National Electronic Injury Surveillance System Database Research Articles

Pediatric Head and Neck Dog Bites in the United States: A NEISS Database Investigation of Risk Factors and Escalation of Care.

Pediatric patients experience increased morbidity secondary to head and neck dog bites. The authors examined risk factors among pediatric head and neck dog bite patients and which factors are associated with admission to inform prevention efforts. All patients who suffered head and neck dog bites from 2013-2022 in the National Electronic Injury Surveillance System (NEISS) database were reviewed. Demographics among discharged and escalation of care (EOC) patients were compared using multinomial logistic regression (MLR), and linear regression was employed to analyze yearly emergency room (ER) visit incidence. Among 949 pediatric patients, 57.2% were male, 43.4% were 2-6 years old, and 77.7% sustained face or mouth injuries. Attacks were commonly provoked (60.5%), occurred in the home (82.3%), and involved a dog known to the patient (61.7%). The most common dog breed involved was Pitbull (33.1%). MLR revealed increased EOC among patients with neck injury (OR=11.82, SE=0.68, P<0.001), orbital injury (OR=12.91, SE=0.55, P<0.001), unprovoked attacks (OR=2.67, SE=0.16, P<0.001), and those under 2 years old (OR=1.83, SE=0.19, P=0.002). There was a significant yearly rise in the number of pediatric head and neck dog bites (model coefficient=6.467, SE=1.40, P=0.002). Overall, increased caution around particular dog breeds in households with children under 2 years old may decrease head and neck dog bite injuries. While pediatricians should perform general safety education, enhanced knowledge of risk factors is essential for proper inpatient counseling by surgical specialists.

Epidemiology of Shoulder Dislocation Treated at Emergency Departments in the United States Between 1997 and 2021.

The exact incidence of shoulder dislocation in the general population of the United States (US) has yet to be well studied. To establish the current incidence and patterns of shoulder dislocations in the US, especially regarding sports-related activity. Descriptive epidemiology study. This was a retrospective analysis of shoulder dislocations encountered in emergency departments in the US between 1997 and 2021 as recorded in the National Electronic Injury Surveillance System (NEISS). Data were further analyzed according to patient age, sex, and sports participation. Information from the United States Census Bureau was used to determine the overall incidence of dislocations. A total of 46,855 shoulder dislocations were identified in the NEISS database, representing a national estimate of 1,915,975 dislocations (mean 25.2 per 100,000 person-years). The mean patient age was 35.3 years. More than half of the dislocations (52.5%) were sports-related, and basketball (16.4%), American football (15.6%), and cycling (9%) were the sports most commonly associated with dislocation. Most dislocations (72.1%) occurred in men. This disparity by sex was more significant for sports-related dislocations (86.1% in men) than nonsports-related dislocations (56.7% in men; P < .001). With sports-related dislocations, people <21 years experienced a significantly higher proportion versus those >39 years (44.6% vs 14.9%; P < .001), while the opposite distribution was seen with nonsports-related dislocations (<21 years: 12% vs >39 years: 51.7%; P < .001). Women outnumbered men with shoulder dislocation among people >61 years. Sports-related shoulder dislocations were more common among younger and male individuals than older and female individuals. Contact sports such as basketball and American football were associated with more shoulder dislocations compared with noncontact sports.

Effect of the COVID-19 Pandemic on Injuries Related to Individual and Team Sports: An Analysis of the NEISS Database Between 2017 and 2021.

The first 2 years of the coronavirus 2019 (COVID-19) pandemic had a profound effect on youth sports participation. The primary aim of this study was to explore the effect of the COVID-19 pandemic on youth sports injury patterns, with a secondary aim of comparing organized team and individual sport-related injuries in diverse age groups. Descriptive epidemiology study. The National Electronic Injury Surveillance System (NEISS) was searched to identify injuries sustained by patients aged 11 to 23 years while playing organized team or individual sports from 2017 to 2021. We investigated reports of concussions, dislocations, fractures, and sprains/strains. Between 2017 and 2021, there were 58,721 and 3778 team and individual sport-related injuries, respectively. When compared with the prepandemic years, there was a 57.07% decrease in 2020 and 22.31% decrease in 2021 for the number of organized team sport-related injuries. Organized individual sport-related injuries had a 56.24% and 35.18% decrease in number in 2020 and 2021, respectively. Male patients were most likely to be injured in team sports (81.0%), and female patients were most likely to be injured in individual sports (67.1%). High school athletes sustained the majority of injuries in team (57.0%) and individual (51.2%) sports. The years 2020 and 2021 saw a decrease in proportion of sprains/strains and an increase in proportion of fractures. The number of organized sport-related injuries reported to emergency departments decreased in 2020, and despite vaccinations and easing of social distancing, the 2021 value did not return to what it was prepandemic. As coronavirus-related restrictions have eased, there should be careful monitoring of sports injuries among youth athletes.

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.

Using the NEISS database to understand pressure cooker related injuries in the USA

ObjectiveTo determine the incidence of pressure cooker related injuries in US hospital emergency departments. To quantify injury patterns associated with pressure cookers and inform prevention recommendation messaging.MethodsThe National Electronic Injury...

Traumatic Amputations Treated in US Emergency Departments: A Review of the NEISS Database.

Trauma is the second most common cause of limb loss in the United States (US), second only to vascular disease. The aim of this study was to evaluate the demographics and commercial products associated with traumatic amputations in the United States. The National Electronic Injury Surveillance System (NEISS) database was analyzed from 2012 to 2021 to identify patients presenting to the Emergency Department (ED) with the diagnosis of amputation. Additional variables included patient demographics, body part amputated, commercial products associated with amputation, and ED treatment disposition. A total of 7323 patients diagnosed with amputation were identified in the NEISS database. Amputations were most frequent in the 0-5years age group, followed by 51-55years. More males than females suffered an amputation during the study period (77% vs 22%). Most patients were Caucasian. Fingers were most frequently amputated (91%), followed by toes (5%). Most injuries occurred in the home (56%). The top commercial product behind these traumatic amputations was doors (18%), followed by bench or table saws (14%) and power lawn mowers (6%). Over 70% of patients were able to be treated and released from the ED, while 22% required hospitalization and 5% were transferred to another facility. Traumatic amputations can cause significant injuries. A better understanding of the incidence and mechanisms behind traumatic amputations may help with injury prevention. Pediatric patients had a high incidence of traumatic amputations, which warrants further research and dedication to injury prevention in this vulnerable group.

Epidemiology of C2 fractures in the United States: A National Electronic Injury Surveillance System database study.

C2 fractures are one of the most common traumatic injuries of the cervical spine, with high rates of morbidity and mortality. Current literature on the incidence of C2 fractures is limited to populations outside of the United States (US), prior to 2014, or specific age cohorts. The purpose of this study is to report the incidence rate (IR) of C2 fractures and associated patient demographics in the US between 2002 and 2021 using the National Electronic Injury Surveillance System (NEISS) database. This study analyzed the NEISS database to identify cases of C2 fractures presenting to US Emergency Departments (EDs) from 2002 to 2021. Annual and overall numbers of fractures, IR, and patient demographics were analyzed. IR is expressed as the number of fractures per 100,000 person-years at risk (PYR). Patients were split into three different age groups for comparison (children and young adults, 0-64 years; older adults, 65-79 years; elderly individuals, 80 + years). A national estimate of n = 72,764 patients (95% confidence interval [CI] = 54,371-91,156) presented to US EDs with a C2 fracture (IR was 1.17/PYR; 95% CI = 0.87-1.46), and elderly individuals had the highest IR overall (IR = 15.9; P < 0.05). The IR of C2 fractures between 2002 and 2021, reported as average annual percent change (AAPC), increased significantly, regardless of age or sex (AAPC = 10.9; 95% CI = 6.3-15.6; P < 0.0001). C2 fractures occur at higher rates than previous years, with especially high IR in elderly individuals. Emphasis of public health efforts toward osteoporosis and coordination difficulties in elderly individuals would likely significantly reduce the overall IR of these injuries.

Emergency Department Visits for Ankle Fractures: Trends Through COVID-19

Category: Ankle Introduction/Purpose: Ankle fractures are common and can potentially lead to devastating consequences if not treated appropriately. The aim of this study was to assess trends in incidence, presentation, causes, and final disposition of emergency department visits for ankle fractures from 2019 to 2020. Methods: The National Electronic Injury Surveillance System (NEISS) database is a probability sample of hospitals in the United States. This sample was stratified and weighted based on ED size, which was used to generate national estimates (NE). The NEISS databases contains variables such as age, race, drug use, alcohol use, location, disposition, cause, body part, and injury type. The NEISS database from 2001 to 2020 was queried for patients who sustained an ankle fracture. Two cohorts: before COVID-19 (BC) (July 2019 - Dec 2019) and during COVID-19 (DC) (July 2020 - Dec 2020) were compared. Results: This study assessed 3,350 (NE: 131, 672) total patients who presented to emergency departments around the United States. 1,683 (NE: 17,936) patients presented BC and 1,667 (NE: 64,380) DC, representing a 4% decrease compared to the year before. The median age was 44 (Interquartile Range (IQR) 24-62), with 60% (NE: 79,051) females. On bivariate analysis, the rate of alcohol related ankle fractures increased (1.9% BC vs. 2.6% DC; p&lt;0.001). Further, the number of ankle fractures at school (3% BC vs. 0.7% DC; p&lt;0.001) and during sports (19% BC vs. 14% DC) decreased. Emergency departments visits leading to hospitalization increased (23% BC vs. 24% DC). The top three causes of ankle fracture during COVID-19 were stairs (NE 18,026, 28%), floors (NE 4,635, 7.2%), and skateboards (4.40%). The three largest increases in ankle fracture etiologies during COVID-19 were skateboards (+2.80%), floors (+1.10%), and powered scooters (+0.80%). Conclusion: There was a decrease in ankle fractures during the COVID-19 pandemic compared to the year before. Drug related fractures increased as did those resulting in hospitalization. Fractures caused by skateboards, powered scooters, and mopeds experienced an increase during COVID-19.

Epidemiology of Product-Related Ocular Injuries in the United States From 2001 to 2020

BackgroundAlthough ocular injuries are a major cause of ocular morbidity, ocular trauma secondary to consumer-related products is often preventable, and epidemiologic data can highlight potential avenues for intervention. ObjectiveOur aim was to characterize epidemiologic trends in product-related ocular injuries presenting to the emergency department (ED) from 2001 to 2020 based on the National Electronic Injury Surveillance System (NEISS) database. MethodsThe NEISS database was reviewed for all ED visits for ocular injuries between 2001 and 2020. Trends in incidences were determined by calculating average annual percent change. ResultsThere were 106,533 ocular injuries reported to the NEISS database, which represented an estimated 4 million national cases. Most injuries occurred during the summer in men (69.2% of cases) younger than 40 years (66.2%). The incidence rates decreased for patients younger than 60 years, but remained steady in those 60 years and older. Although the most common overall cause was home workshop equipment–related products (23.5%), patients younger than 20 years were most likely injured from sports (27.2%), and those 80 years and older experienced injuries due to furniture (24.0%). ConclusionsAlthough the overall incidence of product-related ocular injuries has decreased over the past 2 decades, not all age groups are affected equally. The data showed that the trends in frequency and cause of eye-related ED visits differ depending on the age of the patient and indicated avenues for age-specific interventions.

Trends in Ankle Sprains Presenting to Emergency Departments During the COVID-19 Pandemic

Category: Trauma; Ankle Introduction/Purpose: It has been suggested that the COVID-19 pandemic has led to patients deferring evaluation and treatment of injuries due to fear of contagion. This, in addition to lockdowns and avoidance of outside activities, may have led to a decrease in the recorded incidence of activity-related injuries. The purpose of this study was to evaluate the effect of the 2020 COVID-19 period on Emergency Department (ED) visits for ankle sprains in the United States, including incidence, demographics, and etiology. Methods: The National Electronic Injury Surveillance System (NEISS) database was queried to identify patients who presented to EDs in the U.S. for ankle sprains between 2001-2020. Population estimates were derived from the U.S. Census Bureau from 2001- 2020 for calculation of incidence in person-years. Chi-square analysis and Wald chi-square tests were performed to assess differences between pre-pandemic (2001-2019) and during-pandemic (2020) periods. Results: Between 2001 and 2020, a total of 315,545 actual ankle sprains were identified in the NEISS database for an estimated 11,904,243 ankle sprains (610,445.2 per year) among a population at risk of 6,185,494,962 person-years. The estimated incidence of ankle sprains in the general population presenting to EDs was 1.92 per 1000 person-years. When analyzing pre- and during- pandemic cohorts, ankle sprain incidence was significantly lower during-pandemic (1.98 vs 0.89 per 1000 person-years; P&lt;0.001). Additionally, patients that visited EDs for ankle sprains during the pandemic were older (30.5% vs 27.0%; P&lt;0.001), more likely to be female (57.8% vs 51.8%; P&lt;0.001), and more likely to be Asian (0.83% vs 0.44%; P=0.047), Native American (0.62% vs 0.18%; P=0.001), or of Pacific Islander race (0.13% vs 0.04%; P=0.008). Ankle sprains were due to sport-related activities in 38% of patients pre-pandemic, as opposed to 29% of patients during-pandemic (P&lt;0.001). Conclusion: The incidence of ankle sprains decreased 65% in 2020, probably owing to activity restrictions during the COVID-19 pandemic. This was further supported by a significant decrease in the proportion of ankle sprains due to sport-related activities. Finally, changes in age, gender, and racial patterns were also identified for this injury type.

P54. Emergency department visits for pediatric spine fractures: trends through COVID-19

BACKGROUND CONTEXTPediatric spine fractures are an important medical and surgical emergency.PURPOSEThe aim of this study was to assess trends in emergency department visits for pediatric spine fractures.STUDY DESIGN/SETTINGDescriptive Epidemiological Study.PATIENT SAMPLEA total of 1,930 (national estimate: 49,186) pediatric patients who presented to the emergency room with a spine fracture from 2001 to 2020.OUTCOME MEASURESCauses of spine fractures, discharge disposition and demographic variables.METHODSThe National Electronic Injury Surveillance System (NEISS) database is a probability sample of hospitals in the United States. This sample was stratified and weighted based on ED size, which was used to generate national estimates (NE). The NEISS database from 2001 to 2020 was queried for less than 18 years old who sustained a cervical, thoracic or lumbar spine fracture. The entire cohort was divided by before and after March 11, 2020, which is when the WHO declared the COVID-19 pandemic.RESULTSThere were 1,930 (NE: 49,186) pediatric patients who presented to the emergency room with a spine fracture from 2001 to 2020. There were 135 (NE:2,807) ED patients in 2020 compared to 110 (NE: 2,161) in 2019 representing a 30% increase compared to the year before. The rate of males with spine fractures decreased (50.88% DC vs. 62.77% BC; p < 0.001). The rate of spine fractures at home increased (30% DC vs. 22% BC; p < 0.001) while rate of spine fractures in a place of recreation decreased (25% DC vs. 34% BC; p < 0.001). Lumbar spine fractures decreased (15% vs. 24%) while cervical and thoracic spine fractures increased (p < 0.001). The amount of ED spine fractures leading to admission decreased (14.69% DC vs 25% BC) while the amount released increased (61% vs. 55%) (p < 0.001). The most decreased three causes of pediatric spine fractures were football (6.84% DC vs. 11.18% BC), stairs (1.72% DC vs. 5.89% BC), and sleds (0.22% DC vs. 4.34% BC) (p < 0.001). The most increased three causes of pediatric spine fractures in the ED were swings (8.57% DC vs. 1.31% BC), horseback riding (10.85% DC vs. 4.35% BC), and ATV vehicles (7.92% DC vs. 1.91% BC) (all p < 0.001).CONCLUSIONSThere was a spike in pediatric spine fractures during the COVID-19 pandemic compared to the year before. Fractures in males, and those related to recreational activities in public places as well as fractures due to football decreased. Fractures at home and in isolated recreational activities such as swings, horseback riding and ATVs increased.FDA DEVICE/DRUG STATUSThis abstract does not discuss or include any applicable devices or drugs.

Epidemiologic Changes in Pediatric Fractures Presenting to Emergency Departments During the COVID-19 Pandemic.

Background:Fractures are a common pediatric injury. The coronavirus disease 2019 (COVID-19) pandemic resulted in significant changes in daily life that could impact the incidence of pediatric fractures. The purpose of this study was to compare the incidence of pediatric fractures in the United States during the COVID-19 pandemic to previous seasonally adjusted fracture incidence rates using the National Electronic Injury Surveillance System (NEISS) database and the American Community Survey (ACS).Methods:The NEISS database was queried from 2016 to 2020 for fractures occurring in pediatric (0 to 17 y) patients. ACS population data allowed for the estimation of fracture incidence per 1000 person-years. Using a quasiexperimental interrupted time series design, Poisson regression models were constructed to test the overall and differential impact of COVID-19 on monthly fracture rate by age, sex, fracture site, injury location, and disposition.Results:Our sample consisted of 121,803 cases (mean age 9.6±4.6 y, 36.1% female) representing 2,959,421±372,337 fractures nationally. We identified a stable 27% decrease in fractures per month after February 2020 [risk difference (RD) per 1000 youth years=−2.3; 95% confidence interval: −2.98, −1.57]). We found significant effect modification by age, fracture site and injury location (P<0.05). The fracture incidence among children 5 years or older significantly decreased, as well as the incidence of fractures at school [RD=−0.96 (−1.09, −0.84)] and during sports [risk difference=−1.55 (−1.77, −1.32)]. There was also a trend toward a reduction in upper extremity fractures and fractures requiring admission.Conclusion:A nationally representative injury database demonstrated a 27% decline in monthly pediatric fractures during the COVID-19 pandemic that persisted into the latter half of 2020. These trends appeared most attributable to a reduction in fractures discharged home and upper extremity fractures among older children sustained at school and in sports. Our findings provide unique insight into the epidemiology of pediatric fractures and demonstrate a baseline need for musculoskeletal care among young children even in the setting of a national shutdown.Level of Evidence:Level II—retrospective prognostic study.

A characterization of home maintenance equipment-related hand and lower arm injuries

BackgroundThousands of Americans sustain injuries from various household appliances each year, though injury patterns have not been well characterized. We thus sought to determine the incidence, characteristics, and trends of household appliance-related hand injuries over the past decade. MethodsThe National Electronic Injury Surveillance System database (NEISS) was queried from 2010 through 2019. Our analysis grouped patients into 10-year age groups. We defined types of appliances and injuries Chi-square tests were used to compare the most common injury mechanisms by age group. ResultsBetween 2010 and 2019, 30,336 total cases of home workshop equipment-related upper extremity injuries were recorded; 2,574 (8.48%) of these affected females, compared to 27,762 (91.52%) of the cases affecting males. Across all age groups, males were between 6 and 13 more times likely to be injured than females (p < 0.001). Between 2010 and 2019, we recorded a decline in total injuries from 168,795 to 147,584, with a Pearson correlation coefficient of -0.68 (p = 0.031). The appliances most likely to injure those in their 10s through 40s were mechanical tools such as screwdrivers. Meanwhile, those in their 50s through 70s were most likely to be injured by saws. Both amputations and avulsions were found to significantly increase with age (p = 0.038, p = 0.027, respectively). Most injuries result from manual tools and saws. DiscussionMales are significantly more likely to incur injuries than females from maintenance equipment, and risk of avulsions and amputations increase significantly with age. This aligns with previous research which also suggested that older saws were most likely to injure older individuals; namely, following new regulations on saws, older adults were more likely to be affected. This is especially worrisome in light of recent research showing that older adults with amputations are less likely to be offered replantations. Overall, these results can continue to guide and optimize community interventions on an epidemiological basis.

Emergency Department Visits for Ankle Fractures Through COVID-19: An Analysis of the National Electronic Injury Surveillance System

Background:Societal changes that occurred during the COVID-19 pandemic may have altered the epidemiology of ankle fractures. The aim of this study was to assess trends in emergency department visits for ankle fractures from 2019 to 2020 in the United States.Methods:The National Electronic Injury Surveillance System (NEISS) database is a sample of hospitals in the United States stratified and weighted based on emergency department (ED) size, which was used to generate national estimates (NEs). The NEISS database was queried for patients who sustained an ankle fracture. Patients before COVID-19 (BC) (July 2019–December 2019) were compared to those during COVID-19 (DC) (July 2020–December 2020).Results:This study assessed 3350 (NE: 131,672) patients. Of these, 1683 (NE: 67,292) patients presented BC and 1667 (NE: 64,380) DC, representing a 4% decrease. The rate of alcohol-related ankle fractures increased (1.9% BC vs 2.6% DC; P < .001). The fraction of ankle fractures at school (3% BC vs 0.7% DC; P < .001) and during sports (19% BC vs 14% DC; P < .001) decreased. ED visits for ankle fracture leading to hospitalization marginally increased (23% BC vs 24% DC). The top 3 ankle fracture causes during COVID-19 were stairs (NE: 18,026, 28%), floors (ie, falling on floor) (NE: 4635, 7.2%), and skateboards (NE: 2832, 4.40%). The 3 largest increases in ankle fracture causes during COVID-19 were skateboards (+2.80%), floors (+1.10%), and powered scooters (+0.80%).Conclusion:There was a decrease in ankle fractures during the COVID-19 pandemic compared to the year before. Alcohol-related fractures increased as did fractures resulting in hospitalization. Ankle fractures caused by skateboards, powered scooters, and mopeds increased during COVID-19, whereas fewer occurred in school or during sports, consistent with restrictions to group activities. These findings may aid in proper health care budgeting in times of national and global crises.Level of Evidence:Level III, retrospective comparative study.

A database study on incidence and trends in traumatic lower-extremity amputations in the United States

Background: There is minimal focus on traumatic lower-extremity amputations due to their relatively low incidence, but they often come with a higher morbidity and mortality than their upper extremity counterparts. The purpose of this study was to evaluate the incidence and trends of lower extremity amputations in the United States over 10 yr. Methods: The National Electronic Injury Surveillance System (NEISS) was queried from 2008 to 2017 for lower-extremity amputations presenting to United States emergency departments. Date of presentation, age at presentation, amputated appendage, disposition, and cause of the amputation were reported and used for statistical analysis. Results: From 2008 to 2017, 393 patients were reported to have sustained lower-extremity amputations within the NEISS database with an estimated total of 11,475 patients sustaining a lower-extremity amputation over the past 10 yr and an incidence of 2.2 per 100,000 person-years. The incidence of lower-extremity amputations is highest in those under 5 years old. Lawnmowers were the most common mechanism of injury in all age groups. Discussion: Due to the high morbidity and mortality associated with these injuries, it is prudent to follow the trends in lower-extremity amputations. This is particularly important in promoting awareness and prevention of the more common mechanisms such as lawnmower incidents. Level of Evidence: Level IV.

Epidemiology of Sports-Related Traumatic Hip Dislocations Reported in United States Emergency Departments, 2010-2019.

Background:Traumatic hip dislocations are rare injuries that most commonly occur in motor vehicle accidents. There is a paucity of literature that describes sports-related hip dislocations.Purpose:To estimate the incidence of sports-related hip dislocations and determine any sport- or sex-related epidemiological trends using the National Electronic Injury Surveillance System (NEISS) database.Study Design:Descriptive epidemiology study.Methods:Data regarding sports-related hip dislocations from 2010 to 2019 were retrieved from the NEISS, a database that catalogs injury information during emergency department visits from 100 hospitals across the United States to produce nationwide estimates of the injury burden. The estimated number of injuries was calculated using weights assigned by the NEISS database. The injuries were then stratified by sport and sex to determine any epidemiological patterns.Results:A total of 102 hip dislocation injuries were identified over the surveyed 10 years, indicating 2941 estimated injuries nationwide. Overall, 10 (9.8%) of 102 sports-related hip dislocations presented with concomitant acetabular fractures, representing an estimated 288 injuries nationally over 10 years. Male athletes sustained more sports-related hip dislocations than female athletes, with a relative incidence of 12.51 (P < .001). Adolescents aged 15 to 19 years recorded the highest number of hip dislocations. There were 17 sports identified as having caused at least 1 hip dislocation over the 10-year period. More hip dislocation injuries were sustained from contact sports (91.2%) than noncontact sports (8.8%) (P < .001). Football (estimated 164 injuries per year; 55.6%), snowboarding (28 per year; 9.5%), skiing (26 per year; 8.8%), and basketball (21 per year; 7.1%) had the highest rates of hip dislocation. Additionally, 43 (82.7%) football-related injuries were caused by tackling mechanisms, and 9 (17.3%) were caused by nontackling mechanisms (P < .001).Conclusion:The incidence of traumatic sports-related hip dislocations was extremely low in the United States during the study period. Male adolescents, aged 15 to 19 years, sustained the greatest number of injuries during football. Significantly more hip dislocations occurred in contact sports, most commonly football, snowboarding, skiing, and basketball, compared with noncontact sports. As adolescent athletes may have limited treatment options if osteonecrosis occurs, these data serve to increase the clinical awareness of these injuries.

P152. Vertebral fractures and neurological injury associated with increased recreational vehicle use

<h3>BACKGROUND CONTEXT</h3> Recreational vehicle use has become increasingly popular over the past decade. The global all-terrain vehicle market size was valued at 3.9 billion USD in 2018 and is expected to grow at a rate of 3.1% between 2019 and 2025. Those who suffer accidents while using such vehicles are prone to spinal injury. However, few have examined this relationship at the national scale. <h3>PURPOSE</h3> The goal of this study was to investigate the trends between recreational vehicle use and spinal injury nationwide. <h3>STUDY DESIGN/SETTING</h3> This was a retrospective study reviewing the number of spinal injury cases involved with recreational vehicle use nationwide, utilizing the NEISS (National Electronic Injury Surveillance System) database. <h3>PATIENT SAMPLE</h3> This study isolated spinal injury cases associated with recreational vehicles, ranging from bicycles to four wheeled ATVs, two wheeled ATVs, and other all-terrain vehicles, and evaluated the rate of neurological injury and vertebral fractures in these cases. <h3>OUTCOME MEASURES</h3> Measures evaluated included proportions of vertebral fractures and nerve injuries related to recreational vehicle use. <h3>METHODS</h3> National estimates, standard errors, and 95% confidence intervals were derived using the provided survey parameters in the NEISS database. Crude rate was defined as number of cases per 100,000 persons. Significance was determined using adjusted Wald tests, for which p<.05 (2-sided) were considered significant. Proportions of fracture and nerve injury by recreational vehicle were determined by Pearson's Chi-Squared Test between bicycles, four wheeled ATVs, two wheeled ATVs, and other all-terrain, recreational vehicles. <h3>RESULTS</h3> A total of 56,349 spine injuries related to recreational vehicle use were isolated from the database. Injuries located in the lower trunk/lumbar vertebrae were most common (47.9%). A total of 78.0% of all spine injuries were experienced by males. Between 2010 and 2019, there was an increase in national cases of spine injury involving recreational vehicles (p<0.00001). Nerve injury was more prevalent in four wheeled ATVs (10.2%) when compared to all-terrain vehicles and two wheeled powered vehicles (2.93%) (p<0.0001). Lumbar spine injury, despite being the most prevalent region of spine injury, showed lower odds (p<0.0001) of being admitted. <h3>CONCLUSIONS</h3> With the increasing popularity of recreational vehicles, there is high concern for traumatic spinal injury. This study was able to identify increasing numbers of spinal injury related to such vehicle use. Such injuries are not trivial and lead to not only life-altering limitations for patients but also increasing health care costs. Physicians and patients alike should remain aware and discuss the potential harms regarding the use of recreational vehicles and their high risk for spinal injury. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

258. Epidemiological trends associated with football-related spine injuries

<h3>BACKGROUND CONTEXT</h3> Despite the health-related consequences associated with American football, it remains a ubiquitous part of American athletics. This study investigates trends in football-related spine injuries, focusing on the regional distribution of spine injuries across age demographics. We specifically focus on vulnerabilities in pediatric and adolescent populations, which constitute an overwhelming majority of emergency department (ED) cases. <h3>PURPOSE</h3> To identify age-related trends of football-related spine injuries presenting to the ED and also distinguish independent drivers of hospital admission following presentation for these injuries. <h3>STUDY DESIGN/SETTING</h3> NEISS database is a nationally representative, probability sample of hospital emergency departments (EDs) in the United States. <h3>PATIENT SAMPLE</h3> A total of 7,196 weighted cases of spinal injury associated with playing football were observed in the NEISS database. <h3>OUTCOME MEASURES</h3> National incidence and risk factors for admission to the ED versus discharge following spine fracture or spinal nerve injury associated with playing football. <h3>METHODS</h3> The National Electronic Injury Surveillance System (NEISS) database was queried for annual estimates of spinal injury sustained while playing football that presented to emergency departments across the United States between 2010 and 2019. Data regarding the nature and location of the injury were obtained. Patients' hospital dispositions were tracked as either discharged from ED or admission/transfer to another hospital. A multivariable logistic regression analysis was conducted to identify which factors among the available data were independently associated with admission to the hospital/transfer to another care facility versus discharge from the ED. <h3>RESULTS</h3> A total of 61.60% of football injury patients experienced vertebral fractures, while the other 38.40% of patients experienced spinal nerve injury. 23.29% of all injuries involved the neck/cervical spine, 39.56% affected the upper thoracic spine, and 37.16% involved the lower trunk/lumbar spine. Between ages 9-14, the majority of spinal injury cases involved the thoracic spine (54.86%), whereas ages 15-20 and among those 21 and older, the most common region of spinal injury was the lumbar spine (37.87% & 47.99%, respectively). Age cohort had a significant effect on the region of the spine that was injured (P<0.0001). Of patients who were injured while playing football, 73.2% were directly discharged from the ED, while the other 26.83% required either admission or transfer. Independent predictors of hospital admission/transfer to another hospital following a spinal injury related to playing football included a patient's age between 15 and 20 (OR: 1.960; 95% CI: 1.700 to 2.262) when compared to adults, Black/African American race (OR: 1.537; 95% CI: 1.301 to 1.814) when compared to White race, injury of the cervical spine (OR: 6.853; 95% CI: 5.855 to 7.996) or thoracic spine (OR: 2.810; 95% CI: 2.418 to 3.271) compared to the lumbar spine. <h3>CONCLUSIONS</h3> The pediatric population is more susceptible to injuries involving the thoracic spine while the adolescent and adult populations more commonly sustain injuries afflicting the lumbar spine. In addition to these age and anatomic trends, we found late adolescent age (15-20 years), Black/African American race, cervical spine injuries, and thoracic spine injuries to be independently associated with higher odds of hospital admission. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Epidemiology of rugby-related fractures in high school- and college-aged players in the United States: an analysis of the 1999–2018 NEISS database

ABSTRACT Objectives Rugby is a high-impact collision sport with identical competition rules by sex. The aim of this study was to analyze the trend of rugby-related fractures by body site, sex, and age in amateur athletes from 1999 to 2018. Methods The National Electronic Injury Surveillance System (NEISS) database was queried to characterize rugby-related injuries from 1999 to 2018 in patients aged 14–23 years old. National injury estimates were calculated using sample weights. Chi-square analysis and one-way ANOVA were performed to compare categorical variables. Results Out of a total of 43,722 weighted cases of rugby-related fractures over the 19-year period, 70.9% were among high school- and college-aged males and females between the ages of 14–23 years (N = 30,996). Males constituted 79.3% of cases whereas females composed 20.7% of the cases. The proportion of upper extremity fractures was similar in both males and females, yet facial fractures were significantly more common among males than females (27.9% vs. 14.6%, P < 0.001). Among facial fractures, nasal fractures represented 74.4% of the sample, yet facial fractures only resulted in hospital admittance in 1.3% of cases. Lower extremity fractures were more likely to be severe, with 11.3% of LE cases being admitted to the hospital. Conclusion Rugby players in the US diagnosed in the ED with fractures consisted largely of male, high school- and college-aged athletes. Males and females experienced upper and lower-extremity fractures at comparable rates, yet lower extremity injuries were more likely to be admitted to a hospital. Men were significantly more likely to experience a facial fracture in which a majority were nasal fractures.