LAUSR

Aims Participation in sports prevents obesity and benefits many aspects of children’s health, but injuries such as concussion can result in long term development and educational challenges. Schools must balance promoting participation in sports while protecting against injury. It is not clear whether increasing knowledge on injury prevention in professional sport is being translated into schools, and school injury data are not available due to a lack of injury surveillance in the UK. This study aimed to systematically review guidelines and policies promoting sport safety in schools, to determine the extent to which exposure to injury risk is recognised and managed. Methods A search strategy was developed from previous reviews, piloted and applied to nine electronic databases and various grey literature sources (including expert contacts), to identify guidelines, policies or consensus statements published worldwide since 1990 on safe school sport for children (4–18y). Policies solely focussing on safeguarding were excluded. Included documents were quality assessed using the TAPUPAS framework. Data were analysed using a modified framework analysis. Results Twenty-four documents met inclusion and quality criteria. Most (15/24 [62.5%]) were from the US, with 3 from the UK. Ten (41.7%) focussed on concussion. Analysis identified primary, secondary and tertiary injury prevention measures relating to people (staff, students, parents), systems (processes and plans), school physical environment (facilities and equipment) and national factors (injury surveillance). Clear responsibilities for specific individuals or agencies were seldom reported, or varied between documents. Documents concentrated on emergency management after injuries and returning to activity, and many recommendations for children were based on evidence from adults. Conclusion Robust, evidence-based policies for the reduction of injury risk in school sports are limited. The high proportion of quality documents on concussion illustrates application of evidence from professional sport to schools, but with a focus on injury management rather than prevention. Guidance specific for individual sports may include effective strategies but may not be feasible for implementation in schools. Paediatricians should be advocating for safe physical activity for all in schools, better injury surveillance in the UK, and more research into how to prevent sports injuries for this age group.