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Lawnmower Injuries in Children: A National 13-Year Study of Urban Versus Rural Injuries. J Am Acad Orthop Surg 2020; 28:e387-e394. [PMID: 31688368 DOI: 10.5435/jaaos-d-19-00233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although the American Academy of Orthopaedic Surgery, American Academy of Pediatrics, and Pediatric Orthopedic Society of North America have established lawnmower safety guidelines, a notable number of injuries continue to occur. We sought to elaborate on the epidemiology of lawnmower injuries in the pediatric age group and compare urban versus rural injuries. METHODS The Pediatric Health Information System database was queried for patients of 1 to 18 years of age from 2005 to 2017 who presented with a lawnmower injury. Results were computed using bivariate tests and multinomial regressions. RESULTS A total of 1,302 lawnmower injuries were identified (mean age 7.7 ± 5.1 years, range 1 to 18 years; 78.9% males). Incidence rates by region, adjusted for regional case volume, were 2.16 injuries per 100,000 cases in the South, 2.70 injuries per 100,000 cases in the Midwest, 1.34 injuries per 100,000 cases in the Northeast, and 0.56 injuries per 100,000 cases in the Western United States. After stratifying and adjusting for total case volume by locale (urban/rural), it was found that urban areas had an incidence rate of 1.47 injuries per 100,000 cases, whereas rural areas had a rate of 7.26 injuries per 100,000 cases. Rural areas had higher rates of infection and higher percentages of patients requiring inpatient stay. The surgical complication rate in rural areas was 5.5% as compared to 2.6% in urban areas. Based on urban/rural status, a significant difference was observed with the age group, length of stay, income, surgical complication, and presence of infection at the bivariate level with P < 0.05. Rural areas had an overall amputation rate of 15.5% compared with 9.6% in urban areas, with rural patients being 1.7 times more likely to undergo an amputation (P < 0.05). CONCLUSION The findings of this study show that numerous geographic and locale disparities exist in pediatric lawnmower injuries and reveal the need for improved safety awareness, especially in at-risk rural populations.
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Fletcher AN, Schwend RM, Solano M, Wester C, Jarka DE. Pediatric Lawn-Mower Injuries Presenting at a Level-I Trauma Center, 1995 to 2015: A Danger to Our Youngest Children. J Bone Joint Surg Am 2018; 100:1719-1727. [PMID: 30334881 DOI: 10.2106/jbjs.18.00096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Unintentional injuries are the leading cause of morbidity and mortality among children 0 to 18 years of age in the U.S. An estimated 9,400 to 17,000 pediatric lawn-mower injuries occur each year. The aims of this study were to better define the epidemiology of lawn-mower injuries and to identify predictors of severe lawn-mower injuries to optimize public education and injury prevention. METHODS All patients 0 to 18 years of age who presented to Children's Mercy Hospital (CMH), Kansas City, Missouri, during the period of 1995 to 2015 after sustaining a lawn-mower injury were identified using International Classification of Diseases, 9th Revision (ICD-9) codes. Demographic information and data regarding primary outcome measures (death, amputation, need for prosthesis, Injury Severity Score [ISS]) and secondary outcome measures were collected. Bivariate and multivariate analyses were used to identify risk factors for severe lawn-mower injuries. RESULTS One hundred and fifty-seven patients were identified, with a bimodal age distribution peaking at 4 and 15 years of age. Seventy-five percent of the subjects were male. Sixty-six percent of the patients were admitted to the hospital, with a mean length of stay of 6 days. An average of 3 operations were performed. Nineteen percent of the patients lived in a nonmetro/rural location. Lower-extremity injuries were most prevalent, affecting 84% of the patients. Forty percent of the patients experienced at least 1 traumatic amputation. Thirteen percent of the patients required a prosthesis after the injury. The average ISS was 8. Significant predictors of a higher ISS included an age of 0 to 9 years, a riding lawn mower, a grandparent operator, and a nonmetro/rural location. Younger children were more likely to be injured from a riding lawn mower, be the passenger of the mower or a bystander, be injured with a grandparent operator, and live in a nonmetro/rural location. Younger children also had a higher ISS and amputation rate, longer LOS, and more surgical procedures. CONCLUSIONS Education to protect younger patients should target parent, grandparent, and older sibling operators. Education for the older, teenage group should include safe mowing techniques. Efforts should also target nonmetro/rural populations and grandparents, specifically highlighting the severe dangers of riding lawn mowers when young children are passengers or bystanders. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amanda Nicole Fletcher
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Richard M Schwend
- Orthopedic Surgery Division, Children's Mercy Hospital, Kansas City, Missouri
| | - Mitchell Solano
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Christopher Wester
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Dale E Jarka
- Orthopedic Surgery Division, Children's Mercy Hospital, Kansas City, Missouri
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Garay M, Hennrikus WL, Hess J, Lehman EB, Armstrong DG. Lawnmowers Versus Children: The Devastation Continues. Clin Orthop Relat Res 2017; 475:950-956. [PMID: 27785676 PMCID: PMC5339136 DOI: 10.1007/s11999-016-5132-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/14/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Accidents with lawnmowers can cause mutilating injuries to children. Safety guidelines regarding the use of lawnmowers were promoted by professional organizations beginning in 2001. The Pennsylvania Trauma Systems Foundation maintains a database including all admissions to accredited Levels 1 to 4 trauma centers in the state. The annual rates of admission for children in our state and the severity of injuries subsequent to introduction of safety guidelines have not been reported, to our knowledge. Ride-on lawnmowers have been associated with more severe injuries in children. QUESTIONS/PURPOSES We asked: (1) What was the incidence of hospital admissions for children with lawnmower-related injuries during 2002 to 2013 and did the incidence vary by age? (2) What was the severity of injuries and did the severity vary by age? (3) How often did these injuries result in amputation? (4) What types of lawnmowers were involved? METHODS This was a retrospective study using a statewide trauma registry. We queried the Pennsylvania Trauma Outcome Study database for children 0 to 17 years old admitted to trauma centers in Pennsylvania between January 2002 and January 2014 with injuries resulting from lawnmower-related accidents. All accredited Levels 1 to 4 trauma centers in the state are required to submit their data to the Pennsylvania Trauma Systems Foundation which maintains the Pennsylvania Trauma Outcome Study database. Demographic information, Injury Severity Scores, International Classification of Diseases procedure codes, and injury location codes were recorded. Type of lawnmower was determined from the narratives and was identified in 60% (119/199) of patients. Traumatic and surgical amputations performed during the index hospitalization were included in the analysis. Information on later surgeries was not available. Subjects were stratified by age: 0 to 6, 7 to 12, and 13 to 17 years old. RESULTS The incidence of lawnmower injuries in Pennsylvania was a median five of 100,000 children (range, 4-12/100,000) during the study period. The median age was 6 years (range, 1-17 years). The median Injury Severity Score was 4 (range, 1-75). Children 0 to 6 years old had higher median Injury Severity Scores (median, 8; range, 1-75) compared with those 13-17 years old (median, 4; range, 1-20; difference of the medians, 4; p < 0.001). A total of 53% of the patients (106/199) underwent at least one amputation. There were 83 amputations in or of the foot, 18 in the leg, 14 in the hand, and three in the arm. Ride-on lawnmowers accounted for 92% (110/119) of mowers identified by type. CONCLUSIONS The incidence of serious injuries to children owing to lawnmower-related trauma did not change during the 12-year study period. If children younger than 6 years had not been near the lawnmower and those younger than 12 years had not been operating one, at least 69% of the accidents might have been prevented. We recommend annual publicity campaigns during spring to remind the public of the dangers of lawnmowers to children. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Mariano Garay
- grid.29857.310000000120974281Penn State Hershey College of Medicine, Hershey, PA USA
| | - William L. Hennrikus
- grid.240473.60000000405439901Department of Orthopaedic Surgery, Penn State Hershey Medical Center, 30 Hope Drive, Building A, Hershey, PA 17033 USA
| | - Joseph Hess
- grid.240473.60000000405439901Division of Pediatric Surgery, Penn State Hershey Children’s Hospital, Hershey, PA USA
| | - Erik B. Lehman
- grid.29857.310000000120974281Department of Public Health Sciences, Pennsylvania State University, Milton Hershey Medical Center, Hershey, PA USA
| | - Douglas G. Armstrong
- grid.240473.60000000405439901Department of Orthopaedic Surgery, Penn State Hershey Medical Center, 30 Hope Drive, Building A, Hershey, PA 17033 USA
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Children treated for lawn mower-related injuries in US emergency departments, 1990-2014. Am J Emerg Med 2017; 35:893-898. [PMID: 28325679 DOI: 10.1016/j.ajem.2017.03.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/08/2017] [Accepted: 03/13/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Investigate the epidemiology of lawn mower-related injuries to children in the US. METHODS A retrospective analysis was conducted of children younger than 18years of age treated in US emergency departments for a lawn mower-related injury from 1990 through 2014 using data from the National Electronic Injury Surveillance System. RESULTS An estimated 212,258 children <18years of age received emergency treatment for lawn mower-related injuries from 1990 through 2014, equaling an average annual rate of 11.9 injuries per 100,000 US children. The annual injury rate decreased by 59.9% during the 25-year study period. The leading diagnosis was a laceration (38.5%) and the most common body region injured was the hand/finger (30.7%). Struck by (21.2%), cut by (19.9%), and contact with a hot surface (14.1%) were the leading mechanisms of injury. Patients <5years old were more likely (RR 7.01; 95% CI: 5.69-8.64) to be injured from contact with a hot surface than older patients. A projectile was associated with 49.8% of all injuries among patients injured as bystanders. Patients injured as passengers or bystanders were more likely (RR 3.77; 95% CI: 2.74-5.19) to be admitted to the hospital than lawnmower operators. CONCLUSIONS Lawn mower-related injuries continue to be a cause of serious morbidity among children. Although the annual injury rate decreased significantly over the study period, the number of injuries is still substantial, indicating the need for additional prevention efforts. In addition to educational approaches, opportunities exist for improvements in mower design and lawn mower safety standards.
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[Long-term functional evaluation of complex traumatic heel defects reconstructed by flap in children]. ANN CHIR PLAST ESTH 2014; 61:44-54. [PMID: 25301288 DOI: 10.1016/j.anplas.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/07/2014] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Complex heel injuries in children are rare and their management requires coverage combining resistance and thinness, to allow walking and footwear. The objective of this study was to create a decision-making algorithm for heel defect in children. MATERIALS Children received for heel defect, reconstructed with flap in our plastic surgery unit of Bordeaux with a follow-up greater than 10 years were investigated. Three children operated between 1999 and 2003 were included. A free contralateral reinnervated medial plantar flap, a free latissimus dorsi flap and a lateral supramalleolar flap were performed. Patients were reviewed in consultation to assess quality of reconstruction and functional outcomes. Three scores were used, the Foot Function Index (FFI), the AOFAS Ankle and Hindfoot Scale and the Maryland Foot Score. RESULTS No growth disorder has been found. Scores greater than 80 for the Maryland Foot Score and AOFAS Ankle and Hindfoot Scale and less than 10 for the FFI were very satisfactory in cases 1 and 3. We found pain and greater functional impairment in the second case. CONCLUSIONS "Like-with-like" reconstruction remains the gold standard, whether in loco-regional or free flap. The fasciocutaneous flaps allow custom reliable coverage with little donor site morbidity. Loco-regional flaps remain easily accessible but donor site sequelae are not negligible.
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Roche AJ, Selvarajah K. Traumatic amputations in children and adolescents: demographics from a regional limb-fitting centre in the United Kingdom. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 2011; 93:507-9. [PMID: 21464491 DOI: 10.1302/0301-620x.93b4.25719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is no published literature detailing the demographics of paediatric amputations in the United Kingdom. We performed this review of children and adolescents referred to a regional limb-fitting centre from the 1930s to the current decade who suffered amputation as a result of trauma, and compared our data with similar cohorts from other units. Of the 93 patients included, only 11 were injured in the last 20 years. Road traffic accidents accounted for 63% of traumatic amputations. Of all amputations, 81% were in the lower limb and 19% in the upper limb. Our figures are similar to those from a United Kingdom national statistical database of amputees which showed on average four traumatic amputee referrals to each regional limb-fitting centre in the United Kingdom per ten-year period. Compared with the United States, the incidence of paediatric traumatic amputations in the United Kingdom is low.
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Affiliation(s)
- A J Roche
- Aintree University Hospitals, NHS foundation Trust, Liverpool, UK.
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Harkness B, Andresen D, Kesson A, Isaacs D. Infections following lawnmower and farm machinery-related injuries in children. J Paediatr Child Health 2009; 45:525-8. [PMID: 19702605 DOI: 10.1111/j.1440-1754.2009.01552.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Because of the paucity of previous data, we report the organisms causing infection in children with injuries from lawnmowers and farm machinery. METHODS Retrospective study of children admitted to the Children's Hospital at Westmead for lawnmower and farm machinery-related injuries from 1998 to 2007. RESULTS Twenty-four patients were admitted for lawnmower-related injuries. They had a bimodal age distribution, with peaks at 2-4 years and 14 years. Twenty-one (87.5%) were boys. Positive wound cultures were obtained in 16.7% and included Gram-positive and Gram-negative organisms. Eight patients were admitted for farm machinery-related injuries. Two patients (25%) returned positive wound cultures with multiple organisms including bacteria, fungi and mycobacteria and were diagnosed with osteomyelitis caused by Stenotrophomonas maltophilia and Scedosporium prolificans, respectively. CONCLUSION The rate of infection in our small series of children with lawnmower and farm machinery-related injuries was comparable to previous reports. We found a wide range of causative organisms, often inherently antibiotic resistant, and we add a case of invasive fungal infection to previous case reports. Because of the wide range of organisms, empirical antibiotic therapy is difficult and our data emphasise the need for cultures to direct ongoing therapy.
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Affiliation(s)
- Ben Harkness
- Medical Student, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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8
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Abstract
BACKGROUND Progressive varus deformity of the tibia in pediatric patients after transtibial and Syme amputations has not been reported in a series. A distal tibia to fibula synostosis, created surgically to minimize the risk of terminal overgrowth or occurring spontaneously, was noted in most patients. The goals of this study are to address the causes of the deformity, the implications for prosthetic wear, and potential treatment options. METHODS Twelve patients identified from the juvenile amputee database at 2 centers developed progressive varus deformity of the residual limb. One patient had bilateral involvement. A distal tibia-fibula synostosis was noted in 12 (92%) of the residual limbs, and in one, a fibrous union was suspected. The level of amputation was trans-tibial in 10 patients, and Syme amputation in 3 patients. Two patients had acquired trans-tibial level of amputation from congenital constriction band syndrome. Nine of the patients (75%) were between the ages of 3 and 5 years at the time of injury. RESULTS The mean proximal medial tibial angle was 80.5 degrees (range, 75-85 degrees). Ten of the patients underwent procedures to correct the mechanical axis and resolve or prevent problems with prosthetic fitting. Four patients has proximal tibial osteotomies (HTO), 2 oblique closing wedge osteotomies, 1 shaft osteotomy, and 4 lateral proximal tibial hemi-epiphyseodesis. In 2 patients, no correction was recommended. CONCLUSIONS The presence of a distal tibia-fibula synostosis in pediatric amputee patients may contribute to the risk of developing a progressive varus deformity and should be monitored during a child's growth. Distal tibiofibular synostosis may disrupt normal differential longitudinal growth and may contribute to this progressive angular deformity. Severe deformity may require prosthetic modifications or operative correction to provide for a normal mechanical axis. Lateral hemiepiphyseodesis of the proximal tibia can be effective if the deformity is detected early. We do not recommend creation of a synostosis in the young child for terminal growth. LEVEL OF EVIDENCE Level 4.
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Nguyen A, Raymond S, Morgan V, Peters J, Macgill K, Johnstone B. LAWN MOWER INJURIES IN CHILDREN: A 30-YEAR EXPERIENCE. ANZ J Surg 2008; 78:759-63. [DOI: 10.1111/j.1445-2197.2008.04644.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vollman D, Smith GA. Epidemiology of lawn-mower-related injuries to children in the United States, 1990-2004. Pediatrics 2006; 118:e273-8. [PMID: 16882772 DOI: 10.1542/peds.2006-0056] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Our objective for this study was to describe the epidemiology of lawn mower-related injuries among children in the United States. METHODS A retrospective analysis was conducted of data from children who were 20 years and younger in the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1990-2004. RESULTS There were an estimated 140700 lawn mower-related injuries to children who were 20 years and younger and treated in hospital emergency departments in the United States during the 15-year period of 1990-2004. This yielded an average of 9400 injuries annually, or 11.1 injuries per 100000 US children per year. The mean age was 10.7 (SD: 6.0) years, and 78% were boys. The leading type of lawn mower-related injury sustained by patients was a laceration (41.2%), followed by soft tissue injury (21.4%), burn (15.5%), and fracture (10.3%). The most common body region injured was the hand/finger (34.6%), followed by lower extremity (18.9%) and foot/toe (17.7%). The eyeball/face and upper extremity accounted for 10.6% and 7.4% of injuries, respectively. Burns accounted for 34.5% of injuries to the hand/finger compared with 5.5% to other body regions. Ninety-seven percent of amputation injuries occurred to the foot/toe (49.5%) and hand/finger (47.5%) compared with 3% of amputations to other body regions. Burns accounted for 41.8% of injuries among children who were < or = 5 years of age compared with 6.5% of injuries to children who were older than 5 years. Foreign body injuries accounted for 4.8% of injuries among children who were > or = 12 years of age compared with 1.6% of injuries to children who were younger than 12 years. Amputations (31.9%), lacerations (28.8%), and fractures (26.0%) accounted for almost 87% of injuries among children who were admitted or transferred to another hospital. In contrast, lacerations (42.3%), soft tissue injuries (23.3%), and burns (16.9%) predominated among children who were treated and released to home from the emergency department. Children with amputations were more likely to be admitted than children with other types of injury. CONCLUSIONS Injuries related to lawn mowers are an important cause of pediatric morbidity. The relative consistency of the number of lawn mower-related injuries to children during the 15-year study period is evidence that current prevention strategies are inadequate. Passive protection that is provided by safer product design is the strategy with the highest likelihood of success in preventing these ongoing injuries. The lawn mower voluntary safety standard American National Standards Institute/Outdoor Power Equipment Institute B71.1-2003 should be revised to include more rigorous performance provisions regarding prevention of penetration of feet and toes under the mower and into the path of the blades, shielding of hot mower parts from access by young children, and equipping all ride-on lawn mowers with a no-mow-in-reverse default feature with location of its override switch behind the seating position of the ride-on mower operator. By locating the no-mow-in-reverse override switch behind the ride-on mower operator, the operator would be required to look behind the mower before mowing in reverse.
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Affiliation(s)
- David Vollman
- Ohio State University College of Medicine and Public Health, Columbus, Ohio, USA
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Costilla V, Bishai DM. Lawnmower Injuries in the United States: 1996 to 2004. Ann Emerg Med 2006; 47:567-73. [PMID: 16713787 DOI: 10.1016/j.annemergmed.2006.02.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Revised: 02/09/2006] [Accepted: 02/16/2006] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE We update the epidemiology of lawnmower injuries, together with leading mechanisms of lawnmower injury in the United States, for the entire age range by using nationally representative data. METHODS Data were obtained from the National Hospital Discharge Survey 1996-2003 and the National Electronic Injury Surveillance System 1996-2004. RESULTS Individuals in the 60- to 69-year age group had the highest push mower injury incidence in 2004, whereas those in the 70 years and older age group had the highest riding mower injury incidence. Children younger than 15 years also had a substantial injury incidence. Individuals in the 15- to 19-year age group had the highest rate of hospitalizations caused by lawnmower injuries from 1996 through 2003, with 0.72 per 100,000 person-years (95% confidence interval 0.07 to 1.36). Debris from under the mower hitting a body part or entering the eye was the most common mechanism for lawnmower injury. The second most common mechanism of injury was nonspecific pain onset after the ordinary operation of the mower. Fracture of 1 or more phalanges of the foot was the most common diagnosis among lawnmower injury hospitalizations, with 34.4%, followed by traumatic amputation of the toe, with 32.4%. There is an increasing trend of lawnmower injuries in the United States during the last 9 years. CONCLUSION Lawnmower injuries increase with age, with peaks in persons older than 59 years. Given the high incidence of projectile-related injuries, improved protective apparel and eyewear could lower the rate of injury for all age groups. The increasing trend of lawnmower injuries in the United States suggests that more must be done to prevent lawnmower injuries.
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Abstract
Play and sports activities are important to the healthy development of children worldwide. Many accidents are the result of the normal desire of children for excitement and adventure. Injury prevention has been difficult to evaluate and manage because of many variables. The frequency of injuries can be reduced with parental input and adult supervision, as well as proper equipment design and installation, followed by regular inspection and maintenance. Current initiatives hold promise, especially with equipment designs and manufacture, but injuries continue to be a significant and costly health problem. By identifying where and how children are injured, recommendations can be made to increase the safety of play areas, gyms, and equipment.
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Affiliation(s)
- Severino R Bautista
- Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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13
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Stewart DG, Kay RM, Skaggs DL. Open fractures in children. Principles of evaluation and management. J Bone Joint Surg Am 2005; 87:2784-2798. [PMID: 16322632 DOI: 10.2106/jbjs.e.00528] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- David G Stewart
- Children's Bone and Spine Surgery, 10001 South Eastern Avenue, Suite 407, Henderson, NV 89052
| | - Robert M Kay
- Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 69, Los Angeles, CA 90027.
| | - David L Skaggs
- Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS 69, Los Angeles, CA 90027.
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Hostetler SG, Schwartz L, Shields BJ, Xiang H, Smith GA. Characteristics of pediatric traumatic amputations treated in hospital emergency departments: United States, 1990-2002. Pediatrics 2005; 116:e667-74. [PMID: 16263981 DOI: 10.1542/peds.2004-2143] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the characteristics of children with traumatic amputations and the products associated with these injuries. METHODS Data regarding amputation injuries to children younger than 18 years treated in US emergency departments from 1990 to 2002 were obtained from the National Electronic Injury Surveillance System. Data included demographics, product involved, and body region injured. RESULTS An estimated 111,600 children younger than 18 years with amputation injuries were treated in US emergency departments from 1990 to 2002. The average age was 6.18 years (median: 4 years; mode: 1 year old). Males experienced 65.5% of these injuries. Finger amputations accounted for 91.6% of all amputations, ranging from 95.2% among 0- to 2-year-olds to 87.9% among 13- to 17-year-olds. Complete amputations accounted for 70.2% of all amputations among 13- to 17-year-olds compared with 52.6% of amputations among 0- to 2-year-olds. Adolescents also had the highest proportion of amputations resulting in hospital admission (26.6% for 13- to 17-year-olds compared with 11.9% for 0- to 2-year-olds). Adolescents had the highest proportion of amputation injuries involving lawn mowers (14.1% for 13- to 17-year-olds compared with 1.4% for 0- to 2-year-olds) and the highest proportion of amputations involving tools (29.3% for 13- to 17-year-olds compared with 2.5% for 0- to 2-year-olds). The percentage of amputations involving doors peaked in the youngest age group and decreased as age increased (65.8% of all amputations for 0- to 2-year-olds compared with 14.1% for 13- to 17-year-olds). CONCLUSIONS To our knowledge, this is the first study to use a nationally representative sample to broadly investigate amputation injuries among children. The majority of traumatic amputation injuries occur to young children, to males, and to fingers and the majority involve doors. Adolescents experience a higher proportion of more serious amputation injuries. Effective interventions exist but are inadequately used to prevent many of these injuries, including door stops and modifications, bicycle-chain and spoke guards, wearing closed-toe footwear while bicycling, a no-mow-in-reverse default feature on ride-on lawnmowers with the override switch located behind the mower operator, and a SawStop system on power saws. Use of these technical countermeasures and changes in relevant product standards to promote their implementation and use could lead to a decrease in pediatric traumatic amputations.
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Affiliation(s)
- Sarah Grim Hostetler
- Center for Injury Research and Policy, Columbus Children's Research Institute, Children's Hospital, Columbus, Ohio, USA
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15
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Shilt JS, Yoder JS, Manuck TA, Jacks L, Rushing J, Smith BP. Role of vacuum-assisted closure in the treatment of pediatric lawnmower injuries. J Pediatr Orthop 2005; 24:482-7. [PMID: 15308896 DOI: 10.1097/00004694-200409000-00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lawnmower injuries in children often present treatment challenges due to complex soft tissue damage. Vacuum-assisted closure (VAC), the application of controlled subatmospheric pressure to a wound surface, has been used to treat complex lacerations in many patients and has been shown to be safe and effective in children. However, VAC treatment of lawnmower injuries in children has not been reported. This study analyzes the outcomes of treatment following the use of VAC in children with lawnmower injuries and compares the results of VAC treatment to historical controls who were treated before VAC was available for wound treatment. The use of VAC demonstrated a trend toward a decrease in revision amputations and an improvement in function after treatment. There were no complications or adverse reactions related to VAC treatment. The VAC system is a safe and effective method of treating soft tissue injuries resulting from lawnmower accidents in children.
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Affiliation(s)
- Jeffrey S Shilt
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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16
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Abstract
Power lawnmowers are among the most ubiquitous household tools, yet they pose significant danger to operator and bystanders. Despite of the United States Consumer Products Safety Commission's push to have safety standards established for walk-behind mowers in 1982 and for ride-on mowers in 1986, by 2000 approximately 80,000 injuries nationwide were estimated to be associated with power mowers. Large numbers of these injuries are thought to be preventable, especially those to individuals younger than 14 years. Orthopaedic surgeons treat a significant number of the injuries associated with mower use including lacerations, amputations, fractures, infections, and skin defects. Therefore, the orthopaedic community has a stake in the prevention and outcome of these injuries. To date, changes in mower design have seemed to be more successful than user education programs in decreasing the numbers of these injuries. Involving orthopaedists in safety education programs to help prevent injuries associated with power mower use may be one method of increasing user knowledge and preventing injury.
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Affiliation(s)
- William W Robertson
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, USA.
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17
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Abstract
Foot fractures account for 5% to 8% of all pediatric fractures and for approximately 7% of all physeal fractures. A thorough understanding of the anatomy of the child's foot is of central importance when treating these injuries. Due to the difficulties that may be encountered in obtaining an accurate physical examination of a child with a foot injury and the complexities of radiographic evaluation of the immature foot, a high index of suspicion for the presence of a fracture facilitates early and accurate diagnosis. Although the treatment results in pediatric foot trauma are generally good, potential pitfalls in the treatment of Lisfranc fractures, talar neck and body fractures, and lawn mower injuries to the foot must be anticipated and avoided if possible.
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Affiliation(s)
- R M Kay
- Orthopaedic Surgery, University of Southern California School of Medicine, Los Angeles, CA, USA
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18
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19
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MESH Headings
- Accidents, Home/prevention & control
- Accidents, Home/statistics & numerical data
- Child
- Child, Preschool
- Emergency Nursing/methods
- Emergency Treatment/methods
- Emergency Treatment/nursing
- Female
- Fractures, Bone/diagnostic imaging
- Fractures, Bone/etiology
- Fractures, Bone/therapy
- Fractures, Comminuted/diagnostic imaging
- Fractures, Comminuted/etiology
- Fractures, Comminuted/therapy
- Humans
- Manubrium/injuries
- Parietal Bone/injuries
- Poaceae
- Radiography
- Skull Fracture, Depressed/diagnostic imaging
- Skull Fracture, Depressed/etiology
- Skull Fracture, Depressed/therapy
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Affiliation(s)
- A P Bowen
- Children's Hospital, Boston, Massachusetts, USA
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20
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Trautwein LC, Smith DG, Rivara FP. Pediatric amputation injuries: etiology, cost, and outcome. THE JOURNAL OF TRAUMA 1996; 41:831-8. [PMID: 8913212 DOI: 10.1097/00005373-199611000-00011] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To provide a comprehensive profile of amputation injuries in children and adolescents. DESIGN A retrospective case series. MATERIALS AND METHODS All patients 18 years old or less, admitted to the regional Level I trauma center hospital with a traumatic amputation injury over a 10-year period (74 patients, 77 extremities) were included in the study. Etiology and mechanism of injury, length of hospital stay, number of surgeries and procedures, presence of infection, final outcome of injury (amputation vs. salvage), anatomic location of final outcome, and total charges were recorded for each patient. MEASUREMENTS AND MAIN RESULTS There were 47 injuries to the upper extremity, and 30 to the lower extremity. The average length of stay was 11.3 days, with a mean of 4.3 procedures in 2.3 surgeries and average charges of $22,015. Twenty-two percent of the injuries were caused by power lawn mowers; all of these patients had amputations. Motor vehicle related crashes accounted for 16% of all injuries; 77% of these ultimately had amputations. Gunshot wounds had the highest mean length of hospital stay, surgery days, number of procedures, and charges. Out of 32 extremities that were revascularized for attempted salvage, 27 were successful (84%), all in the upper extremity, and all but one were digits. CONCLUSIONS Injuries caused by a sharp mechanism with a smaller area of involvement are more likely to be successfully salvaged with revascularization, regardless of ischemic time. Long-term follow-up is needed to evaluate final functional and psychosocial outcome. Lawn mowers represent a serious hazard to children, and should be addressed through changes in engineering and parent education.
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Affiliation(s)
- L C Trautwein
- Department of Emergency Medicine, University of Washington, Seattle, USA
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Farley FA, Senunas L, Greenfield ML, Warschausky S, Loder RT, Kewman DG, Hensinger RN. Lower extremity lawn-mower injuries in children. J Pediatr Orthop 1996; 16:669-72. [PMID: 8865057 DOI: 10.1097/00004694-199609000-00023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lower extremity lawn-mower injuries in children result in significant morbidity with a significant financial burden to the family and society. We reviewed 24 children with lower extremity lawn-mower injuries; all mothers completed standardized psychologic assessments of their children, and 18 children were interviewed. Fifty percent of the mothers had defensive profiles on the standardized psychologic assessment, suggesting the likelihood of denial or underreporting of the child's psychologic difficulties. Therefore, we found the interview with the child to be a more accurate measure of psychologic distress. Prevention measures aimed at parents must emphasize that a child must not be allowed in a yard that is being mowed with a riding mower.
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