injury then
we recommend use of home trampolines. Lastly, muscle
strength and proprioceptive sensation training should be
done before and after jumping on the trampoline in all
children to prevent injury, especially in the female sex.
We want this study to be the turning point in changing
the policy maker belief then the newest AAP recommen-
dation should include the result of this systematic review
in the future.
The strength of this study is that adequate method-
ology was used for systematic reviews in accordance
with PRISMA guidelines [32] as well as providing
exploration and reduction of the heterogeneity of the
studies using subgroup analysis and adequate statistical
analysis.
Moreover, this study has conclusive evidence about
risk factors such as size, place, age and sex that should
be selected to decrease risk of surgery after trampoline-
related injury. Some limitations in this study are that the
number of patients & studies was also not high. Another
Table 2 Estimation of the pooled prevalence of treatment (conservative and surgery) related trampoline injury
Author Year Hospital stay N Treatment
Conservative Surgery
Doty J 2019 6.5 (7.1) 150 131 19
Doty Y 2019 1.25 (0.3) 289 269 20
Cho MJ 2019 178 166 12
Choi ES 2018 2799 2537 262
Thi Huynh AN 2018 113 100 13
Yule MS 2016 344 183 151
Arora V 2016 7.3 (5.8) 50 12 38
Sandler G 2011 10.2 (10.8) 383 147 236
Leonard H 2009 8.1 (9.0) 7 3 4
Eberl R, 2009 265 248 17
Rattya J 2008 5.5 (5.8) 76 45 31
Hurson C 2007 6.1 (5.1) 101 89 12
Mcdermott C 2006 2.0 (0.9) 88 52 36
Shankar A 2006 168 6 162
Shields BJ 2005 137 137 0
Shields BJ 2005 143 143 0
Larson BJ 1995 217 204 13
Woodward GA 1992 114 19 95
Pooled prevalence of treatment related trampoline injury (95%CI) 0.69 (0.54, 0.84) 0.31 (95%CI: 0.16, 0.46)
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Table 3 Estimation of subgroup analysis of the pooled prevalence of treatment (conservative and surgery) related trampoline injury
Author Year N Treatment
Conservative Surgery
Rattya J 2008 76 45 31
Hurson C 2007 101 89 12
Mcdermott C 2006 88 52 36
Shields BJ, 2005 143 143 0
Larson BJ 1995 217 204 13
Pooled prevalence of treatment related full size trampoline injury (95% CI) 0.70 (95% CI: 0.42, 0.97) 0.3 (95% CI: 0.03, 0.58)
Eberl R, 2009 265 248 17
Shields BJ 2005 137 137 0
Pooled prevalence of treatment related mini size trampoline injury (95% CI) 0.94 (95% CI: 0.91, 0.97) 0.06 (95% CI:0.04, 0.09)
Doty J 2019 150 131 19
Choi ES 2018 2799 2537 262
Mcdermott C 2006 88 52 36
Woodward GA 1992 114 19 95
Pooled prevalence of treatment related park trampoline injury (95% CI) 0.64 (95% CI: 0.33, 0.94) 0.36 (95% CI: 0.06, 0.67)
Doty J 2019 289 269 20
Rattya J 2008 76 45 31
Hurson C 2007 101 89 12
Shields BJ 2005 137 137 0
Shields BJ 2005 143 143 0
Pooled prevalence of treatment related home trampoline injury (95% CI) 0.89 (95% CI: 0.78, 1.00) 0.11 (95% CI: 0.0, 0.22)
Cho MJ 2019 178 166 12
Choi ES 2018 2799 2537 262
Thi Huynh AN 2018 113 100 13
Yule MS 2016 344 183 151
Sandler G 2011 383 147 236
Leonard H 2009 7 3 4
Eberl R 2009 265 248 17
Rattya J 2008 76 45 31
Hurson C 2007 101 89 12
Mcdermott C 2006 88 52 36
Shankar A 2006 168 6 162
Shields BJ 2005 137 137 0
Shields BJ 2005 143 143 0
Woodward GA 1992 114 19 95
Pooled prevalence of treatment of children related trampoline injury (95% CI) 0.67 (95% CI: 0.47, 0.86) 0.33 (95% CI: 0.14, 0.53)
Doty J 2019 150 131 19
Doty J 2019 289 269 20
Arora V 2016 50 12 38
Larson BJ 1995 217 204 13
Pooled prevalence of treatment of adult related trampoline injury (95% CI) 0.76 (95% CI: 0.62, 0.91) 0.24 (95% CI: 0.07, 0.11)
Eberl R, 2009 265 248 17
Rattya J 2008 76 45 31
Hurson C 2007 101 89 12
Mcdermott C 2006 88 52 36
Shankar A 2006 168 6 162
Shields BJ 2005 137 137 0
Shields BJ 2005 143 143 0
Pooled prevalence of treatment of female related trampoline injury (95% CI) 0.51 (95% CI: 0.49, 0.53) 0.49 (95% CI: 0.47, 0.51)
Doty J 2019 150 131 19
Muljadi et al. BMC Sports Science, Medicine and Rehabilitation (2020) 12:37 Page 7 of 10
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limitation is this study did not pool an important out-
come such as frequency of using trampoline and injury
rates with multiple users on the trampoline at the same
time due to the fact that there was insufficient data. Fur-
ther research that assesses a larger sample size of RCTs
should be done to see any significance of complications.
Conclusions
In trampoline-related injury, full size and park trampo-
lines, children and females had higher surgery rates
when compared to mini size and home trampolines,
adults and males with indirect meta-analysis methods.
This result recommended use of the mini trampoline
Table 3 Estimation of subgroup analysis of the pooled prevalence of treatment (conservative and surgery) related trampoline injury
(Continued)
Author Year N Treatment
Conservative Surgery
Doty J 2019 289 269 20
Choi ES 2018 2799 2537 262
Arora V 2016 50 12 38
Sandler G 2011 383 147 236
Leonard H 2009 7 3 4
Larson BJ 1995 217 204 13
Woodward GA 1992 114 19 95
Pooled prevalence of treatment of female related trampoline injury (95% CI) 0.62 (95% CI: 0.47, 0.78) 0.38 (95% CI: 0.22, 0.53)
Fig. 2 Comparison of prevalence of trampoline related surgery between place of trampoline, size of trampoline, sex and age of injury participants
Muljadi et al. BMC Sports Science, Medicine and Rehabilitation (2020) 12:37 Page 8 of 10
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could lower the risk of injury, children should be under
adult supervision and always wear protection to prevent
lower and upper extremities injury, Jump park trampo-
lines should be banned and only of home trampolines
should be used. Prospective randomized controlled stud-
ies are needed to confirm these findings as the current
literature is still insufficient.
Abbreviations
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-
Analyses; RCT: randomized controlled trial; SD: standard deviation; OR: odds
ratio; AAP: American Academy of Pediatrics
Acknowledgements
Not applicable.
Authorscontributions
All authors have read and approved the manuscript. JM: conception and
design, analysis and interpretation of the data, drafting of the article, critical
revision of the article for important intellectual content, final approval of the
article, collection and assembly of data. KC: conception and design, drafting
of the article, critical revision of the article for important intellectual content,
final approval of the article. AA: conception and design, drafting of the
article, critical revision of the article for important intellectual content, final
approval of the article, collection and assembly of data. JK: conception and
design, analysis and interpretation of the data, drafting of the article, critical
revision of the article for important intellectual content, final approval of the
article, collection and assembly of data.
Funding
This study has no funding support.
Availability of data and materials
All data generated or analyzed during this study are included in this
published article.
Ethics approval and consent to participate
This article does not contain any studies with human participants performed
by any of the authors.
Consent for publication
Not applicable.
Competing interests
All authors declare that they have no conflicts of interests.
Author details
1
Mater Dei School, Bangkok, Thailand.
2
Orthopedic department, College of
Sports Science and Technology, Mahidol University, Bangkok, Thailand.
3
Orthopedics Department, Bumrungrad Hospital, Bangkok, Thailand.
4
Section
for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi
Hospital and Orthopedic department, Payathai3 Hospital, Bangkok, Thailand.
Received: 20 September 2019 Accepted: 3 June 2020
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... Trampoline use is known to pose a risk for extremity injuries. 6,20 This agrees with our findings, because patients with extremity injury were more likely to require hospitalization after trampolinerelated injury. ...
Article
Objective As trampoline use grows more popular in the United States, the frequency of injuries continues to climb. We hypothesized that toddlers would be at the highest risk for trampoline injuries requiring hospitalization. Methods The National Electronic Injury Surveillance System database was examined for trampoline injuries from 2009 to 2018. Patients were categorized into 3 main age groups: toddlers (<2 years), children (2–12 years), and adolescents (13–18 years). Regression models were used to identify patients at high risk for injury or hospitalization. Results There was a total of 800,969 meeting inclusion criteria, with 433,827 (54.2%) occurring at their own homes and 86,372 (18.1%) at the sporting venue. Of the total, 36,789 (4.6%) were admitted to a hospital. Fractures (N = 270,884, 34%), strain/sprain injuries (N = 264,990, 33%), followed by skin contusions/abrasions (N = 115,708, 14%) were the most common diagnoses. The most frequent injury sites were lower and upper extremities accounting for 329,219 (41.1%) and 244,032 (30.5%), whereas 175,645 (21.9%) had head and neck injuries. Musculoskeletal injuries (74%) and concussions (2.6%) were more frequent in adolescents than children (67.6% and 1.6%) and toddlers (56.3% and 1.3%). Internal organ and soft tissue injuries were frequent in toddlers. There were no fatalities reported in the injured patients. Multivariate analysis showed adolescents, female sex, extremity injuries, and musculoskeletal injuries were associated with hospitalization. Injury at a sporting venue was not associated with hospitalization. Conclusions Adolescents and girls are at increased risk of trampoline injury, warranting hospitalization. Safety standards may help prevent extremity and musculoskeletal injuries in the pediatric population. Finally, use of trampolines at sporting venues does not appear to be particularly dangerous.
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Introduction: With the increasing use of recreational trampolines, more injuries are seen in emergency depart-ments (ED). Little is known about the relationship between adherence to safety precautions and injuries. This retro-spective study aims to describe the types of injuries and the precautions taken when using trampolines, and to investigate the relationship between injuries and safety precautions. Methods: We reviewed patient lists and the medical records of children younger than 18 years who were treated between 1 April and 30 September 2014 at the ED of Hospital Unit West, Denmark. Demographic data and type of injury were recorded. Patients or guardians were contacted for a structured telephone interview to describe the safety precautions they had taken before the injury occurred. A total of 113 patients were identified, and 100 patients were included in the phone interviews. A total of 13 patients were excluded due to incorrect/missing phone numbers or lack of a Danish home address. Results: 6% of all children treated in the ED had trampoline-related injuries. A total of 58 (51.3%) patients had fracture injuries, and 55 (48.7%) patients had non-fracture injuries. 4% had complied with all five recommended safety precautions. Conclusions: This study describes types of injuries and safety precautions related to trampoline use. 6% of all children in the ED had an injury related to trampoline use. 4% complied with all five recommended safety precautions. Funding: none. Trial registration: not relevant.
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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.
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Introduction: Trampoline-related injuries in adults are uncommon. Participation in trampolining is increasing following its admission as a sport in the Olympics and the opening of local recreational trampoline centres. The aim of this study was to assess the number and outcomes of adult trampoline-related orthopaedic injuries presenting to four trauma hospitals in Victoria. Methods: A cohort study was performed for the period 2007-2013. Adult patients registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who had sustained a trampolining related injury were included in this study. Descriptive analyses were used to describe the patient population, the injuries sustained and their in-hospital and 6-month outcomes. Results: There was an increase in trampolining injuries from 2007 (n=3) to 2012 (n=14) and 2013 (n=18). Overall, fifty patients with a median age of 25 (range 16-66) were identified. Thirty-five patients (70%) had lower limb injuries, 20 patients (40%) had spinal injuries and one patient had an upper limb injury. Thirty-nine patients (78%) required surgery. Fractures of the tibia (n=13), ankle fractures (n=12) and cervical spine injuries (n=7) were the most common injuries; all of which required surgery. Complications included death, spinal cord injuries, compartment syndrome and open fractures. At 6 months post injury, more than half (52%) of the patients had not achieved a good recovery, 32% had some form of persistent disability, 14% did not get back to work and overall physical health for the cohort was well below population norms for the SF-12. Conclusion: Adult trampoline-related injuries have increased in the last few years in this cohort identified through VOTOR. Lower limb and spinal injuries are most prevalent. Public awareness and education are important to reduce the risk for people participating in this activity.
Article
Despite previous recommendations from the American Academy of Pediatrics discouraging home use of trampolines, recreational use of trampolines in the home setting continues to be a popular activity among children and adolescents. This policy statement is an update to previous statements, reflecting the current literature on prevalence, patterns, and mechanisms of trampoline-related injuries. Most trampoline injuries occur with multiple simultaneous users on the mat. Cervical spine injuries often occur with falls off the trampoline or with attempts at somersaults or flips. Studies on the efficacy of trampoline safety measures are reviewed, and although there is a paucity of data, current implementation of safety measures have not appeared to mitigate risk substantially. Therefore, the home use of trampolines is strongly discouraged. The role of trampoline as a competitive sport and in structured training settings is reviewed, and recommendations for enhancing safety in these environments are made. Pediatrics 2012;130:774-779