Firecracker Injury Research Articles

Effectiveness of safety precaution intervention regarding use of fire crackers on knowledge and fire accidents among school children

Diwali is one such joyous festival which is loved and celebrated by everyone over the country as the festival of lights. It is celebrated by lighting oil lamps and firecrackers like a bomb, flowerpots, chakri, rockets, etc. Firecracker injuries are common in India, of which the majority takes place during diwali. A quasi experimental study was done to assess the effectiveness of safety precaution intervention regarding use of fire crackers on knowledge and fire accidents among school children at Government Middle school, Tiruvannamalai.110 subjects in experimental & 110 subjects in control group were selected by using convenience sampling technique. Post test only design was used. Knowledge and fire accidents were assessed by using questionnaire and observational checklist respectively. The study findings revealed that in control group, the mean posttest score for knowledge was 9.2 whereas in experimental group, the mean score was 18.1 and the calculated t value is 8.5 shows statistically significant at P<0.001 level.The mean score for fire accidents in control group is 4.19 whereas in experimental group mean score was 2.8 and the calculated unpaired t value t=5.5 shows statistically significant at P<0.001 level. The study concluded that safety precaution intervention is necessary to create awareness and control the fire crackers injuries among school children and they are also the message carrier.

Outcomes of Simple Limbal Epithelial Transplantation Without Amniotic Membrane Grafting in Unilateral Limbal Stem Cell Deficiency: A Case Series of 6 Patients.

This study describes the technique of simple limbal epithelial transplantation (SLET) without amniotic membrane grafting (AMG) in limbal stem cell deficiency (LSCD). Retrospective, interventional case series of 6 patients who underwent SLET without AMG were included. The procedure followed the standard technique, involving limbal biopsy from the healthy eye, resection of symblephera, and pannus dissection in the affected eye. Following host bed preparation, limbal explants were placed on the bare cornea and secured with fibrin glue. A large-diameter bandage contact lens was applied post surgery. No amniotic membrane was used. Preoperative data, including age, gender, cause of LSCD, best-corrected visual acuity, and previous ocular surgeries, were recorded. Postoperative clinical information, such as the duration of follow-up and recurrence of LSCD, best-corrected visual acuity, and other ocular examination findings, was recorded in an excel sheet. Preoperatively, 2 patients had total LSCD (secondary to a firecracker injury and excision biopsy for ocular surface squamous neoplasia). 4 patients had partial LSCD (3 chemical injuries, 1 firecracker injury). The mean age of participants was 30.67 ± 15.91 years, with a mean follow-up duration of 9.33 ± 8.04 months. Intraoperatively, all patients exhibited a smooth corneal surface after pannus removal. Postoperatively, all limbal explants remained securely attached, with complete corneal epithelialization achieved within 2 to 3 weeks. The ocular surface remained stable throughout, and no recurrence of LSCD was observed in any patient. No loss of explants was seen. The present series suggests that AMG may not be a necessary step for performing SLET.

A Study on Prevalence of Firecracker Injury and Outcomes with Demographic Profile of Patients Visiting the Emergency Department of a Tertiary Care Center of North India during the Festive Season of Diwali

A Study on Prevalence of Firecracker Injury and Outcomes with Demographic Profile of Patients Visiting the Emergency Department of a Tertiary Care Center of North India during the Festive Season of Diwali

A Case of Berlin’s Edema after Fire Cracker Injury

A 22 year old medical student presented in ophthalmic out patient department with fire cracker injury. On examination, hisright eye anterior segment was normal, and there was corneal edema with mild congestion in the left eye. Fundus examinationrevealed commotio retinae or Berlin’s edema in left eye. Ultrasonography B scan was normal and OCT revealed Berlin’s edemawith images of specific retinal layers affected by commotio retinae. The case report describes corneal edema and Berlin’s edemain detail. The case report also describes the importance of public awareness regarding the safe handling of firecrackers.

Clinical Study of Paediatric Ocular Trauma and its Assessment with Paediatric Ocular Trauma Score

The study aimed to evaluate and estimate the visual prognosis of paediatric ocular trauma using the Paediatric Ocular Trauma Score (POTS). The results showed that the most common causes of ocular injuries in children were during sports and play, followed by firecracker injuries. It is recommended that preventive measures, such as proper supervision and the use of safety gear, should be taken to avoid such injuries. The study suggests the use of mass media to promote safety procedures and the development of a standardised documentation system to facilitate research and improve emergency care services. The loss of vision can have a profound impact on a child's life, and health education about eye protection should be provided at schools, educational health centres, and sports academies. Ultimately, preventing and managing ocular trauma in paediatric patients requires a collaborative effort between parents, teachers, and doctors.

Retrospective multifactorial analysis of ocular firecracker injuries and review of literature

Purpose To analyse demographics, risk factors, clinical features, functional, anatomical outcomes, and prevalence of blindness in firecracker injury patients presenting to a tertiary eye care centre. Methodology A retrospective analysis of ocular firecracker injuries patients who presented to our hospital from April 2018 to March 2019 was performed. A total of 114 patients with a minimum follow-up of 3 months were included. The parameters recorded were demographics, mode of injury, type of cracker, baseline and last follow up best-corrected visual acuity (BCVA), anterior and posterior segment findings, seidel's test, intraocular pressure, gonioscopy, treatment, functional and anatomical outcomes. Investigations in form of B Scan, X-ray, or CT scan were undertaken whenever indicated. Results A total of 132 eyes of 114 patients were analysed. The mean (SD) age was 18.96 +/−15.4 years (range 3–71 years). Seventy-four (64.91%) patients were ≤ 18 years of age. The male-to-female ratio was 4:1. The ratio of right: left eye involvement was 1:1. Eighteen patients (15.79%) had bilateral involvement. A total of 125 eyes had closed globe injury, 7 eyes had open globe injury and 17 patients needed hospital admission for management. The mean (SD) baseline BCVA was 0.54(+/−0.75). The mean (SD) final BCVA improved to 0.23(+/−0.62) till the last follow-up. The final outcome was good in most patients, except 5 eyes (3.78%) which resulted in near/total blindness. Conclusion Firecracker injuries are a major cause of irreversible blindness, especially among the younger age group. Prompt diagnosis with meticulous management can prevent devastating sequelae.

Visual outcomes in pediatric traumatic cataract

To study epidemiology, biometry and visual outcomes (with or without posterior capsulorhexis) in cases of pediatric traumatic cataract. This was a prospective observational study conducted on 30 children of traumatic cataract belonging to an age group of less than 16 years. All patients were subjected to detailed history and ocular examination. Patients underwent cataract surgery with or without intraocular lens (IOL) implantation. Posterior capsulorhexis with posterior optic capture was done in all patients presenting with primary posterior capsular opacity. All patients were followed up till 6 months and surgical outcomes in terms of Best Corrected Visual Acuity (BCVA), and visual axis opacification (VAO) were observed. Firecracker injury was found to be the most common causal agent, followed by arrow and ball injuries. Males were more commonly injured than females (70%:30%). Open-globe injury was more frequent than closed globe injury (CGI) (53.3%:46.7%). Anterior capsular rupture was the most frequent preoperative complication. Mean axial length was 22.53 which was not significantly different from the fellow eye. 3 patients were left aphakic, 10 patients underwent single piece IOL implantation and 16 patients underwent multipiece IOL implantation. Anterior chamber IOL (ACIOL) was implanted in one case. Intraoperatively 6 patients were found to have posterior capsular plaque and were implanted with multipiece IOL with posterior optic capture. Visual acuity significantly improved in 21 out of 30 eyes from baseline after cataract surgery (p<0.001). 9 patients (30%) had posterior capsular opacification (PCO) on follow up. Posterior capsular opacity in pediatric traumatic cataracts can be effectively managed with posterior capsulorhexis and posterior optic capture.

Effect of legislation and changing trends of Diwali ocular firecracker injuries in Northern India.

OBJECTIVE:The objective of this study is to study the impact of temporary legislation implemented during Diwali on ocular firecracker injuries in Delhi-National Capital Region (NCR) region.MATERIALS AND METHODS:In this retrospective study, records of the patients presenting with ocular firecracker injury during 10 days of Diwali (prediwali, Diwali and 8 days postdiwali) from 2014 to 2019 were retreived from the medical record section. Clinico-demographic profile, relevant history pertaining to the use of firecracker, and details of eye examination, namely presenting visual acuity (VA), laterality and classification of injury based on Birmingham Eye Trauma Terminology System were noted.RESULTS:Six hundred and sixty-seven eyes of 646 patients were recruited. The median age of patients was 14 years (R = 3–65 years) and male: Female ratio was 4.9:1. Majority of patients (57.7%; n = 373) were from outside Delhi. Most of them were open globe injuries (66.8%). In 55.4% (n = 356) eyes, presenting VA was perception of light to finger counting close to face and 28% (n = 180) eyes could not perceive any light. A significant reduction was noted in the number of ocular firecrcaker injuries after regulation (preregulation [2014–2016] n = 456; postregulation [2017–2019] n = 211; [P = 0.01, t-test]). During preregulation period, presenting VA was worse than 1/60 in significantly higher number of eyes (85.5%; n = 376) than post regulation (78.8%, n = 160) (P = 0.03, Chi-square test).CONCLUSION:Although temporary legislation seems to be effective in reducing ocular firecracker injuries (52.7% reduction) in NCR, uniform implementation of stricter laws nationwide is essential to further minimize the problem.

Ocular firecracker injury

Ocular firecracker injury

Prevention of firecracker injuries via the digital platform: A Malaysian experience

IntroductionHealth campaigns include physical campaigns in schools, community halls, or community malls. They can also be broadcast via television, newspaper, and radio. We launched a health campaign on social media platforms that have a powerful impact in this digital era. MethodsA three-dimensional short animation was developed for the Burn and Blast Injury Awareness campaign. It was launched during the fasting month and Eid 2020 when firecracker-related injuries are highly incident in Malaysia. The video was launched primarily on Universiti Sains Malaysia (USM) and Wau Animation Sdn Bhd social media platforms. Each party shared the video on the top 3 social media platforms, which are Facebook, Instagram, and YouTube. The numbers of viewers, reaches, and shares, and demographic data were captured at 1 month after the release. ResultsWe recorded 29,585 views, 60,920 reach, and 874 shares from the USM and Wau Animation platforms alone. The USM Facebook platform showed predominant female viewership (60%), whereas the Wau Facebook platform showed predominant male viewership (66%). In both platforms, the viewers were aged 18–34 years. ConclusionHealth awareness campaigns on digital platforms are powerful because the message spreads faster, and it is also safe during the pandemic.

A Jelly cyst - Keep your mind ticking.

Case An 8-year-old boy presented with diminution of vision in left eye (OS) following firecracker injury 3 days back. There were no previous ocular or systemic complaints. The best corrected visual acuity (BCVA) was 20/20 in right eye (OD) and 20/120 OS. On examination, OD was within normal limits while OS upper and lower lid revealed burn marks due to fire-cracker injury [Fig. 1a]. Anterior segment evaluation revealed ciliary congestion, 4+ cells, dispersed hyphema, and dilated pupil with multiple sphincter tears. The crystalline lens was transparent and in normal position. Dispersed vitreous bleed precluded the visualization of retina. Ultrasonography revealed mild to moderate amplitude spikes in the vitreous cavity. In addition, a cystic structure with central hyperechoic area was seen [Fig. 1b]. Though the clinical features were suggestive of traumatic vitreous hemorrhage, ultrasonography image indicated the possibility of a parasitic cyst.Figure 1: Burns on the left eyelids following fire cracker injury (a). Ultrasonography showing cyst with central hyper echoic spot in the vitreous cavity (b). Ultrawide field imaging showing pigmented vitreous cyst and resolving vitreous hemorrhage (c)What is Your Next Step? Observation Conservative management with topical steroids and cycloplegic. Computed tomography (CT) scan of orbit and brain Pars-plana vitrectomy Findings The patient was managed conservatively with topical steroids and cycloplegics (B). At 1 week, BCVA in OS had improved to 20/20. Hyphema, and anterior chamber reaction was resolving. Dilated fundus examination revealed a pigmented cystic structure freely floating in the vitreous cavity along with resolving vitreous hemorrhage [Fig. 1c]. No undulating movements of the cyst were noted. The retinal periphery was normal. The patient was advised tapering of topical medication with regular follow-up. Diagnosis Pigmented congenital vitreous cyst. Correct Answer B. Discussion Congenital vitreous cysts (CVC) are usually identified on incidental examination or following trauma. Approximately 15 cases of free-floating cyst are described in literature but very few presented in childhood. Vitreous cysts can be congenital or acquired. Acquired cyst can develop after trauma. While trauma can trigger formation of a new cyst, it may also displace an already formed one.[1] CVCs are usually asymptomatic and they originate from the pigment epithelium of ciliary body. These cysts can be confused with cysticercosis and with melanoma especially if they are in posterior vitreous.[23] Ultrasound in cysticercosis shows a cystic structure with hyperechoic scolex lining internal surface. A similar appearance in our case led to suspicion of cysticercosis. As vitreous hemorrhage resolved, the pigmented appearance without any undulating movement suggested the diagnosis of CVC. This case highlights that the possibility of CVC should be kept in mind in such a clinical scenario. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Fire-cracker burn injuries during Diwali, a seasonal and preventable epidemic

Background: Firecracker injuries are common in India, of which the majority takes place during Diwali. This study analyzes the profile of firecracker injuries in the emergency department (ED) of GMCH, Guwahati. Materials and Methods: This is a retrospective observational study of all firecracker-related injury patients presenting to our ED 3 days prior and post Diwali from 2016 to 2020. Details of the demographics, cause, and percentage of burns were included. Treatment given for the patients is not mentioned in this study. Results: We received a total number of 195 patients with burn injuries to the ED from 2016 to 2020, 3 days prior and post Diwali, of which 54.3% (106) cases are firecracker-related burn injuries. 46.2% of the cases were under the age of 19 years. Male (71.7%) predominance was noted. The majority of the injuries involved <20% total body surface area (80.2%). It is noted that the right hand (54%) is most commonly involved followed by the face (17%) and torso (17%). Fountain (38%) is observed to be the most common firecracker causing injuries. In 2020, during the COVID pandemic, there were only two reported cases attending to the ED during the specified period. Conclusions: This study has expressed the pattern of firecracker injuries in our place during Diwali. An alarmingly high number of young adolescents with significant upper limb injuries were noted. These injuries are prevalent in the productive age groups. Public awareness and education along with an increase in legislative enforcement are needed for the betterment and well-being of the people during the festival season to prevent the catastrophe.

Firecracker-induced gastric perforation: A case report and review of literature

Firecracker-induced injuries are commonly reported as superficial soft-tissue injuries affecting the head, neck, and upper limbs. Deep penetrating injuries due to firecrackers misuse are a less known identity. People usually suffer from firecracker injuries due to misuse or because of their risk-taking behavior. Such cases pose a special challenge to the surgeons due to the type of population, usually young and the social, cultural, legal, and emotional factors involved with the injuries. Judicious decisions and empathy toward patients as well as toward relatives can resolve lots of problems. We are hereby reporting a rare case of gastric perforation in a young 22-year-old male which was caused by a broken piece of steel glass due to the explosion of a firecracker.

Arterial rupture: A delayed sequela of burn injury

Burn injuries, especially electrical burns, can lead to significant soft-tissue damage. A delayed sequela of both electric burn and firecracker injury is arterial rupture. The initial phase is characterized by occlusion of small vessels. Large vessels are prone to aneurysm formation due to medial necrosis. This can result in unanticipated bleeding, which can lead to loss of the limb or even be life-threatening. We are presenting here two cases treated in our burns department for electrical burns and firecracker injury involving the lower limbs. Both these patients presented with delayed vascular complications, which were successfully managed and limbs salvaged. We are presenting these cases to emphasize that timely intervention leads to better outcomes.

Spectrum of Ocular Injuries and Visual Outcome Following Firework Injury to the Eye.

Background:Ocular injury due to fireworks requires urgent ophthalmic assessment and management to preserve vision.Methods:Spectrum of injury, type of intervention, visual outcome, and reasons for visual loss were assessed in consecutive patients presenting over 2 years with firework-related eye injury. The final visual outcome was recorded as best-corrected visual acuity.Results:In the 96 patients (75 males) enrolled, 122 eyes were involved. Twenty-six patients had bilateral eye injury. The median (interquartile) age was 14 (8, 28.5) years. Injuries occurred during Diwali festival (59.4%) and funeral processions (20.8%); over half (53.8%) were bystanders. Injury was due to negligence (78%), device malfunction (12.5%), and attempts to reignite (5.2%) or recover failed device (4.2%). Presenting symptoms were redness (100%), pain (97%), watering (86%), and reduced vision (77%). Facial laceration, contusion, or hematoma occurred in 13 patients. The most frequent adnexal and ocular surface injuries were lid burns (57.3%), edema (44.2%), charred eyelashes (24.6%), and laceration (13.9%). Open-globe injury occurred in 8 eyes. Common anterior segment injuries were corneal epithelial defect (51.6%) and hyphema (20.5%). Posterior segment injuries included commotio retinae (13.1%) and Berlin's edema (7.4%). Surgical treatment was required in 15 eyes; 107 (88%) were managed conservatively. At study completion, of the 99 eyes evaluated, 21 had reduced visual acuity (<6/6) including 7 with monocular blindness. Factors associated with poor vision were open-globe injury (P < 0.001) and poor initial visual acuity (P = 0.05).Conclusions:Open-globe injury and poor visual acuity at presentation predict the final visual outcome. Monocular blindness following firecracker injury is common.

A retrospective study on clinical profile of patients with firecracker-related injury presenting to the emergency department of a tertiary care center in South India

Background: Firecracker injuries are very common in India. They are mostly used during the various festivals celebrated in India. This study analyses the profile and outcome of firecracker injuries in the emergency department (ED). Materials and Methods: This was a retrospective observational study of all firecracker-related injury patients presenting to our ED. Details of the incident, injuries, management, and outcome were noted. Data were extracted from the ED triage software and hospital electronic database. Results: We received a total number of 13,604 trauma patients to our ED, among which 92 (0.7%) had firecracker burst-related injury. The mean age of the patient was 27 (standard deviation 11.6) years. Male (97.8%) predominance was noted. Majority of them were triaged to Priority II, i.e., 64 (70%) patients and 6 (6%) in Priority I. The mean number of incidents per month during the festive season of Diwali was 3.25 compared to 3.95 during the rest of the year. The majority of the injuries had sustained lacerations (78.5%), followed by abrasions (12.9%). Among all patients, only 4.3% (4) suffered second- and third-degree burns each. It was noted that the upper limbs (79.6%) were most commonly involved as expected, followed by the face (16.1%). The new injury severity score was more than 5 in (6.4%) of patients. Most patients were taken up for emergency procedures such as wound wash, debridement, suturing, or nailing of the fractures in the ED. Majority (81.5%) required hospital admission and had to undergo major surgical intervention. The rest were either discharged stable or discharged against medical advice after primary care. Conclusions: This study has expressed the pattern of firecracker injuries. An alarmingly high number of young adolescents with significant upper limb injuries were noted. Public awareness and education along with increase legislative enforcement are needed for the betterment and well-being of the mass during the festival season to prevent the catastrophe since these injuries are prevalent in the productive age groups.

Analysis of ocular trauma due to firecracker injury in oculoplasty clinic at a tertiary care hospital of North India

Purpose: To evaluate the spectrum of ocular injuries, clinical and demographic profile and management patterns following firecracker injury during three days of festive season of ‘Deepavali’. Materials and Methods: A hospital-based, retrospective study of 19 patients, who sustained ocular injuries following firecracker injury during three days of festive season of Deepavali from 28/10/19 to 30/10/19 visiting emergency department of SMIH, Dehradun. All the patients were attended in collaboration with on call ophthalmologists and plastic surgery burn unit team. Vision assessment was done using Snellen’s chart. Slit lamp examination including anterior segment evaluation and fundus examination was done in cases possible. USG B-scan and X-Ray orbit were done in cases required. Patients with severe injuries were advised admission and managed either conservatively or surgically. Surgical intervention included corneo-scleral tear repair and evisceration. Rest of the patients were treated on outpatient basis. Results: The firecrackers causing ocular injuries include Bomb in 37% cases, Flowerpot in 31.5%, Rocket in 21% and Sparkles in 10.5% cases. The spectrum of ocular involvement included periocular burns in 100% cases, corneal abrasion in 74%, corneal perforation and hyphema in 16%, lid and conjunctival laceration and globe rupture in 11%, and iridodialysis and vitreous hemorrhage in 5% cases. The devastating visual outcomes were seen in 10% cases. 89.5% cases underwent medico-legal consultation. Conclusion: Firecracker injury leads to physical and mental trauma to the patients. Adult supervision is very crucial while igniting firecrackers. Appropriate triage management and coordinated treatment was critical to ensure best possible patient outcome. Enforcement of legislations, health education and public awareness are essential in preventing this hazard to ocular health in country. Keywords: Ocular trauma, Firecracker injury, Medicolegal.

First dorsal metacarpal artery flap a workhorse for reconstruction of selected small defects of the hand

Background: The first dorsal metacarpal artery (FDMA) flap is used mainly for reconstruction of thumb defects. We share our experience of this flap for various defects of thumb and also its use to cover other defects. Materials and Methods: Case records of 15 patients with FDMA flap between October 2015 and February 2018 at our center were analyzed retrospectively. Data were analyzed for etiology, associated comorbidities, interval between injury and operation, site of defect, harvesting technique, and inclusion of dorsal interossei muscle cuff, complications, donor-site morbidities, and postoperative sensory recovery. Results: Of 15 patients, 13 were male and 2 were female. Eleven patients had a posttraumatic defect, 2 had post-electric burn defect, 1 had a firecracker injury, and 1 had a post snakebite defect. Of 15 patients, 12 patients had thumb defects, 1 patient with defect of first web space, 1 on volar aspect of palm, and 1 on the dorsum of hand over the head of third metacarpal. All patients showed protective sensations and 6 patients with 12-month follow-up showed minimum of 9 mm of two-point discrimination with no donor-site morbidity. Conclusions: The FDMA flap has a constant anatomy, easy dissection, and shows good functional and esthetic results. FDMA flap is the first treatment of choice for defects of the thumb, but it can be used for selected small defects of hand due to its wide arc of rotation.

Profile of firecracker injuries of the eye during Diwali: A tertiary eye-care center study

Aims and Objectives: The aim was to study the demographic pattern, clinical features, management, and prognosis of the patients with firecracker-related ocular injuries during Diwali. Materials and Methods: This institution-based prospective study was done in 30 patients who attended eye emergency and outpatient department (OPD) of Calcutta National Medical College and Hospital, West Bengal, during the period of 1 week of Diwali in 2016 and 2017. The parameters studied were the age and sex of the patients, type of firework (crackers and sparklers), eye involved, severity of injury with respect to active and passive participants, management, severity of injury, and visual outcome with respect to type of firecrackers. Results: A total of 30 patients attended eye OPD and emergency during our study period, of which 23 (76.7%) were male and 7 (23.3%) were female. All of them were in the pediatric age group (1–15). All patients were examined on the day of injury. Patients between 6 and 10 years of age were most commonly affected. Four cases (13.3%) were open-globe injuries and 26 (86.7%) cases were closed-globe injuries. Visual acuity varied from 6/9 to no perception of light. The most common firework involved was the crackers. Conclusions: Careless and indiscriminate use of firecrackers may sometimes lead to serious ocular damage. In India, use of fireworks is quite common during various festivals, particularly during Diwali, thus fireworks-related ocular injuries are important causes of blindness. This prospective study revealed the presentation and outcome of ocular injuries due to firecrackers in this area of mixed culture during this festive week.

Post Fire Cracker Injury Corneal Perforation with Endophthalmitis in a Child

Post Fire Cracker Injury Corneal Perforation with Endophthalmitis in a Child