2017-18 HSC Section 3 Green Book

Umstattd and Chang

data analysis suggests that injury incidence has decreased substantially within a 30-year period. The CPSC NEISS database was created with the objectives of establishing product safety standards and identifying unsafe consumer products. While specific industry safety standards have yet to be universally mandated on particular electrical consumer products, volunteer consensus technical standards have been put forth by various global and national organizations, including the American Society for Testing and Materials, the National Electrical Manufactures Association, and the Underwriters Laboratories. 15-17 Adoption and modification of these standards over the years may be partially responsi- ble for the decreased incidence of injury found in our study. Education and legislation are critical for injury preven- tion in children. Parents and caretakers may not be univer- sally familiar with the hazards that underlie household electrical appliances and accessories. Beyond describing demo- graphic and consumer product-specific trends for pediatric electrical burns to the mouth, this project should promote dis- cussion toward the advancement of electrical appliance/cord design and toward caretaker and/or user education to prevent future injuries of the oral cavity with electrical cords, appli- ances, and outlets. Based on seasonal analysis of injury rates, public service announcements would best serve their purpose during early spring months. Alternatively, age-targeted preven- tion maneuvers would be most effectively directed at care- takers of children \ 3 years old. This study has several limitations. The projected esti- mates of all oral electrical burns is underestimated because the NEISS sampling frame solely captures injuries treated in US EDs. Patients who sought treatment in other health care settings (eg, urgent care centers) or at home were not repre- sented by the data. The NEISS also reports only the most severe injury for each patient, which may underrepresent the number of minor injuries. Additionally, disposition of patient care is labeled in the NEISS database as ‘‘dis- charged,’’ ‘‘admitted,’’ or ‘‘transferred,’’ without detailing treatment needs or interventions performed. The variable that is associated with the greatest degree of limitation is the statistical projection of race. Racial projec- tions provided by this study are limited by incomplete data entry (with only 58% of recorded incident cases accompanied by a specific race designation). Imputation was not per- formed, as it is not advisable if . 20% of the data are miss- ing. 18 In addition, statistical weights assigned to incident cases do not well account for racial distributions. Projected injury incidence, in regard to racial distribution, is limited by the inherent assumptions that are necessary when projecting a heterogeneous population in a homogenous manner. Despite these limitations, the strengths of this study are its large, nationally representative sample and 16-year study period. Conclusion Pediatric oral burns are preventable injuries. Electrical appliances and accessories are a rare but important source of injury for young children, particularly those \ 5 years old. Despite the decreasing incidence of oral electrical

burns, otolaryngologists should continue to be aware of this potentially disfiguring pediatric injury. Acknowledgments We thank Gregory F. Petroski, PhD, Chelsea Deroche, PhD, and assistant Bin Ge for their assistance with statistical interpretation of the data. Author Contributions Lauren A. Umstattd , acquisition of data, analysis and interpretation of data, article drafting, final approval of submitted version, agree- ment to be accountable for all aspects of the work; C. W. David Chang , conception and design, analysis and interpretation of data, critical article revision, final approval of submitted version, agreement to be accountable for all aspects of the work.

Disclosures Competing interests: None. Sponsorships: None. Funding source: None.

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