Nicolas G. Nelson

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.

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.

Football-Related Injuries Among 6- to 17-Year-Olds Treated in US Emergency Departments, 1990-2007

Football is one of the most popular youth sports in the United States despite the high rate of injuries. Previously published studies have investigated football-related injuries that occurred in organized play but have excluded those that occurred during unorganized play. Through use of the National Electronic Injury Surveillance System database, cases of football-related injuries were identified for analysis. Sample weights were used to calculate national estimates. An estimated 5 252 721 children and adolescents 6 to 17 years old were treated in US emergency departments for football-related injuries. The annual number of cases increased by 26.5% over the 18-year study period. The 12- to 17-year-old age group accounted for 77.8% of all injuries and had nearly twice the odds of sustaining a concussion. The findings suggest the need for increased prevention efforts to lower the risk of football-related injury in children and adolescents.

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.

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.

Pediatric mobility aid-related injuries treated in US emergency departments from 1991 to 2008.

OBJECTIVES: Although mobility aids such as crutches, walkers, and wheelchairs are typically beneficial, they can be associated with injury. The objective of this study was to describe the incidence, patterns, and trends of pediatric mobility aid–related injuries to children and adolescents who were aged ≤19 years and treated in US emergency departments between 1991 and 2008. METHODS: A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System database for children and adolescents who were aged ≤19 years. Sample weights were used to calculate national estimates of mobility aid–related injuries on the basis of 2301 actual cases. RESULTS: An estimated 63 309 cases of children and adolescents who were aged ≤19 years were treated in US emergency departments for mobility aid–related injuries. Approximately 70% of mobility aid– related injuries occurred while patients were using wheelchairs. Children who were aged 2 to 10 years were more likely to sustain injuries while using walkers and wheelchairs, injure their heads, and sustain traumatic brain injuries. Children who were aged 11 to 19 years were more likely to sustain injuries while using crutches, injure their lower extremities, and sustain sprains and strains. Injuries involving wheelchairs were more likely to be traumatic brain injuries and result in hospitalization. Injuries involving crutches were more likely to involve misuse and be triggered by stairs or curbs. CONCLUSIONS: Injuries related to crutches, walkers, and wheelchairs have distinct injury patterns, mechanisms of injury, and trigger factors. Injury patterns between younger and older children were different. Additional research is needed to identify effective injury prevention strategies for the pediatric population.

Track-related injuries in children and adolescents treated in US emergency departments from 1991 through 2008.

Abstract Background: Track is a popular sport among children and adolescents. Track participants have a high rate of injury, often from overuse. Purpose: To determine national patterns of track-related injuries among children and adolescents aged 10 to 18 years treated in US emergency departments. Study Design: Descriptive epidemiologic study. Methods: A retrospective analysis was conducted using data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for patients aged 10 to 18 years from 1991 through 2008. Sample weights were used to calculate national estimates of track-related injuries based on 4496 actual cases. Bivariate comparisons between categorical variables were assessed with odds ratios and 95% CIs. Trend significance of the numbers and rates of track-related injuries over time was analyzed using linear regression. Results: From 1991 through 2008, an estimated 159 663 patients aged 10 to 18 years were treated for track-related injuries in US emergency departments, with an average of 8870 cases per year. The overall number of cases increased 36.3%, from 7702 injuries in 1991 to 10 496 injuries in 2008 (P = 0.039). Boys were more likely to sustain pelvic injuries and girls were more likely to sustain ankle injuries. Body parts injured varied by the specific track activity or event performed; hurdling was more likely to result in an injury to the upper extremities and to the head, whereas sprinting was more likely to result in an injury to the pelvis or upper leg. Conclusion: There are several age-, sex-, and activity-specific patterns of track-related injuries. Given the increased participation and corresponding increase in track-related injuries, more research is needed to determine how best to prevent these injuries.

Running-Related Injuries in School-Age Children and Adolescents Treated in Emergency Departments From 1994 Through 2007

Running for exercise is a popular way to motivate children to be physically active. Running-related injuries are well studied in adults but little information exists for children and adolescents. Through use of the National Electronic Injury Surveillance System database, cases of running-related injuries were selected by using activity codes for exercise (which included running and jogging). Sample weights were used to calculate national estimates. An estimated 225 344 children and adolescents 6 to 18 years old were treated in US emergency departments for running-related injuries. The annual number of cases increased by 34.0% over the study period. One third of the injuries involved a running-related fall and more than one half of the injuries occurred at school. The majority of injuries occurred to the lower extremities and resulted in a sprain or strain. These findings emphasize the need for scientific evidence-based guidelines for pediatric running. The high proportion of running-related falls warrants further research.