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Framme C, Book B, Hufendiek K, Panidou-Marschelke E, Sinicin E, Lindziute M, Rauscher J, Hamann M, Agostini H, Gabel-Pfisterer A. [Spectrum of firework injuries at a university eye clinic after the COVID-19 lockdown]. DIE OPHTHALMOLOGIE 2024; 121:27-35. [PMID: 37815541 DOI: 10.1007/s00347-023-01927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/06/2023] [Accepted: 08/31/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND The handling of fireworks regularly leads to a variety of injuries affecting the periocular region. Due to the COVID-19 lockdown and a sales ban on consumer fireworks for the private sector the number of injuries massively decreased; however, a considerable increase was registered again at the last New Year festivities. The aim of this work was to present the extent and spectrum of such injuries in a maximum care center. METHODS As part of the nationwide survey of firework-associated eye injuries in emergency care eye clinics and hospitals, data from the MHH Eye Hospital in Hannover were compiled over the period of 3 days (30.12.2022-01.01.2023) and evaluated with respect to gender, age, severity, injury pattern, type of fireworks and treatment. RESULTS Of a total of n = 25 injured patients, n = 19 (76%) were male. Most patients presented on New Year's Day (n = 14, New Year's Eve: n = 9; 30.12.2022: n = 2), with the majority of cases presenting with mild injuries with irritation and erosion of the ocular surface (n = 15; 60%). Of the patients four sustained moderate to severe injuries with bulbar contusion, hyphema, and sometimes iris base tears (16%). Of the patients six suffered severe, mainly open, eye injuries (24%), two of which required primary evisceration. Ignition of fireworks batteries revealed the highest risk of serious injury, affecting mainly males 31-40 years of age. Children up to 12 years of age generally sustained only minor injuries, although there were exceptions as there were among adolescents. The person who caused the fireworks injury was affected in about 52% of the cases; in 48% the victim of the accident was a bystander. In cases of complex injuries, under certain conditions only surgical exploratory diagnostics could lead to the correct diagnosis and best possible care. CONCLUSION The extent of firework injuries is manifold and the consequences including blindness are considerable. The burden on physicians on duty on New Year's Eve and New Year's Day was enormous, as with the permission of private fireworks a large number of patients had to be cared for via the emergency room, some of whom required complex surgical care. To prevent serious eye injuries, targeted education about the risks of private fireworks and possibilities to increase safety should be intensified.
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Affiliation(s)
- C Framme
- Universitäts-Augenklinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland.
| | - B Book
- Universitäts-Augenklinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - K Hufendiek
- Universitäts-Augenklinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - E Panidou-Marschelke
- Universitäts-Augenklinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - E Sinicin
- Universitäts-Augenklinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - M Lindziute
- Universitäts-Augenklinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - J Rauscher
- Universitäts-Augenklinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - M Hamann
- Universitäts-Augenklinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - H Agostini
- Klinik für Augenheilkunde, Medizinische Fakultät, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg im Breisgau, Deutschland
| | - A Gabel-Pfisterer
- Klinik für Augenheilkunde, Ernst von Bergmann Klinikum, Charlottenstr. 72, 14467, Potsdam, Deutschland
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Harrison L, Yee P, Sundararajan M, Ding L, Feng S. Local Firework Restrictions and Ocular Trauma. JAMA Ophthalmol 2024; 142:33-38. [PMID: 38095891 PMCID: PMC10722385 DOI: 10.1001/jamaophthalmol.2023.5698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023]
Abstract
Importance Fireworks can cause vision-threatening injuries, but the association of local legislation with the mitigation of these injuries is unclear. Objective To evaluate the odds of firework-related ocular trauma among residents of areas where fireworks are permitted vs banned. Design, Setting, and Participants This case-control study was conducted at a level 1 trauma center in Seattle, Washington, among 230 patients presenting with ocular trauma in the 2 weeks surrounding the Independence Day holiday, spanning June 28 to July 11, over an 8-year period (2016-2022). Exposures Firework ban status of patient residence. Main Outcomes and Measures Odds of firework-related injuries among residents of areas where fireworks are legal vs where they are banned, calculated as odds ratios (ORs) and 95% CIs. Results Of 230 consultations for ocular trauma during the study period, 94 patients (mean [SD] age, 25 [14] years; 86 male patients [92%]) sustained firework-related injuries, and 136 (mean [SD] age, 43 [23] years; 104 male patients [77%]) sustained non-firework-related injuries. The odds of firework-related ocular trauma were higher among those living in an area where fireworks were legal compared with those living in an area where fireworks were banned (OR, 2.0 [95% CI, 1.2-3.5]; P = .01). In addition, the odds of firework injuries were higher for patients younger than 18 years (OR, 3.1 [95% CI, 1.7-5.8]; P < .001) and for male patients (OR, 3.3 [95% CI, 1.5-7.1]; P = .004). Firework injuries were more likely to be vision threatening (54 of 94 [57%]) compared with non-firework-related injuries (54 of 136 [40%]; OR, 2.1 [95% CI, 1.2-3.5]; P = .01). Conclusions and Relevance This case-control study suggests that the odds of firework-related ocular trauma were slightly higher among residents of areas where fireworks were legal compared with residents of areas where fireworks were banned. Although these results suggest that local firework bans may be associated with a small reduction in the odds of firework-related ocular trauma, additional studies are warranted to assess what actions might lead to greater reductions.
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Affiliation(s)
- Luke Harrison
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Philina Yee
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Miel Sundararajan
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Leona Ding
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
| | - Shu Feng
- Department of Ophthalmology, University of Washington School of Medicine, Seattle
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Winicki NM, Waldrop I, Orozco JV, Novak D, Sheets NW. The epidemiology of firework-related injuries in the US, 2012-2022. Inj Epidemiol 2023; 10:32. [PMID: 37403127 DOI: 10.1186/s40621-023-00446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND This study aimed to examine the epidemiology of firework-related injuries within a national population between 2012 and 2022, including the severity of injury by year, patient demographics, body region injured, firework type, and diagnosis category of injury. METHODS Data were collected from the Consumer Product Safety Commission's National Electronic Injury Surveillance System, which is a representative nationwide database that collects data on consumer product-related injuries occurring in the US. Injury rates were calculated based on patient age, sex, body region injured, firework type, and diagnosis category. RESULTS A total of 3219 injuries, representing an estimated 122,912 firework-related injuries, were treated in emergency departments within the US from 2012 to 2022. The overall incidence rate of firework-related injuries in the study rose by over 17% from 2012 [2.61 cases per 100,000 people (95% CI 2.03-3.20)] to 2022 and [3.05 cases per 100,000 people (95% CI 2.29-3.80)]. The rate of injuries was highest in adolescents and young adults (age 20-24; 7.13 cases per 100,000 people). Men experienced firework injuries at more than double the rate of women (4.90 versus 2.25 cases per 100,000 people). The upper extremities (41.62%), head/neck (36.40%), and lower extremities (13.78%) were the most commonly injured regions. Over 20% of cases in patients older than 20 were significant injuries requiring hospitalization. Aerial devices (32.11%) and illegal fireworks (21.05%) caused the highest rates of significant injury of any firework type. CONCLUSIONS The incidence of firework-related injuries has risen over the past decade. Injuries remain the most common among adolescents and young adults. In addition, significant injuries requiring hospitalization occur most often during aerial and illegal firework use. Further targeted sale restrictions, distribution, and manufacturing regulations for high-risk fireworks are required to reduce the incidence of significant injury.
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Affiliation(s)
- Nolan M Winicki
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA.
| | - Ian Waldrop
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Jesus V Orozco
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Daniel Novak
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Nicholas W Sheets
- School of Medicine, University of California Riverside, 900 University Ave, Riverside, CA, 92521, USA
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Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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5
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Injuries From Explosions: More Differences Than Similarities Between Various Types. Disaster Med Public Health Prep 2022; 17:e154. [PMID: 35514263 DOI: 10.1017/dmp.2022.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare injury patterns of different types of explosions. METHODS A retrospective study of 4508 patients hospitalized due to explosions recorded in the Israel National Trauma Registry between January 1997 and December 2018. The events were divided into 4 groups: terror-related, war-related, civilian intentional explosions, and civilian unintentional explosions. The groups were compared in terms of injuries sustained, utilization of hospital resources, and clinical outcomes. RESULTS Civilian intentional and terror-related explosions were found to be similar in most aspects except for factors directly influencing mortality and a larger volume of severely injured body regions among terror-victims. Comparisons between other groups produced some parallels, albeit less consistent. Civilian intentional explosions and civilian unintentional explosions were different from each other in most aspects. The latter group also differed from others by its high volume of life-threatening burns and a higher proportion of children casualties. CONCLUSIONS While consistent similarities between explosion casualties exist, especially between victims of intentional civilian and terror-related explosions, the general rule is that clinical experience with a type of explosion cannot be directly transferred to other types.
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6
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Galanis DJ, Koo SS, Puapong DP, Sentell T, Bronstein AC. Decrease in injuries from fireworks in Hawaii: associations with a county policy to limit access. Inj Prev 2022; 28:325-329. [PMID: 35086916 DOI: 10.1136/injuryprev-2021-044402] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/10/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine trends in fireworks-related injuries (FRI) before and after enactment of an ordinance to limit access in the City and County of Honolulu (the island of Oahu). METHODS Surveillance of FRI treated in all emergency departments in the state, for 18 new year's periods (31 December through 1 January) from 2004 to 2021. Prelaw (2004 to 2011) and postlaw (2012 to 2021) number of FRI were compared, by patient age and county. RESULTS The average annual number of FRI for all ages decreased significantly in Oahu, from 74 during the prelaw period to 27 during the postlaw period (p<0.01), but not in the remaining neighbour islands (p=0.07). Decreases were particularly evident for Oahu paediatric patients (under 18 years), among whom FRI declined from 42 to 10 per year (p<0.01). FRI were approximately halved for older Oahu patients and neighbour island paediatric patients. CONCLUSIONS Legislation requiring permits for a specified number and type of fireworks, and limiting access to persons 18 years and older was associated with significant decreases in FRI in the City and County of Honolulu.
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Affiliation(s)
- Daniel J Galanis
- Emergency Medical Services and Injury Prevention System Branch, Hawaii State Department of Health, Honolulu, Hawaii, USA
| | - Sylvia Sj Koo
- John A Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Devin P Puapong
- Department of Surgery, Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii, USA
| | - Tetine Sentell
- Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, Hawaii, USA
| | - Alvin C Bronstein
- Emergency Medical Services and Injury Prevention System Branch, Hawaii State Department of Health, Honolulu, Hawaii, USA
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7
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Bitter CC, Zhang Z, Talbert AW, Weber AK, Hinyard L. Firework injuries are increasing in the United States: An analysis of the National Emergency Department Sample. J Am Coll Emerg Physicians Open 2021; 2:e12600. [PMID: 34918008 PMCID: PMC8641913 DOI: 10.1002/emp2.12600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Firework-related injuries cause significant morbidity to persons in the United States and globally. Prior studies have shown that hands and eyes are frequently injured, with loss of hand function and blindness being common after serious injury. Many jurisdictions in the United States have relaxed laws governing sales of consumer fireworks in recent years. Given the increased availability of consumer fireworks, we sought to determine the incidence of firework-related injuries compared with historical controls. METHODS Firework-related injuries were identified in the National Emergency Department Sample (NEDS) using the corresponding International Classification of Disease codes for the years 2008-2017. Demographics, timing of presentation, and hospital characteristics were analyzed. Data were weighted to approximate population estimates of injury. Statistical analyses were completed using SAS. The National Electronic Surveillance System was also queried for firework-related visits to check for consistency in observed trends. RESULTS There were an estimated 7699 injuries attributed to fireworks in 2017 (2.37 per 100,000 population) compared with 5727 (1.88 per 100,000 population) in 2008. The majority of victims were male (74.6%), and injuries clustered in the pediatric and young adult age groups. The Midwest and South (both 38.1%) had more firework-related injuries compared with the West (15.6%) and Northeast (8.2%) regions. Most visits occurred in July (71.4%) with smaller peaks in June (6.9%) and January (6.0%). Patients were disproportionately seen in trauma centers (34.0%) and teaching hospitals (49.6%). CONCLUSION Emergency department visits for firework injuries are increasing in the United States. Pediatric patients and young adult males comprise the majority of victims. Injuries are clustered around the Fourth of July and New Year's holidays. Public health interventions targeted at high-risk groups may reduce the burden of injury.
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Affiliation(s)
- Cindy C. Bitter
- Division of Emergency MedicineSaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Zidong Zhang
- Department Health and Clinical Outcomes Research, Advanced HEAlth Data (AHEAD) Research InstituteSaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Andrew W. Talbert
- Division of Emergency MedicineSaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Alizabeth K. Weber
- Division of OtolaryngologySaint Louis University School of MedicineSt. LouisMissouriUSA
| | - Leslie Hinyard
- Department Health and Clinical Outcomes Research, Advanced HEAlth Data (AHEAD) Research InstituteSaint Louis University School of MedicineSt. LouisMissouriUSA
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Hoskin AK, Low R, de Faber JT, Mishra C, Susvar P, Pradhan E, Rousselot A, Woreta FA, Keay L, Watson SL, Agrawal R. Eye injuries from fireworks used during celebrations and associated vision loss: the international globe and adnexal trauma epidemiology study (IGATES). Graefes Arch Clin Exp Ophthalmol 2021; 260:371-383. [PMID: 34453604 DOI: 10.1007/s00417-021-05284-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/31/2021] [Accepted: 06/11/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To report on the factors associated with severe vision loss from fireworks-related ocular trauma during celebrations, including festivals. METHODS Tertiary eye care hospitals in 5 countries and private ophthalmology practices in the Netherlands. Patients included received treatment for fireworks-related ocular trauma during celebrations. Demographic and clinical data for patients affected were analyzed and associations with severe vision loss reported. RESULTS Of 388 patients, 71 (18.3 %) had severe vision loss (worse than 6/60) at 4-week follow-up due to fireworks-related ocular trauma. Mean age overall was 20.6 years (range 2 to 83 years), and there was a male predominance of 4:1. Clinical factors associated with severe vision loss included penetrating injury (OR 4.874 [95% CI 1.298-18.304; p = 0.02]) and lens injury (OR 7.023 [95% CI 2.378-20.736; p = 0.0004]). More patients with closed-globe injuries (CGIs) had improved vision after 4 weeks (OR 3.667, 1.096-12.27) compared to those with open-globe injuries (OGI) (p = 0.035). Eye protection use was reported by 7 patients, and 39.4% patients < 18 years were unsupervised by an adult at the time of injury. CONCLUSIONS Severe vision loss from fireworks-related ocular trauma occurred during celebrations in a variety of countries and was associated with penetrating and/or lens injury and poor presenting vision. New initiatives are needed to prevent severe vision loss associated with these injuries.
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Affiliation(s)
- Annette K Hoskin
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Rebecca Low
- National Healthcare Group Eye Institute at Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | | | | | | | - Eli Pradhan
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Andres Rousselot
- Ophthalmology Department, Universidad del Salvador, Buenos Aires, Argentina
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW, Sydney, Australia.,The George Institute for Global Health, UNSW, Sydney, Australia
| | - Stephanie L Watson
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute at Tan Tock Seng Hospital, Singapore, 308433, Singapore.
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Van Yperen DT, Van Lieshout EMM, Dijkshoorn JN, Van der Vlies CH, Verhofstad MHJ. Injuries, treatment, and impairment caused by different types of fireworks; results of a 10 year multicenter retrospective cohort study. Scand J Trauma Resusc Emerg Med 2021; 29:11. [PMID: 33413553 PMCID: PMC7788980 DOI: 10.1186/s13049-020-00811-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives The primary aim of this study was to evaluate the number of patients reported to a hospital with injuries from consumer fireworks in the months December–January in the past 10 years, and to describe the association between the type of fireworks, injury pattern, treatment, and permanent impairment. Methods A multicenter, retrospective, observational case series. Patients were selected from two hospitals in the Southwest Netherlands: a level 1 trauma center and a specialized burn center. All patients with any fireworks-related injuries treated between December 1 and January 31, during 2007 (December) to 2017 (January), were eligible for participation. The primary outcome was the number of patients with any type of injury caused by fireworks. The secondary outcome measures were patient and injury characteristics, treatment details, and whole person impairment (WPI). The percentage WPI expresses a patient’s degree of permanent impairments as a result of fireworks-related injuries. Results Of the 297 eligible patients, 272 patients were included. From 2007 to 2017, between 21 and 40 patients were treated, and no clear increase or decrease was observed in the number of patients and in the number of patients per type of fireworks. Explosive fireworks mainly caused upper extremity (N = 65; 68%) injuries, while rockets (N = 24; 41%) and aerials (N = 7; 41%) mainly affected the head/neck. Decorative fireworks predominantly resulted in burns (N = 82; 68%), and explosive fireworks in soft tissue lacerations (N = 24; 25%), fractures (N = 16; 17%), and amputations (N = 14; 15%). Patients injured by explosive and homemade fireworks were most often admitted to a hospital (respectively N = 24; 36% and N = 12; 80%), and resulted in the highest proportion undergoing surgical procedures (respectively N = 22; 33% and N = 7; 47%). WPI found in this study was between 0 to 95%, with a median of 0%. In 34 (14%) patients, the injuries resulted in a WPI of ≥1%, mostly as a result of explosive fireworks (N = 18; 53%). Conclusion This study found no increase or decrease in the number of patients treated in two specialized hospitals. Explosive and homemade fireworks could be considered as most dangerous, as they result into the most hospital admissions, surgical procedures, and into the most injuries with permanent impairment as a result.
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Affiliation(s)
- Daan T Van Yperen
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.,Burn Center, Maasstad Hospital, P.O. Box 9100, 3079 DZ Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - J Niels Dijkshoorn
- Burn Center, Maasstad Hospital, P.O. Box 9100, 3079 DZ Rotterdam, The Netherlands
| | - Cornelis H Van der Vlies
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.,Burn Center, Maasstad Hospital, P.O. Box 9100, 3079 DZ Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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