Of 200 pupil patients attending the Royal Aberdeen Children's Hospital during the spring term of 1996, 90 per cent were from city schools and only 14 per cent had serious injuries.
John Hiscox, an accident and emergency consultant, and Diana Macgregor, paediatric registrar, write in the Scottish Medical Journal that referrals from schools were probably not being made "purely for medical reasons, but to avoid complaints and litigation".
Levels of school referrals have remained as high as during the 1996 survey, Mr Hiscox told The TES Scotland.
Education authority guidelines state that the general practitioner should be the first line of contact. But Mr Hiscox said: "GPs are hard pushed as it is. If there is a problem here, it is in the provision of health care in schools. "
Aberdeen's education department is reviewing how schools report on health and safety matters, including minor traumas. John Mager, an assistant director, said: "There are a large number of minor incidents that don't go any further than the school office." But he accepted that heads may interpret guidelines "cautiously".
Fred Forrester, depute general secretary of the Educational Institute of Scotland, said heads were "quite right" to show caution. With pressures in schools "the training of teachers in first aid has declined substantially".
A Scottish Office spokesman said that Government solicitors had been asked "to determine where the balance of responsibility for medical treatment lies between the health service and the education authorities".