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Effect of Fireworks Type on Injury Pattern and Permanent Impairment Following Severe Fireworks-Related Injuries
Brinkley K Sandvall, MD; Lauren Jacobson, BS; Erin Miller, MD; Ryan Edward Dodge III, BS; D Alexander Quistberg, PhD, MPH; Ali Rowhani-Rahbar, MD, MPH, PhD; Monica Vavilala, MD; Jeffrey B Friedrich, MD; Kari A Keys, MD
University of Washington, Seattle, WA
Introduction: Injuries from fireworks vary widely in patterns and severity. Severe injuries are of particular interest from the perspective of resulting impairment and increased health care utilization. It is unknown whether injury patterns and magnitude of impairment depend on fireworks type. Our objective was to examine the effect of fireworks type on injury patterns and permanent impairment following severe fireworks-related injuries.
Materials & Methods: Adult and pediatric patients who sustained fireworks-related injuries were identified from the hospital's Trauma Registry. Patients were eligible if they sustained an injury due to fireworks requiring either inpatient admission and/or an operation July 2005 to September 2015. A retrospective cohort study was conducted. The two main outcomes were injury patterns (combination of body region and injury type) and permanent impairment.
Results: 294 patients age 1 to 61 years (mean 24) were included. Table 1 shows demographics by fireworks type with shells/mortars causing the highest proportion (48%). Table 2 displays body region injured by fireworks type. Injuries to the face, brain, and hands were disproportionately attributable to shells/mortars. Compared to non-shell/mortar legal fireworks, illegal fireworks had nearly two and a half times greater risk of any face injury (RR 2.41, 95%CI 1.39-4.20) and nearly two times greater risk of an operative hand injury (RR 1.87, 95%CI 0.89-3.92); shells/mortars had over one and a half times greater risk of any face injury (RR 1.67, 95%CI 0.96-2.91) and two and a half times greater risk of an operative hand injury (RR 2.53, 95%CI 1.24-5.15). Compared to homemade fireworks, shells/mortars had about 11% higher rate of surgery (RR 1.11, 95%CI 0.75-1.65); all other fireworks types had a lower risk of surgery (p<.06). Compared to homemade fireworks, rockets were over two times more likely to cause permanent eye impairment (OR 2.17, 95%CI 0.98-4.77); shells/mortars were 41% more likely to cause permanent hand impairment (OR 1.39, 95%CI 1.02-1.90).
Conclusion: Severe fireworks-related injuries from illegal fireworks and shells/mortars have a significantly increased risk of specific injury patterns. Shells/mortars have a disproportionately high risk of permanent impairment from hand injury. Findings of this study highlight the importance of fireworks safety and injury prevention.
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