Pediatric treadmill injuries: a public health issue

Stationary bike injuries prompting emergency department presentation in pediatric patients: an epidemiological study

OBJECTIVES

Potential harms of stationary bike injuries in pediatric patients have been highlighted in the literature, but prior work is limited to case series and without population-level analysis. The purpose of this study is to examine the epidemiology of pediatric stationary bike injuries occurring in the US over the last decade using a national database.

METHODS

Injuries resulting from stationary bike use in pediatric patients from 2012 to 2021 were identified using coding from the National Electronic Injury Surveillance System (NEISS) database. Patient demographics, injury characteristics, and case narratives were examined. National annual estimates of injury frequency/incidence were calculated using weighting and survey package in R. Univariate analyses were used to compare injuries among groups.

RESULTS

We identified 525 stationary bike injuries representing an estimated total of 15,509 injuries in the population. Pediatric patients sustained an average of 1,551 injuries annually, with an estimated yearly increase of 288 injuries (p < 0.01) after 2019. While males sustained more injuries, there were age-dependent differences in frequency of injuries between sexes (p < 0.01). The upper extremity was the most commonly injured body region overall, but children 5 and under sustained more injuries to the head/neck. The most common overall injury type was lacerations, while fractures predominated in the 6 to 11-year-old age group. Fifty-six percent of injuries were sustained not while riding the bike, most notably among children under 12.

CONCLUSION

Our findings indicate that the impact of stationary bike injury in the pediatric population is not insignificant, and most injuries are related to improper play rather than traditional exercise use. Gender and age-related patterns differed in regard to the type and mechanism of injury sustained. Children 5 and under sustain a disproportionate amount of injuries to the head, neck, and upper extremity. As stationary bikes grow in popularity, preventative measures should be considered to reduce injuries to young children.

Friction-Induced Skin Disorders-A Review

ABSTRACT

Friction is unavoidable in activites of daily life and is associated with various dermatological disorders. A comprehensive literature review showed friction can induce epidermal changes, dermatitis, alteration of the dermis, diseases of abnormal deposition, alteration of the hair and follicles, nail diseases, pigmentary disorders, and skin tumors. Cultural, religious, and occupational factors may predispose to the development friction-related skin disorders. However, friction often occurs together with other external stimuli, such as pressure and occlusion. Careful observation and investigation are required to establish the exact role of friction in the development of various dermatoses.

Treadmill Hand Injuries Among Children: A Retrospective Case Series From Hospitalized Patients

Background: With the progress of modernization, treadmill hand injury in pediatric population is taking on a global trend in recent years. The purpose of this study was to investigate the epidemiology and clinical features in a developing country, thereby providing some experience in the treatment and prevention of this particular type of injury. Methods: A 5-year retrospective review of patients with treadmill hand injury in Burn and Plastic Surgery ward at Children' Hospital of Chongqing Medical University was conducted. Demographics, injury details, therapy performed, length of hospital stay, complications, and outcome were analyzed. Results: Forty-six patients were surveyed, with a mean age of 3.5 ± 2.0 years old, including 24 males and 22 females. Injuries (77.8%) occurred between dinner to bedtime, and 95.7% happened indoors. Fingers were the most vulnerable part, of which the middle finger, ring finger, and index finger were the top three ones. The mean body surface area (BSA%) was 0.3 ± 0.2, but at least in deep dermal. Dressing changes, full-thickness skin grafts (FTSG), and Negative Pleasure Wound Therapy (NPWT) assisted FTSG were performed. The scar contracture, as the most severe complication, occurred in 26 patients, of which 22 originally received dressing changes at the time of injury. Conclusion: Treadmill hand injury in children should be highly regarded. Compared with conservative dressing changes, surgical intervention from a professional team may achieve more satisfactory prognosis and fewer complications. A prevention strategy based on "Time-Space-Person" was summarized according to its epidemiological characteristics, may help to decrease the incidence of this specific type of injury theoretically.

Upper Extremity Friction Burns in the Pediatric Patient: A 10-year Review

Background

Upper extremity friction burn due to powered home equipment is a growing problem in the pediatric population. The purpose of this study was to review the etiology, presentation, characteristics, and treatment of this particular type of pediatric mechanism of injury.

Methods

A retrospective chart review using International Classification of Diseases, version 9, codes for patients treated at a large tertiary care, free-standing children's hospital was performed to identify all patients presenting with an upper extremity friction burn from 2003 to 2012.

Results

Sixty-nine patients sustained upper extremity friction burns. The average age at the time of injury was 3.3 years (range, 0.7-10.6) with presentation to our center occurring 16.6 days (range, 0-365 days) following injury. Mean follow-up was 23.3 months (range, 2-104). Mechanism of injury included treadmills (n = 63) and vacuum cleaners (n = 6). Twenty-eight operations were performed on 21 patients (30%). All patients requiring a surgical intervention sustained injury via treadmill mechanism (P = 0.0001). Unlike treadmill burns, vacuum cleaner injuries affected the dorsal hand or a single digit (P = 0.00004). Scar hyperpigmentation was more prevalent in these patients compared with the treadmill group (P = 0.003). All vacuum-induced burn patients had full range of motion and function with conservative treatment alone, whereas only 55.6% of treadmill burn patients had full recovery of range of motion and 50.8% recovery of full hand function.

Conclusions

Friction burns from vacuum cleaners are less prevalent, have different injury patterns, and can be treated conservatively with excellent functional outcomes. Treadmill friction burns result in more significant injury and risk for dysfunction, requiring surgical intervention.

Emergency department-reported injuries associated with mechanical home exercise equipment in the USA

The goal of this study was to generate national estimates of injuries associated with mechanical home exercise equipment, and to describe these injuries across all ages. Emergency department (ED)-treated injuries associated with mechanical home exercise equipment were identified from 2007 to 2011 from the National Electronic Injury Surveillance System. Text narratives provided exercise equipment type (treadmill, elliptical, stationary bicycle, unspecified/other exercise machine). Approximately 70 302 (95% CI 59 086 to 81 519) mechanical exercise equipment-related injuries presented to US EDs nationally during 2007-2011, of which 66% were attributed to treadmills. Most injuries among children (≤4 years) were lacerations (34%) or soft tissue injuries (48%); among adults (≥25 years) injuries were often sprains/strains (30%). Injured older adults (≥65 years) had greater odds of being admitted, held for observation, or transferred to another hospital, compared with younger ages (OR: 2.58; 95% CI 1.45 to 4.60). Mechanical exercise equipment is a common cause of injury across ages. Injury awareness and prevention are important complements to active lifestyles.

Friction burns in children: does laser Doppler imaging have a role?

Laser Doppler imaging (LDI) has been increasingly used to predict pediatric burn wound outcome. A majority of these wounds are scald, contact, or flame burns. No study has specifically evaluated the use of LDI in pediatric friction burns. Our objective was to critically evaluate LDI assessment of pediatric friction burns to determine its predictive value with this mechanism of injury. We conducted a retrospective review of all LDI scans performed on pediatric friction burns during a 2-year period. We identified 36 patients with a mean age of 3.6 years (range, 19 months to 15 years). LDI accurately predicted burn wound outcome in 23 (64%) cases. In 13 cases, LDI did not correctly predict burn wound outcome. Eight were expected to heal within 14 days, but six of those eight took an average of 20.3 days to heal (range, 18-29 days), and the other two required skin grafting. Of the remaining five incorrect predictions, four were caused by an inability to correlate the flux scan with the clinical appearance of the burn, and one was thought to take more than 21 days to heal but healed within this period. Our data suggest that LDI appears to be a less reliable tool in predicting the outcome of friction burns when compared to other mechanisms of burn injury in children. This may reflect the physical differences in the mechanism of friction burns as opposed to other forms of thermal injury.

Management of treadmill hand injuries using soft tissue distraction

Background:

In the modern day cities, home treadmill usage is increasing. Toddlers are prone to a special injury by the treadmill, during workout the toddler tries to get on the belt and the roller action pulls the fingers under the belt and get caught between the belt and a metal rod under the machine and the belt scrapes the fingers. If untreated some of these injuries will lead to flexion contracture. The usual treatment is release of contracture and skin grafting, however, graft discoloration and recurrence of contracture are the complications of this method and the patients usually seek treatment for the brown discoloration of the grafts at a later age.

Objectives:

In this study we assess the results of Z-plasty in combination with soft tissue distraction without skin grafting with long term usage of splint as an alternative treatment for these patients.

Materials and Methods:

In this retrograde descriptive cross-sectional study, we evaluated the patients presented with treadmill hand injuries between the years 2006 and 2011. Demographic data including age and sex in addition to other information including location of trauma, severity of trauma, time elapsed between the trauma and treatment, type of treatment including wound care and surgical method and treatment outcomes were assessed.

Results:

A total of 8 patients (3 girls and 5 boys) following finger treadmill injury were assessed. 15 fingers in 7 patients had volar injury. The middle finger was the most commonly injured finger. In all patients a minimum of 2 fingers were injured and in just 1 patient 3 fingers were injured. In long-term follow-up all the patients had acceptable volar skin and complete ROM of the fingers.

Conclusions:

Due to discoloration of the skin graft and recurrence of contracture following skin graft as the sole treatment for the injury, application of Z-plasty with soft tissue distraction and long term splints seems to be a proper alternative treatment for these patients.

Paediatric injuries due to home treadmill use: an emerging problem

INTRODUCTION

The use of home exercise equipment is increasing and treadmills are becoming more popular. This has brought with it an emerging but preventable problem. We present our experience, highlight the importance and promote public awareness of this type of injury. To our knowledge this has not been reported previously in the UK.

METHODS

A retrospective review was conducted of the medical records at two regional burn units of children who sustained treadmill-related injuries between July 2003 and July 2009. Data on patient demographics, mechanism of injury, management, surgical intervention and outcome were recorded.

RESULTS

Twenty-nine children (15 boys, 14 girls) sustained treadmill-related injuries. The mean age was 3.8 years (range: 1-13 years). All injuries occurred at home and the majority of children trapped their hand under the running belt when an adult was using the machine. Most of the injuries were to the upper limb (97%) with less than 1% of the total body surface area burnt. More than two-thirds of patients had deep burns and 17 (58%) required surgical intervention. Five patients developed hypertrophic scars. All patients achieved a good functional outcome.

CONCLUSIONS

Treadmills can pose a significant danger to children. These injuries are preventable. Regulatory authorities, manufacturers and parents should take steps to prevent this emerging health problem.