Increases in Fireworks-Related Upper Extremity Injuries Correspond to Increasing Fireworks Sales: An Analysis of 41,195 Injuries Across 10 Years
Patrick J. Morrissey, B.S., Marc El Beaino, M.D., M.Sc, William Harris, B.S., Neil V. Shah, M.D., M.S., Barrett B Torre, B.A., Daniel R. Woolfenden, N/A, Karan Dua, M.D., Charles Ekstein, M.D. and Steven M. Koehler, M.D., State University of New York (SUNY), Downstate Medical Center, Brooklyn, NY
Introduction: Increasing firework sales prompted the American Society for Surgery of the Hand (ASSH) to issue a bulletin in 2015 urging the public to avoid amateur firework usage. We sought to evaluate the epidemiology of fireworks-related upper extremity (UE) injuries from 2008-2017, hypothesizing UE injuries from fireworks were increasing in the US.
Methods: The National Electronic Injury Surveillance System (NEISS) provides a nationwide probability sample of injuries related to consumer products based on emergency department (ED) visits from approximately 100 US hospitals. The NEISS was queried for any fireworks-related UE injuries (product codes 1313 and 1718) from 2008-2017. Temporal trends were determined, and age/demographics, injury location, and injury type were collected.
Results: A total of 1,079 individuals, representing a weighted estimate of 41,195 fireworks-related UE injuries, presented to US EDs from 2008-2017. The number of injuries increased significantly from 2,576 in 2008 to 5,101 in 2017 (R2=0.85, R=0.92, p<0.001) (Figure 1). A strong, positive correlation between increasing firework sales and increasing number of injuries was observed (rs =.939, p<0.01). The overwhelming majority of fireworks-related injuries were in males (77%). The 11-20 age group represented the highest proportion (n=10,293; 27%) of injuries, followed by 21-30 (n=10,171; 25%), ≤10 (n=7,239; 18%), 31-40 (n=6,916; 17%) and 41+ (n=5,946; 14%). Most injuries occurred between June and August (n=31,582; 76%). Caucasians were the most commonly reported race of injured patients (n=24,346; 59%), followed by African-Americans (n=3,087; 7.4%) and Hispanics (n=2,255; 5.5%). The most commonly injured body parts were the hand (n=21,712; 52.7%) and digits (n=13,643; 33.1%). The thumb was the most commonly injured finger (n=4,266; 31.3%), followed by the index finger (n=1,320; 9.7%) and combined thumb-index injuries (n=849; 6.2%). Burns injuries were most common across all body sites except the wrist, where fractures were more common (Table 2).
Conclusions: 10-year fireworks-related UE injuries increased, corresponding with increased consumer sales across the same period. Injuries predominantly occurred in June-August. Most injuries were in male 11-30yo patients. The hand was most commonly injured, with the thumb as the most injured digit. Combined thumb-index finger injuries were common.
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