2017-18 HSC Section 3 Green Book

Umstattd and Chang

Figure 1. Number of projected oral electrical burn–related emergency department (ED) visits in National Electronic Injury Surveillance System database among children ( 18 years old) and projected annual incidence nationwide, 1997-2012. 95% CI, 95% confidence interval.

urban, suburban, rural, and children’s hospitals, representing a stratified probability sample of approximately 6100 hospi- tals nationwide with 24-hour ED services and a minimum of 6 beds. Statistical weights are applied to each injury reported by participating hospitals to provide estimates for all US hospital EDs, and weights are ratio adjusted annually to reflect the number of total US ED visits. At sampled hos- pitals, ED medical charts are reviewed by professional NEISS coders; information is gathered on each patient who sustained an injury associated with consumer products or sports; and data are recorded pertaining to patients’ age, sex, race, injury diagnosis, body part injured, locale of injury, products involved, and disposition from the ED, along with a brief narrative of the incident. 7,8 All NEISS cases between January 1, 1997, and December 31, 2012, were reviewed (n = 57) as identified by the diagnosis code for ‘‘electrical burn’’ (diagnosis code 46) and affected body part code for ‘‘mouth’’ (body part code 88) in patients \ 18 years of age. Injuries coded under the affected body part code for ‘‘mouth’’ included injuries that occurred to the lips, tongue, and teeth. Independent variable codes remained consistent throughout the study period. Overall incidence, demographic data, injury location, associated products, ED disposition, and narrative supple- mentation were analyzed. Injury locations were classified as home (including apartment/condominium, mobile home, farm), industrial place, other public property, school, sports or recreation place, street or highway, and unknown. Disposition was classified as treated and released, treated and admitted (including admitted for observation), treated and transferred to another hospital, and unknown. No infor- mation was available regarding the severity of injury and/or subsequent medical or surgical intervention. A sample weight was assigned to each case by the CPSC on the basis of the inverse probability of selection, and weights were used to generate national estimates (US CPSC NEISS Tool for Researchers). Data analyses were conducted

by utilizing SAS software (version 9.3; SAS Institute, Cary, North Carolina), and the SAS procedure PROC SURVEYFREQ was employed to incorporate complex survey sample designs for the calculation of incidence with a 95% confidence interval (95% CI). Results From 1997 to 2012, the NEISS recorded 57 ED cases for electrical burns to the mouth for patients 18 years of age, representing a projection of 1042 nationwide visits, or an average of approximately 65.1 cases per year (95% CI: 58- 72; Figure 1 ). In comparison, from 1997 to 2012, the NEISS recorded 5,688,035 ED visits for all patients 18 years old, representing a projection of 210,097,961 nation- wide ED visits (95% CI: 210,001,695-210,194,227). Pediatric oral electrical burns represented 0.001% of all pediatric injuries with fluctuations in annual incidence rates through the period studied (1997-2012). Nearly half of ED visits involved patients \ 3 years of age, and more than three-fourths of ED visits involved patients \ 5 years of age ( Figure 2 ). A pattern of increased injury incidence was observed during the spring through fall months, with a subsequent decline during winter months ( Figure 3 ). Sex and race data are represented in Table 1 . Among the cases for which the location of injury was recorded, all oral electrical burns occurred at home (100%). A total of 77.2% of patients were treated and released from the ED, while 19.2% were admitted to the hospital and 3.5% were treated and transferred to another hospital. Table 2 lists the frequency and proportion of oral electrical injury associated with various consumer products. The majority of cases were recorded with a case narrative (50.9%), which provided additional information on the mechanism of injury. Among the cases for which a case narrative was provided, 93.1% of patients were seen chewing, mouthing, or biting on isolated electrical cords or on electrical cords associated with low-voltage consumer appliances (eg, fan, radio). In the

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