Trimming- and pruning-related injuries in the United States, 1990 to 2007.

BACKGROUND: Trimming and pruning equipment is used frequently in the United States, and associated injuries are common. METHODS: The National Electronic Injury Surveillance System database was used to examine trimming- and pruning-related injuries treated in US hospital emergency departments from 1990 through 2007. RESULTS: An estimated 648,100 individuals (95% confidence interval: 535,500-760,700) were treated in US hospital emergency departments for trimming- and pruning-related injuries during the 18-year study period. The average annual injury rate was 13.0 per 100,000 US population, and the annual rate of injury increased 35.1% from 11.4 in 1990 to 15.4 in 2007 (slope = 0.241, p < 0.01). Approximately two-thirds (67.6%) of the injuries occurred among males, and 62.8% of incidents occurred to individuals 18 years to 54 years of age. Lacerations and puncture injuries occurred most often (71.0%), and injuries to the arms and hands accounted for 67.8% of cases. A majority (56.8%) of injuries involved the use of a power tool. The most common project at the time of injury was hedge/shrub trimming (66.5%), followed by grass/lawn trimming (24.3%) and tree trimming (9.1%). Patients required hospitalization in 2.1% of cases. Most injury incidents (98.5%) occurred around the home. CONCLUSIONS: This is the first study to examine trimming- and pruning-related injuries in the United States using a nationally representative sample. The increasing number and rate of injuries associated with trimming activities in the United States underscore the need for increased prevention efforts, including enhanced safety features of trimming equipment and better education of equipment operators regarding the potential hazards of trimming activities.

Pediatric submersion events in portable above-ground pools in the United States, 2001-2009.

OBJECTIVE: The goal of this study was to describe the epidemiology of pediatric submersion events occurring in portable pools in the United States. METHODS: A retrospective analysis of fatal and nonfatal submersion events involving children younger than 12 years in portable pools was conducted using injury and fatality data compiled by the US Consumer Product Safety Commission from 2001 through 2009. RESULTS: There were 209 fatal and 35 nonfatal submersion cases reported to the commission from 2001 through 2009. The majority (94%) involved children younger than 5 years, 56% involved boys, 73% occurred in the child's own yard, and 81% occurred during the summer months. The number of submersion events increased rapidly from 2001 to 2005 and then leveled off from 2005 to 2009. CONCLUSIONS: The use of portable pools in residential settings poses a significant risk of submersion-related morbidity and mortality to children, especially in the <5-year-old age group. No single strategy will prevent all submersion deaths and injuries; therefore, layers of protection are recommended. Industry is advised to engage in development of protective devices that are effective and affordable for portable pools, including isolation fencing, pool alarms, and safety covers. A strong and pervasive consumer education campaign is needed to make consumers aware of the dangers of portable pools, because these small, inexpensive, consumer-installed pools may not generate the same sense of risk as an in-ground pool.

Pediatric volleyball-related injuries treated in US emergency departments, 1990-2009.

This study describes the epidemiology of pediatric volleyball-related injuries treated in US hospital emergency departments. Data for children younger than 18 years obtained from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission from 1990 through 2009 were analyzed. An estimated 692 024 volleyball-related injuries to children younger than 18 years occurred during the study period. The annual number of injuries declined significantly by 23% during the study period; however, the annual injury rate remained unchanged, and the number of volleyball-related concussions/closed head injuries increased significantly. Upper (48%) and lower (39%) extremity injuries occurred most frequently, as did strains/sprains (54%). Contact with the net/pole was associated with concussions/closed head injury our findings indicate opportunities for making volleyball an even safer sport for children. Protective padding, complying with US volleyball standards, should cover all volleyball poles and protruding hardware to prevent impact-related injuries.

Epidemiology of strain/sprain injuries among cheerleaders in the United States.

OBJECTIVE: The aim of this study is to describe the epidemiology of cheerleading-related strain/sprain injuries by type of cheerleading team and type of event. METHODS: Athlete exposure (AE) and injury data were collected from 412 United States cheerleading teams via the Cheerleading Reporting Information Online surveillance tool, and injury rates were calculated. RESULTS: Strains/Sprains were the most common injury (53%; 0.5 injuries per 1000 AEs) sustained by cheerleaders during our 1-year study. The lower extremities (42%), particularly the ankles (28%), were injured most often. Most injuries occurred during practice (82%); however, the rate of injury was higher during competition (0.8 injuries per 1000 AEs; 95% confidence interval [CI], 0.6-1.0) than during practice (0.6 injuries per 1000 AEs; 95% CI, 0.5-0.6) for all team types. Injuries were sustained most frequently by high school cheerleaders (51%), although college cheerleaders had the highest injury rate (1.2 injuries per 1000 AEs). Strains/Sprains occurred most frequently while attempting a stunt (34%) or while tumbling (32%). Spotting/Basing other cheerleaders (19%) was the most common mechanism of injury and was more likely to result in a lower back strain/sprain than other mechanisms of injury (odds ratio, 3.38; 95% CI, 1.41-8.09; P < .01). CONCLUSIONS: Cheerleaders should increase their focus on conditioning and strength-building training, which may help to prevent strain/sprain injuries. Spotters and bases should additionally focus on proper lifting technique to help avoid back injury. Guidelines may need to be developed for return-to-play after cheerleading-related strain/sprain injuries.

Nonoccupational table saw-related injuries treated in US emergency departments, 1990-2007.

BACKGROUND: Table saws are associated with more injuries than any other type of woodworking tool. There are no published national epidemiologic studies of table saw-related injuries. METHODS: A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, 1990 to 2007. Sample weights provided by the National Electronic Injury Surveillance System were used in all analyses to adjust for the inverse probability of case selection and make national projections regarding table saw-related injuries. RESULTS: An estimated 565,670 (95% confidence interval [CI]: 473,442-657,898) table saw-related injuries were treated in US Emergency Departments from 1990 to 2007. Children (younger than 18 years) were more likely to be injured at school (p < 0.01; relative risk = 68.79; 95% CI: 46.58-101.61), whereas adults were more likely to be injured at home (p < 0.01; relative risk = 2.05; 95% CI: 1.82-2.32). Fingers/thumbs were injured most often (86%; 486,181 of 565,670) and lacerations were the most common type of injury (66%; 373,319 of 565,360). Amputations were associated with 10% (56,848 of 565,360) of the injuries, and most of the amputations involved the finger/thumb (56,817 of 56,848). Eight percent (47,916 of 565,458) of patients were hospitalized. CONCLUSIONS: Most table saw-related injuries result from contact with the saw blade. Passive injury prevention strategies focusing on preventing finger/thumb/hand contact with the blade need to be implemented.

Snow shovel-related injuries and medical emergencies treated in US EDs, 1990 to 2006.

BACKGROUND: Injuries and medical emergencies associated with snow shovel use are common in the United States. METHODS: This is a retrospective analysis of data from the National Electronic Injury Surveillance System. This study analyzes the epidemiologic features of snow shovel-related injuries and medical emergencies treated in US emergency departments (EDs) from 1990 to 2006. RESULTS: An estimated 195 100 individuals (95% confidence interval, 140 400-249 800) were treated in US EDs for snow shovel-related incidents during the 17-year study period, averaging 11 500 individuals annually (SD, 5300). The average annual rate of snow shovel-related injuries and medical emergencies was 4.15 per 100 000 population. Approximately two thirds (67.5%) of these incidents occurred among males. Children younger than 18 years comprised 15.3% of the cases, whereas older adults (55 years and older) accounted for 21.8%. The most common diagnosis was soft tissue injury (54.7%). Injuries to the lower back accounted for 34.3% of the cases. The most common mechanism of injury/nature of medical emergency was acute musculoskeletal exertion (53.9%) followed by slips and falls (20.0%) and being struck by a snow shovel (15.0%). Cardiac-related ED visits accounted for 6.7% of the cases, including all of the 1647 deaths in the study. Patients required hospitalization in 5.8% of the cases. Most snow shovel-related incidents (95.6%) occurred in and around the home. CONCLUSIONS: This is the first study to comprehensively examine snow shovel-related injuries and medical emergencies in the United States using a nationally representative sample. There are an estimated 11 500 snow shovel-related injuries and medical emergencies treated annually in US EDs.

Epidemiology of balcony fall-related injuries, United States, 1990-2006.

BACKGROUND: Falls from heights are common in urban areas in the United States. This study describes the epidemiology of balcony fall-related injuries requiring emergency department (ED) treatment among children and adults in the United States from 1990 through 2006. METHODS: In 2009, a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission was conducted to describe the epidemiology of balcony fall-related injuries. RESULTS: An estimated 86,500 (95% confidence interval [CI], 68,400-104,600) balcony fall-related injuries were treated in US hospital EDs from 1990 through 2006; 70% of cases were male; 63% were adults (≥18 years old); 94% of injury events occurred at home; 24% of patients were hospitalized; and 8 patients died. The rate of balcony fall-related injuries among children decreased significantly during 1990 to 2006 and was similar to that of adults by the end of the study period. Fall heights ranged from 5 to 87.5 ft. Structural failure of the balcony was involved in an estimated 5600 cases. Patients younger than 18 years were more likely to sustain a concussion/closed head injury (relative risk, 2.42; 95% CI, 1.84-3.18) or skull fracture (relative risk, 5.86; 95% CI, 2.58-13.30) than adults. CONCLUSIONS: This is the first study of balcony fall-related injuries requiring emergency treatment using a nationally representative sample. Balcony falls are an important cause of injury in the United States. Age, male sex, and warm months of the year were associated with balcony fall-related injuries in our study population.

Pediatric pedestrian injuries and associated hospital resource utilization in the United States, 2003.

BACKGROUND: The objective was to calculate national estimates of pedestrian-related hospitalizations and associated use of healthcare resources among children or=16. A traffic-related event was the cause of 92.7% of hospitalizations. Older age, higher injury severity, urban and Western hospital location, children's hospital type, and longer LOS were significantly associated with higher total hospital charges. Older age and higher injury severity were significantly associated with longer LOS. CONCLUSION: Pediatric pedestrian injuries contribute substantially to the healthcare resource burden in the United States, accounting for approximately 45,000 days of hospitalization and >USD 290 million in inpatient charges annually.

Epidemiology of cheerleading stunt-related injuries in the United States.

CONTEXT: Cheerleading-related injuries are on the rise. To date, no epidemiologic studies of cheerleading stunt-related injuries have been published. OBJECTIVE: To describe and compare cheerleading stunt-related injuries by type of cheerleading team (All Star, college, high school, middle school, or recreation league) and event (practice, pep rally, athletic event, or cheerleading competition). DESIGN: Prospective injury surveillance study. SETTING: Participant exposure and injury data were collected from US cheerleading teams via the Cheerleading RIO (Reporting Information Online) surveillance tool. PATIENTS OR OTHER PARTICIPANTS: Athletes from enrolled cheerleading teams who participated in official, organized cheerleading practices, pep rallies, athletic events, or cheerleading competitions. MAIN OUTCOME MEASURE(S): The numbers, types, and rates of cheerleading stunt-related injuries during a 1-year period (2006-2007) are reported. RESULTS: Stunt-related injuries accounted for 60% (338/567) of the injuries sustained by US cheerleaders who participated in the study and 96% (22/23) of the concussions and closed head injuries (CHIs) reported during the study. Collegiate cheerleaders were more likely to sustain a concussion or CHI than were cheerleaders on other types of teams (P = .02, odds ratio = 3.10, 95% confidence interval = 1.20, 8.06). Most injuries occurred while the cheerleader was spotting or basing another cheerleader (34%, 115/338), and these injuries comprised 32% (51/161) of all stunt-related strains and sprains. Four cheerleaders (1.2%, 4/335) were admitted to the hospital, and 9 cheerleaders (2.7%, 9/335) required surgery. CONCLUSIONS: Cheerleading stunts pose an increased risk for injury, especially in terms of sustaining a concussion or CHI. Spotters and bases were most likely to be injured during the performance of cheerleading stunts and were at risk for sustaining strain and sprain injuries. The ankle, lower back, and wrist were the sites most likely to be reinjured while performing cheerleading stunts.

Epidemiology of cheerleading fall-related injuries in the United States.

CONTEXT: Over the past several decades, cheerleaders have been performing fewer basic maneuvers and more gymnastic tumbling runs and stunts. As the difficulty of these maneuvers has increased, cheerleading injuries have also increased. OBJECTIVE: To describe the epidemiology of cheerleading fall-related injuries by type of cheerleading team and event. DESIGN: Prospective injury surveillance study. SETTING: Participant exposure and injury data were collected from US cheerleading teams via the Cheerleading RIO (Reporting Information Online) surveillance tool. PATIENTS OR OTHER PARTICIPANTS: Athletes from 412 enrolled cheerleading teams who participated in official, organized cheerleading practices, pep rallies, athletic events, or cheerleading competitions. MAIN OUTCOME MEASURE(S): The numbers and rates of cheerleading fall-related injuries during a 1-year period (2006-2007) are reported. RESULTS: A total of 79 fall-related injuries were reported during the 1-year period. Most occurred during practice (85%, 67/79) and were sustained by high school cheerleaders (51%, 40/79). A stunt or pyramid was being attempted in 89% (70/79) of cases. Fall heights ranged from 1 to 11 ft (0.30-3.35 m) (mean = 4.7 + or - 2.0 ft [1.43 + or - 0.61 m]). Strains and sprains were the most common injuries (54%, 43/79), and 6% (5/79) of the injuries were concussions or closed head injuries. Of the 15 most serious injuries (concussions or closed head injuries, dislocations, fractures, and anterior cruciate ligament tears), 87% (13/15) were sustained while the cheerleader was performing on artificial turf, grass, a traditional foam floor, or a wood floor. The fall height ranged from 4 to 11 ft (1.22-1.52 m) for 87% of these cases (13/15). CONCLUSIONS: Cheerleading-related falls may result in severe injuries and even death, although we report no deaths in the present study. The risk for serious injury increases as fall height increases or as the impact-absorbing capacity of the surfacing material decreases (or both).

Cheerleading-related injuries in the United States: a prospective surveillance study.

CONTEXT: Cheerleading injuries are on the rise and are a significant source of injury to females. No published studies have described the epidemiology of cheerleading injuries by type of cheerleading team and event. OBJECTIVE: To describe the epidemiology of cheerleading injuries and to calculate injury rates by type of cheerleading team and event. DESIGN: Prospective injury surveillance study. SETTING: Participant exposure and injury data were collected from US cheerleading teams via the Cheerleading RIO (Reporting Information Online) online surveillance tool. PATIENTS OR OTHER PARTICIPANTS: Athletes from enrolled cheerleading teams who participated in official, organized cheerleading practices, pep rallies, athletic events, or cheerleading competitions. MAIN OUTCOME MEASURE(S): The numbers and rates of cheerleading injuries during a 1-year period (2006-2007) are reported by team type and event type. RESULTS: A cohort of 9022 cheerleaders on 412 US cheerleading teams participated in the study. During the 1-year period, 567 cheerleading injuries were reported; 83% (467/565) occurred during practice, 52% (296/565) occurred while the cheerleader was attempting a stunt, and 24% (132/563) occurred while the cheerleader was basing or spotting 1 or more cheerleaders. Lower extremity injuries (30%, 168/565) and strains and sprains (53%, 302/565) were most common. Collegiate cheerleaders were more likely to sustain a concussion (P = .01, rate ratio [RR] = 2.98, 95% confidence interval [CI] = 1.34, 6.59), and All Star cheerleaders were more likely to sustain a fracture or dislocation (P = .01, RR = 1.76, 95% CI = 1.16, 2.66) than were cheerleaders on other types of teams. Overall injury rates for practices, pep rallies, athletic events, and cheerleading competitions were 1.0, 0.6, 0.6, and 1.4 injuries per 1000 athlete-exposures, respectively. CONCLUSIONS: We are the first to report cheerleading injury rates based on actual exposure data by type of team and event. These injury rates are lower than those reported for other high school and collegiate sports; however, many cheerleading injuries are preventable.

The potential for brain injury on selected surfaces used by cheerleaders.

CONTEXT: Although playground surfaces have been investigated for fall impact attenuation, the surfaces that cheerleaders use have received little attention. OBJECTIVE: To determine (1) the critical height for selected surfaces used by cheerleaders at or below which a serious head impact injury from a fall is unlikely to occur, (2) the critical heights for non-impact-absorbing surfaces for comparison purposes, and (3) the effect of soil moisture and grass height on g(max) (which is defined as the multiple of g [acceleration due to gravity at the earth's surface at sea level: ie, 32.2 feet x s(-1) x s(-1)] that represents the maximum deceleration experienced during an impact) and the Head Injury Criterion (HIC) at the critical height for a dry grass surface. DESIGN: Observational study. SETTINGS: A local cheerleading gym, indoor locations within the authors' institution, and various outdoor locations. MAIN OUTCOME MEASURE(S): g(max), HIC, and critical height. RESULTS: Critical heights for the surfaces tested ranged from 0.5 ft (0.15 m) for concrete and vinyl tile installed over concrete to more than 11 ft (3.35 m) for a spring floor. Increases in grass height and soil moisture resulted in an increase in the critical height for grass surfaces. Only spring floors and 4-in (0.10-m)-thick landing mats placed on traditional foam floors had critical heights greater than 10.5 ft (3.20 m), thus providing enough impact-absorbing capacity for performance of 2-level stunts. CONCLUSIONS: The potential for serious head impact injuries can be minimized by increasing the shock-absorbing capacity of the surface, decreasing the height from which the person falls, or both. Cheerleaders and cheerleading coaches should use the critical heights reported in this study to compare the relative impact-absorbing capacities of the various surfaces tested, with critical height as an indicator of the impact-absorption capacity of the surface. The findings of this study can be used to select the most appropriate surface for the type of maneuver to be performed, based on the maximum height expected to be achieved by the cheerleader(s) during execution of the maneuver. Cheerleaders should not perform maneuvers at heights that exceed the critical height for the surface on which they are performing.

Consumer products and activities associated with dental injuries to children treated in United States emergency departments, 1990-2003.

OBJECTIVE: Describe the association of consumer products and activities with dental injuries among children 0-17 years of age treated in United States emergency departments. DESIGN: A retrospective analysis of data from the National Electronic Injury Surveillance System, 1990-2003. RESULTS: There was an average of 22 000 dental injuries annually among children <18 years of age during the study period, representing an average annual rate of 31.6 dental injuries per 100 000 population. Children with primary dentition (<7 years) sustained over half of the dental injuries recorded, and products/activities associated with home structures/furniture were the leading contributors. Floors, steps, tables, and beds were the consumer products within the home most associated with dental injuries. Outdoor recreational products/activities were associated with the largest number of dental injuries among children with mixed dentition (7-12 years); almost half of these were associated with the bicycle, which was the consumer product associated with the largest number of dental injuries. Among children with permanent teeth (13- to 17-year olds), sports-related products/activities were associated with the highest number of dental injuries. Of all sports, baseball and basketball were associated with the largest number of dental injuries. CONCLUSION: To our knowledge, this is the first study to evaluate dental injuries among children using a national sample. We identified the leading consumer products/activities associated with dental injuries to children with primary, mixed, and permanent dentition. Knowledge of these consumer products/activities allows for more focused and effective prevention strategies.

Healthcare resource utilization and epidemiology of pediatric burn-associated hospitalizations, United States, 2000.

The objective of this study was to describe the epidemiology and financial burden of burn-associated hospitalizations for children younger than 18 years in the United States. Retrospective data analysis of pediatric burn-associated hospitalizations was done using the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2000. An estimated 10,000 children younger than 18 years were hospitalized for burn-associated injuries in the United States in 2000. These children spent an estimated 66,200 days in the hospital with associated hospital charges equal to USD 211,772,700. Total charges and length of stay for pediatric burn-associated hospitalizations in the United States during 2000 were associated with degree of burn, percentage of total body surface area burned, child's age, region of the United States, hospital location, and hospital type. Children 2 years old or younger were more likely to be nonwhite, be hospitalized for burns, and burn their hands/wrists, compared with children 3 to 17 years of age. Male children in both age groups were more likely to be hospitalized for burns than female children. Children 2 years old or younger were more likely to be burned by hot liquids/vapors and contact with hot substances/objects, while children 3 to 17 years were more likely to be burned by fire/flames. This study is the first national study on healthcare resource utilization for pediatric burn-associated hospitalizations to utilize the KID database. Burns are a major source of pediatric morbidity and are associated with significant national healthcare resource utilization annually. Future burn prevention efforts should emphasize implementing passive injury prevention strategies, especially for young children who are nonwhite and live in low-income communities.

Escalator-related injuries among children in the United States, 1990-2002.

OBJECTIVE: We describe the epidemiology of escalator-related injuries among children 0 to 19 years of age in the United States, with a focus on the pediatric population that is younger than 5 years. METHODS: We conducted a retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission. Reported cases were used to project national estimates and rates of escalator-related injuries in the United States. The analysis included all patients who were 0 to 19 years of age in the National Electronic Injury Surveillance System database and were seen in an emergency department for an escalator-related injury during the 13-year period 1990-2002. RESULTS: There were an estimated 26000 escalator-related injuries among children who were 0 to 19 years of age in the United States during 1990-2002, yielding an average of 2000 of these injuries annually (rate = 2.6 per 100,000 population per year). The mean age was 6.5 years at the time of injury, and 53.4% of the patients were male. When comparing cases by 5-year age groups, children who were younger than 5 years had the highest estimated number of injuries (12000), as well as the highest annual escalator-related injury rate (4.8 per 100000). The most common mechanism of injury for all age groups was a fall, accounting for 13000 (51.0%) injuries. Entrapment accounted for 29.3% of all injuries and 36.5% of injuries among children who were younger than 5 years. Six percent (723) of injuries to children who were younger than 5 years involved a stroller, with most injuries occurring when a child fell out of the stroller while on the escalator. The most common body part injured for all ages was the leg, accounting for 27.7% of all injuries. Among children who were younger than 5 years, the hand was the most common injury site (40.6%), with hand injuries frequently occurring as a result of entrapment (72.4%). A laceration was the most common type of injury, accounting for 47.4% of escalator-related injuries. Amputations and avulsions were uncommon; however, 71.4% (595 of 833) occurred among children who were younger than 5 years. CONCLUSIONS: There was a disproportionate number of escalator-related injuries among children who were younger than 5 years. Entrapment occurred more frequently among children who were younger than 5 years than in any other age group, which may explain the increased number of hand injuries in this age group. Escalator designs that reduce the gap between the steps and sidewall or shield against access to the gap may decrease entrapment risk. Young children should be supervised properly and should not be transported in a stroller while riding on an escalator. All passengers should use caution and remain alert when riding an escalator to avoid injuries related to falls or entrapment. Additional research is needed to determine the relationship among passenger behavior, escalator design, and escalator-related injury.

Incidence of pediatric traumatic brain injury and associated hospital resource utilization in the United States.

OBJECTIVE: The goal was to examine the influence of sociodemographic characteristics and health care system factors on the utilization of hospital resources by US children < or = 17 years of age with a diagnosis of traumatic brain injury. METHODS: A retrospective analysis of data from the Healthcare Cost and Utilization Project Kids' Inpatient Database, from January 1, 2000, to December 31, 2000, was performed. National estimates of traumatic brain injury-associated hospitalization rates and resource use were calculated with Kids' Inpatient Database sample weighting methods. RESULTS: Of 2,516,833 encounters between January 1, 2000, and December 31, 2000, 25,783 cases involved patients < or = 17 years of age with a recorded diagnosis of traumatic brain injury. On the basis of these data, there were an estimated 50,658 traumatic brain injury-associated hospitalizations among children < or = 17 years of age in the United States in 2000. The traumatic brain injury-associated hospitalization rate was 70 cases per 100,000 children < or = 17 years of age per year; 15- to 17-year-old patients had the highest hospitalization rate (125 cases per 100,000 children per year). Pediatric inpatients accrued more than $1 billion in total charges for traumatic brain injury-associated hospitalizations in this study. In the multivariate regression models, older age, Medicaid insurance status, and admission to any type of children's hospital were associated with a longer length of stay for pediatric traumatic brain injury-associated hospitalizations. Older age, longer length of stay, and in-hospital death predicted higher total charges for traumatic brain injury-associated hospitalizations. CONCLUSION: Pediatric traumatic brain injury is a substantial contributor to the health resource burden in the United States, accounting for more than $1 billion in total hospital charges annually.

Success in the prevention of infant walker-related injuries: an analysis of national data, 1990-2001.

OBJECTIVE: Here we describe the epidemiologic characteristics and secular trends of infant walker-related injuries among children who are younger than 15 months in the United States. METHODS: A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, 1990-2001. Sample weights that were provided by the National Electronic Injury Surveillance System were used in all analyses to adjust for the inverse probability of case selection and make national projections regarding infant walker-related injuries. RESULTS: An estimated 197200 infant walker-related injuries occurred among children who were younger than 15 months and treated in US emergency departments from 1990 through 2001. Five percent of these children required admission to the hospital. The number of infant walker-related injuries remained relatively constant from 1990 through 1994, averaging 23,000 cases per year. After the introduction in 1994 of stationary activity centers as an alternative to mobile infant walkers and the implementation of the revised American Society for Testing and Materials F977 voluntary infant walker standard in 1997, there was a marked decrease in the number of infant walker-related injuries. Overall, there was a 76% decrease in the number of injuries from 1990 to 2001 from 20,900 injuries in 1990 to 5100 in 2001. Soft tissue injuries and lacerations represented 63% of the injuries. Trauma to the head region occurred in 91% of cases. Skull fractures were the most common (62%) type of fracture. Falls down stairs was the mechanism of injury in 74% of cases. CONCLUSIONS: The adoption of passive injury-prevention strategies, such as use of stationary activity centers as alternatives to mobile infant walkers and redesign of infant walkers to prevent falls down stairs, were associated with a marked decrease in the number of infant walker-related injuries.

Cheerleading-related injuries to children 5 to 18 years of age: United States, 1990-2002.

OBJECTIVE: To describe the epidemiology of cheerleading-related injuries among children in the United States. DESIGN: A retrospective analysis of data for children 5 to 18 years old from the National Electronic Injury Surveillance System (NEISS) of the US Consumer Product Safety Commission, 1990-2002. METHODS: Sample weights provided by the NEISS were used to make national estimates of cheerleading-related injuries. Injury rates were calculated for the most frequently occurring types of injury using cheerleading participation data. RESULTS: An estimated 208,800 children (95% confidence interval [CI]: 166,620-250,980) 5 to 18 years of age were treated in US hospital emergency departments for cheerleading-related injuries during the 13-year period of 1990-2002. The number of injuries increased by 110% from 10,900 in 1990 to 22,900 in 2002, with an average of 16,100 (95% CI: 12,848-19,352) injuries per year (P < .01). The average age of injured children was 14.4 years (median: 15.0 years); 97% were female; and 85% of injuries occurred to children 12 to 17 years old. The number of injuries per 1000 participants per year was greater for 12- to 17-year-olds (8.1) than for 6- to 11-year-olds (1.2) for all cheerleading-related injuries combined (P < .01; relative risk [RR]: 6.49; 95% CI: 6.40-6.58), as well as for injuries grouped by body part injured and type of injury. The body parts injured were lower extremity (37.2%), upper extremity (26.4%), head/neck (18.8%), trunk (16.8%), and other (0.8%). Injury diagnoses were strains/sprains (52.4%), soft tissue injuries (18.4%), fractures/dislocations (16.4%), lacerations/avulsions (3.8%), concussions/closed head injuries (3.5%), and other (5.5%). Children in the 12- to 18-year age group were more likely to sustain strains or sprains to the lower extremity than 5- to 11-year-olds (P < .01; RR: 1.62; 95% CI: 1.50-1.88). The majority of patients with cheerleading-related injuries was treated and released from the emergency department (98.7%). Patients sustaining fractures or dislocations were more likely to be admitted to the hospital than those sustaining other types of injury (P < .01; RR: 5.30; 95% CI: 3.29-6.43). CONCLUSIONS: To our knowledge, this study is the first to report numbers, rates, and trends of cheerleading-related injuries to children using a nationally representative sample. Cheerleading is an important source of injury to girls. The number of cheerleading-related injuries more than doubled during the 13-year study period. A set of uniform rules and regulations directed at increasing the safety of cheerleading, that are universally enforced, should be implemented. Mandatory completion of a safety training and certification program should be required of all cheerleading coaches. Establishment of a national database for cheerleading-related injuries would facilitate the development and evaluation of injury-prevention strategies based on epidemiologic evidence.

Sledding-related injuries among children requiring emergency treatment.

OBJECTIVES: The aims of the study were to describe sledding-related injuries among children requiring emergency treatment and assess the use of safety measures before and after these injuries. METHODS: This is a study of a consecutive series of patients treated for sledding-related injuries in the emergency department of a large, urban, academic children's hospital during a 5-year period. Follow-up contact with patients' families was made by telephone or mail within 2 months after the injury. RESULTS: One hundred sixty-eight children were treated for sledding-related injuries during the study period. Children ranged in age from 2 to 18 years (mean +/- SD, 9.1 +/- 3.8 years). The most common mechanism of injury was a collision with a stationary object (45.2%). The area of the body most commonly injured was the head/neck (53.6%). Soft tissue injuries were the most common type of injury (43.4%). Children 6 years or younger were more likely to sustain a head/neck injury (P < 0.001; relative risk [RR], 2.60; 95% confidence interval [CI], 1.46-4.64) and lacerations (P < 0.001; RR, 2.45; 95% CI, 1.58-3.82) than older children. Children 7 to 18 years were more likely to sustain an extremity injury (P < 0.005; RR, 1.39; 95% CI, 1.17-1.65), a fracture or dislocation (P < 0.05; RR, 1.31; 95% CI, 1.10-1.55), and a fall off a sled (P < 0.05, RR, 1.30; 95% CI, 1.08-1.55) than younger children. Children 7 to 18 years were also more likely to be admitted to the hospital (P < 0.05, RR, 1.39; 95% CI, 1.20-1.62) than younger children. Helmet use occurred in only 3.0% of the cases. No other safety equipment was used. Sixty-five percent of injuries occurred when adult supervision was present. After the injury, helmet use was reported to be 25.3%, representing a statistically significant increase (P < 0.001). Other safety measures implemented after the injury include change in behavior on the sled (59.5%) and change in location of sledding activity (19.2%). Only 1.0% of parents reported increased adult supervision after the injury event. CONCLUSIONS: More than 50% of sledding-related injuries were to the head/neck region, but only 3% of patients were wearing a helmet at the time of injury. A program to increase helmet use while sledding could have a significant impact on reducing head injuries. Because most injuries occurred when sledders struck a stationary object in their path, checking the sledding location for the presence of obstacles is also an important preventive measure.