Fireworks type, injury pattern, and permanent impairment following severe fireworks-related injuries

• Published in: The American journal of emergency medicine Vol. 35; no. 10; pp. 1469 - 1473
• Main Authors: Sandvall, Brinkley K., MD, Jacobson, Lauren, BS, Miller, Erin A., MD, Dodge, Ryan E., BS, Alex Quistberg, D., PhD, MPH, Rowhani-Rahbar, Ali, MD, MPH, PhD, Vavilala, Monica S., MD, Friedrich, Jeffrey B., MD, Keys, Kari A., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2017; Elsevier Limited
• Subjects: Adolescent; Adult; Amputation; Blast; Brain injury; Burns; Burns - epidemiology; Burns - pathology; Child; Child, Preschool; Children; Emergency; Emergency medical care; Emergency Service, Hospital; Explosive Agents - adverse effects; Eye; Eye injuries; Eye Injuries - epidemiology; Eye Injuries - pathology; Female; Fires; Fireworks; Hand Injuries - epidemiology; Hand Injuries - pathology; Hospitals; Humans; Impairment; Independence Day; Infant; Injuries; Injury pattern; Male; Middle Aged; Pediatrics; Retrospective Studies; Shells; Surgery; Trauma; Trauma Severity Indices; Young Adult; Blast; Injury pattern; Fireworks; Impairment
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2017.04.053

Abstract Background There is a paucity of clinical data on severe fireworks-related injuries, and the relationship between firework types, injury patterns, and magnitude of impairment is not well understood. Our objective was to describe the relationship between fireworks type, injury patterns, and impairment. Methods Retrospective case series (2005–2015) of patients who sustained consumer fireworks-related injuries requiring hospital admission and/or an operation at a Level 1 Trauma/Burn Center. Fireworks types, injury patterns (body region, injury type), operation, and permanent impairment were examined. Results Data from 294 patients 1 to 61 years of age (mean 24 years) were examined. The majority (90%) were male. 119 (40%) patients were admitted who did not undergo surgery, 163 (55%) patients required both admission and surgery, and 12 (5%) patients underwent outpatient surgery. The greatest proportion of injuries was related to shells/mortars (39%). There were proportionally more rocket injuries in children (44%), more homemade firework injuries in teens (34%), and more shell/mortar injuries in adults (86%). Brain, face, and hand injuries were disproportionately represented in the shells/mortars group. Seventy percent of globe-injured patients experienced partial or complete permanent vision loss. Thirty-seven percent of hand-injured patients required at least one partial or whole finger/hand amputation. The greatest proportion of eye and hand injuries resulting in permanent impairment was in the shells/mortars group, followed by homemade fireworks. Two patients died. Conclusions Severe fireworks-related injuries from homemade fireworks and shells/mortars have specific injury patterns. Shells/mortars disproportionately cause permanent impairment from eye and hand injury.