Unintentional needlestick injuries in livestock production : a case series and review

Livestock producers and their employees sometimes experience unintentional needlestick injury (NSI) while vaccinating or injecting medications into animals. There is little published regarding the medical complications that can develop from this occupational exposure. The objectives of this study were to (1) perform a retrospective review of animal-related NSIs treated at a tertiary medical center of a rural state; and (2) review the risks of NSI and measures to decrease their occurrence. Medical records of patients with NSI related to animal injection were identified from the University of Iowa Hospitals and Clinics database from 2002 to 2008 and reviewed. Nine patients received medical care for NSI that occurred while vaccinating farm animals. Most common NSI site was the nondominant hand and most occurred while attempting to inject the animal. Soft tissue infection was common and all nine received oral and/or intravenous antibiotics. Two thirds required hospital admission. Three required surgery and one had a bedside incision and drainage procedure. One patient had a serious inflammatory reaction with necrosis in the leg due to the oil adjuvant in the animal vaccine. Another case had a probable mycetoma with osteomyelitis and soft tissue infection due to the bacteria Streptomyces, which is a NSI complication not previously reported. Although medical complications from farm-related NSIs do not appear to be common, this case series illustrates how these injuries can be debilitating, costly, and lead to loss of work time and productivity. Producers and employees who inject livestock need to be aware of the risks and utilize measures to decrease unintentional NSI. <br /

The Effect of Passengers on All-Terrain Vehicle Crash Mechanisms and Injuries

Traditional all-terrain vehicles (ATVs) are designed for single riders. Although carrying passengers is a known risk factor for injury, how passengers contribute to ATV crashes remains poorly understood. To address this question, we performed a retrospective chart review of ATV crash victims at a U.S. trauma center (2002–2013). Of 537 cases, 20% were passengers or drivers with passengers. The odds of backward rollovers, falls/ejections, crashes on sloped terrain, and collisions with motorized vehicles were all significantly greater when passengers were present. In contrast, the odds of self-ejection or falls/ejections over the handlebars were significantly lower than falls/ejections to the side or rear, in crashes with multiple riders. Among all ejections, self-ejections had the lowest head and highest extremity injury scores and being ejected over the handlebars or to the rear resulted in worse head injury scores than being ejected to the side. In summary, our study found that passengers increased the odds of specific crash and injury mechanisms and that head and extremity injury severity varied by ejection type. Safety interventions including seat design changes that prevent carrying passengers, and a strict, well-enforced no-rider rule are needed to effectively prevent passenger–related deaths and injuries

Playground slide-related injuries in preschool children: increased risk of lower extremity injuries when riding on laps

Abstract Background The purpose of this study was to better understand the factors associated with playground slide-related injuries in preschool children and to test the hypothesis that riding on laps increases the likelihood of lower extremity injuries. Methods Playground slide-related injuries (product code 1242) in children ≤5 years of age treated in emergency departments from 2002 to 2015 were identified (N = 12,686) using the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS). Descriptive and comparative analyses, including chi-square testing and binary logistic regression, were performed. Results Based on NEISS stratified national sampling estimates, over 350,000 children ≤5 years of age were injured on slides from 2002 to 2015. Overall, 59% of the children were male, and 65% were white. Almost 60% of injuries occurred in parks or other public areas. The most frequent diagnosis was a fracture (36%); lacerations were 19% of the injuries. A higher proportion of musculoskeletal injuries were seen in toddlers < 3 years old as compared to those 3–5 years of age (p < 0.001). Injuries to the lower extremities increased in frequency as age decreased, whereas injuries to the upper extremities and head/neck/face were more common in older preschoolers. Children < 3 years of age were 12 times more likely to be identified from narratives as being on another person’s lap at the time of injury. Children identified as being on a lap had an increased odds of injury to the lower extremity than to other body parts (OR 43.0, 95% confidence interval (CI) 32.0–58.0), and of lower leg/ankle fracture than fractures elsewhere (OR 49.5, 95% CI 31.7–77.4). Conclusions Decreasing age was associated with a higher likelihood of being identified as sliding down on another person’s lap and a higher likelihood of lower extremity injuries. Healthcare providers should be mindful of the potential for these slide-related injuries as they can result in a toddler’s fracture of the tibia, which may be occult. Parents should also be made aware of this increased risk and counseled that a child’s foot can catch on the slide’s surfaces when going down on a person’s lap with subsequent twisting forces that can result in a fracture

Using Geospatial Mapping to Determine the Impact of All-Terrain Vehicle Crashes on Both Rural and Urban Communities

Introduction: Deaths and injuries from all-terrain vehicle (ATV) crashes result in approximately 700 deaths each year and more than 100,000 emergency department (ED) visits. Common misconceptions about ATV crashes are a significant barrier to injury prevention efforts, as is the lack of key information about where and how crashes occur. The purpose of this study was to determine ATV crash patterns within a state, and to compare and contrast characteristics of these crashes as a function of crash-site rurality. Methods: We performed descriptive, comparative, and regression analyses using a statewide off-road vehicle crash and injury database (2002–2013). Comparisons were performed by rurality as defined using the Rural Urban Commuting Area (RUCA) coding system, and we used geographic information system (GIS) software to map crash patterns at the zip code and county levels. Results: ATV crashes occurred throughout the state; 46% occurred in urban and 54% in rural zip code areas. Comparisons of rider and crash characteristics by rurality showed similarities by sex, age, seating position, on vs. off the road, and crash mechanism. Conversely, helmet use was significantly lower among victims of isolated rural crashes as compared to other victims (p=0.004). Crashes in isolated rural and small rural areas accounted for only 39% of all crashes but resulted in 62% of fatalities. In both rural and urban areas, less than one-quarter of roadway injuries were traffic related. Relative crash rates varied by county, and unique patterns were observed for crashes involving youth and roadway riders. During the study period, 10% and 50% of all crashes occurred in 2% and 20% of the state’s counties, respectively. Conclusion: This study suggests that ATV crashes are a public health concern for both rural and urban communities. However, isolated rural ATV crash victims were less likely to be helmeted, and rural victims were over-represented among fatalities. Traffic was not the major factor in roadway crashes in either rural or urban areas. Unique crash patterns for different riding populations suggest that injury prevention experts and public policy makers should consider the potential impact of geographical location when developing injury prevention interventions

The Effect of All-Terrain Vehicle Crash Location on Emergency Medical Services Time Intervals

Over 100,000 all-terrain vehicle (ATV)-related injuries are evaluated in U.S. emergency departments each year. In this study, we analyzed the time intervals for emergency medical services (EMS) providers responding to ATV crashes in different location types. Data from the Iowa State Trauma Registry and a statewide ATV crash/injury database was matched with Iowa EMS Registry records from 2004&ndash;2014. Ground ambulance responses to 270 ATV crashes were identified, and response characteristics and time intervals were analyzed. Off-road crashes had a longer median patient access interval (p &lt; 0.001) and total on scene interval (p = 0.002) than roadway crashes. Crashes in remote locations had a longer median patient access interval (p &lt; 0.001) and total on scene interval (p &lt; 0.001), but also a longer median on scene with patient interval (p = 0.004) than crashes in accessible locations. Fifteen percent of remote patient access times were &gt;6 min as compared to 3% of accessible crashes (p = 0.0004). There were no differences in en route to scene or en route to hospital time. Comparisons by location type showed no differences in injury severity score or number of total procedures performed. We concluded that responding EMS providers had an increased length of time to get to the patient after arriving on scene for off-road and remote ATV crashes relative to roadway and accessible location crashes, respectively

Enforcement of Off-Road Vehicle Laws in Iowa

Safety laws are among the most successful means of reducing injuries, but their effectiveness is strongly influenced by the level of enforcement. To characterize enforcement of off-road vehicle (ORV) laws statewide, analyses of citations were performed using Iowa Court Information System data. From 2005&#8211;2015, 5173 individuals were charged with 5643 citations issued. Citations averaged &lt;5/county/year, decreased dramatically over time, and varied by county when normalized to registered all-terrain vehicles (ATVs). Over 90% of operators cited were male and Caucasian. One-fifth were &lt;18 years old. The top five violations were: operation on a highway/snowmobile trail (51%), registration/identification number not documented/displayed (19%), prohibited use in a park/preserve (5.5%), and operation with more persons than the vehicle is designed to carry (4.4%). The Department of Natural Resources issued the highest percentage of citations, followed in decreasing order by Sheriff, Police, State Patrol, and Conservation officers. Significant differences were identified when citations were compared by sex, age, race, enforcement agency, disposition (guilty vs. not guilty), and when comparing counties with or without an ORV park. These characteristics suggest limited and variable enforcement of laws statewide that may reduce their potential to prevent deaths and injuries, and that improved strategies to support ORV law enforcement are needed

Child abuse and neglect experts’ determination of when a child being left home alone constitutes child neglect

Abstract Background Only 14 states have laws or guidelines regarding the minimum age a child may be left home alone. These ages range from 6 to 14 years. Our objective was to identify factors that influence child neglect determination by experts with regards to parents leaving children home alone. Methods American Academy of Pediatrics Section on Child Abuse and Neglect members (N = 523) were surveyed from July–August, 2015. Respondents were asked whether scenarios involving a child of varying age knowingly left home alone for 4 h were neglect in the presence or absence of injury to the child and the legality of the situation. Comparisons were performed using the chi-square test. Results One hundred ninety-three members responded (36.9%). In the scenario where there were no relevant laws and the child was uninjured, nearly 100% of the child experts determined this as being child neglect when the child was 6 years old. For 8, 10, 12, and 14 year olds, this was 88, 48, 4, and 1%, respectively. However, a significantly higher percentage of experts considered it child neglect for most ages when there was a law making the scenario illegal as compared when there was no law, and when the child was injured versus when they were not. The only demographic variable that showed a difference in child neglect determination was that females were more likely to consider higher aged children as having been neglected when there were no laws but the child was injured. The vast majority of experts (85%) stated that leaving a child home alone for 4 h should be illegal if the child is < 9 years old, and nearly one-half (44%) said it should be illegal for children < 11 years old. Conclusions A number of factors affect how experts view children being left home alone as potential child neglect. Our data suggests that such cases may be evaluated differently due to variations in state laws, even though the risk to the child is the same. These results call for child safety law reform to provide greater uniformity in the evaluation of potential child neglect cases and better protect the safety of children

Pediatric lawn mower-related injuries and contributing factors for bystander injuries

Abstract Background Riding lawn mower injuries are the most common cause of major limb loss in young U.S. children. Our study objective was to investigate the circumstances surrounding pediatric riding lawn mower injuries and to identify potential contributing risk factors and behaviors leading to these events. Methods Followers/members of both a public and a private lawn mower injury support and prevention Facebook page who had or were aware of children who had suffered a lawn mower-related injury were invited to complete an electronic survey on Qualtrics. Duplicate cases and those involving push mowers were removed. Frequencies and chi-square analyses were performed. Results 140 injured children were identified with 71% of surveys completed by parents and 19% by an adult survivor of a childhood incident. The majority of injured children were Caucasian (94%), male (64%), and ≤ 5 years of age at the time of the incident (63%). Bystanders were 69% of those injured, 24% were lawn mower riders, and mower operators and others accounted for 7%. The lawn mower operator was usually male (77%), being the father/stepfather in almost half. Overall, 59% of injuries occurred while traveling in reverse, 29% while moving forward. Nearly all (92%) had an amputation and/or permanent disability. Subgroup analysis (n = 130) found injured bystanders were younger than injured passengers with 71% versus 45% being < 5 years of age, respectively (p = 0.01). Over three-quarters of bystander incidents occurred while moving in reverse as compared to 17% of passenger incidents (p < 0.01). Amputations and/or permanent disabilities were greater among bystanders (97%) as compared to passengers (79%, p = 0.01). Only 3% of bystanders had an upper extremity injury as compared to 21% of passengers (p = 0.01). Seventy-three percent of bystander victims had received at least one ride on a lawn mower prior to their injury incident. Conclusions Child bystanders seriously injured by riding lawn mowers were frequently given prior rides likely desensitizing them to their inherent dangers and leading them to seek rides when mowers were being used. Engineering changes preventing blade rotation when traveling in reverse and not giving children rides (both when and when not mowing) may be critical in preventing mower-related injuries

Using Geospatial Mapping to Determine the Impact of All-Terrain Vehicle Crashes on Both Rural and Urban Communities

Introduction: Deaths and injuries from all-terrain vehicle (ATV) crashes result in approximately700 deaths each year and more than 100,000 emergency department (ED) visits. Commonmisconceptions about ATV crashes are a significant barrier to injury prevention efforts, as is the lackof key information about where and how crashes occur. The purpose of this study was to determineATV crash patterns within a state, and to compare and contrast characteristics of these crashes as afunction of crash-site rurality.Methods: We performed descriptive, comparative, and regression analyses using a statewide off-roadvehicle crash and injury database (2002-2013). Comparisons were performed by rurality as defined usingthe Rural Urban Commuting Area (RUCA) coding system, and we used geographic information system(GIS) software to map crash patterns at the zip code and county levels.Results: ATV crashes occurred throughout the state; 46% occurred in urban and 54% in rural zip codeareas. Comparisons of rider and crash characteristics by rurality showed similarities by sex, age, seatingposition, on vs. off the road, and crash mechanism. Conversely, helmet use was significantly loweramong victims of isolated rural crashes as compared to other victims (p=0.004). Crashes in isolatedrural and small rural areas accounted for only 39% of all crashes but resulted in 62% of fatalities. In bothrural and urban areas, less than one-quarter of roadway injuries were traffic related. Relative crash ratesvaried by county, and unique patterns were observed for crashes involving youth and roadway riders.During the study period, 10% and 50% of all crashes occurred in 2% and 20% of the state’s counties,respectively.Conclusion: This study suggests that ATV crashes are a public health concern for both rural and urbancommunities. However, isolated rural ATV crash victims were less likely to be helmeted, and rural victimswere over-represented among fatalities. Traffic was not the major factor in roadway crashes in eitherrural or urban areas. Unique crash patterns for different riding populations suggest that injury preventionexperts and public policy makers should consider the potential impact of geographical location whendeveloping injury prevention interventions. [West J Emerg Med. 2017;18(5)913-922.

Using Geospatial Mapping to Determine the Impact of All-Terrain Vehicle Crashes on Both Rural and Urban Communities

Introduction: Deaths and injuries from all-terrain vehicle (ATV) crashes result in approximately700 deaths each year and more than 100,000 emergency department (ED) visits. Commonmisconceptions about ATV crashes are a significant barrier to injury prevention efforts, as is the lackof key information about where and how crashes occur. The purpose of this study was to determineATV crash patterns within a state, and to compare and contrast characteristics of these crashes as afunction of crash-site rurality.Methods: We performed descriptive, comparative, and regression analyses using a statewide off-roadvehicle crash and injury database (2002-2013). Comparisons were performed by rurality as defined usingthe Rural Urban Commuting Area (RUCA) coding system, and we used geographic information system(GIS) software to map crash patterns at the zip code and county levels.Results: ATV crashes occurred throughout the state; 46% occurred in urban and 54% in rural zip codeareas. Comparisons of rider and crash characteristics by rurality showed similarities by sex, age, seatingposition, on vs. off the road, and crash mechanism. Conversely, helmet use was significantly loweramong victims of isolated rural crashes as compared to other victims (p=0.004). Crashes in isolatedrural and small rural areas accounted for only 39% of all crashes but resulted in 62% of fatalities. In bothrural and urban areas, less than one-quarter of roadway injuries were traffic related. Relative crash ratesvaried by county, and unique patterns were observed for crashes involving youth and roadway riders.During the study period, 10% and 50% of all crashes occurred in 2% and 20% of the state’s counties,respectively.Conclusion: This study suggests that ATV crashes are a public health concern for both rural and urbancommunities. However, isolated rural ATV crash victims were less likely to be helmeted, and rural victimswere over-represented among fatalities. Traffic was not the major factor in roadway crashes in eitherrural or urban areas. Unique crash patterns for different riding populations suggest that injury preventionexperts and public policy makers should consider the potential impact of geographical location whendeveloping injury prevention interventions. [West J Emerg Med. 2017;18(5)913-922.