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.     

Evaluation of the National Electronic Injury Surveillance System – All injury program’s self-directed violence data,United States, 2018

Introduction: National estimates for nonfatal self-directed violence (SDV) presenting at EDs are calculated from the National Electronic Injury Surveillance System – All Injury Program (NEISS–AIP). In 2005, the Centers for Disease Control and Prevention and Consumer Product Safety Commission added several questions on patient characteristics and event circumstances for all intentional, nonfatal SDV captured in NEISS–AIP. In this study, we evaluated these additional questions along with the parent NEISS–AIP, which together is referred to as NEISS–AIP SDV for study purposes. Methods: We used a mixed methods design to evaluate the NEISS–AIP SDV as a surveillance system through an assessment of key system attributes. We reviewed data entry forms, the coding manual, and training materials to understand how the system functions. To identify strengths and weaknesses, we interviewed multiple key informants. Finally, we analyzed the NEISS–AIP SDV data from 2018—the most recent data year available—to assess data quality by examining the completeness of variables. Results: National estimates of SDV are calculated from NEISS–AIP SDV. Quality control activities suggest more than 99% of the cause and intent variables were coded consistently with the open text field that captures the medical chart narrative. Many SDV variables have open-ended response options, making them difficult to efficiently analyze. Conclusions: NEISS–AIP SDV provides the opportunity to describe systematically collected risk factors and characteristics associated with nonfatal SDV that are not regularly available through other data sources. With some modifications to data fields and yearly analysis of the additional SDV questions, NEISS–AIP SDV can be a valuable tool for informing suicide prevention. Practical Applications: NEISS-AIP may consider updating the SDV questions and responses and analyzing SDV data on a regular basis. Findings from analyses of the SDV data may lead to improvements in ED care.     

Non-occupational injuries caused by transport packaging: Residential and retail hazards

BackgroundBackground: Pallets are key components of domestic supply chains, and yet present unique hazards when used by homeowners and retailers for unintended uses. No previous works have investigated non-occupational injuries that occur due to unintentional contact with pallets. This study sought to describe the incidence and epidemiology of non-occupational pallet-related injuries as seen in United States emergency departments (EDs). Method: The National Electronic Injury Surveillance System database was used to derive national, weighted estimates of pallet-related injuries by age, sex, injured body part, and location where injury occurred. Data for the years 2014 to 2018 were analyzed with all relevant narratives reviewed. Results: From 2014 to 2018, there were an estimated 30,493 persons who visited an ED for a pallet-related injury. The yearly incidence of pallet injuries rose during this period. The 35–44 age group (n = 5,481) was most likely to be injured, but about 3,000 children and youth under 18 years of age were injured and more than 4,000 persons 65 years of age or older suffered injuries. The elderly were especially likely to suffer injuries from slip, trip and fall incidents. The lower extremities were the most commonly injured body parts. An estimated 3,964 persons, accounting for approximately 14% of all pallet-related injuries, were treated for injuries incurred while at a retail establishment. African Americans, Hispanics, and the elderly appeared to be disproportionately more likely to have pallet-related injuries in retail locations. Conclusions: Non-occupational pallet-related injuries affect a wide range of patients and cause a variety of injuries, with the elderly being especially vulnerable to tripping incidents. Retailer prevention strategies should focus on the misuse of pallets for merchandising purposes. Industry should maintain control of pallets so they are not used for unintended purposes. Practical applications: Retailers should limit the use of pallets for floor-level merchandising purposes and remove pallets from customer-facing locations where unintentional contact could occur. Owners of pallets should maintain them in a controlled supply chain so that they don’t leak out into the hands of homeowners. Policy-makers should educate the public about the dangers of used pallets.