This study examines the causes and outcomes of injuries occurring at school and highlights the need for injury prevention strategies. Descriptive statistics were applied to data from a national pediatric trauma database on 1,558 K-12 graders injured at school severely enough to require hospitalization. Factors analyzed included age, gender, cause, place, time, injured body regions, use of hospital resources, in-hospital fatality rate, and functional limitations. Most injuries were unintentional (89.7%) and occurred mostly to children 10-14 years old. Almost half occurred in recreational areas. Falls and sports were the most frequent causes, but the pattern varied by grade and gender. Most children sustained injuries to the extremities (41.3%) or to the head (39.2%). Two percent sustained spinal cord injuries, mainly from sports. Eight children died, and 43.6% developed one or more functional limitations. Frequent, severe, and costly injuries should be the focus of school safety policies, and a mix of injury prevention strategies should be applied.