Temporal variation in childhood injury from common recreational activities

Changes in pediatric fracture patterns presenting to US emergency departments before, during, and after the COVID-19 pandemic

The purpose of this study was to analyze the demographics of pediatric fracture patients before, during, and after the COVID pandemic using US national emergency department (ED) data. The National Electronic Injury Surveillance System (NEISS) data for the years 2018 through 2021 was extracted for those <16 years of age, and organized into 24 consecutive bimonthly groups. There was a decrease in the number of ED visits for fractures in 2020 and returned to pre-COVID levels by March/April of 2021, except for small hospitals which demonstrated an earlier rebound beginning in late 2020. During the pandemic the incident locale was more frequently the home and less at schools/sporting venues, which returned to pre-COVID levels by March/April 2021. The proportion of those not discharged from the ED increases from March/April 2020 to March/April 2021. The median age was 8.8, 9.0, 8.2, and 8.7 years respectively for the years 2018, 2019, 2020, and 2021. Early in the pandemic there were more radius/ulna and fewer finger fractures and more tibia/fibula and fewer toe fractures; these changes did not return to pre-COVID percentages until the end of 2021. Fractures associated with bicycles and trampolines remained stable throughout the pandemic, those due to skateboards increased, and those due to playground and sporting activities decreased, with varying times of return to pre-COVID levels. In conclusion pediatric fracture patterns during the COVID-19 pandemic demonstrated many changes; most returned to baseline patterns by early/mid 2021 except for small hospital EDs which saw a much quicker rebound by late 2020. This national data gives health care providers/administrators information about what can happen during a modern day pandemic. If another pandemic occurs in the future mandating lockdowns, this data may be useful to guide resource and manpower allocations.

Fractures in Children Due to Firearm Activity

The purpose of this study was to investigate fracture patterns due to pediatric firearm injuries. The data used was from the US Firearm Injury Surveillance Study 1993–2019. Over these 27 years, there were 19,033 children with fractures due to firearm activity with an average age of 12.2 years; 85.2% were boys and the firearm was a powder type in 64.7%. The finger was the most common fracture location, while the tibia/fibula was the most common location for those admitted to the hospital. Children ≤ 5 years of age sustained more skull/face fractures; most spine fractures occurred in the 11–15-year age group. The injury was self-inflicted in 65.2% of the non-powder and 30.6% of the powder group. The injury intent was an assault in 50.0% of the powder and 3.7% of the non-powder firearm group. Powder firearms accounted for the majority of the fractures in the ≤5 and 11–15 year-olds, non-powder firearms accounted for the majority of the fractures in the 6–10 year-olds. Injuries occurring at home decreased with increasing age; there was an increase in hospital admissions over time. In conclusion, our findings support the need for safe storage of firearms in the home away from children. This data will be helpful to assess any changes in prevalence or demographics with future firearm legislation or other prevention programs. The increasing acuity of firearm-associated injuries seen in this study is detrimental to the child, impacts familial wellbeing, and results in significant financial costs to society.

Epidemiology of child playground equipment-related injuries in the USA: Emergency department visits, 1995-2019

AIM

To analyse the most recent trends and characteristics of playground equipment-related injuries in children.

METHODS

We used the National Electronic Injury Surveillance System database to acquire cases of playground equipment-related injuries in children ≤17 years old between 1995 and 2019. A total of 184 580 unweighted cases met our study inclusion criteria.

RESULTS

A total of 5 356 703 (95% confidence interval 4 235 530-6 477 876) emergency department visits for playground-related injuries in the USA were estimated during the study period which was equal to an average of 29.4 annual injuries per 10 000 US population ≤17 years. The mean age was 6.5 (standard error 0.049) years. School-aged (42.7%) and pre-school children (35.3%) accounted for most playground injuries. More than half of the injuries were reported in males (53.6%). Most injuries occurred with climbing apparatuses (36%), followed by swings (25.9%) and slides (20.9%). Overall number of injuries (∆ - 22.3%, P = 0.01) and incidence (∆ - 21.6%, P = 0.01) had a declining trend after 2012. However, reported concussion injuries showed an increasing trend during the study (∆ + 28.3%, P < 0.001). A marked seasonal variation in number of injuries existed with most injuries in May and September.

CONCLUSIONS

Although injuries arising from playground equipment have decreased during the past 8 years, there was an increase in number of reported concussions. The outcomes of this study suggested that further efforts should be directed towards such serious injuries.

Seasonal differences in emergency department visits for scooter associated injuries

Hoverboards and electric scooters have surged in popularity in the past decade. These devices carry their own injury profiles and have caused increasing emergency department visits for injury. The purpose of this study was to compare both hoverboards and electric scooters to more traditional scooters and evaluate seasonal variations in their injury patterns. The National Electronic Injury Surveillance System (NEISS) database was used, downloading cases with the appropriate consumer product codes. Four distinct scooter groups were created, and were: non-powered scooters, powered scooters, electric scooters, and hoverboards. Statistical analyses were first performed with SUDAAN software to account for the stratified and weighted nature of the data to obtain national estimates of injuries and associated demographic variables. Cosinor analyses were performed to analyze the estimated number of emergency department (ED) visits for rhythmic variation by month and weekday of injury. Weekday by month analyses were studied using a three-dimensional topographic concept. Overall, there were over 1 million ED visits over the 20 years for injuries due to the four different types of scooters (75.8% nonmotorized scooters, 12.4% motorized scooters, 6.8% hoverboards, and 2.4% electric scooters). Cosinor analyses demonstrated that there was a peak in injuries in the summer and on weekends for all scooters, except for hoverboards. For hoverboards 21% of all ED visits occurred in December, with mostly occurring exactly around Christmas Day. This study confirms previous findings that scooter injuries occur mostly in warmer months and is the first to demonstrate a topographical "Christmas Effect" of hoverboard injuries. This information can be used in health care resource allocation as well as design of potential prevention strategies.

Playground Equipment-related Genital Injuries in Children: An Analysis of United States Emergency Departments Visits, 2010-2019

OBJECTIVE

To evaluate the demographics, epidemiology, and common mechanisms associated with playground equipment-related genital injuries in children.

METHODS

We examined the National Electronic Injury Surveillance System database to obtain playground-related genital injuries sustained in children ≤17 years from 2010 to 2019. Demographics of the patients and injury characteristics were analyzed using sample weights to produce national estimates.

RESULTS

During the study period, an estimated 27,738 (95% confidence interval 18,602-36,874) emergency department visits with an average annual incidence of 3.8 (95% confidence interval 2.5-5) per 100,000 United States population ≤17 years were reported. The mean age was 6.6 (standard error 0.152) years with most injuries occurring in pre-school children (48.1%) and females (81.1%). Over ½ of genital injuries (55.2%) were associated with climbing apparatus. This was followed by slides (10.7%), swings (9%), and seesaws (4.8%). Most genital injuries occurred at public (41.4%) and school settings (36.3%). Straddling and/or falling was the most common mechanism leading to genital injuries (84.4%). The incidence of injuries remained constant during the 10-year study period (change = + 2.6%; r² = 0.121, P = .326). Monthly variations in the number of injuries existed with peak injuries in April-May, and September-October.

CONCLUSION

Despite current safety standards, genital injuries arising from playground equipment have remained stable since 2010. By defining common devices, mechanisms, and conditions associated with genital injuries, this study may help guide efforts aimed at the prevention of such injuries in various locations.

Comprehensive Analysis of Pediatric Supracondylar Fractures in the Emergency Department; A Single Center Experience

Objective:

To describe the demographic characteristics and to assess possible risk factors related to the moment of presentation at Emergency Department (ED) for pediatric humeral supracondylar fractures.

Methods:

This was cross-sectional study being conducted during 5-year period from 2013 to 2017 at ED of a regional hospital in Spain. We have included all the pediatric patients (<14 years) with supracondylar fractures referring to our center during the study period. The demographic, clinical and radiological characteristics of the patients were recorded. The outcome and treatment strategies were also recorded. The risk factors of the pediatric supracondylar fracture was also assessed in our series.

Results:

We have included 52 pediatric patients with supracondylar fractures in this series. The mean age was 7.48 ± 2.97 years with a minimum age of 2 years and a maximum of 14 years. Among the patients there were 32 (61.54%) male and 20 (38.46%) female. Age less than 7 years found to be a protective factor against unstable fractures [OR 0.33 (0.10 - 1.02)]. Fractures presented during daytime hours showed a greater instability [OR 3.49 (1.07-11.39)]. However, the risk of presentation at nighttime was higher during the summer months (June to September).

Conclusion:

The older is the child, the greater is the risk of suffering an unstable fracture, which increases the need for surgery. This risk is greater during the daytime. Otherwise, during the summer months, there is a higher risk of patient presentation at nighttime.

Pediatric and adolescent injury in aquatic adventure sports

Drowning is a leading cause of death in children. Each year there are thousands of injuries in children, some fatal, associated with aquatic adventure sports. Personal water craft rapidly accelerate children to high velocities, as does being towed behind boats on skis or tubes, whereupon children have no control of their speed or direction. Canoeing and white-water kayaking particularly stress the upper limbs and shoulder dislocations are a primary concern. Surfing and kite-surfing generate more injuries to the head and face than other parts of the body and, in scuba diving, children most frequently injure their ears due to the acute pressure changes experienced. Aquatic injuries cost more in children than in adults and residual functional deficits may last a lifetime. There is a pressing need for research into the prevalence and incidence of aquatic injuries in children, so the effectiveness of preventive interventions can be determined.

Rapidly growing pediatric trampoline-related injuries in Korea: a 10-year single center retrospective study

Purpose

Several published policy statements have warned against the risks associated with trampoline use and recommended safety guidelines. However, few studies have focused on trampoline-related injuries in Korea. This study aimed to assess the incidence and characteristics of pediatric trampoline-related injuries presented to Ulsan University Hospital.

Methods

We retrospectively reviewed the medical records of children aged <16 years with trampoline-related injuries who visited our Emergency Department between 2008 and 2017.

Results

Over the 10-year period, 178 trampoline-related injuries were reported, which represented a significant increase (P=0.016). Most (87.6%) of the injuries occurred during the last 5 study years, and a rapid increase in injuries was observed in children aged <6 years. Lower extremity injuries (62.4%) were the most common, followed by injuries of the upper extremities, head and face, and trunk, including injuries to the neck and spine. Sixty-seven children (37.6%) had fractures, and proximal tibia fractures were the most common. Fractures were significantly more common in younger children (<6 years old) than in older children (P=0.026).

Conclusion

In Korea, the mechanism of trampoline injury is similar to that of injuries incurred in indoor trampoline parks but is characterized by smaller spaces and multiple users. Trampoline use and the incidence of trampoline-related injuries in children aged <6 years are increasing rapidly. Prohibiting the use of trampolines for children aged <6 years, restricting simultaneous use by multiple children, and ensuring adult supervision should be strictly emphasized. Public awareness and policy guidelines are needed to reduce the incidence of trampoline-related injuries.

Inflatable bouncer-related injuries to children: increasing phenomenon in pediatric emergency department, 2002-2013

A sharp uptrend in emergency department (ED) visits for injuries associated with inflatable bouncers (IBs) has been observed recently. The aim of this study is to describe the epidemiology and features of injuries resulting from the use of IBs at an Italian pediatric ED. We collected data of 521 children from GIPSE (regional software for management of admission at ED) in the period of 2002-2013. The injuries were slightly more frequent in males than females (52.4 vs 47.6 %). Preschooler children were the most commonly injured (45.7 %). The occurrence of injuries increased by year (eight cases in 2002 and 90 cases in 2013), and a seasonal variability was reported (207 cases in the period of April-June). The most common body region injured was the upper extremity (52.4 %). Children with fractures were 126 times more likely to have injured the upper extremity rather than other body regions compared with patients with no fracture (p < 0.05). Humerus and radius/ulna fractures occurred most commonly in preschooler children (p < 0.05). Fractures were 43 times more likely to be hospitalized than children with no fracture (p < 0.05).

CONCLUSION

Injuries associated with IBs increased over time. Preschooler children were most injured, and this means there is insufficient adherence to existing recommendations concerning an age limit.

WHAT IS KNOWN

• Along with the skyrocketing popularity of IBs among children, the number of children presenting to ED with injuries from these plays has also been increasing at an alarming rate; • The European literature about this phenomenon is scarce and no specific legislations exist for safety of these devises in European Union (EU). What is New: • This is the first study in EU that examines trends for pediatric inflatable bouncer-related injuries at ED over an 11-year period. • Although American Academy of Pediatrics recommends restrictions of attendance to IBs under 6 years old, injuries and fractures continue to occur more frequently under this age.

Emergency department visits resulting from intentional injury in and out of school

BACKGROUND AND OBJECTIVE

Previous studies have reported concerning numbers of injuries to children in the school setting. The objective was to understand temporal and demographic trends in intentional injuries in the school setting and to compare these with intentional injuries outside the school setting.

METHODS

Data from the National Electronic Injury Surveillance System-All Injury Program from 2001 to 2008 were analyzed to assess emergency department visits (EDVs) after an intentional injury.

RESULTS

There were an estimated 7,397,301 total EDVs due to injuries sustained at school from 2001 to 2008. Of these, an estimated 736,014 (10%) were reported as intentional (range: 8.5%-10.7% for the study time period). The overall risk of an EDV after an intentional injury in school was 2.33 (95% confidence interval [CI]: 1.93-2.82) when compared with an EDV after an intentional injury outside the school setting. For intentional injury-related EDVs originating in the school setting, multivariate regression identified several demographic risk factors: 10- to 14-year-old (odds ratio [OR]: 1.58; 95% CI: 1.10-2.27) and 15- to 19-year-old (OR: 1.69; 95% CI: 1.01-2.82) age group, black (OR: 4.14; 95% CI: 2.94-5.83) and American Indian (OR: 2.48; 95% CI: 2.06-2.99) race, and Hispanic ethnicity (OR: 3.67; 95% CI: 2.02-6.69). The odds of hospitalization resulting from intentional injury-related EDV compared with unintentional injury-related EDVs was 2.01 (95% CI: 1.50-2.69) in the school setting. These odds were found to be 5.85 (95% CI: 4.76-7.19) in the outside school setting.

CONCLUSIONS

The findings of this study suggest a need for additional prevention strategies addressing school-based intentional injuries.

Seasonal variation in musculoskeletal extremity injuries in school children aged 6-12 followed prospectively over 2.5 years: a cohort study

OBJECTIVES

The type and level of physical activity in children vary over seasons and might thus influence the injury patterns. However, very little information is available on the distribution of injuries over the calendar year. This study aims to describe and analyse the seasonal variation in extremity injuries in children.

DESIGN

Prospective cohort study.

SETTING

10 public schools in the municipality of Svendborg, Denmark.

PARTICIPANTS

A total of 1259 school children aged 6-12 years participating in the Childhood Health, Activity, and Motor Performance School Study Denmark.

METHODS

School children were surveyed each week during 2.5 school-years. Musculoskeletal injuries were reported by parents answering automated mobile phone text questions (SMS-Track) on a weekly basis and diagnosed by clinicians. Data were analysed for prevalence and incidence rates over time with adjustments for gender and age.

RESULTS

Injuries in the lower extremities were reported most frequently (n=1049). There was a significant seasonal variation in incidence and prevalence for lower extremity injuries and for lower and upper extremity injuries combined (n=1229). For the upper extremities (n=180), seasonal variation had a significant effect on the risk of prevalence. Analysis showed a 46% increase in injury incidence and a 32% increase in injury prevalence during summer relative to winter for lower and upper extremity injuries combined.

CONCLUSIONS

There are clear seasonal differences in the occurrence of musculoskeletal extremity injuries among children with almost twice as high injury incidence and prevalence estimates during autumn, summer and spring compared with winter. This suggests further research into the underlying causes for seasonal variation and calls for preventive strategies to be implemented in order to actively prepare and supervise children before and during high-risk periods.

Epidemiology of nonfatal bicycle injuries presenting to United States emergency departments, 2001-2008

OBJECTIVES

The purpose of this study was to describe the epidemiology of bicycle-related injuries presenting to United States emergency departments (EDs).

METHODS

The National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) database was used to derive national, weighted estimates of nonfatal ED visits for bicycle-related injuries by patient age, sex, diagnosis, injured body part, locale of incident, traffic-relatedness of incident, and month of incident.

RESULTS

Males accounted for 73% of all bicycle-related injury ED visits. Patients aged 10 to 14 years represented the 5-year age interval with the highest rate of bicycle injury visits (488 per 10,000). Fifty-six percent of ED visits for bicycle-related injuries came from cyclists who were riding on the street, with increased street ridership in those who were older than 15 years, and 99.7% of all patient injuries occurring on the street (as opposed to other locations) were related to motor vehicle collisions (MVCs). The head and face were the most injured body parts in the overall population. In addition, the largest proportion of head injuries, relative to total injuries in the age group, occurred in the very young (0 to 4 years) and elderly (65+ years) populations. The leading rider injury diagnoses were contusion, abrasions, and hematomas. The incidence of bicycle-related injuries peaked in the month of July.

CONCLUSIONS

The study identified the characteristics of bicycle-related injuries across various age groups of riders. This information will aid in developing more effective age-appropriate injury prevention strategies. The frequency of MVC-related injuries deserves attention and suggests the need to examine strategies for limiting interactions between moving vehicles and bicyclists.