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Reprinted by permission of Otolaryngol Head Neck Surg. 2016; 155(1):94-98.

Original Research—General Otolaryngology

Otolaryngology– Head and Neck Surgery 2016, Vol. 155(1) 94–98 American Academy of Otolaryngology—Head and Neck

Pediatric Oral Electrical Burns: Incidence of Emergency Department Visits in the United States, 1997-2012

Surgery Foundation 2016 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599816640477 http://otojournal.org

Lauren A. Umstattd, MD 1 and C. W. David Chang, MD 1

E lectrical appliances began making their way into homes in the early- to mid-20th century, and not long after, articles soon appeared in the medical liter- ature describing associated injuries with such consumer products. Early reports of electrical injuries highlighted a particular type of injury specific to young children that was capable of leading to devastating functional and aesthetic outcomes. Such burns were found at the oral commissure as a result of chewing on an electrical cord or mouthing the live female end of an open or connected extension cord. 1-5 The US Consumer Product Safety Commission (CPSC) report 6 in 1974 estimated that 4000 persons received emer- gency department (ED) treatment for injuries associated with extension cords and appliance cords based on data accrued over a single year (1972-1973). Of these injuries, 28% involved an electrical burn to the mouth. Patients aged 0 to 14 years composed 51% of the total cases. This would approxi- mate roughly 570 cases of pediatric oral electrical burns per year. We hypothesize, as compared with historical estimates, an overall decrease in modern injury rates based on single- institution surveillance. Our objective is to provide a more accurate and updated epidemiologic analysis of this injury pat- tern by reviewing data over a recent 16-year period. Methods Since injury data were collected from the National Electronic Injury Surveillance System (NEISS), which is operated by the CPSC, formal exemption was obtained from the University of Missouri Institutional Review Board for the completion of this project. The NEISS data represent a stratified probability sample of hospital ED visits that provides data on consumer product-related and sports-related injuries treated in US EDs. Data originate from a network of approximately 100 1 Department of Otolaryngology–Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA This article was presented at the 2015 AAO-HNSF Annual Meeting & OTO EXPO; September 27-30, 2015; Dallas, Texas. Corresponding Author: C. W. David Chang, MD, Department of Otolaryngology–Head and Neck Surgery, University of Missouri School of Medicine, One Hospital Dr,

No sponsorships or competing interests have been disclosed for this article.

Abstract Objectives. To investigate the epidemiology of emergency department visits for pediatric patients presenting with elec- trical burns to the mouth.

Study Design. Cross-sectional analysis of a national database.

Setting. National Electronic Injury Surveillance System Database.

Subjects and Methods. The Consumer Product Safety Commission’s National Electronic Injury Surveillance System database was used to derive a national weighted estimate of emergency department visits for oral electrical burns and was queried for each patient’s age, sex, race, local of inci- dence, disposition, and related consumer product. Results. There were an estimated 1042 emergency depart- ment visits for pediatric oral electrical burns from 1997 to 2012, or an average of approximately 65.1 cases per year. A total of 59.6% of patients were male. Nearly half of emer- gency department visits involved patients \ 3 years of age, and more than three-fourths of emergency department visits involved patients \ 5 years of age. A total of 77.2% of patients were examined, treated, and released from the emergency department, while 19.2% were admitted to the hospital. Most injuries involved electrical outlets or recepta- cles (10.8%), extension cords (18.5%), and electrical wires (21.5%). Conclusion. Earlier incidence estimates of pediatric oral elec- trical burns varied substantially within the literature and varied from small case reports to single-year studies. Our multiyear data analysis provides evidence of decreasing annual incidence when compared with historical estimates for a common but potentially morbid injury among the pediatric population.

Keywords otolaryngology, pediatrics, oral, mouth, electrical burn, National Electronic Injury Surveillance System

Received September 18, 2015; revised February 18, 2016; accepted March 2, 2016.

MA314, Columbia, MO 65212, USA. Email: changda@health.missouri.edu

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