Pediatric Farm Injuries Presenting to United States Emergency Departments, 2001‐2014

Agricultural Injury Surveillance in the United States and Canada: A Systematic Literature Review

INTRODUCTION

Agricultural injuries remain a major concern in North America, with a fatal injury rate of 19.5 deaths per 100,000 workers in the United States. Numerous research efforts have sought to compile and analyze records of agricultural-related injuries and fatalities at a national level, utilizing resources, ranging from newspaper clippings and hospital records to Emergency Medical System (EMS) data, death certifications, surveys, and other multiple sources. Despite these extensive efforts, a comprehensive understanding of injury trends over extended time periods and across diverse types of data sources remains elusive, primarily due to the duration of data collection and the focus on specific subsets.

METHODS

This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, consolidates and analyzes agricultural injury surveillance data from 48 eligible papers published between 1985 and 2022 to offer a holistic understanding of trends and challenges.

RESULTS

These papers, reporting an average of 25,000 injuries each, were analyzed by database source type, injury severity, nature of injury, body part, source of injury, event/exposure, and age. One key finding is that the top source of injury or event/exposure depends on the chosen surveillance system and injury severity, underscoring the need of diverse data sources for a nuanced understanding of agricultural injuries.

CONCLUSION

This study provides policymakers, researchers, and practitioners with crucial insights to bolster the development and analysis of surveillance systems in agricultural safety. The overarching aim is to address the pressing issue of agricultural injuries, contributing to a safer work environment and ultimately enhancing the overall well-being of individuals engaged in agriculture.

Outcomes of farm compared to nonfarm pediatric injuries: A propensity-matched analysis

OBJECTIVES

Pediatric farm-related injuries are rare but tend to be severe relative to other types of pediatric injury and may result in worse clinical outcomes. However, the comparison of farm and nonfarm injuries is confounded by different injury mechanisms, patient characteristics, and treating facilities. Therefore, we used propensity score matching to compare outcomes of pediatric farm and nonfarm injuries in the United States.

METHODS

Data were obtained from the 2017-2019 Trauma Quality Program database. Farm as compared to nonfarm injury was defined as the location of an injury and served as the independent variable analyzed in this study. The outcome variables analyzed were in-hospital mortality, hospital length of stay (LOS), and admission to the intensive care unit (ICU).

RESULTS

We identified 2,040 farm injuries and 201,865 nonfarm injuries meeting inclusion criteria. In this cohort, the mortality rate was 1%, median LOS was 2 days, and 14% of patients were admitted to the ICU. In the propensity-matched analysis (including 2,039 farm cases matched to 2,039 nonfarm controls), farm as compared to nonfarm injuries were associated with 5% longer LOS (95% CI: 1%, 8%; P = .01), but not mortality or ICU admission.

CONCLUSIONS

In a propensity-matched analysis, pediatric farm injuries resulted in prolonged hospital stay compared to nonfarm injuries. Identifying patient- and health care system-level factors contributing to prolonged LOS may help optimize the care of children injured on farms.

Regional surveillance of medically-attended farm-related injuries in children and adolescents

Purpose

Due to numerous environmental hazards such as heavy machinery and large livestock, youth who live and work on farms are at high risk of injury, disability, and death. This study described a regional surveillance system for monitoring farm-related injuries in children and adolescents. As the risk of farm-related injuries are not exclusive to farm residents, trends in farm-related injuries over the previous 5 years were reported and compared between children/adolescents who did and did not live on farms in north-central Wisconsin.

Methods

A retrospective cohort of child and adolescent patients of the Marshfield Clinic Health System was assembled. Incident farm-related injuries, including from agricultural work or other activities in a farm environment, were extracted from medical records from 2017 through 2021. Generalized linear models were created to compare age- and sex-adjusted farm-related injury rates by year.

Results

There were 4,730 (5%) in-farm and 93,420 (95%) out-farm children and adolescents in the cohort. There were 65 incident farm-related injury cases in the in-farm group and 412 in the out-farm group. The annual incidence rate of farm-related injuries was higher in the in-farm group, but changes during the 5-year timeframe were not significant in either group. In the in-farm group, rates ranged from a high of 61.8 [95% confidence interval (CI): 38.3, 94.5] incident farm-related injuries per 10,000 children/adolescents in 2017 to a low of 28.2 (13.5, 51.9) injuries per 10,000 children/adolescents in 2018. In the out-farm group, rates ranged from 10.7 (8.3, 13.6) to 16.8 (13.7, 20.5) incident farm-related injuries per 10,000 children/adolescents per year between 2017 and 2021. The in-farm group had a higher proportion of injured males and heavy machinery injuries, while the out-farm group had more all-terrain vehicle injuries and pesticide poisonings.

Conclusion

Farm residency remains hazardous for children and adolescents, as injury rates were three times higher in the in-farm group and remained stable over 5 years. All-terrain vehicle injuries were high in both groups, and should be a priority in rural safety interventions. With additional adaptations to other states, this surveillance model could be scaled across other healthcare systems.

Protecting Young Agricultural Workers: The Development of an Online Supervisor Training

Adolescents and young adults working in agriculture are at greater risk of injury. We describe the development of an online safety and health training for people who hire, teach, or supervise young agricultural workers. The online training targeted specific skills supervisors can use to effectively supervise, train, and communicate with young workers about health and safety hazards that impact injury risk. Consistent with NIOSH's evidence-based Total Worker Health® approach, the training integrated safety and health promotion and was also informed by behavioral change theories. An iterative approach was used to develop and evaluate the training. A content review provided feedback on topics and organization of material. Safety and health experts assessed the revised training content and rated the training topics on clarity, accuracy, and completeness. Finally, a pilot study with employers and health and safety professionals was used to evaluate the training materials. The content review suggested ways to reorganize the material to improve flow and reduce redundancy. Ratings of clarity, accuracy, and completeness were high, ranging from 5 to 7 (mean ratings from 5.8 to 7.0) on a scale of 1 ("does not do this at all") to 7 ("does this very well"). The pilot study led to changes in wording and items used to assess knowledge. A theoretically-informed approach was used to develop an online supervisor training to increase awareness and build skills. An iterative process that included expert review, evaluation of learning competencies, and a pilot study with the end-users is described.

Nonfatal Agricultural Injuries Treated in Emergency Departments: 2015-2019

Utilizing emergency department admissions to estimate and describe agricultural injuries in the United States (U.S.) provides a unique view of one of the country's most dangerous occupations. This study characterizes and provides nationally representative estimates of persons with non-fatal agricultural-related injuries treated in emergency departments in the U.S.We conducted a cross-sectional study using U.S. Consumer Product Safety Commission, National Electronic Injury Surveillance System (NEISS) data for patients treated in emergency departments from January 1, 2015 to December 31, 2019. We queried all cases in the NEISS database using the location code "farm" and with a narrative search using relevant key words.An estimated 62,079 people were treated in an emergency department for agricultural related injuries. The mean age estimate in this population was 39 years-old, with ages ranging from 1 to 95. Almost two-thirds of patients were male, and almost 80% were white. Approximately 30% and 22% of those injured were youth and elderly patients, respectively. The majority of injuries occurred from April through September. The most common injury was fracture, followed by open wound or amputation. There were significant differences between the body parts injured in youth versus adult patients. The primary source of injury was in the vehicles category, with tractors being the dominant vehicle type.Agricultural vehicles remain a major source of injuries that require treatment in emergency departments. Previous methods of quantifying severe ag-related injuries were limited; our research utilized NEISS data to portray injury statistics more accurately.

Childhood Agricultural Injury Prevention Among Organic Farmer Mothers

Purpose: Rates of organic farms and women organic farmers are increasing. Yet, this recent surge brings new and uncertain challenges for injury epidemiology. Since many in the population are of child-bearing age, and child agricultural injury is a significant threat, of particular relevance are the knowledge, attitudes, and beliefs towards risk of child injury.Methods: A paper, self-administered 11-question questionnaire was distributed at four events geared towards early career women organic farmers. The questionnaire generated data around select demographics, attitudes towards farm safety, and sources of safety knowledge.Findings & Discussion: The questionnaire had a 45% response rate. As expected, most respondents were new to farming (1-3 years' experience as a primary owner/operator), and 47% reported having a child under the age of 18 years work on the farm. While respondents recognized farms were generally unsafe for children, they reported their own farm as safe for children. Preferred sources of safety knowledge were those with user-generated content from other farmers.Conclusion: Interventions with new women organic farmers in the Midwest are likely to be most effective by incorporating social media, networking with area farmers' groups, and addressing the optimism bias. Information not explicitly marketed as safety information may gain traction. A more complete analysis of risk, incidence, and prevalence of this niche population is important.

Using hospitalization data for injury surveillance in agriculture, forestry and fishing: a crosswalk between ICD10CM external cause of injury coding and The Occupational Injury and Illness Classification System

BACKGROUND

While statistics related to occupational injuries exist at state and national levels, there are notable difficulties with using these to understand non-fatal injuries trends in agriculture, forestry, and commercial fishing. This paper describes the development and testing of a crosswalk between ICD-10-CM external cause of injury codes (E-codes) for agriculture, forestry, and fishing (AFF) and the Occupational Injury and Illness Classification System (OIICS). By using this crosswalk, researchers can efficiently process hospitalization data and quickly assemble relevant cases of AFF injuries useful for epidemiological tracking.

METHODS

All 6810 ICD-10-CM E- codes were double-reviewed and tagged for AFF- relatedness. Those related to AFF were then coded into a crosswalk to OIICS. The crosswalk was tested on hospital data (inpatient, outpatient, and emergency department) from New York, Massachusetts, and Vermont using SAS9.3. Injury records were characterized by type of event, source of injury, and by general demographics using descriptive epidemiology.

RESULTS

Of the 6810 E-codes available in the ICD-10-CM scheme, 263 different E-codes were ultimately classified as 1 = true case, 2 = traumatic/acute and suspected AFF, or 3 = AFF and suspected traumatic/acute. The crosswalk mapping identified 9969 patient records either confirmed to be or suspected to be an AFF injury out of a total of 38,412,241 records in the datasets, combined. Of these, 963 were true cases of agricultural injury. The remaining 9006 were suspected AFF cases, where the E-code was not specific enough to assign certainty to the record's work-relatedness. For the true agricultural cases, the most frequent combinations presented were contact with agricultural/garden equipment (301), non-roadway incident involving off-road vehicle (222), and struck by cow or other bovine (150). For suspected agricultural cases, the majority (68.2%) represent animal-related injuries.

CONCLUSIONS

The crosswalk provides a reproducible, low-cost, rapid means to identify and code AFF injuries from hospital data. The use of this crosswalk is best suited to identifying true agricultural cases; however, capturing suspected cases of agriculture, forestry, and fishing injury also provides valuable data.