Injury

Attributable risk factors and trends in global burden of falls from 1990 to 2021: A comprehensive analysis based on Global Burden Of Disease Study 2021

Injury. 2025 Mar 24;56(6):112296. doi: 10.1016/j.injury.2025.112296. Online ahead of print.

ABSTRACT

BACKGROUND: Falls are a leading cause of disability-adjusted life years (DALYs) and mobility difficulties. Previous estimates have relied on restricted regional scope and lack a thorough global study. This study, for the first time, examines the evolving trends in the global burden of falls from 1990 to 2021, focusing on geographic variation in disease burden and risk factors, predicting the development of burden of falls. Our aim was to provide information for allocating medical resources, taking health policies into action, and making patient management systems operate better.

METHOD: Data on incident cases, deaths, and DALYs were collected for countries, regions, ages, and sexes worldwide from the Global Burden Disease (GBD) 2021 database. Using R (version 4.3.2), we calculated estimated annual percent changes (EAPCs) for assessing trends in age-standardized rates, visualized risk factors, and predicted the global burden of falls. Joinpoint regression (version 4.9.1.0) was used to identify significant temporal trends and change points.

RESULTS: In 2021, 548.8 million people were affected by falls. There were 215 million incidence, 43.8 million DALYs, and 800,000 deaths caused by falls. The incidence rate of falls increases with age, and sex inequalities exist. Compared with 1990, the age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate (ASDALYsR) declined despite an increase in absolute numbers. The ASDR and ASDALYsR of falls are expected to decline in the future, whereas the ASIR is expected to rise. The fall burden varied significantly according to region and its sociodemographic index (SDI). Both ASIR (R = 0.510, p < 0.001) and ASDALYsR (R = 0.2762, p < 0.001) were positively correlated with SDI. In contrast, ASDR (R=-0.536, p < 0.001) showed a consistently negative association with SDI. Low bone mineral density, occupational injuries, alcohol use, and smoking emerged as the top factors associated with fall-related DALYs and deaths.

CONCLUSIONS: The overall burden of falls declined between 1990 and 2021, but the future incidence is expected to increase. The global burden of falls remains unchanged and shows significant regional and sex-based differences. Effective prevention and strategies against risk factors are imperative for reducing the future burden.

PMID:40168890 | DOI:10.1016/j.injury.2025.112296

Characterizing the epidemiology of traumatic ear injuries: A 20 year analysis of emergency department visits in the U.S

Injury. 2025 Mar 26;56(6):112287. doi: 10.1016/j.injury.2025.112287. Online ahead of print.

ABSTRACT

BACKGROUND: The ear is one of the most technically difficult areas to reconstruct following traumatic injury. Utilizing the largest national multicenter patient sample to date, this study seeks to provide a critical overview of the epidemiology of traumatic ear injuries.

METHODS: The NEISS database was searched from 2003-2022 to identify patients with related traumatic ear injuries. Three age groups were examined: geriatric (65+), adult (18-64), and pediatric (2-17). Variables including race, sex, incident location, commercial products involved, and emergency department disposition were evaluated between the groups utilizing two-proportion z-tests with Bonferroni correction.

RESULTS: 25,285 patients who sustained ear injuries were identified from the NEISS database. The top five types of ear injuries were laceration, contusion, puncture, hematoma, and burn. Geriatric patients experienced a significantly higher frequency of ear lacerations (82.5 % vs 68.6 %, p < 0.001) relative to non-geriatric adults, while children had a significantly greater frequency of hematomas (3.7 % vs 2.8 %, p = 0.001), and contusions (18.0 % vs 16.0 %, p = 0.006). The top five products involved for ear injuries were tables, first aid equipment, bed/bedframe, jewelry, and chairs. Geriatric adults had a significantly higher frequency of ear injuries from bed frames relative to non-geriatric adults (20.0 % vs 3.2 %, p < 0.001) and were over five times more likely to be admitted to the hospital..

CONCLUSIONS: This study offers novel insights into the epidemiology of traumatic ear injuries in the U.S especially across different age demographics. The greater prevalence of ear injuries from tables, first aid equipment, and with sporting activities among children highlights needs for childproofing homes and providing greater patient education and regulation on ear safety. The increased fragility of tissue and greater prevalence of fall injuries among geriatric patients demonstrates need for ongoing physical therapy and fall risk measures to be implemented. Collectively, the results help inform public health strategies to prevent such injuries as well as provide invaluable clinical context for reconstructive surgeons.

PMID:40168889 | DOI:10.1016/j.injury.2025.112287

Adolescent optimism - Coping well after severe injury: A qualitative study

Injury. 2025 Mar 22:112278. doi: 10.1016/j.injury.2025.112278. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma is the leading cause of death and disability in children globally. Studies indicate that severe traumatic brain injury (TBI) negatively affects quality of life (QoL) in children, but little is known about QoL after injury in children without TBI. This study aimed to investigate QoL in this group six months post-discharge.

METHODS: Trauma patients aged 13-17 years admitted to a major Scandinavian trauma center were eligible if they met the following criteria: received by a trauma team, ISS > 9, required ICU monitoring, and hospital stay > 4 days. Patients with moderate to severe head injuries (AIS > 2) were excluded. Eighteen consenting adolescents were interviewed six to nine months after discharge.

RESULTS: The main finding was that most participants were "coping well after experienced injuries." A minority reported challenges in daily life, including fatigue and difficulty in keeping up. Few used regular painkillers, and most were unconcerned about long-term consequences. However, many felt that more structured follow-up post-discharge would have been helpful.

CONCLUSION: Among 18 moderate to severely injured adolescents, we found that the majority were coping well. Strong social relationships and involvement in school and social activities was important in all interviews. While several experienced fatigue and challenges in keeping up, the negative impact on daily life was manageable at the time of the interviews.

PMID:40164532 | DOI:10.1016/j.injury.2025.112278

Risk factors associated with surgical site infection after internal fixation of ballistic diaphyseal fractures

Injury. 2025 Mar 25;56(6):112302. doi: 10.1016/j.injury.2025.112302. Online ahead of print.

ABSTRACT

OBJECTIVES: Management of civilian gunshot wound (GSW) fractures is controversial, with limited data on infection risk and controversy regarding treatment. While lower-energy GSWs are considered lower risk than other open fractures, complication rates remain high. This study aimed to identify risk factors for infection in operatively treated ballistic fractures.

METHODS: After institutional review board approval, we identified 2136 GSW-related fractures from 01/01/2012 to 12/31/2021 at our level one trauma center. After excluding articular, hand, foot, injuries through viscera and pre-existing infections, 110 patients with 125 long bone fractures were retrospectively reviewed. The primary outcome was infection requiring reoperation. Statistical analysis included Mann-Whitney U, T-tests, Pearson's Chi-square, ROC analysis, and Youden's index.

RESULTS: Sixteen patients (14.5 %) developed infections requiring reoperation. The cohort had a mean age of 30 years, 90 % male, BMI 27.7 ± 7.2 kg/m², Charlson comorbidity index <1, and 37 % smokers. Increased infection risk was associated with admission glucose (p < 0.001) and length of stay (p < 0.001). Admission glucose >156 mg/dL increased odds of infection sixfold (OR 6.1, 95 % CI 2.0-19.0), while a hospital stay >10 days increased odds of infection twentyfold (OR 21.1, 95 % CI 5.3-82.7). Transfusion (p = 0.004), abdominal (p = 0.007), and chest trauma (p = 0.010) also correlated with infection risk. No significant associations were found with nicotine use, Charlson comorbidity index, or BMI.

CONCLUSIONS: Operatively treated long bone injuries had a 14.5 % infection rate. Elevated admission glucose and prolonged hospital stay significantly increased infection risk, particularly in polytrauma patients. Identifying high-risk patients, promoting early mobilization, and ensuring glycemic control may help reduce infections. Further research is needed to develop targeted prevention strategies.

LEVEL OF EVIDENCE: 3 (Retrospective Comparative Study).

PMID:40163958 | DOI:10.1016/j.injury.2025.112302

Implementation and validation of a novel clinical bedside tool (Time-Up and Flex) in rehabilitation for geriatric hip fracture patients post hip fracture surgery

Injury. 2025 Mar 25;56(6):112282. doi: 10.1016/j.injury.2025.112282. Online ahead of print.

ABSTRACT

OBJECTIVE: Fragility fractures in the elderly population is increasing due to the global aging population. Rehabilitation following hip fracture surgery plays a crucial role in restoring functional independence and quality of life. There are currently limited bedside rehabilitation tool for geriatric hip fracture patients. A novel tool (Time-Up and Flex [TUF]) was designed with the aim to allow patients perform bedside rehab exercises, provide objective feedback and enhance recovery.

DESIGN: A single centre, double-blinded, prospective validation study. A 3D printed TUF tool measures time taken to actively flex the operated hip to 30° on post-operative days [POD] 1, 7 and 14. The time is compared against subjective (Numerical Patient Reported Pain Scale [NPRS]) and objective outcomes (Tinetti Scale [TS], Functional Ambulation Category [FAC]). Assessors of the TUF score are blinded to the assessors of patient report outcome measures.

RESULTS: Mean time for TUF were 12.7 s (seconds), 9.5 s and 6.7 s, NPRS were 7.3, 4.8, 3.2, TS were 9.8, 14.1, 18.6, FAC were 1.2, 2.0, 3.1 on POD1, 7 and 14 respectively. Coefficient of correlation for TUF time against NPRS was 0.729 (p < 0.05), TUF time against TS was -0.721 (p < 0.05), TUF time against FAC -0.688 (p < 0.05). A decrease in TUF time correlated to a statistically significant decrease in NPRS, increase in TS and FAC. The calculated Cohen's D and Cronbach Alpha for TUF tool supported its ability to produce consistent and valid results.

CONCLUSION: TUF tool is valid and correlates with patient's subjective and objective outcomes. It has a good predictor value for the patient's pain, mobility and future falls risk. TUF tool has potential to be incorporated into geriatric hip fracture rehabilitation pathway in the future.

PMID:40163957 | DOI:10.1016/j.injury.2025.112282

Does the timing of debridement of an upper extremity open fracture really matter?

Injury. 2025 Mar 24;56(6):112300. doi: 10.1016/j.injury.2025.112300. Online ahead of print.

ABSTRACT

- A 49yo woman was involved in a car crash. She suffered an isolated, open, left both bones forearm mid-diaphyseal fracture. She had a sling applied at the scene but had a 16-hour transport time from an isolated rural location. She was found to have no other injuries upon her careful work-up at the Level 1 emergency department. The injury had not compromised the distal neurovascular status of the limb. The ER staff admitted the patient to the orthopedic team. The patient had an evaluation by a senior resident and their assessment was that this was a grade 3A open fracture of the dorsum of the mid forearm (Figure 1 and Figure 2). By the time surgery could be initiated at the Trauma center, fully 36 hours had passed. Most of the delay at the Trauma center was due to other very significant injuries in the Trauma room that day. PAST MEDICAL HISTORY AND SOCIAL HISTORY: - She is a married woman and lives with her husband and a university aged teenager. She has been a nonsmoker. She has no medical problems that she sees a physician about. She works as a secretary but presently is unemployed. She has only had obstetrical surgery, has no allergies and takes no medications. She is a regular wine drinker.

PMID:40158403 | DOI:10.1016/j.injury.2025.112300

FDA regulatory considerations for innovative orthopedic devices: A review

Injury. 2025 Mar 22;56(4):112291. doi: 10.1016/j.injury.2025.112291. Online ahead of print.

ABSTRACT

Novel and innovative orthopedic devices are needed to address clinical challenges in orthopedic practice. Obtaining regulatory authorization for such devices, however, can prove challenging. An inherent dilemma exists between innovation to address unmet needs and imitation to demonstrate substantial equivalence to a predicate device, which is required for the less burdensome 510(k) pathway. This article provides both an overview of highly innovative orthopedic devices over the last 10 years as well as considerations for FDA regulatory pathways and programs available to manufacturers of such devices. A review of 20 innovative orthopedic devices receiving Breakthrough Device Designation and/or a De Novo classification found that devices had diverse features and applications, but did possess shared technological trends including bioresorption, flexible components, and new substance/material use. A review of all new orthopedic devices authorized through the three major regulatory pathways in the last 10 years was also conducted. Spinal devices represented the largest share of recent orthopedic devices (38 % of 510(k) clearances and 25 % of De Novo classifications). Across all three pathways, decision time was on average around 30 % shorter for orthopedic devices with a Breakthrough Device Designation versus those without, though differences were not significant. New orthopedic devices authorized in the last 10 years were found to be highly reliant on the 510(k) pathway, with a 99 % utilization rate. However, the FDA Breakthrough Devices Program and De Novo pathway offer opportunities specific to innovative technologies, such as expedited review and potential market competition protection, as demonstrated through specific case studies in this review. As these FDA initiatives continue to evolve and manufacturers continue to take advantage of these opportunities, orthopedic device development, which has primarily prioritized incremental innovation, may too evolve to produce more breakthrough innovations.

PMID:40157338 | DOI:10.1016/j.injury.2025.112291

Prediction of psychological continuing health problems based on types of injury and manner of accident in Mozambique: A population-based analysis of burns, fractures, internal injuries, and wound injuries

Injury. 2025 Mar 20;56(6):112274. doi: 10.1016/j.injury.2025.112274. Online ahead of print.

ABSTRACT

The long-term effects of injuries have significant implications for forensic practice. There is a dearth of research highlighting long-term psychological problems resulting from various injuries in under-researched populations like Mozambique. This study employed multiple logistic regression analyses on the 2022-2023 Mozambique Demographic and Health Survey (DHS) data to determine injury types predictive of emotional trauma, limb function loss, and chronic pain as continuing health problems. The data from the Accidents and Injury module was used for all participants. The injuries analyzed included broken bones, wounds, internal injuries, and burns. Additionally, we investigated the predictive capacity of unintentional and violent injuries on emotional trauma as a continuing health problem. The total number of injured people (whether due to traffic or non-traffic accidents) was 419. The proportion of unintentional injuries was much higher than violent injuries (86.4% vs 7.7%). Our results indicated that burn injuries were strongly associated with emotional trauma (Odds Ratio (OR) = 4.15, 95% CI: [1.24-13.84], P = 0.021), broken-bone injuries predicted both limb function loss (OR = 2.67, 95% CI: [1.17- 6.09], P = 0.02) and emotional trauma (OR = 3.73, 95% CI: [1.51-9.22], P = 0.005), internal injuries predicted chronic pain (OR = 2.52, 95% CI: [1.18-5.38], P = 0.018), and violent injuries predicted emotional trauma (OR = 4.41, 95% CI: [1.16-16.67], P = 0.03). These findings enhance comprehension of how injury types predict long-term psychological complications in Mozambique and provide valuable insights regarding the enduring consequences of various injuries in similar populations.

PMID:40157228 | DOI:10.1016/j.injury.2025.112274

Comparative evaluation and ranking of anterior surgical approaches for acetabular fractures: A systematic review and network meta-analysis

Injury. 2025 Mar 3;56(4):112241. doi: 10.1016/j.injury.2025.112241. Online ahead of print.

ABSTRACT

BACKGROUND: To compare the outcome of pararectus, ilioinguinal, and intrapelvic approaches in patients with acetabular fracture and to rank the best, second best, and third best surgical approach.

METHODS: A literature search was conducted in PubMed, Epistemonikos, and Embase up to 30 November 2024. A network meta-analyses was conducted to assess the outcomes of pararectus, ilioinguinal, and intrapelvic surgical approaches. Random-effects models with mean differences (MDs) and odds ratios (ORs) were calculated for continuous and binary variables, respectively, all with 95 % confidence intervals (CIs).

RESULTS: A total of 30 primary studies (2,348 patients) were included. There was no statistically significant difference between the pararectus and intrapelvic approach in overall complications (OR 0.86, 95 % CI 0.47 to 1.58). The pararectus approach had 0.51 lower odds for overall complications compared with the ilioinguinal approach (OR 0.51, 95 % CI 0.28 to 0.94). The intrapelvic approach had 0.59 lower odds for overall complications compared with the ilioinguinal approach (OR 0.59, 95 % CI 0.37 to 0.94). There was no statistically significant difference between the pararectus and intrapelvic approach in reduction quality (OR 1.32, 95 % CI 0.89 to 1.95). The pararectus approach had 2.02 higher odds for reduction quality compared with the ilioinguinal approach (OR 2.02, 95 % CI 1.30 to 3.15). The intrapelvic approach had 1.53 higher odds for reduction quality compared with the ilioinguinal approach (OR 1.53, 95 % CI 1.12 to 2.10). There was no statistically significant difference between the pararectus and intrapelvic approach in intraoperative blood loss (MD -31.38, 95 % CI -105.62 to 42.85). The pararectus approach had a 207.35 mL lower intraoperative blood loss compared with the ilioinguinal approach (MD -207.35, 95 % CI -288.52 to -126.18). The intrapelvic approach had a 175.97 mL lower intraoperative blood loss compared with the ilioinguinal approach (MD -175.97, 95 % CI -233.51 to -118.42).

CONCLUSION: This is the first study to rank the three anterior surgical approaches for acetabular fractures. The findings establish that while the pararectus and intrapelvic approaches are comparable, the ilioinguinal approach ranks third. The superior outcomes of the pararectus and intrapelvic approaches in complications, operative efficiency, and reduction quality highlight their importance in surgical practice.

PMID:40154238 | DOI:10.1016/j.injury.2025.112241

Time to union in ballistic trauma lower extremity diaphyseal fractures treated with intramedullary nailing

Injury. 2025 Mar 14;56(4):112268. doi: 10.1016/j.injury.2025.112268. Online ahead of print.

ABSTRACT

BACKGROUND: Time to union in civilian firearm injuries is variable and not well described in the literature. This study measures the time to union for femoral and tibial shaft fractures treated with an intramedullary nail (IMN). Time to union is compared across open, closed, or ballistic trauma (BT) fractures. The goal of the study is to answer the questions: (1) Do tibial shaft fractures heal in specific temporal patterns based on mechanism of injury and (2) Do these temporal healing patterns apply to both the tibia and femur?

PATIENTS AND METHODS: Included patients had tibial or femoral shaft fractures (OTA/AO 32 and 42) treated at an urban level 1 trauma center between 2015 and 2020 with IMN. Patients were eligible if radiographic imaging was available for any four of five follow-up timepoints, absence of preexisting hardware, and BT was from low velocity handgun injuries. Radiographic union scale (RUS) was compared amongst six groups (Open, Closed or BT for Femur and Tibia fractures), at 60-90 days, 91-180 days, 181- 270 days, and 271-365 days and greater than 365 days. Statistical comparison was performed using a two-way ANOVA and Tukey's multiple comparisons.

RESULTS: Included in the study were 114 patients, with 20 patients in each group except the OPEN femur fracture group with 14.

TIBIA: At the 91-180 day time point, CLOSED tibia RUS was significantly higher than for BT and OPEN tibia RUS. At 181-270 days, CLOSED tibia RUS was significantly higher than OPEN tibia. At 271-365 days and >365, CLOSED and BT RUS were significantly higher than OPEN RUS.Femur: At the 91-180 day time point, OPEN femur RUS was significantly lower than CLOSED and BT femur RUS. At later timepoints, all three groups achieved union with mean RUS>10.

DISCUSSION: This study demonstrates that healing of tibial shaft fractures from BT is not significantly different from closed fractures after 180 days post-operatively. Additionally, femoral shaft fractures from a BT healed similarly to closed and open fractures after 180 days post-operatively.

LEVEL OF EVIDENCE: Prognostic Level III.

PMID:40154237 | DOI:10.1016/j.injury.2025.112268

Artificial intelligence versus orthopedic surgeons as an orthopedic consultant in the emergency department

Injury. 2025 Mar 22;56(4):112297. doi: 10.1016/j.injury.2025.112297. Online ahead of print.

ABSTRACT

INTRODUCTION: ChatGPT, a widely accessible AI program, has demonstrated potential in various healthcare applications, including emergency department (ED) triage, differential diagnosis, and patient education. However, its potential in providing recommendations to emergency department providers with orthopedic consultations has not been evaluated yet.

METHODS: This study compared the performance of four board certified orthopedic surgeons, two attendings and two trauma fellows who take independent call at the same institution and ChatGPT-4 in responding to clinical scenarios commonly encountered in emergency departments. Five common orthopedic ED scenarios were developed (lateral malleolar ankle fractures, distal radius fractures, septic arthritis of the knee, shoulder dislocations, and Achilles tendon ruptures), each with four questions related to diagnosis, management, surgical indication, and patient counseling, totaling 20 questions. Responses were anonymized, coded, and evaluated by independent reviewers including emergency medicine physicians using a five-point Likert scale across five criteria: accuracy, completeness, helpfulness, specificity, and overall quality.

RESULTS: When comparing the ratings of AI answers to non-AI responders, the AI answers were shown to be superior in completeness, helpfulness, specificity, and overall quality with no difference in regards to accuracy (p < 0.05). When considering question subtypes including diagnosis, management, treatment, and patient counseling, AI was shown to have superior scores in helpfulness, and specificity in diagnostic questions(p < 0.05). In addition, AI responses were superior in all the assessed categories when looking at the patient counseling questions (p < 0.05). When considering different clinical scenarios, AI outperformed non-AI groups in completeness in the distal radius fracture scenario. Furthermore, AI outperformed non-AI groups in helpfulness in the lateral malleolus fracture scenario. In the shoulder dislocation scenario, AI responses were more complete, helpful, and had a better overall quality. AI responses were non-inferior in the remaining categories of the different scenarios.

CONCLUSION: Artificial intelligence exhibited non-inferior and often superior performance in common orthopedic-ED consultations compared to board certified orthopedic surgeons While current AI models are limited in their ability to integrate specific images and patient scenarios, our findings suggest AI can provide high quality recommendations for generic orthopedic consultations and with further development, will likely have an increasing role in the future.

PMID:40147063 | DOI:10.1016/j.injury.2025.112297

Trends and determinants of falls: A generalized estimating equations modelling approach using serial data from the geelong osteoporosis study

Injury. 2025 Mar 24;56(4):112298. doi: 10.1016/j.injury.2025.112298. Online ahead of print.

ABSTRACT

BACKGROUND: With Australia's aging population, the incidence of falls is expected to rise. The proportion of adults aged ≥65 years is projected to increase from 15 % in 2017 to 22 % by 2057, highlighting the growing need for effective fall prevention measures. Therefore, this study aimed to assess fall trends and determinants using repeated follow-up data from a population-based study.

METHODS: This study utilized data from the Geelong Osteoporosis Study (GOS) to analyse fall trends in men and women. Men's data were collected at baseline (2001-2006; n = 1533), 5 years (2006-2011; n = 968), and 15 years (2016-2021; n = 627), while women's data were from 6 years (2001-2003; n = 1014), 10 years (2004-2008; n = 1098), and 15 years (2011-2014; n = 844). Falls data, self-reported for the past 12 months, were age-standardised to the Australian population. Data included self-reported prior fractures, medications, comorbidities, alcohol use, and smoking, along with measured anthropometrics, muscle strength, biochemical tests, and imaging. A multivariable Generalised Estimating Equation model identified fall determinants, reporting adjusted odds ratios (AORs) and 95 % confidence intervals.

RESULTS: In men, the age-adjusted prevalence of falls declined over time, while in women, it initially dropped by 4.2 % before a slight 0.6 % increase. After adjusting for confounders, each additional year of age raised the fall risk by 1 % (AOR = 1.01, 95 % CI: 1.00-1.02). Women had a 52 % higher likelihood of falling than men (AOR = 1.52, 95 % CI: 1.22-1.88). Diabetes increased the risk by 69 % (AOR = 1.69, 95 % CI: 1.23-2.31), while a 1 N/kg increase in hip flexion strength lowered the risk by 3 % (AOR = 0.97, 95 % CI: 0.95-0.99).

CONCLUSION: Men experienced a steady decrease in fall prevalence over time, whereas women displayed a more intricate trend, with falls initially declining before subsequently rising, following a polynomial pattern. The key predictors of falls included age, sex, diabetes and hip flexion strength. Policies should prioritize tailored fall prevention, strength training, and diabetes care integration.

PMID:40139100 | DOI:10.1016/j.injury.2025.112298

Decrease in pediatric farm-related injuries presenting to United States emergency departments: A national study from 2014-2023

Injury. 2025 Mar 22;56(4):112299. doi: 10.1016/j.injury.2025.112299. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric farm-related injuries, while less common than other pediatric injuries, are often more severe. Agricultural youth injuries can require costly treatment and have higher hospitalization rates, often resulting from industrial hazards, unsafe worksites, or agricultural recreational activities. Injuries in rural areas often necessitate travel to larger hospitals for specialized treatment, delaying care.

OBJECTIVE: This study aims to evaluate trends in farm-related injuries among youth presenting to emergency departments (EDs) in the United States (US).

METHODS: The National Electronic Injury Surveillance System (NEISS), a publicly available database representing approximately 100 US EDs, was queried for all injuries among individuals aged 0-18 occurring in farms (land, pasture, farm, barn, outbuildings). Queries were restricted to injuries from 2014 to 2023.

RESULTS: From 2014 to 2023, a total of 750 ED visits from farm-related injuries were identified, resulting in a national estimate (NE) of 33,664 cases. Injury rates decreased significantly across the study period (P=0.012). The most common diagnosis was fracture (NE 7337, 21.8 % of all injuries), with males accounting for 52.1 % and females for 47.9 %. In an age-specific analysis, 12-year-olds experienced more farm-related injuries than any other age group (NE 3185, 9.5 %), followed by 11-year-olds (NE 2769, 8.2 %), who also sustained the highest number of head injuries (NE 711, 13.2 % of all head injuries). The most commonly affected body part across ages was the head (NE 5384, 16 % of all injuries). The most common mechanism of injury was horseback riding (NE 10,691, 31.8 % of all injuries). The overall rate of hospitalization was 13.5 %.

CONCLUSION: The incidence of farm-related injuries in young people has decreased over time. Most injuries are caused by horseback riding, with a majority involving the head and relatively high hospitalization rates. 11-12-year-olds are the most affected, highlighting the importance of continued targeted prevention efforts. Although occupational hazards are a concern, this study demonstrates that younger patients are also frequently affected by farm injuries, emphasizing the need for increased focus on child access and safety in agricultural recreational activities.

PMID:40139099 | DOI:10.1016/j.injury.2025.112299

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