Unintentional injuries are the leading cause of mortality among college students.¹ Most injuries in college students do not result in death, and students often receive care for injuries at emergency departments near campus. Utilization of emergency services by college students is poorly understood and most studies have focused on alcohol or mental health-related emergency department visits.^2,3 The purpose of this project is to provide a comprehensive understanding of the causes of injuries and accidents resulting in emergency care for college students in order to inform public health approaches to injury prevention on college campuses.

Methods

This retrospective cohort study evaluated all emergency department encounters by enrolled students between August 29, 2021 and April 30, 2022 at a large, university-affiliated academic medical center in the Midwest United States. Encounter-associated ICD-10 codes were matched with Agency for Healthcare Research and Quality’s ICD-10 diagnosis classification system⁴ and only visits coded in the ‘Injury, poisoning and certain other consequences of external causes’ category were retained for analysis. Demographic information was extracted from the electronic health record for each encounter, and manual chart reviews were performed to capture narrative details of how the injury or accident occurred. Two separate groups used a content analysis approach to review the narrative details to create a central codebook. The two groups then separately coded each encounter and met to reconcile differences. In addition to the cause of injury, if the encounter narrative stated that the student was intoxicated, was around other intoxicated individuals, or was in a setting (like a party, bar, or club) where intoxication frequently occurs, reviewers assigned an intoxication-related subcategory. Findings were summarized using descriptive statistics.

Results

During the study period, 813 students had 859 injury or accident-related visits in an on-campus emergency department. Of all visits, 14.8% were related to alcohol or other drug intoxication. The three largest categories of visits were general accidents (n=293, 34.1%), sports/recreation-related accidents (n=180, 21.0%), and vehicle accidents (n=76, 8.8%). Of all visits related to alcohol or other drug intoxication, 77.2% were in the general accident category. Of visits related to vehicle accidents, the majority (n=46, 60.5%) were related to self-propelled vehicles like bikes or electric scooters rather than related to a motor vehicle.

Conclusions

There are many causes of injuries that result in emergency care among the college student population, including sports and recreational activities, use of motor or self-propelled vehicles, and alcohol or other drug use. Our finding that 14.8% of injury visits were also alcohol or other drug-related is consistent with previous studies and demonstrates an additional consequence of substance use in college students. The volume of injury encounters related to sports or recreation highlights the need for injury treatment and prevention services on campus, especially at campus recreation centers. Our finding that the majority of vehicle-related injuries are related to self-propelled vehicles should encourage a closer examination of the campus built environment to identify additional opportunities for injury prevention.