United States Hospital Emergency Departments Research Articles

Epidemiologic trends in upper extremity burns treated in United States hospital emergency departments, 2013–2022

Epidemiologic trends in upper extremity burns treated in United States hospital emergency departments, 2013–2022

Characteristics of pepper spray-related injuries reported to the National Electronic Injury Surveillance System during 2000–2020

Introduction Exposure to pepper spray may result in adverse dermal, ocular, and inhalation effects. Furthermore, pepper spray, including the more potent bear spray, was used by both law enforcement and protesters in 2020 in the protests related to racial justice and COVID-19 pandemic restrictions. The objective of this study was to characterize pepper spray-related injuries treated at United States (US) emergency departments (EDs). Methods Data were obtained from the National Electronic Injury Surveillance System, a database of consumer product-related injuries collected from approximately 100 US hospital EDs. Pepper spray-related injuries reported during 2000–2020 were identified by reviewing all records that included the letter groups “pep” or “bear” in the Narrative field and “spray” in the Narrative field or Product code 1619 in the Product_1, Product_2, or Product_3 fields. Results A total of 1112 pepper spray-related injuries were identified, resulting in a national estimate of 34,582 pepper spray-related injuries, of which 43.4% were reported during 2014–2020. Of the estimated exposures, the age distribution was 14.5% 0–5 years, 18.5% 6–12 years, 18.2% 13–19 years, 19.6% 20–29 years, 11.8% 30–39 years, 9.1% 40–49 years, and 8.3% 50 years or older; 55.9% of the patients were male. The exposure route was 52.0% ocular, 25.7% dermal, 13.6% inhalation, 2.9% ingestion/oral, and 14.1% unknown. Conclusions Patients with pepper spray-related injuries tended to be older children and young adults, and the majority of patients were male. The route of exposure of most of the injuries was ocular.

Fun ride or risky transport: Golf cart-related injuries treated in U.S. emergency departments from 2007 through 2017

Introduction: Golf cart-related injuries constitute a substantial source of morbidity, most notably in pediatric populations. Despite the high rate of injuries, there have been no meaningful changes in golf cart design or legislation to reduce the overall burden of these injuries. This study sought to characterize the epidemiology of golf cart-related injuries treated in United States hospital emergency departments. Method: A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System for patients of all ages who were treated in emergency departments (EDs) (2007–2017) for a golf cart-related injury. Results: From 2007 through 2017, an estimated 156,040 (95% CI = 102,402–209,679) patients were treated in U.S. EDs for golf cart-related injuries. The average rate of traumatic brain injuries (TBIs) in children (1.62 per 100,000 children) was more than three times that of TBIs in adults (0.52 per 100,000 adults; rate ratio = 2.38; 95% CI = 2.36–2.41) and nearly twice that of TBIs in seniors (1.11 per 100,000 seniors; rate ratio = 1.21; 95% CI = 1.19–1.22). The rate of injuries in seniors increased significantly by 67.6% from 4.81 per 100,000 seniors in 2007 to 8.06 per 100,000 seniors in 2017 (slope = 0.096; p = 0.041). Conclusions: Golf cart use remains an important source of injury for people of all ages, especially in children. As use continues to increase, it is unlikely that golf cart-related injuries will decrease without substantial changes to product design, regulation, and/or legislation. Practical Applications: Use of golf carts pose a considerable risk of injury and morbidity; safety recommendations should be followed.

Characteristics of ocular nail glue exposures reported to the National Electronic Injury Surveillance System during 2000–2019

Introduction Nail glue often consists of a mixture of alcohol, cyanoacrylate, or photo-bonded methacrylate. Ocular exposures to nail glue may result in potentially serious clinical effects, and patients may be treated at healthcare facilities. The objective of this study was to characterize ocular nail glue exposures treated at United States emergency departments. Methods Data were obtained from the National Electronic Injury Surveillance System, a database of consumer product-related injuries collected from approximately 100 United States hospital emergency departments. Ocular nail glue exposures reported during 2000–2019 were identified by reviewing all records with product code 0909 (Adhesives) and with “nail” and “glue” or “nail” and “adhesive” in the Narrative field. Results A total of 498 ocular nail glue exposures were identified, resulting in a national estimate of 18,402 exposures. Of the estimated exposures, the age distribution was 14.1% 0–5 years, 15.1% 6–12 years, 14.3% 13–19 years, and 56.6% 20 years or older; 87.5% of the patients were female. The nail glue was mistaken for eye drops in 20.8% of the cases, splashed into the eye in 15.0% cases, and rubbed into the eye in 3.3% cases. The most commonly reported clinical effects were 41.8% foreign body, 33.8% corneal abrasion, and 11.0% conjunctivitis. Conclusion The most common circumstance leading to ocular nail glue exposures treated at United States emergency departments involved nail glue being mistaken for eye drops. The most frequently reported clinical effects were the presence of a foreign body, corneal abrasion, and conjunctivitis.

49,000 Avocado Cutting Injuries.

Objectives: In the United States (US), avocado consumption has increased dramatically since the year 2000. Despite media attention concerning injuries resulting from cutting or pitting avocados, such injuries have not been monitored systematically. The current study is the first to estimate the number of people with avocado cutting injuries presenting to US hospital emergency departments. Methods: We utilized cross-sectional data from the US Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS). We used keyword searches of case narrative text to identify avocado cutting and pitting injuries from 2000 to 2017. Sampling weights were applied to generate national estimates of avocado cutting injuries. Results: From 2000 to 2017, there were an estimated 49,331 avocado cutting injuries presenting to US emergency departments (95% CI 34,178-64,483). The increase in these injuries appears to coincide with increases in per capita avocado consumption. Avocado cutting injuries now constitute nearly 2% of knife-related injuries presenting to US hospital emergency departments. Conclusions: Due to the increase in avocado cutting injuries and the severity of these injuries, more systematic surveillance is needed as well as improved safety measures.

National estimates of poisoning events related to liquid nicotine in young children treated in US hospital emergency departments, 2013\u20132017

BackgroundAn estimated 2 million youth (in 2017) and 7.9 million adults (in 2015) reported currently using electronic nicotine delivery systems (ENDS). Reports of poisoning events related to liquid nicotine (e-liquids) in ENDS have been on the rise, but current, nationally-representative estimates of hospital-treated poisoning cases related to e-liquid nicotine exposure in the United States (US) are lacking.FindingsWe used National Electronic Injury Surveillance System (NEISS) data from 2013 to 2017 to calculate national estimates with 95% confidence intervals (CIs) of poisoning incidents related to e-liquid nicotine exposure. From 2013 to 2017, an estimated 4745 poisoning cases related to e-liquids among children under age five were treated in US hospital emergency departments; the number of cases increased from 181 (95% CI: 0–369) in 2013 to 1736 (95% CI, 871–2602) in 2015 and then decreased to 411 (95% CI, 84–738) in 2017. Most of the cases were treated and released; 4.1% were admitted to the hospital. The most common route of exposure was through ingestion (96.9%), and 2.6% of the cases were through dermal exposure. The highest amounts of e-liquids or nicotine ingested were 118.2mL, 1 bottle, and 100 mg, and the most common symptoms (63.6%) related to nicotine poisoning were nausea and vomiting.ConclusionsThis study provides national estimates of poisoning cases associated with nicotine exposure from e-liquids among children under age five. Findings on e-liquid volume or nicotine dose, when available, provide important insights into exposures associated with toxicity in children. Since NEISS data do not include product codes specific to ENDS or provide information on poisoning severity, we used general keywords to capture these events, which might underestimate the population burden. Information from this study may complement efforts, such as public education, to prevent unintended exposure to nicotine in e-liquids among children.

National Estimates of Noncanine Bite and Sting Injuries Treated in United States Hospital Emergency Departments, 2001–2010: Langley R, Mack K, Haileyesus T, Proescholdbell S, Annest JL. Wilderness Environ Med 2014;25:14–23.

National Estimates of Noncanine Bite and Sting Injuries Treated in United States Hospital Emergency Departments, 2001–2010: Langley R, Mack K, Haileyesus T, Proescholdbell S, Annest JL. Wilderness Environ Med 2014;25:14–23.

Carbon Monoxide Exposure Associated with High-risk Features and Intentional Exposure are Infrequently Treated with Hyperbaric Oxygen

Data is conflicting regarding the management of carbon monoxide (CO) poisoned patients. Objective: To determine the emergency department management (ED) of intentional CO poisoned patients regarding hyperbaric oxygen therapy (HBO2), compared to those who are unintentionally exposed. Methodology Design: A multi-center retrospective emergency department cohort study. Population: Consecutive patients presenting to 23 Northeastern United States hospital emergency departments, comprising academic, non-academic, urban, suburban, and rural hospitals with the International Classification of Disease primary diagnosis of “toxic effects CO”. Patients were “a priori” divided into intentional/unintentional and “high-risk” (syncope, serum carboxyhemoglobin level ≥ 20%, change in mental status, cardiac arrest, and/or seizures) or “low-risk” (without the above). Results: “Toxic effects of CO” was diagnosed in 1136 patients, 1026 charts were available for analysis and 52 (4.8%) met inclusion criteria as intentional.Mean age was 40 years (standard deviation (SD) ± 13), for intentional patients. Overall, high risk intoxication was reported in 12% (N = 124/1026) of patients, compared to 50% (N= 26/52) of the intentional patients (p ≤ 0.0001). Mean overall CO level was 7%, compared to an intentional rate of 17% (p ≤ 0.0001). Fifty percent of intentionally exposed high-risk patients received HBO2, while only 36% (N = 45/124) of high-risk patients overall did (p = 0.27). Conclusions: Carbon monoxide poisoned patients with intentional exposures and high-risk clinical features are not more likely to receive HBO2.

Television-Related Injuries to Children in the United States, 1990–2011

To investigate the epidemiology of television (TV)-related injuries to children in the United States. Using data from the National Electronic Injury Surveillance System, children aged <18 years treated in United States hospital emergency departments for an injury associated with a TV from 1990 through 2011 were investigated. An estimated 380,885 patients aged <18 years were treated in emergency departments for a TV-related injury during the 22-year study period, which equals an annual average of 17,313 children. The median age of patients was 3 years; children <5 years represented 64.3% of patients, and boys comprised 60.8%. The average annual injury rate was 2.43 (95% confidence interval [CI]: 2.07-2.80) injuries per 10,000 children aged <18 years, with a range of 2.15 (95% CI: 1.64-2.66) to 2.90 (95% CI: 2.31-3.49). Although the overall injury rate was steady, the number and rate of injuries associated with falling TVs increased significantly by 125.5% and 95.3%, respectively, during the study period. In addition, there was a significant 344.1% increase in the number of injuries associated with a TV falling from a dresser/bureau/chest of drawers/armoire during 1995-2011. The rate of pediatric injuries caused by falling TVs is increasing, which underscores the need for increased prevention efforts. Prevention strategies include public education, provision of TV anchoring devices at the point of sale of TVs, TV anchoring device distribution programs, strengthening of standards for TV stability, and redesign of TVs to improve stability.

Epidemiology of infant ocular and periocular injuries from consumer products in the United States, 2001-2008

To quantify and characterize eye injuries related to consumer products in the infant population (0-12 months) treated in United States hospital emergency departments during the period from 2001 to 2008. This study is a descriptive analysis of consumer-product related eye injury data derived from the National Electronic Injury Surveillance System, a probability sample of 100 hospitals nationwide with 24-hour emergency departments. Narrative data were used to assign each case with the consumer products (CPs) causing the eye injury. The proportions of eye injury visits were calculated by age, sex, diagnosis, disposition, locale of incident, and CP categories. We examined the US Consumer Product Safety Commission National Electronic Injury Surveillance System data for all nonfatal eye injuries (853 cases) in the infant population (0-12 months) treated in US emergency departments from 2001 to 2008. These data can be used to project national, annual, weighted estimates of nonfatal injury treated in US emergency departments. There were an estimated 21,271 visits to US emergency departments by patients aged 0-12 months for CP-related eye injuries during the study period. Of these, 63% involved infants aged 9-12 months and 54% involved male patients; 78% of all injuries occurred at home. The CPs causing the most eye injuries belonged to the categories of chemical (46%) and household items (24%). Contusions and abrasions were the leading eye injuries diagnoses (37%). This study suggests that most CP-related infant eye injuries in the United States occur at home and are predominantly caused by chemicals and household products.

Aerosol Container-Related Eye Injuries in the United States: 1997–2009

To quantify and characterize eye injuries related to aerosol container consumer products treated in United States hospital emergency departments (EDs) from 1997 through 2009. Retrospective study. Descriptive analysis of aerosol container-related eye injury data derived from the National Electronic Injury Surveillance System, a stratified probability sample of hospital-affiliated United States EDs. Data collected included demographic variables (gender and age), locale, diagnoses, and hospital disposition associated with aerosol container-related eye injuries treated in United States EDs from 1997 through 2009. Products associated with injury and mechanisms of injury also were extracted and analyzed. There were an estimated 10 765 (95% confidence interval [CI], 9842 to 11 688) visits to United States EDs for aerosol container-related eye injuries during the study period; 6756 (95% CI, 5771 to 7742; 63%) patients were male; 5927 (95% CI, 4956 to 6897; 55%) injuries occurred in children (age < 18 years). The most common product was spray paint, accounting for 2048 (95% CI, 1402 to 2694; 19%) injuries. The most common mechanism of injury was self-inflicted spray to the eye, occurring in 4649 (95% CI, 3746 to 5552; 43%) cases. The most common diagnosis was dermatitis or conjunctivitis, occurring in 3880 (95% CI, 2995 to 4765; 36%) cases. This study suggests that most aerosol container-related eye injuries in the United States occur in men and children and that self-inflicted spray to the eye is the most common mechanism of injury. Further research is needed to devise effective prevention strategies for these types of injuries.

Play at Your Own Risk: Sport and the Injury Epidemic

Each year, more than 30 million children and adolescents participate in organized sports in the United States (US), and more than 4.3 million nonfatal sports- and recreation-related injuries are treated in US hospital emergency departments. Two types of activity-related injuries, in particular, that we study in the Bone and Joint Injury Prevention and Rehabilitation Center at the University of Michigan are anterior cruciate ligament (ACL) injuries and head injury and concussion. Knee ACL injuries are occurring in epidemic-like proportions. In the US alone there are approximately 200,000 new ACL injuries at a total cost of over $1 billion per year. ACL-injured patients are at a significant risk of developing early onset osteoarthritis. Exacerbating the concern is the increase in ACL injury rates in youth and adolescents; particularly girls can experience ACL injury rates from two to five times greater than boys in the same sport. In addition, 3.8 million sports- and recreation-related concussions occur in the US each year. Significantly more research is needed, but intriguing findings are surfacing. For example, high school athletes’ recovery times for a concussion are longer than college athletes’ recovery times. Moreover, high school athletes who sustain a concussion are 3 times more likely to sustain a second concussion. Preliminary studies state suggest women have a higher risk for head injury and post concussion syndrome due to potentially weaker neck muscles, different muscle activation patterns, and hormone variations. Three key questions must be answered to understand these and other sports-related injuries: 1) What is the magnitude of the epidemic? 2) What are the causes of injury? and 3) What can we do to prevent injuries? Without a greater awareness of the injury risk and a better understanding of the injury mechanisms, the risk of sport-related injuries may escalate in the coming years. Participation in sport can be beneficial for adults and children to promote exercise and healthy lifestyles. The benefits of exercise include decreasing the incidence of cardiovascular disease, obesity, osteoporosis, and diabetes and fostering a healthy image for children and youth. Although exercise and physical activity can have major benefits, some disadvantages do exist, including the

Unintentional Child Poisonings Treated in United States Hospital Emergency Departments: National Estimates of Incident Cases, Population-Based Poisoning Rates, and Product Involvement: Franklin RL, Rodgers G. Pediatrics 2008;122:1244–51

This study from the United States (US) Consumer Product Safety Commission evaluated unintentional poisoning rates by consumer products among children < 5 years of age who were treated at hospital emergency departments (EDs). From a sample of approximately 2% of US hospitals, all of whom report to the National Electronic Injury Surveillance System, the authors estimated the nationwide incidences of poisoning in this age group. A total of 3145 reports were made to the system over a 1-year period. This represented more than 86,000 poisoned children treated in EDs or an estimated 429.4 injuries per 100,000 children < 5 years old.

Unintentional Child Poisonings Treated in United States Hospital Emergency Departments: National Estimates of Incident Cases, Population-Based Poisoning Rates, and Product Involvement

The goals were to develop national estimates of unintentional child poisoning cases treated in US hospital emergency departments, to determine population-based poisoning rates, and to evaluate characteristics of the victims and the products involved. Cases reported through the US Consumer Product Safety Commission National Electronic Injury Surveillance System, involving a national probability sample of US hospital emergency departments, were used as a basis for developing national estimates of product-related poisonings involving children<5 years of age treated in US hospital emergency departments in 2004. There were an estimated 86194 child poisoning incidents treated in US hospital emergency departments in 2004, amounting to 429.4 poisonings per 100000 children. Approximately 70% of the poisonings involved children 1 or 2 years of age, slightly more than one half involved boys, and 13.3% resulted in hospital admission. Approximately 59.5% of the poisonings involved oral prescription drugs, oral nonprescription drugs, or supplements. Other major product categories resulting in poisonings included cleaning products (13.2%), drugs and ointment preparations intended for external use (4.9%), and personal care products (4.7%). Approximately 54.7% of the poisonings involved products already subject to child-resistant packaging requirements under the Poison Prevention Packaging Act. Despite advances in recent years, unintentional child poisonings remain an important public health concern. The circumstances surrounding poisonings need to be evaluated further, and intervention strategies need to be developed.