Lara B. McKenzie

Pediatric Burn Injuries Treated in US Emergency Departments Between 1990 and 2006

OBJECTIVE: The goal was to examine comprehensively the patterns and trends of burn-related injuries in children, adolescents, and young adults treated in US emergency departments between 1990 and 2006. METHODS: Through use of the National Electronic Injury Surveillance System database, cases of nonfatal burn-related injuries were selected by using diagnosis codes for burns (scalds, thermal, chemical, radiation, electrical, and not specified). Sample weights were used to calculate national estimates. US Census Bureau data were used to calculate injury rates per 10000 individuals ≤20 years of age. Computation of relative risks with 95% confidence intervals was performed. RESULTS: An estimated 2054563 patients ≤20 years of age were treated in US emergency departments for burn-related injuries, with an average of 120856 cases per year. Boys constituted 58.6% of case subjects. Children <6 years of age sustained the majority of injuries (57.7%), and more than one half of all injuries (59.5%) resulted from thermal burns. The body parts injured most frequently were the hand/finger (36.0%), followed by the head/face (21.1%). Of the 1542913 cases for which locale was recorded, 91.7% occurred at home. The rate of burn-related injuries per 10000 children decreased 31% over the 17-year time period. CONCLUSIONS: Burn-related injuries are a serious problem for individuals ≤20 years of age and are potentially preventable. Children <6 years of age consistently sustained a disproportionately large number of injuries during the study period. Increased efforts are needed to improve burn-prevention strategies that target households with young children.

Household Cleaning Product-Related Injuries Treated in US Emergency Departments in 1990–2006

OBJECTIVE: The goal was to examine comprehensively the patterns and trends of household cleaning product-related injuries among children treated in US emergency departments. METHODS: Through use of the National Electronic Injury Surveillance System database, cases of unintentional, nonfatal, household cleaning product-related injuries were selected by using product codes for drain cleaners, ammonia, metal polishes/tarnish removers, turpentine, dishwasher detergents, acids, swimming pool chemicals, oven cleaners, pine oil cleaners/disinfectants, laundry soaps/detergents, toilet bowl products, abrasive cleaners, general-purpose household cleaners, noncosmetic bleaches, windshield wiper fluids, caustic agents, lye, wallpaper cleaners, room deodorizers/fresheners, spot removers, and dishwashing liquids. Products were categorized according to major toxic ingredients, mode of action, and exposure. RESULTS: An estimated 267 269 children ≤5 years of age were treated in US emergency departments for household cleaning product-related injuries. The number of injuries attributable to household cleaning product exposure decreased 46.0% from 22 141 in 1990 to 11 964 in 2006. The product most-commonly associated with injury was bleach (37.1%). Children 1 to 3 years of age accounted for 72.0% of cases. The primary mechanism of injury was ingestion (62.7%). The most common source or container was spray-bottles (40.1%). Although rates of household cleaner-related injuries from regular bottles or original containers and kitchenware decreased during the study period, spray-bottle injury rates showed no decrease. CONCLUSION: Although national rates of household cleaning product-related injuries in children decreased significantly over time, the number of injuries remains high.

Basketball-Related Injuries in School-Aged Children and Adolescents in 1997–2007

OBJECTIVE: The objective was to determine national patterns of basketball-related injuries treated in emergency departments in the United States among children and adolescents <20 years of age. METHODS: A retrospective analysis was conducted with data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, from 1997 to 2007. Sample weights provided by the Consumer Product Safety Commission were used to calculate national estimates of basketball-related injuries. Trend significance of the numbers and rates of basketball-related injuries over time was analyzed by using linear regression. RESULTS: An estimated 4 128 852 pediatric basketball-related injuries were treated in emergency departments. Although the total number of injuries decreased during the study period, the number of traumatic brain injuries (TBIs) increased by 70%. The most common injury was a strain or sprain to the lower extremities (30.3%), especially the ankle (23.8%). Boys were more likely to sustain lacerations and fractures or dislocations. Girls were more likely to sustain TBIs and to injure the knee. Older children (15–19 years of age) were 3 times more likely to injure the lower extremities. Younger children (5–10 years of age) were more likely to injure the upper extremities and to sustain TBIs and fractures or dislocations. CONCLUSIONS: Although the total number of basketball-related injuries decreased during the 11-year study period, the large number of injuries in this popular sport is cause for concern.

Lacrosse Injuries Among High School Boys and Girls in the United States Academic Years 2008-2009 Through 2011-2012

Background: Lacrosse is a fast growing youth sport in the United States. Although there have been published studies examining injuries associated with lacrosse, significantly less research has been conducted in high school lacrosse players than in older lacrosse players. The objective of this study was to compare high school lacrosse injury rates and patterns by type of athletic activity (ie, competition vs practice) and sex. Hypothesis: Lacrosse injury rates and patterns differ by type of athletic activity and sex. Study Design: Descriptive epidemiology study. Methods: Using the High School RIO (Reporting Information Online) database, lacrosse exposure and injury data were collected during 4 academic years, 2008-2012, from a large sample of high schools in the United States. Schools’ certified athletic trainers submitted exposure and injury information weekly. Results: During the study period, 1406 injuries occurred during 716,812 athlete exposures, for an injury rate of 1.96 per 1000 athlete exposures (AEs). Injury rates were higher in competition than in practice (3.61 vs 1.23 per 1000 AEs, respectively; rate ratio [RR], 2.94; 95% CI, 2.65-3.27). Boys had a higher injury rate than girls (2.26 vs 1.54 per 1000 AEs, respectively; RR, 1.47; 95% CI, 1.32-1.64). The most common injury diagnoses among both boys and girls were sprains/strains (boys: 35.6%; girls: 43.9%) and concussions (boys: 21.9%; girls: 22.7%). The most commonly injured body sites in competition were the head/face (32.0%), lower leg/ankle/foot (17.8%), and knee (12.2%), while in practice, the most commonly injured body sites were the lower leg/ankle/foot (34.9%), head/face (16.4%), and knee (12.7%). Among boys, the most common mechanisms of injury were contact with another person (40.9%) and no contact (21.1%). Among girls, the most common mechanisms of injury were no contact (26.2%), contact with a playing apparatus (24.0%), and overuse/chronic (17.7%). Most injured athletes (71.8%) returned to activity in ≤21 days, but 6.9% of all injuries required surgery. Conclusion: Lacrosse injury rates and patterns among high school athletes in the United States differ by type of athletic activity and sex. Future studies should continue to compare differences in injury rates and patterns in high school lacrosse, with particular emphasis placed on high-risk plays in competition and the prevention and management of concussions in both boys and girls.

Injuries Associated With Cribs, Playpens, and Bassinets Among Young Children in the US, 1990-2008

OBJECTIVE: To describe the epidemiology of injuries related to cribs, playpens, and bassinets among young children in the United States. METHODS: A retrospective analysis was done using data from the National Electronic Injury Surveillance System for children younger than 2 years of age treated in emergency departments in the United States from 1990 through 2008 for an injury associated with cribs, playpens, and bassinets. RESULTS: An estimated 181 654 (95% confidence interval: 148 548–214 761) children younger than 2 years of age were treated in emergency departments in the United States for injuries related to cribs, playpens, and bassinets during the 19-year study period. There was an average of 9561 cases per year or an average of 12.1 injuries per 10 000 children younger than 2 years old per year. Most of the injuries involved cribs (83.2%), followed by playpens (12.6%) and bassinets (4.2%). The most common mechanism of injury was a fall from a crib, playpen, or bassinet, representing 66.2% of injuries. Soft-tissue injuries comprised the most common diagnosis (34.1%), and the most frequently injured body region was the head or neck (40.3%). Patients with fractures were admitted 14.0% of the time, making them 5.45 (95% confidence interval: 3.80–7.80) times more likely to be hospitalized than patients with other types of injury. Children younger than 6 months were 2.97 (95% confidence interval: 2.07–4.24) times more likely to be hospitalized than older children. CONCLUSIONS: This study is the first to use a nationally representative sample to examine injuries associated with cribs, playpens, and bassinets. Given the consistently high number of observed injuries, greater efforts are needed to ensure safety in the design and manufacture of these products, ensure their proper usage in the home, and increase awareness of their potential dangers to young children.

Injuries Associated With Bathtubs and Showers Among Children in the United States

OBJECTIVE: The goal was to describe the epidemiological features of injuries associated with bathtubs and showers, especially those related to slips, trips, and falls, among US children. METHODS: A retrospective study was performed by using nationally representative data from the US Consumer Product Safety Commission National Electronic Injury Surveillance System from 1990 through 2007 for children ≤18 years of age. RESULTS: There were an estimated 791 200 bathtub- and shower-related injuries among children ≤18 years of age who were treated in US emergency departments in 1990–2007, with an average of 43 600 cases per year or ∼5.9 injuries per 10 000 US children per year. The largest number of injuries involved children 2 years of age; children ≤4 years accounted for 54.3% of injuries. The most common diagnosis was laceration (59.5%). The most common mechanism of injury was a slip, trip, or fall, accounting for 81.0% of cases or 4.6 injuries per 10 000 US children per year. The most frequently injured body part was the face (48.0%), followed by the head/neck (15.0%). The majority (71.3%) of injuries occurred in a bathtub. Of the cases with a known place of injury, 97.1% occurred at home. An estimated 2.8% of patients were admitted, transferred to another hospital, or held for observation. CONCLUSIONS: This is the first study on bathtub- and shower-related injuries using nationally representative data. Slips, trips, and falls in bathtubs and showers are a common cause of injury among children, especially children ≤4 years of age. The incidence of these injuries may be decreased by increasing the coefficient of friction of bathtub and shower surfaces.

Golf Cart–Related Injuries in the U.S

BACKGROUND Golf carts today are used in a variety of public and private settings. Injuries related to golf carts are an important and increasing problem for people of all ages. This study analyzes trends and potential causes of nonfatal golf cart-related injury on a national level. METHODS The National Electronic Injury Surveillance System database was used to examine all cases of nonfatal golf cart-related injury treated in U.S. emergency departments (EDs) from 1990 to 2006. Analysis was conducted in 2007. RESULTS An estimated 147,696 (95% CI=144,404; 150,987) injuries, involving individuals aged 2 months to 96 years, were treated in EDs in the U.S. for golf cart-related injuries during the study period. Injuries to children (aged<16) constituted 31.2% of the cases. The most common type of injury was soft tissue damage (47.7%). Patients required hospitalization in 7.8% of the cases. Falling from a golf cart was the most common cause of injury (38.3%). Of golf cart-related injuries with a reported location, 70.3% occurred at sports facilities, 15.2% occurred on streets or public property, and 14.5% occurred around a home or farm. The number of golf cart-related injuries increased steadily each year, with an increase of 132.3% over the 17-year study period. CONCLUSIONS Given the growing capabilities and popularity of golf carts, coupled with the marked increase in golf cart-related injuries observed over the study period (>130%), intensified efforts are needed to prevent these injuries, especially among children.

Pediatric and Adolescent Sledding-Related Injuries Treated in US Emergency Departments in 1997–2007

OBJECTIVES: The objectives were to examine comprehensively the patterns and to estimate the rates of sledding-related injuries among children and adolescents treated in US emergency departments between 1997 and 2007. METHODS: Through the use of the National Electronic Injury Surveillance System database, cases of sledding-related injuries were selected by using diagnosis codes for sleds. Sample weights were used to calculate national estimates. US Census Bureau data were used to calculate injury rates per 100 000 individuals ≤19 years of age. Computation of odds ratios with 95% confidence intervals was performed. RESULTS: From 1997 through 2007 an estimated 229 023 patients ≤19 years of age were treated for sledding-related injuries in US emergency departments, with an average of 20 820 cases per year. Children 10 to 14 years of age sustained 42.5% of sledding-related injuries, and boys represented 59.8% of all cases. The most frequent injury diagnoses were fractures (26.3%), followed by contusions and abrasions (25.0%). The head was the most commonly injured body part (34.1%), and injuries to the head were twice as likely to occur during collisions as through other mechanisms. Traumatic brain injuries were more likely to occur with snow tubes than with other sled types. A total of 4.1% of all cases required hospitalization. CONCLUSIONS: More research on the prevention of sledding-related injuries is warranted, particularly regarding the impact of helmets in reducing injury rates. The use of sledding products that may reduce visibility (such as snow tubes) should be discouraged.

Bunk bed-related injuries among children and adolescents treated in emergency departments in the United States, 1990-2005.

OBJECTIVE. Our goal was to comprehensively examine bunk bed–related injuries in the United States by using a nationally representative sample. METHODS. Using the National Electronic Injury Surveillance System database, cases of nonfatal bunk bed–related injuries treated in US emergency departments from 1990 through 2005 were selected by using the National Electronic Injury Surveillance System bunk bed product code (0661). Cases concerning individuals ≤21 years old were included. RESULTS. An estimated 572 580 children and adolescents aged ≤21 years were treated in US emergency departments for bunk bed–related injuries during the 16-year study period, yielding an average of 35 790 cases annually. An average of 42 per 100 000 population were treated annually. Bunk bed–related injuries occurred more frequently among males (60.6%). Lacerations were the most common type of injury (29.7%), followed by contusions and abrasions (24.0%) and fractures (19.9%). The body parts most frequently injured were the head and neck (27.3%) in all age groups. Falls were the most common mechanism of injury (72.5%). Of the cases for which locale of injury was recorded, 93.5% occurred at home. Approximately half of the bunk bed–related injuries that occurred at schools involved individuals aged 18 to 21 years (50.9%). An estimated 2.9% of injuries resulted in hospitalization or transfer to another hospital or required additional observation. The number of bunk bed–related injuries showed no significant trend from 1990 to 2005. CONCLUSIONS. Bunk beds are a common source of injury among children and adolescents, and these injuries mostly involve the head and face. Given the continuing large numbers of bunk bed–related injuries at homes and in schools, increased efforts are needed to prevent bunk bed–related injuries among children and adolescents.

Hot tub, whirlpool, and spa-related injuries in the U.S., 1990-2007.

BACKGROUND Recreational use of hot tubs, whirlpools, and spas has increased within the past 3 decades. Injuries due to hot tubs, whirlpools, and spas can affect people of all ages and can result in serious disabilities. PURPOSE This study examines nonfatal hot tub, whirlpool, and spa-related injuries on a national level. METHODS The National Electronic Injury Surveillance System database was used to examine cases of nonfatal hot tub, whirlpool, and spa-related injuries treated in U.S. emergency departments from January 1, 1990, through December 31, 2007. Analysis was conducted from November 2008 to March 2009. RESULTS An estimated 81,597 patients, aged <1-102 years, were treated in U.S. emergency departments for hot tub, whirlpool, and spa-related injuries, with the number increasing 160% over the 18-year study period (p<0.001). Nearly 73% of injuries occurred in patients aged >or=17 years. Lacerations were the most common diagnosis (27.8%) and accounted for 58% of all head injuries. Slips and falls were the most common mechanism of injury (47.6%); were more likely to result in an injury to the trunk than other body parts (OR=2.49, 95% CI=1.83, 3.39); and were more likely to result in concussions and fractures/dislocations than any other diagnosis (OR=7.813, 95% CI=2.194, 27.823 and OR=3.017, 95% CI=2.057, 4.425, respectively). CONCLUSIONS Given the increase in hot tub, whirlpool, and spa ownership and the 160% increase in injuries during the study period, more research is needed to identify the cause of the increase in hot tub, whirlpool, and spa-related injuries and what injury-prevention solutions and policies may be appropriate.