Consumer Product Safety Commission Research Articles

Frequency and mechanism of injury for unintentional paediatric femoral fractures associated with consumer products over a 10-year period in the USA.

Femoral shaft fractures tend to be rare among children; however, these injuries are the most common major paediatric injuries treated by orthopaedic surgeons. The purpose of this study is to characterise the demographics and mechanisms of femoral injury associated with consumer products in the age group treated with spica casting, children 6 months to 6 years, to identify areas for injury prevention. Data from 2012 to 2021 were obtained from the National Electronic Injury Surveillance System maintained by the Consumer Products Safety Commission, documenting emergency department visits for unintentional injuries associated with consumer products. Narrative descriptions were analysed to identify common factors in the injury events such as location, products and mechanisms of action. From 2012 to 2021, the estimated incidence of femur fractures was 23.5 cases per 100 000 children with no significant difference in yearly frequency. The most common mechanism of injury was a fall with the most frequent fracture sources being bed/bunk beds (16.1%), floor (slips/falls, 9.7%) and trampolines (9.7%). Most fractures occurred at the patient's home (58.4%). The incidence of injury outside of the home and frequency of fractures involving play structures/trampolines increased with age. The incidence and demographic characteristics of paediatric femur fractures associated with consumer products have remained consistent over the past 10 years. As home was the most common location of fracture, prevention of femur fractures should focus on caregiver education around high-risk sources of fracture (bed, stairs and trampolines) and manufacturers should consider design alternatives that discourage potential misuse.

Recently Recalled Children's Products Due to Lead Hazards.

We reviewed recent reports of recalled children's products contaminated with lead to learn more about what could be done to inform public health partners about the recalls in a timely manner to assist with broader consumer notification for proactive lead poisoning prevention efforts. Centers for Disease Control and Prevention staff reviewed lead-related recall notices for children's products issued during June 2022 through April 2024. Recall notices were extracted from the Consumer Product Safety Commission using Really Simple Syndication feed technology to identify and capture the most current recall information. Specific product details in the database were extracted and analyzed descriptively to identify response trends and best practices. Centers for Disease Control and Prevention's automated tool identified 30 recalls from Consumer Product Safety Commission. Lead-contaminated toys were the most frequent type of product recalled (n = 11, 37%). Most products were manufactured in China (n = 24, 86%). Products were on the market for an average of 25 months before they were recalled. No injuries were reported. The 30 recalls resulted in a combined number of 914 598 recalled units sold. The current approach to protecting children from lead hazards in consumer products could be augmented by timely notifying the public health community about recalls so they can broadly disseminate information through their channels to reduce lead exposure in children. Additional steps to reduce lead contamination in children's products when sourcing raw materials and components may help to decrease the number of recalls.

Use of Generative AI to Identify Helmet Status Among Patients With Micromobility-Related Injuries From Unstructured Clinical Notes

Large language models (LLMs) have potential to increase the efficiency of information extraction from unstructured clinical notes in electronic medical records. To assess the utility and reliability of an LLM, ChatGPT-4 (OpenAI), to analyze clinical narratives and identify helmet use status of patients injured in micromobility-related accidents. This cross-sectional study used publicly available, deidentified 2019 to 2022 data from the US Consumer Product Safety Commission's National Electronic Injury Surveillance System, a nationally representative stratified probability sample of 96 hospitals in the US. Unweighted estimates of e-bike, bicycle, hoverboard, and powered scooter-related injuries that resulted in an emergency department visit were used. Statistical analysis was performed from November 2023 to April 2024. Patient helmet status (wearing vs not wearing vs unknown) was extracted from clinical narratives using (1) a text string search using researcher-generated text strings and (2) the LLM by prompting the system with low-, intermediate-, and high-detail prompts. The level of agreement between the 2 approaches across all 3 prompts was analyzed using Cohen κ test statistics. Fleiss κ was calculated to measure the test-retest reliability of the high-detail prompt across 5 new chat sessions and days. Performance statistics were calculated by comparing results from the high-detail prompt to classifications of helmet status generated by researchers reading the clinical notes (ie, a criterion standard review). Among 54 569 clinical notes, moderate (Cohen κ = 0.74 [95% CI, 0.73-0.75) and weak (Cohen κ = 0.53 [95% CI, 0.52-0.54]) agreement were found between the text string-search approach and the LLM for the low- and intermediate-detail prompts, respectively. The high-detail prompt had almost perfect agreement (κ = 1.00 [95% CI, 1.00-1.00]) but required the greatest amount of time to complete. The LLM did not perfectly replicate its analyses across new sessions and days (Fleiss κ = 0.91 across 5 trials; P < .001). The LLM often hallucinated and was consistent in replicating its hallucinations. It also showed high validity compared with the criterion standard (n = 400; κ = 0.98 [95% CI, 0.96-1.00]). This study's findings suggest that although there are efficiency gains for using the LLM to extract information from clinical notes, the inadequate reliability compared with a text string-search approach, hallucinations, and inconsistent performance significantly hinder the potential of the currently available LLM.

Poster 397: Orthopaedic Injury Analysis Among Male and Female High School and Collegiate Aged Soccer Players Presenting to United States Emergency Departments

Objectives: Soccer is the second most played sport in America by participation, with upwards of 12 million players nationally in 2018. A majority of those athletes are adolescents and young adults, with 71% of players falling between the ages of 6 and 24. This study aimed to determine if any injury profile differences exist in the intra- and post-COVID eras between male and female soccer players in both high school and college. Methods: Deidentified Emergency Department data for the years 2020-2022 were queried using the Consumer Product Safety Commission's National Electronic Injury Surveillance System (CPSC NEISS). The raw data was further stratified for a high school age range of 13-17 and a college age range of 18-24. Each of these age ranges were filtered for diagnosis codes 52, 55, 57, and 64 correlating with concussions, dislocations, fractures, and sprains/strains, respectively. The location filter was set to code 9 for a location of sports and recreation. Using the narrative filter, the resultant cases were limited to those that mentioned “soccer”. The identified patient data for each year was collated for total case counts. A Test of Equal Proportions with a Yates Continuity Correction was performed to compare the rate of individual and categorized injuries by sex within each age range and within the same sex between age groups. Results: There were 693, 1371, and 1524 injuries in 2020, 2021, and 2022 respectively, for a total of 3588 injuries. Using statistical weights, this translated to a national estimate of 88,576 soccer-related injuries over that timeframe. Categorically, in each of the three years, males had a higher proportion of fractures when compared to females in the 13-17 age range (p&lt;0.001), while the high school aged females sustained a significantly higher proportion of concussions and sprains/strains (p&lt;0.001). Per specific injury, males experienced a greater rate of clavicular, isolated radial, wrist, nonspecific forearm, finger, and nonspecific lower leg fractures than females aged 13-17 (p&lt;0.001, p&lt;0.027, p&lt;0.001, p&lt;0.001, p&lt;0.025, p&lt;0.029). Conversely, high school aged females were diagnosed with knee and ankle sprains/strains at a higher rate than their male counterparts (p&lt;0.012, p&lt;0.001). There were no significant injury profile differences between college aged male and female soccer athletes. When comparing high school versus college aged males, those in the 13-17 group experienced a larger rate of fractures and concussions, while those in the 18-24 group experienced a greater proportion of dislocations and sprains/strains (p&lt;0.001, p&lt;0.037, p&lt;0.004, p&lt;0.001). College aged males were diagnosed with higher rates of shoulder dislocations, skull fractures, finger fractures, knee sprains/strains, and ankle sprains/strains when compared to their younger counterparts (p&lt;0.001, p&lt;0.007, p&lt;0.001, p&lt;0.001, p&lt;0.05). On the other hand, high school aged male soccer players proportionally sustained more isolated radial, nonspecific forearm, wrist, and pelvic fractures (p&lt;0.001, p&lt;0.001, p&lt;0.002, p&lt;0.002). The only significant difference between high school and college aged females were higher rates of concussions in the 13-17 age group, whereas 18-24 year olds experienced a larger proportion of skull fractures (p&lt;0.01, p&lt;0.01). Conclusions: Since 2020, high school aged males experienced a significantly higher rate of fractures, whereas their female counterparts sustained a larger proportion of concussions and sprains/strains. Within males across all age ranges, higher rates of concussions and fractures were found in adolescents, whereas college males were more often diagnosed with dislocations and sprains/strains. Within females across all ages, high school soccer players experienced a larger proportion of concussions, while college players were diagnosed with a higher rate of skull fractures. Injury profiles between males and females soccer players in college showed no significant differences. Current literature surrounding age and skill-level based soccer injury profiling is limited, with most data reflective of the previous two decades. Our findings allow for insight on the intra- and post-COVID athlete, highlighting potential areas for injury prevention based on sex and age, while underscoring injuries of high clinical suspicion commonly seen in soccer players presenting to US emergency departments.

Poster 390: Combat Sports Related Upper Extremity Injuries Presenting to Emergency Departments in the United States: A NEISS Database Study

Objectives: Combat sports continue to be a popular form of recreation within the United States. With this continually increasing popularity and participation comes an increase in associated injuries as well. Despite this, there remains a paucity of studies characterizing injury patterns, types, and anatomic distributions of injuries sustained during participation in combat sports, thus necessitating further investigation. The goal of this study is to provide an updated description of injuries within combat sports, specifically to the upper extremity and presenting to US emergency departments (EDs). It is our hope that this information may be utilized by participants and trainers to help develop preventative strategies, as well as by health care professionals to diagnose patients and provide the appropriate treatment more readily and accurately. Methods: A retrospective analysis was performed utilizing data from the United States Consumer Product Safety Commission’s (CPSC) National Electronic Injury Surveillance System (NEISS) between 2003 and 2022. Data were limited to product codes 1200 (unclassified sports or recreational activity), 1207 (boxing), 1270 (wrestling), and 3257 (martial arts). The year designation variable was added to each year’s remaining dataset, and all years were concatenated into a single compiled dataset containing 84,812 observations. Beginning in 2019, the NEISS database updated their gender designations to include sexes which were unidentified or non-binary. Designations of unidentified or nonbinary genders were removed from the dataset, reducing the sample size to 84,807 observations. Data were then filtered to include only injuries of the upper extremity, reducing sample size to 29,364. Anatomic regions of interest included shoulder, upper arm, elbow, forearm, wrist, hand, and fingers. Narratives were reviewed to remove unclassified injuries that did not describe a combat sport of any type, injuries where the reference was to a different primary cause, or terminology overlap. For example, boxing injuries occurring from punching bag arcade games were excluded. Finally, several diagnoses were excluded, such as contusion, crushing injuries, dermatitis, puncture wounds, hematomas, hemorrhages, and other/not stated. Diagnoses of interest included dislocations, fractures, and strains/sprains. The final sample size was 12,642. Injury rates for specific injury types and upper extremity subregions were described as percentages of total injuries, both within each sport category and across all sports. Injury rates were also assessed on a year-by-year basis, and year-to-year variation within and between sports was assessed using chi-square tests. Results: Of the 12,642 upper extremity injuries for which patients presented to US EDs between the years 2003 and 2022, nearly half were sustained from wrestling (6230, 49.3%) whereas the remaining half were more evenly distributed between boxing (3318, 26.2%) and martial arts (3094, 24.5%). There was a significant effect of time on injury distributions by sport (chi-square test: X2 =80.89, P &lt; 0.001). Even when accounting for the years during COVID-19, significant differences between sports and over time were still detected. When assessing anatomic regions injured by sport, wrestling unsurprisingly accounted for most shoulder (59.5%), upper arm (67.7%), elbow (75.3%), forearm (57.6%), and finger (50.3%) injuries given the amount of overall wrestling injuries compared to boxing and martial arts. Boxing, however, accounted for most hand (64.1%) and wrist (37.7%) injuries, despite fewer overall injuries compared to wrestling. The most frequently injured regions within boxing, wrestling, and martial arts were the hand (40.1%), shoulder, (33.8%), and shoulder (28%), respectively. Regarding injury types, wrestling accounted for the highest percentage of each type, including dislocations (55.7%), fractures (46.9), and strains/sprains (50%). Remaining frequencies for dislocations, fractures, and strains/sprains were roughly equal in distributions for boxing and martial arts. Strains/sprains were much more common than dislocations in each sport as well, with a ~4:1 ratio in boxing, and a ~3:1 ratio in wrestling and in martial arts. The most common specific injuries (anatomic region + injury type) sustained across all sports were shoulder strain/sprain (14.7%), followed by hand fractures (13.1%), wrist strain/sprain (9.5%), finger fractures (8.7%), forearm fractures (7.2%), shoulder dislocation (7.1%), finger strain/sprain (6.4%), shoulder fractures (6.2%), wrist fractures (5.4%), and elbow strain/sprain (5.0%). Wrestling accounted for most of these injuries; however, boxing accounted for the majority of hand fractures and dislocations, as well as strains/sprains of the wrist and upper arm. Conclusions: This study demonstrates significant variability in pattern and location of injuries sustained from wrestling, boxing, and martial arts. By providing updated insight regarding the temporal trends and injury patterns to the upper extremity in boxing, wrestling, and martial arts, this study may assist in the efforts to continue advancing safety measures in a group of sports that continues to gain interest in the United States.

A nationwide analysis of upper extremity injuries in martial arts.

Given the rise of martial arts within the fitness and recreational industry, it is important to study trends in injury and note that practicing martial arts comes with a risk of injury, particularly to the upper extremities. By studying consumer product-related injuries to the upper extremities and addressing the current gap in the literature, future martial arts equipment can come with increased safety features, better provide information to healthcare providers treating such injuries, and improve risk mitigation through the Consumer Product Safety Commission. The National Electronic Injury Surveillance System Database was analyzed to collect data on martial arts equipment-related injuries on the upper extremities within the last 10 years. Over the most recent span of 10 years (2013-2022), there were approximately 78,680 injuries reported to the ED. The majority of them took place in 2013 (12.8%). Men were 2.4 times more likely to get injured than women. Injuries peaked in the age group 10-19-year-olds (33%) and particularly age 12 (4.8%). The upper extremity most commonly affected was the shoulder (29.1%), and the most common diagnosis group was a fracture (29.2%). Most injuries presented to the emergency department were not hospitalized (98.7%). This study highlights the occurrence of upper extremity injuries due to martial arts within the last 10 years and provides new information on the prevalence of such injuries. The results highlight that these injuries are usually non-severe and most commonly affect adolescent males; however, future research should explore performance-based recovery post-injury and long-term pain.

Barriers: Location, Functionality, and Method of Access in Childhood Pool/Spa Submersion Incidents, United States, 2000-2017

Drowning is a leading cause of fatality among children in the United States, and residential pools/spas currently account for as much as 80% of these submersion incidents. This study reviewed narrative case reports obtained from the United States Consumer Product Safety Commission (CPSC) to understand barrier location, type, and functionality as methods of pool/spa access for childhood submersion incidents. Retroactive analysis of 1,523 fatal and non-fatal submersion incidents among children aged 13 years old and younger was conducted using the CPSC in depth investigation dataset from 2000-2017. Narrative descriptions were coded according to the attributes of barrier location, functionality, and method of access; to our knowledge, these characteristics of barriers have not been previously investigated to this depth. Outcomes indicate that consumer education campaigns should target households with swimming pools/spas and reiterate key findings that (1) submersion incidents occur even when barriers are present and (2) the importance of multiple layers of protection against unauthorized pool/spa access. Additionally, improved documentation of barriers is imperative to better understand and prevent drowning among children.

The impact of the COVID-19 pandemic on ocular trauma in American infants and toddlers

To assess the impact of the COVID-19 pandemic on infant and toddler ocular trauma in the United States. This retrospective analysis of ocular injury data for children ≤3 years of age focused on epidemiologic trends in pediatric ocular injuries in the United States caused by consumer products from 2017 to 2021 and compared differences between pre-pandemic (2017-2019) and pandemic (2020-2021) time periods. Data were collected from the US Consumer Product Safety Commission National Electronic Injury Surveillance System, which includes emergency department visits caused by consumer product-related injuries from a nationally representative sample of hospitals. The national-level estimate of ocular injuries in infants and toddlers was 51,250 (95% CI, 30471-72030). Most injuries occurred at home. We found a significant decline in the proportion of projectile ocular injuries from 0.89% (95% CI, 0.35-2.25) to 0.12% (95% CI, 0.03-0.45) (P = 0.037). The proportion of patients diagnosed with chemical-burn-related injuries increased significantly, from 23.34% (95% CI, 19.73-27.38) in the pre-pandemic period to 31.63% (95% CI, 26.98-36.69) in the pandemic period (P=0.048), with 71.75% (95% CI, 65.25-77.46) due to cleaning products. After adjusting for confounding variables, the odds of sustaining a chemical-burn-related injury in the post-pandemic period were 1.51 times higher than in the pre-pandemic period (95% CI, 1.10-2.08). The proportion of children diagnosed with chemical-burn-related injuries increased significantly in the post-pandemic period, with a large portion due to cleaning products.

Health Science Approaches for Fall and Injury Prevention

According to the National Electronic Injury Surveillance System (NEISS) Injury Program operated by the Consumer Product Safety Commission, falls represent the number one cause of nonfatal injuries, increasing overtime from 2017-2021 (31.89%)1. Indeed, falls and fall-related injuries appear to be a growing concern, especially for an aging population and those with disabilities (e.g., mobility deficits, visual impairments). One challenge is that falls are multi-faceted, with the likelihood of a fall depending on various factors (e.g., visual, hearing, and muscular strength deficits) that affect balance and increase in prevalence with age. The projected number of individuals aged 40 and above with blindness or low vision will double between 2015 and 2050. Additionally, approximately 27.8% of adults 71 years and older have vision impairment, with 10% having contrast sensitivity impairment2. For those 85 years and older, contrast sensitivity worsens to 22.6%, which affects one’s ability to perceive sharp and clear outcomes of objects. Indeed, low vision negatively impacts one’s ability to do everyday activities, and challenges in identifying key objects compound the risk of falls3-5. Unfortunately, fall risk for individuals with visual impairment is as much as two to three times more than those without visual impairment6, with falls resulting in injury, decreased mobility, and loss of independence7. Given the preventative lenses of the health science field, future research should leverage preventative approaches to reduce fall risks and related injuries.

Opportunities in Assessing and Regulating Organohalogen Flame Retardants (OFRs) as a Class in Consumer Products.

In 2015, the U.S. Consumer Product Safety Commission (CPSC) received and then, in 2017, granted a petition under the Federal Hazardous Substances Act to declare certain groups of consumer products as banned hazardous substances if they contain nonpolymeric, additive organohalogen flame retardants (OFRs). The petitioners asked the CPSC to regulate OFRs as a single chemical class with similar health effects. The CPSC later sponsored a National Academy of Sciences, Engineering, and Medicine (NASEM) report in 2019, which ultimately identified 161 OFRs and grouped them into 14 subclasses based on chemical structural similarity. In 2021, a follow-up discussion was held among a group of scientists from both inside and outside of the CPSC for current research on OFRs and to promote collaboration that could increase public awareness of CPSC work and support the class-based approach for the CPSC's required risk assessment of OFRs. Given the extensive data collected to date, there is a need to synthesize what is known about OFR and how class-based regulations have previously managed this information. This commentary discusses both OFR exposure and OFR toxicity and fills some gaps for OFR exposure that were not within the scope of the NASEM report. The objective of this commentary is therefore to provide an overview of the OFR research presented at SOT 2021, explore opportunities and challenges associated with OFR risk assessment, and inform CPSC's work on an OFR class-based approach. A class-based approach for regulating OFRs can be successful. Expanding the use of read-across and the use of New Approach Methodologies (NAMs) in assessing and regulating existing chemicals was considered as a necessary part of the class-based process. Recommendations for OFR class-based risk assessment include the need to balance fire and chemical safety and to protect vulnerable populations, including children and pregnant women. The authors also suggest the CPSC should consider global, federal, and state OFR regulations. The lack of data or lack of concordance in toxicity data could present significant hurdles for some OFR subclasses. The potential for cumulative risks within or between subclasses, OFR mixtures, and metabolites common to more than one OFR all add extra complexity for class-based risk assessment. This commentary discusses scientific and regulatory challenges for a class-based approach suggested by NASEM. This commentary is offered as a resource for anyone performing class-based assessments and to provide potential collaboration opportunities for OFR stakeholders. https://doi.org/10.1289/EHP12725.

Utilization of Single-Incision Laparoscopy in the Management of Ingested Magnets.

Background: A ban on neodymium magnets was lifted by the U.S. Consumer Product Safety Commission in 2016. Pediatric gastroenterologists and surgeons were increasingly tasked with removing these problematic objects. The purpose of this study was to assess the utility of single-incision laparoscopic surgery (SILS) in the management of ingested magnets. Patients and Methods: This is a single-center, retrospective assessment of surgical interventions for ingested magnets. International Classification of Disease, 10th revision codes were used to identify 349 patients ≤21 years of age evaluated for foreign body ingestion over a 4.5-year period. A medical record review helped isolate 29 (8.3%) magnet ingestions, 9 requiring surgical intervention. RedCap was used for analysis. Results: Of 9 surgical patients, 7 underwent SILS intervention by 1 surgeon. Another surgeon performed an open operation, whereas a third performed a multiport operation. Of the 7 SILS cases, 3 were completed without conversion to open. In one of these cases, bowel resection with primary anastomosis was performed. For SILS cases, average operating room time was 109 minutes (38-170 minutes), time to enteral feeds was 23 hours (0.28-79.2 hours), and hospital length of stay (LOS) was 3.8 days (1.96-6.68 days). Thirty-day readmission for SILS was 14.3%. No other complications were observed. Conclusions: SILS has been safely utilized for magnet retrieval. It offers an ability to identify the affected intestinal segment and an opportunity to intervene extracorporeally through an uncapped port. In addition, knowing where matted bowel is located can direct a limited incision during conversion to laparotomy. This may confer benefits of decreased pain, shortened time to enteral feeds, and decreased hospital LOS.

Explicit and Computational Fluid Dynamics Analysis of a Novel Polo Helmet Design: A Parametric Study

Abstract Polo is a popular sport in New Zealand, Australia, the United Kingdom, and many other countries. Polo is a vigorous sport involving players and horses moving at speed and can result in head injuries caused by falls. Helmets play a vital role in the safety and protection of Polo players. This study investigates different hemispheric bumper shapes of the helmet to improve the impact resistance performance using finite element analysis (FEA) and explicit dynamics analysis (EDA). The aerodynamic performance of the proposed helmet is investigated using computational fluid dynamics (CFD) to account for drag impact on the Polo player's speed. These are investigated for impact resistance and the drag coefficient under different speeds. The EDA results show that the new proposed bumper will absorb the impact and reduce the energy transferred to the inside foam at a relative impact speed of 6.2 m/s, as recommended by the U.S. Consumer Product Safety Commission (CPSC), with a maximum total deformation of 4.42 mm compared to 4.19 mm and 3.85 mm for impact speeds of 5.9 m/s by the European standard PAS015:2011 helmets for equestrian use and 5.42 m/s BS EN 1078 helmets for bicyclists' use, respectively. Additionally, under speeds ranging from 15 km/h to 65 km/h, the new helmet demonstrated a drag coefficient of 0.454, similar to that of the national team helmet, at 0.423.

Has Sustained Time Away From Sports Due to the COVID-19 Pandemic Led to Increased Sport-Related Soft Tissue Injuries?

A decrease in sport-related injuries was observed in 2020, which has been attributed to COVID-19 and recommendations to suspend organized sports. In adult populations, increased injury rates have been noted in athletes returning to play after an extended period of reduced play, attributable to deconditioning. There is growing literature surrounding concern over increased injury risk after return to sport after the COVID-19 shutdowns. Like adults, pediatric patients experience an increase in sport-related injuries after periods of "deconditioning," such as during the COVID-19 shutdown. Descriptive epidemiology study. Level 4. The Consumer Product Safety Commission's National Electronic Injury Surveillance System database was queried to identify 13- to 18-year-old patients who sustained a sprain/strain type injury in 2019 or 2021 to an extremity, and involved sporting equipment for basketball, baseball/softball, soccer, and football. The control group was established as patients who sustained injury in 2019, and the post-COVID-19 group was established as those in 2021. Quantity of injuries sustained in these 2 groups were compared and analyzed by subgroup. There was a significant difference in the total number of sport-related sprains/strains in 2019 versus 2021 (P = 0.01), with more injuries in 2019 (n = 151,067) than in 2021 (n = 104,041). There were more injuries in boys than in girls. Proportion of injuries by sports were similar in both time periods. There was a significant decrease in basketball-related injuries by 21% (P ≤ 0.01, relative risk ratio [rrr] = 0.7979) and a significant increase in football-related injuries by 14% (P = 0.01, rrr = 1.1404) and in soccer injuries by 14.2% (P = 0.03, rrr = 1.1422). There is significant heterogeneity in injury rates by sports, with no conclusive increase in injuries, contrary to expectations. This study suggests that the relationship between deconditioning and injury may be less clear in the child-athlete, and gives recommendations for return to sport after extended breaks. Level 2c.

The epidemiology of crib-related head injuries: A ten-year nationwide analysis

IntroductionFalls from cribs resulting in head injury are understudied and poorly characterized. The purpose of this study was to advance current understanding of the prevalence, descriptive characteristics of injury victims, and the types of crib fall-related head injuries (CFHI) using queried patient cases from the National Electronic Injury Surveillance System (NEISS) database. MethodsUsing the US Consumer Product Safety Commission's System NEISS database, we queried all CFHIs among children from over 100 emergency departments (EDs). Patient information regarding age, race, sex, location of the incident, diagnoses, ED disposition, and sequelae were analyzed. The number of CFHI from all US EDs during each year was also collected from the database. ResultsThere were an estimated 54,799 (95% CI: 30,228–79,369) total visits to EDs for CFHIs between 2012 and 2021, with a decrease in incidence of approximately 20% during the onset of the COVID-19 pandemic (2019: 5616 cases, 2020: 4459 cases). The annual incidence of injuries showed no significant trend over the 10-year study period. An available subset of 1782 cases of head injuries from approximately 100 EDs was analyzed, and 1442 cases were included in final analysis. Injuries were sorted into three primary categories: unspecified closed head injury (e.g., closed head injury, blunt head trauma, or traumatic brain injury), concussion, or open head injury and skull fracture. Unspecified closed head injuries were the most common of all head injuries (95.4%, 1376/1442). Open head injuries (14/1442, 0.97%) and concussions 3.6% (52/1442, 3.6%) were rare. Most injuries involved children under the age of 1 (42.6%) compared to children who were 1, 2, 3, or 4-years old. About a fourth of patients had other diagnoses in addition to their primary injury including scalp/forehead hematomas, emesis, and contusions. Female patients were more likely to present with other diagnoses in addition to their primary head injury (Difference: 12.3%, 95% CI: 9.87%–15.4%, p < .0001). ConclusionDespite minimum rail height requirements set by the Consumer Safety Product Commission (CPSC), head injuries associated with crib falls are prevalent in the United States. However, most injuries were minor with a vast majority of patients being released following examination and treatment.

Examination and Scientific Analysis of Thoracic Vertebral Fractures.

Background Thoracic vertebral fractures are clinically important due to their association with the thoracic spinal cord and the potential to cause devastating neurological injury. Using the National Electronic Injury Surveillance System (NEISS) data, this study investigated fracture patterns to understand associated factors to improve prevention strategies. We explored different factors associated with thoracic vertebral fractures to improve our understanding of preventative strategies and patient care standards, focusing on spatial distribution, sex-age dynamics, and location of injury. Methodology This retrospective, cross-sectional study examines thoracic vertebral fractures across diverse age groups from 2013 to 2022, utilizing the NEISS database from the U.S. Consumer Product Safety Commission. Inclusion criteria based on specific terms related to thoracic fractures were employed. Descriptive statistics illustrated fracture distribution by age groups and associated products. Statistical analyses, including chi-square tests and multivariate logistic regressions, were conducted to explore associations between fracture occurrence, locations, products, age, and gender. Results The analysis of thoracic vertebral fractures by location and associated products yielded several statistically significant findings. Notably, the prevalence of fractures at home (39.67%) was significantly higher than in other locations, and these differences in fracture distribution were statistically significant (χ² = 7.34, p < 0.001). Among the associated products, ladders (10.46%) emerged as the most frequent product associated with fractures.Multivariate logistic regression analysis showed that the age groups of 41-50, 51-60, and 61-70 had increased odds of fractures with adjusted odds ratios (AORs) of 1.08 (95% confidence interval (CI) = 1.04-1.42, p < 0.05), 1.21 (95% CI = 1.13-1.56, p < 0.001), and 1.17 (95% CI = 1.08-1.39, p < 0.001), respectively. The likelihood of thoracic vertebral fractures did not significantly differ between males and females (AOR = 1.12, 95% CI = 0.87-1.53, p = 0.262). Fracture distribution by age groups and products indicated increasing ladder-related fractures within the 41-50 age group and 51-60 age group.Football-related fractures peaked within the 21-30 age group. Fracture distribution patterns for bicycles had increased prevalence within the 11-20 and 21-30 age groups, and football-related fractures in younger age groups. Conclusions This study analyzed factors associated with thoracic vertebral fractures, showing the significance of targeted preventative interventions, such as earlier screening, physical therapy, and nutritional status assessment, in the setting of significant location and age-related susceptibilities. The observed patterns of injury provide a foundation for future research to elucidate the underlying mechanisms between different environments and the likelihood of injury to improve preventive strategies.

Classifying chemicals into toxicity categories based on LC50 values- Pros and cons

Classifying chemicals into toxicity categories based on LC50 values- Pros and cons

Injuries Due to Law Enforcement Use of Force in the United States, 2006-2015: Trends in Severity and by Race.

The purpose of the study was to assess incidence and severity of hospital reported injuries related to law enforcement Use of Force (UoF) in the US over time, and by race. Data from the National Emergency Department Sample from the Healthcare Cost and Utilization Project and the National Electronic Injury Surveillance System (NEISS-AIP) from US Consumer Product Safety Commission were queried to identify UoF injuries. Regression analysis, t-tests, and chi-square tests were used in the analysis. Between 2006-15, there were 529,259 emergency department admissions for UoF injury in the NEDS, and 870,779 admissions in the NEISS-AIP. In a model adjusting for year, sex, and age, the Injury Severity Score increased by 1.1% annually (p<0.0001). Black people were 6 times as likely to be admitted to the ED as White people or Native Americans/Alaska Natives, and 25 times as likely as Asians/Pacific Islanders. Black patients were 4 times as likely as White patients to be admitted as inpatients. Per arrest rate by race using FBI uniform crime reporting data, Black arrestees were 2.5-3.1 times as likely as any other race to be hospitalized for UoF injury. The results of the study demonstrate that US law enforcement are injuring civilians more frequently and severely over time, and that Black people are disproportionately affected.

Pediatric Concussions in Female Contact Sports: A 10-Year Analysis of Mechanisms and Associated Symptoms

Background: Increased popularity and accessibility for female athletes has led to an increased incidence of sports-related injuries. Concussions make up a significant proportion of sports injuries and are associated with immediate and long-term consequences for youth athletes. However, despite the increasing participation in female contact sports, there is relatively little research on gender-specific characteristics in concussions. The objective of this study is to describe the characteristics, mechanisms of injury (MOI), and associated symptoms of pediatric female patients diagnosed with concussions from contact sports. Methods: The National Electronic Injury Surveillance System (NEISS) database of the US Consumer Product Safety Commission was queried from 2012-2021 for concussions evaluated in emergency departments (EDs) sustained by athletes aged 4 to 18. The contact sports analyzed included Basketball, Cheerleading, Gymnastics, Hockey, Lacrosse, Soccer, Softball, and Volleyball. Demographics, incidence rates, mechanism of injury, and associated symptoms were analyzed for each sport during the study period. Results: There were 3,906 female athletes who sustained concussions from 2012-2021 from contact sports with a national estimate of 87,468. Most sports-related concussions were treated as outpatients (97.4%). From 2012-2019 there were no significant differences in the number of concussions, while 2020 and 2021 saw a significantly lower number of concussions. Soccer had the greatest number of concussions at 34.1%, followed by basketball 21%, and Softball 14.1%. The most common MOI was player-to-player contact (1214, 31%) and head-to-ground (1103, 28.2%). MOI was sport specific with soccer and basketball having the highest proportion of player-to-player and gymnastics and cheerleading comprising mostly head-to-ground injuries. Loss of consciousness (LOC) was reported in 5.5% of concussions with hockey having the highest rate at 6.9%. The most frequently reported associated symptoms were headache/head pain (41.1%), dizziness (28.12%), and confusion (9.2%). Conclusion: There was a significant decrease in the number of concussions in 2020 and 2021 compared to 2012-2019, which may be attributed to social restrictions that occurred during the COVID-19 pandemic and raises concerns for undertreatment of concussions in female contact sports. Mechanism of injury in female concussions is sport specific with high rates of player-to player and player-to-ground injuries. Finally, there were no significant differences in symptom presentation among the different contact sports analyzed. Athletes, coaches, and physicians aware of common symptoms and mechanisms of injury for each sport can better develop preventative strategies and improve patient care for concussions in female contact sports.

Pediatric Diving-Related Injuries in Swimming Pools Presenting to US Emergency Departments: 2008-2020.

Recreational swimming/diving is among the most common physical activities in US children and a significant cause of morbidity across the United States. This study updates the national epidemiology of diving-related injuries. The Consumer Product Safety Commission's National Electronic Injury Surveillance System database was queried for patients aged 0 to 19 from 2008 to 2020 who presented to any of the 100 National Electronic Injury Surveillance System-participating emergency departments for a diving-related injury. Dive characteristics such as dive height, dive skill, dive direction, and dive sequence were determined from case narratives. A total of 1202 cases were identified for analysis corresponding to a total national estimate of 37,387 diving related injuries during the period from 2008 to 2020 and a national incidence of 3.6 injuries per 100,000 population. Males accounted for 64% of injuries. The average yearly incidences of injury in the 10 to 14 and 15 to 19 age groups were identical at 5.8 per 100,000. Contact with the diving board or platform was the most common cause of injury (34%). Diving backwards or attempting a flip or handstand dive were associated with increased odds of sustaining an injury resulting from contact with the diving board or platform (odds ratio, 16.0 and 6.9, respectively). In 2020, the incidence of diving-related injury fell to 1.6 per 100,000 population. Diving injuries are common in children and adolescents, especially in boys aged 10 to 19. There was a significant reduction in diving-related injury corresponding with the COVID-19 pandemic.

The epidemiology of firework-related injuries in the US, 2012–2022

BackgroundThis 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.MethodsData 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.ResultsA 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.ConclusionsThe 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.