National Electronic Injury Surveillance System Research Articles

Trends and epidemiology of spine fractures in the super-elderly population in the United States.

Spine fractures occur commonly in the geriatric population. Super-elderly individuals (i.e., those 80 years of age and older) represent a growing segment of the population and are especially prone to these fractures. The contemporary epidemiology of spine fractures in the super-elderly population is incompletely described in the literature. This descriptive epidemiology study used the National Electronic Injury Surveillance System to examine the incidence and recent trends of spine fractures occurring among super-elderly individuals in the United States (US) from 2011 to 2020. Annual, overall, and age-/sex-specific incidence rates (IRs) were analyzed. Average annual percent change (AAPC) estimates were calculated to indicate the magnitude/direction of trends in annual injury rates. An estimated n = 385,375 super-elderly patients sustained spine fractures over the 10-year study period for an overall IR of 31.5 per 10,000 person-years at-risk. Lumbar fractures (IR = 16.3) were the most common, followed by thoracic (IR = 9.4) and cervical (IR = 6.9) fractures. Incidence was significantly higher in super-elderly females (IR = 35.6) than in males (IR = 24.8). Incidence was significantly higher in nonagenarians (IR = 50.7) and centenarians (IR = 42.6) than in octogenarians (IR = 26.8). Accounting for population growth yielded a significantly increasing incidence over the study period from 20.8 in 2011 to 40.3 in 2020 (AAPC = 8, P < 0.0001). This study suggests that the annual incidence of spine fractures in the oldest cohort of patients in the US (80 + years of age) increased significantly during the recent decade from 2011 to 2020. Increased IRs highlight the need for future research aimed at optimizing outcomes and quality of life in this frail and ever-growing segment of the population.

Between 2008 and 2022, Lower-Extremity Injuries Declined in Male Rugby Players, Whereas Noncontact Knee Injuries Showed No Decline in Female Rugby Players

PurposeThe purpose of this study was to assess the distribution and mechanisms of lower extremity injuries among high school and college age rugby players presenting to United States (US) emergency departments (EDs) from 2008 to 2022. MethodsThe National Electronic Injury Surveillance System (NEISS) was queried for lower extremity rugby injuries (ages 14-23) from January 2008 to December 2022. Patient demographics, injury location, diagnosis, and disposition were extracted for each case. Linear regression analysis assessed differences over time. Injury distribution for males versus females was evaluated using Pearson’s chi-square analysis. ResultsAn estimated 31,318 (845 NEISS cases) high school and college-age rugby players presented to US EDs with a lower extremity injury during the study period. Males accounted for 66.9% of the injuries. Linear regression analysis revealed a significant decrease in annual frequency of lower extremity injuries presenting to US EDs from 2008 to 2022 (p=0.001). The most common injury mechanism was overwhelmingly a non-contact twisting motion (11,108, 35.5%) followed by a hit/collision (5,298, 16.9%). Strains/sprains were the most common diagnosis (17,243, 55.1%). Injuries most commonly occurred at the ankle (12,659, 40.4%) and knee (11,016, 35.2%). In a sex-specific linear regression analysis, there was a significant decrease in lower extremity injuries sustained by male players (p=0.001), but no significant decrease among female players (p=0.112). Furthermore, chi-squared analysis revealed that females sustained a significantly higher proportion of knee injuries secondary to twists (15.9% for females vs. 9.0% for males, p=0.01). ConclusionLower extremity injuries are declining among high school and college-age male rugby players. However, there has not been a corresponding decrease among female rugby players. Furthermore, females are disproportionately affected by non-contact twisting knee injuries.

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.

Poster 399: The 10-Year Decreasing Trend of Youth Soccer Concussions Presenting to U.S. Emergency Departments

Objectives: Soccer is one of the most popular youth sports with nearly 3 million annual participants in the United States alone. Importantly, concussion incidence and awareness in youth soccer has prompted implementation of various protective measures. Despite these interventions, no studies have investigated the prevalence of youth soccer concussions over time. The purpose of this study is to analyze trends and etiologies of youth soccer concussions presenting to United States emergency departments (EDs). Methods: Data from National Electronic Injury Surveillance System were analyzed for soccer players 2 to 18 years old sustaining concussions from January 2013 to December 2022. Patient data collected included age, sex, mechanism of injury, diagnosis, loss of consciousness, and disposition. Raw data were used to calculate national estimates based on assigned statistical sample weight of each hospital. Results: 182,462 youth soccer concussions were diagnosed in US EDs (52.6% male). Most common mechanism of injury was head to ball (29%). Between 2013 and 2022, concussions decreased 28%. Overall concussions decreased by 1,449 per year (95% CI: -2383 to -515, p=0.007). Not specified concussions decreased by 340 per year (95% CI: -501 to -180, p=0.001), head to body by 378 per year (95% CI: -527 to -229, p&lt;0.001), head to ground by 275 per year (95% CI: -463 to -87, p=0.01), and other mechanisms by 56 per year (95% CI: -109 to -3, p=0.04). There were no changes in head to ball or head-to-head mechanisms. Exclusion of years 2020 and 2021 due to COVID demonstrated decreases in not specified concussions by 256 per year (95% CI = -394 to -118, p=0.004), head to body by 314 per year (95% CI: -431 to -196, p=0.001), and head to ground by 182 per year (95% CI: -331 to -33, p=0.02). Conclusions: There is a decreasing trend in youth soccer concussions from 2013 to 2022. Although concussion risk is greatest from contact with the ball, there was no decrease in head to ball concussions during the study period despite implementation and utilization of protective gear. This study contributes to growing literature regarding concussions in youth soccer athletes.

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.

Epidemiology of Testicular Trauma in Sports: Analysis of the National Electronic Injury Surveillance System Database

BackgroundThe epidemiology of testicular trauma in sports on a national scale has not been well studied. Timely management and treatment after testicular trauma is critical to avoid serious, long-term ramifications of mismanagement. ObjectiveThe aim was to analyze trends in sports-related testicular trauma based on specific sports and patient demographic characteristics over time. MethodsThe National Electronic Injury Surveillance System was queried for emergency department cases between 2012 and 2021 with injuries in the pubic region related to 10 commonly played sports. Variables examined included patient age, race, disposition, and sport using incidence rate, incidence rate ratios, and χ2 analysis. ResultsThere were an estimated 28,844 emergency department cases of sports-related testicular trauma between 2012 and 2021. Young patients, aged between 10 and 14 years and 15 and 19 years, accounted for most cases, and results of χ2 analysis showed a significant difference in incidence based on age group (p < 0.01). Most injuries occurred while athletes played basketball, football, and soccer (73.6%). ConclusionsSports-related testicular trauma injury rates remained steady between 2012 and 2021, which suggests greater efforts are necessary to reduce the incidence of sports-related testicular trauma. Education efforts should focus on 10- to 19-year-olds because they have the highest incidence. Given the high incidence in sports like basketball and soccer compared with football and lacrosse, testicular trauma seems to be a risk for athletes competing both recreationally and competitively.

Decreasing the Size of Bottle Caps: Helping or Hurting Children?

Our study aims to assess if decreasing bottle cap size was associated with more ingestions and injuries nationally. STUDYDESIGN: Retrospective chart review. The National Electronic Injury Surveillance System (NEISS) database. The NEISSwas queried for bottle cap ingestions in children 0 to 18 years old between 2002 and 2021. Demographic factors including age, race, and sex of the patient were recorded. The location where the ingestion took place and the disposition of the patient were also analyzed. Data were excluded if the narrative did not specify the ingestion of a cap of a drinking bottle. A total of 415 bottle cap ingestion injuries were identified, for a national estimate of 11,683 injuries. The mean age at the time of ingestion was 10.3 ± 5.2 years and the majority of the injuries occurred in males (N = 9129, 78.4%). 46.4% (N = 5398) were Caucasian, 17.6% (N = 2046) were Black or African American, and 2.7% (N = 311) were Hispanic. 55.0% (N = 6405) of injuries occurred at an unknown location, 41.4% (N = 4781) occurred at home, and 2.8% (N = 326) occurred at school. 82.3% (N = 9584) of patients were treated in the emergency department and released, 6.9% (N = 808) were treated and admitted, 6.7% (N = 783) were treated and transferred, and 0.9% (N = 110) were held for observation. From 2002 (N = 6) to 2021 (N = 2291), there was a statistically significant increase in bottle cap ingestions (P < .001). Plastic bottle cap ingestions have increased in children over the last 20 years, coincident with the change to smaller bottle caps.

Epidemiology of Pediatric Dog Walking-Related Injuries Among Children Presenting to US Emergency Departments, 2001 to 2020.

Dog walking is associated with a significant injury burden among adults, but the risk of injury associated with dog walking among children is poorly understood. This study describes the epidemiology of children treated at US emergency departments for injuries related to leash-dependent dog walking. The National Electronic Injury Surveillance System (NEISS) database was retrospectively analyzed to identify children (5 to 18years of age) presenting to US emergency departments between 2001 and 2020 with dog walking-related injuries. Primary outcomes included annual estimates of injury incidence, injury characteristics, and risk factors for fracture or traumatic brain injury (TBI). Weighted estimates, odds ratios (ORs), and 95% confidence intervals (CIs) were generated using NEISS sample weights. An estimated 35,611 children presented to US emergency departments with injuries related to dog walking. The mean age of patients was 11 years, and most patients were girls (63%). Over half (55%) of injuries were orthopaedic, and patients commonly injured their upper extremity (57%) and were hurt while falling when pulled or tripped by the leash (55%). The most frequent injuries were wrist strain/sprain (5.6%), finger strain/sprain (5.4%), and ankle strain/sprain (5.3%). On multivariable analysis, injured children aged 5 to 11 years were more likely to have sustained a TBI (OR: 3.2, 95% CI: 1.1-9.7) or fracture (OR: 1.6; 95% CI: 1.1-2.3). Boys were more likely than girls to have experienced a fracture (OR: 2.0, 95% CI: 1.3-2.5). Dog walking-related injuries in children are primarily orthopaedic and involve the upper extremity. Younger children and boys are at greater risk for serious dog walking-related injuries. Level III.

Sports and Recreation-Related Wrist Fractures: An Epidemiological Study.

Background Wrist fractures have increased over the past several decades. The objective of this study was to identify all-cause and sports-related incidence rates of wrist fractures presenting to emergency departments (EDs) in the United States (U.S.) from 2013 to 2022. A secondary aim of the study was to identify if wrist fractures significantly decreased during 2020. Methodology The National Electronic Injury Surveillance System database was queried to identify the number of wrist fractures presenting to U.S. EDs from 2013 to 2022. Incidence rates in 100,000 person-years were calculated by sport, age, sex, and year. Results From 2013 to 2022, there were 2,027,131 wrist fractures evaluated at U.S. EDs. Injuries peaked in the 10-14-year-old age group, followed by the 5-9 and 85+-year-old age groups. In total, 1,096,598 were sustained during sports and recreation. Cycling, playgrounds, and skateboarding were the leading sports and recreation-related activities. Sports-related wrist fractures followed a unimodal distribution peaking in the 10-14-year-old age group. Females sustained 52% of wrist fractures overall but only 39% of sports-related wrist fractures. All-terrain vehicle and skateboarding-related wrist fractures significantly increased over the study period. Playground and soccer-related wrist fractures significantly decreased in 2020. Conclusions All-cause wrist fractures presenting to U.S. EDs significantly increased from 2013 to 2022 though sports-related wrist fractures did not. Pediatric males and elderly females are most at risk for wrist fractures overall while sports-related wrist fractures predominate in the pediatric population. Youth sports and recreation officials should be aware of the risks to mitigate the incidence of sports-related wrist fractures.

Comparing alcohol involvement among injured pedalcycle and motorcycle riders across three national public-use datasets

Background Annually since 2008; over 38% of fatally injured motorcycle riders and 20% of pedalcyclists involved in traffic crashes were under the influence of alcohol, yet public health surveillance of alcohol involvement in these injuries is underdeveloped. This study determined alcohol involvement among fatally and non-fatally injured pedalcycle and motorcycle riders and compared findings across three national public-use datasets. Methods Using the 2019 National Emergency Medical Services Information System (NEMSIS), the Fatality Analysis Reporting System (FARS), and National Electronic Injury Surveillance System (NEISS) datasets, we identified alcohol involvement in fatal and non-fatal injuries to pedalcycle and motorcycle riders (≥21 years). Alcohol involvement was positive based on the clinician’s evaluation of alcohol at the scene (NEMSIS) or within the ED record (NEISS); or when Blood Alcohol Content (BAC) values were ≥.01 (FARS). Pedalcycle and motorcycle injuries were identified across datasets using: 1) ICD10 codes for pedalcycle (V10-V19) or motorcycle (V20-V29) within the cause of injury and EMS respondent’s impression of the encounter variables (NEMSIS); 2) product codes for bicycles or moped/power-assisted cycle/minibike/two-wheeled, powered, off-road vehicles (NEISS); and 3) American National Standard Institute’s classifications for pedalcycle and motorcycle in the person and vehicle type variables (FARS). The descriptive epidemiology was compared across datasets. Results There were 26,295 pedalcyclist and 50,122 motorcycle rider injuries resulting in an EMS response within NEMSIS data; 10.2% and 8.5% of these injuries respectively involved alcohol. These estimates were greater than the 7.3% of pedalcyclist and 6.1% of moped/power-assisted cycle/minibike/two-wheeled, powered, off-road vehicle injuries involving alcohol among patients who presented to an ED within the NEISS dataset. Based on FARS data, alcohol was involved in 27.0% of pedalcyclist and 42.0% of motorcyclist fatal injuries. Regardless of the data source, pedalcyclist and motorcycle fatal and non-fatal injuries were more likely to involve alcohol among middle-aged adults compared to older and early aged adults, and for men compared to women, with proportions that were generally 3-8% higher for men. Conclusions Measures for pedalcycle and motorcycle injuries and alcohol involvement vary substantially across national public-use datasets. Standardized, valid, and feasible methods are needed to accurately inform injury prevention efforts.

Factors Associated With Head and Neck Polytrauma Presentation and Admissions at Emergency Departments of Varying Sizes.

Timely diagnosis of acute head and neck polytrauma presenting to emergency departments (EDs) optimizes outcomes. Since ED capacity influences triage and admission, the authors utilized the National Electronic Injury Surveillance System database to understand how ED size and trauma characteristics affect head and neck polytrauma presentation and admissions. Demographics and injury characteristics from the National Electronic Injury Surveillance System database from 2018 to 2021 were analyzed to delineate factors contributing to polytrauma presence and admission through multivariable logistic regressions. The authors' 207,951-patient cohort was primarily females (48.6%), non-Hispanic (62.4%), and white (51.4%) people who averaged 57.2 years old. Nonspecific head injuries were predominant (59.7%), followed by facial trauma (22.6%) with rare substance involvement (alcohol, 6.3%; drugs, 4.1%) presenting to high-volume EDs (48.5%). Of the patients, 20% were admitted, whereas 31.1% sustained polytrauma. Substance use [alcohol, odds ratio (OR) = 4.44; drugs, OR = 2.90] increased polytrauma likelihood; neck (OR = 1.35), face (OR = 1.14), and eye (OR = 1.26) associated with polytrauma more than head injuries. Burns (OR = 1.38) increased polytrauma likelihood more than internal organ injuries. Black patients sustained higher polytrauma when presented to non-small EDs (OR = 1.41-1.90) than white patients showed to small EDs. Admissions were higher for males (OR = 1.51). Relative to small EDs, large EDs demonstrated a higher increase in admissions (OR = 2.42). Neck traumas were more likely admitted than head traumas (OR = 1.71). Fractures (OR = 2.21) and burns (OR = 2.71) demonstrated an increased admission likelihood than internal organ injuries. Polytrauma presence and admissions likelihood are site, injury, and substance dependent. Understanding the impact of factors influencing polytrauma presence or admission will enhance triage to optimize outcomes.

Skiing Injuries in the US Pediatric Population: An Analysis of National Injury Trends and Mechanisms Between 2012 and 2022.

While prevention protocols have been implemented, skiing-related musculoskeletal injuries and concussions continue to present to emergency departments in the United States. Previous literature has suggested the pediatric population may constitute up to 40% of skiing-related injuries. To assess injury trends and the underlying mechanisms of skiing injuries in pediatric patients seen at emergency departments in the United States. Descriptive epidemiology study. The National Electronic Injury Surveillance System (NEISS) was queried for pediatric (age ≤18 years) skiing injuries between January 1, 2012, and December 31, 2022. Injury mechanism, location, disposition, and diagnosis were recorded, and the statistical sample weight assigned by NEISS by hospital was used to calculate national estimates (NEs). Injury trends were evaluated with linear regression analysis. Overall, 2951 pediatric skiing injuries were included (NE = 123,386). The mean age of the patients was 12.4 ± 3.5 years, with 61.3% of the injuries occurring in male patients. Impact with the ground was the most common injury mechanism (NE = 87,407; 70.8%). Fractures were the most common diagnosis (NE = 38,527, 31.2%), followed by strains/sprains (NE = 22,562, 18.3%), contusions/abrasions (NE = 16,257, 13.2%), and concussions (NE = 12,449, 10.1%). The lower leg was the most common fracture site (NE = 9509, 24.7%), followed by the shoulder (NE = 7131, 18.5%) and lower arm (NE = 5876, 15.3%). Analysis of annual injuries revealed no significant trend between 2012 and 2022 (P = .17), with fluctuations apparent throughout the study period. Significant decreases were seen in strains/sprains (P < .01) and contusions/abrasions (P < .01), but not in concussions (P = .57) or fractures (P = .70). Impacts with the snow/ground made up 70.8% of all injuries. Fractures were the most common injury diagnosis, followed by strains/sprains, with the lower leg being most frequently fractured. While strains/sprains and contusions/abrasions showed a significant decline, there were no significant trends in fractures and concussions between 2012 and 2022.

Pickleball-Related Fractures in the United States From 2002 to 2022: An Analysis Using the NEISS Database.

Pickleball is one of the fastest-growing sports in the United States, with more than an 11-fold increase in injuries from 2010 to 2019. To (1) determine the prevalence and demographic variables associated with pickleball-related fractures among patients evaluated at emergency departments in the United States between 2002 and 2022 and (2) identify variables influencing patient disposition status. Descriptive epidemiology study. The US Consumer Product Safety and Commission's publicly available database, the National Electronic Injury Surveillance System (NEISS), was used in this study. Analyses consisted of descriptive statistics for fracture prevalence and demographic variables as well as univariate analysis for disposition status (discharged home vs hospital admission). A total of 397 pickleball-related fractures were recorded between 2002 and 2022, which indicated a 90-fold increase in our study period. Based on weighted national average of NEISS sampling, this equated to approximately 5400 fractures annually. Players who sustained pickleball fractures were primarily aged >60 years (n = 344 [87%]; P < .001) and female (n = 273 [69%]; P < .001). Most fractures involved the upper extremity (n = 262 [66%]; P < .001), with the most common ones involving the radius (n = 79 [30%]), humerus (n = 22 [8%]), and ulna (n = 8 [3%]). Fractures were due most commonly to falls (n = 365 [92%]; P < .001) and occurred in the winter months (n = 142 [36%]; P < .001). There was a significant difference in disposition status, with most patients discharged (n = 320 [81%] vs n = 77 [19%] for hospital admission; P < .001). Univariate analysis revealed that age >60 years, male sex, and fractures to the trunk and lower extremity all led to significantly increased odds of being admitted (odds ratios: 2.27, 2.31, 2.89, and 13.8, respectively). Between 2002 and 2022, there was a 90-fold increase in pickleball-related fractures. Most fractures were of the upper extremity after a fall in women aged >60 years. Despite female fracture predominance, men were 2.3 times more likely to be admitted after sustaining a fracture.

Impact of modern recreational conveyances on rates of pediatric craniofacial fractures.

Trauma remains the leading cause of death for children over a year old. Motorized recreational conveyances (RCs) adds another potential cause of pediatric trauma. This study aims to determine the impact of adding electric motors to RCs on the severity and frequency of pediatric injuries and craniofacial fractures. Pediatric trauma information was obtained from the National Electronic Injury Surveillance System (NEISS) database between 2012 and 2021. Demographics, injury cause, diagnoses, and incident narrative were collected. Bivariate and multivariate regression analyses were used to determine injury factors associated with serious injuries. One million five hundred ninety-six thousand five hundred fifty-nine encounters were examined; 113,905 (7.1%) were related to pediatric RCs and 5354 (5.4%) of those involved RCs with electric motors. 14.3% of injuries were related to scooters, 18.6% to skateboards, 54.2% to bicycles, and 12.9% to other RCs. There were significant differences in age, sex, race, helmet use, serious injuries, and craniofacial fractures between RC modalities. RC users were more likely to develop facial fractures (OR 2.12; 95%CI 2.01, 2.23; p < .001) and be involved in serious injuries (OR 1.42; 95%CI 1.38, 1.46; p < .001). Compared to their self-propelled counterparts, motorized scooters (OR 2.24; 95%CI 1.86, 2.69; p < .001) but not motorized skateboards (OR 1.01; 95%CI 0.88, 1.17; p = 0.88) were more likely to cause serious injuries. Helmet use was associated with fewer serious injuries (OR 0.5; 95%CI 0.46, 0.54; p < .001), facial fractures (OR 0.48; 95%CI 0.41, 0.55; p < .001), and skull fractures (OR 0.13; 95%CI 0.09, 0.17; p < .001). The addition of electric motors to RCs significantly increases the risk of pediatric craniofacial fractures and serious injuries. 3.

Injuries from electronic cigarettes, and cigarette/cigar-related paraphernalia, NEISS, 2012-2022.

There is a need to determine the role of smoking/vaping related products in Emergency Department (ED) product-related injuries by age and sex to determine if interventions are warranted. These products include the combustible tobacco products' paraphernalia to light them (CTPP), electronic nicotine delivery systems (ENDS), and electronic non-nicotine delivery system (ENNDS). Data from the National Electronic Injury Surveillance System (NEISS), years 2012-2022, were examined for injury data associated with CTPP and ENDS/ENNDS. Bivariate comparisons were conducted. There were an estimated 3,142 (95%CI: 2,384-3,975) ED-treated ENDS/ENNDS product-related injuries and 46,116 (95%CI: 38,712-53,520) CTPP product-related injuries. Males were more likely to have an ED-treated ENDS/ENNDS product-related injury than females (proportion 0.93 [95%CI: 0.82, 0.98] versus 0.70 [95%CI: 0.02, 0.19]) as well as a CTPP product-related injury than females (proportion, 0.60 [95%CI: 0.56, 0.64] versus 0.40 [95%CI: 0.37, 0.44]). There were more ED-treated ENDS/ENNDS product-related injuries among persons ≥18 years than <18 years (proportion, 0.89 [95%CI: 0.75, 0.96] versus 0.11 [95% CI: 0.4, 0.35]). There were also more ED-treated CTPP product injuries among persons ≥ 18 years than <18 years (proportion, 0.73 [95%CI: 0.68, 0.78] versus 0.27 [95%CI: 0.22, 0.32]). No change in the proportion of injuries in our sample associated with END/ENNDS over time were observed. There is a need to consider injuries related to ENDS/ENNDS and CTPP product-related injuries in the discussion of the risks associated with smoking/vaping. Although ENDS/ENNDS have had fewer ED-treated injuries, the number of such injuries has remained stable, rather than declined over the previous decade. Injury prevention is a public health imperative and targeted interventions by healthcare providers during routine care, and the use of public service announcements could specifically target adults ≥18 years. Providing peer-to-peer educational programs, and initiating similar programs targeted at males who use CTP and ENDS/ENNDS have the potential to decrease injury risk.

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 Dislocations Presenting to Emergency Departments in the United States, 2007–2020

Context: Shoulder dislocations are the most commonly treated joint dislocation in the emergency department. Zacchilli and Owens previously reported on the epidemiology of shoulder dislocations presenting to the emergency department in the United States from 2002 to 2006. At the time of data collection and analysis, no epidemiological report had been published to update these findings. Purpose: The purpose of our study was to provide an updated epidemiological report from 2007 to 2020. Results: A total of 26,203 shoulder dislocations were recorded in the National Electronic Injury Surveillance System database from 2007 to 2020. The highest rates occurred in males (71.4%, n = 18,722) and patients aged 20–29 years old (28.2%, n = 7,292). The most common mechanism of injury was sports involvement (48.6%, n = 12,735). Interpretation: Our findings suggest that rates of shoulder dislocations have remained consistent with previous research on this topic, indicating no significant changes over the past 19 years. More effective prevention strategies are needed, especially for at-risk populations.

The Delayed Presentation and Diagnosis of Youth Wrestling Injuries: A 20-Year Analysis of National Injury Data.

The nature of wrestling may lead athletes to mask injuries with the delayed presentations of youth wrestling-related injuries not being well characterized. This descriptive epidemiological study queried the National Electronic Injury Surveillance System database to characterize delayed presentations of wrestling-related injuries in middle and high-school athletes. Data collection consisted of national estimates, demographics, and injury characteristics of patients with delayed (D) presentations (≥1 day) and same-day (S) presentations to US emergency departments after sustaining a wrestling-related injury during the scholastic wrestling season (December to February, 2000 to 2019). Of middle and high-school wrestlers presenting to US emergency departments, 5.6% (95% confidence interval [CI] 4.3% to 7.1%) reported delayed presentations for a total of 1,110 patients (CI, 591 to 1,630) annually. Most commonly (P < 0.001), injuries were sustained on Saturdays in both cohorts (D, 28.2%; CI, 22.4% to 34.8%; S, 29.6%; CI, 24.3% to 35.5%). Patients reporting delayed presentations were less likely to sustain fractures (D, 11.5%; CI, 8.3% to 15.6%; S, 18.9%; CI, 15.0% to 23.5%; P = 0.019) and injuries of the head/neck (D, 20.0%; CI, 16.5 to 24.1%; S, 26.2%; CI, 21.4% to 31.7%; P = 0.011). A substantial proportion of adolescent wrestlers report delayed presentations of injuries. This emphasizes the need for vigilance in detecting subtle signs of injury.

Modern Trends in Nasal Bone Fractures and the Effect of Social Distancing

Objectives: To assess differences in demographics, incidence, and cause of nasal bone fractures (NBFs) between pre–coronavirus disease 2019 (COVID-19) and COVID-19 eras. Methods: The National Electronic Injury Surveillance System was queried for adult NBF. Two sample t tests and Wald χ2 tests were used to identify changes across the 2012 to 2019 period and 2020 to 2021 period (age, sex, race, location, disposition, and product). Results: There was a total of 523,259 (95% CI: 445,082–601,436) emergency department (ED)–treated adult NBFs in the United States. There was a greater incidence of NBF during COVID-19 (61,621 annual cases; 95% CI: 61,572–61,669) compared with pre–COVID-19 (50,773 annual cases; 95% CI: 50,195–51,351; P &lt; 0.01). Fewer patients with NBF were discharged after ED evaluation during COVID-19 (79.46%; 95% CI: 74.45%–83.70%) compared with before (84.41%; 95% CI: 82.36%–86.28%; P = 0.049, t test). During COVID-19, there was a decrease in sport-associated NBFs, such as basketball [2.36% (95% CI: 1.71%–3.27%) versus 5.21% (95% CI: 4.20%–6.45%), P &lt; 0.01] and baseball [1.18% (95% CI: 0.82%–1.69%) versus 2.22% (95% CI: 1.80%–2.74%), P&lt;0.01], but an increase in fall (66.34% versus 75.02%), alcohol (7.04% versus 12.89%), and drug-associated (0.47% versus 5.70%) NBFs (all P &lt; 0.001). Conclusion: A greater incidence of NBFs has been observed since the start of the COVID-19 pandemic without significant changes in sex or race. Nasal bone fractures during COVID-19 were less likely to be related to sports or discharged from the ED and more likely to be associated with drugs and alcohol. Changes in sociobehavioral patterns during these unprecedented times may account for post–COVID-19 NBF etiologic drift. Level of Evidence: Level II—retrospective cohort study.

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.