Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. e667-e674 (doi:10.1542/peds.2004-2143)
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ELECTRONIC ARTICLE

Characteristics of Pediatric Traumatic Amputations Treated in Hospital Emergency Departments: United States, 1990–2002

Sarah Grim Hostetler, BA*, Lila Schwartz*, Brenda J. Shields, MS*, Huiyun Xiang, MD, MPH, PhD*,{ddagger} and Gary A. Smith, MD, DrPH*,{ddagger}

* Center for Injury Research and Policy
{ddagger} Ohio State University College of Medicine and Public Health, Columbus Children's Research Institute, Children's Hospital, Columbus, Ohio

Objective. To examine the characteristics of children with traumatic amputations and the products associated with these injuries.

Methods. Data regarding amputation injuries to children younger than 18 years treated in US emergency departments from 1990 to 2002 were obtained from the National Electronic Injury Surveillance System. Data included demographics, product involved, and body region injured.

Results. An estimated 111600 children younger than 18 years with amputation injuries were treated in US emergency departments from 1990 to 2002. The average age was 6.18 years (median: 4 years; mode: 1 year old). Males experienced 65.5% of these injuries. Finger amputations accounted for 91.6% of all amputations, ranging from 95.2% among 0- to 2-year-olds to 87.9% among 13- to 17-year-olds. Complete amputations accounted for 70.2% of all amputations among 13- to 17-year-olds compared with 52.6% of amputations among 0- to 2-year-olds. Adolescents also had the highest proportion of amputations resulting in hospital admission (26.6% for 13- to 17-year-olds compared with 11.9% for 0- to 2-year-olds). Adolescents had the highest proportion of amputation injuries involving lawn mowers (14.1% for 13- to 17-year-olds compared with 1.4% for 0- to 2-year-olds) and the highest proportion of amputations involving tools (29.3% for 13- to 17-year-olds compared with 2.5% for 0- to 2-year-olds). The percentage of amputations involving doors peaked in the youngest age group and decreased as age increased (65.8% of all amputations for 0- to 2-year-olds compared with 14.1% for 13- to 17-year-olds).

Conclusions. To our knowledge, this is the first study to use a nationally representative sample to broadly investigate amputation injuries among children. The majority of traumatic amputation injuries occur to young children, to males, and to fingers and the majority involve doors. Adolescents experience a higher proportion of more serious amputation injuries. Effective interventions exist but are inadequately used to prevent many of these injuries, including door stops and modifications, bicycle-chain and spoke guards, wearing closed-toe footwear while bicycling, a no–mow-in-reverse default feature on ride-on lawnmowers with the override switch located behind the mower operator, and a SawStop system on power saws. Use of these technical countermeasures and changes in relevant product standards to promote their implementation and use could lead to a decrease in pediatric traumatic amputations.

Key Words: trauma • amputation • injury • door • bicycle • lawn mower • power saw • children

Abbreviations: NEISS, National Electronic Injury Surveillance System • CPSC, US Consumer Product Safety Commission • ED, emergency department • CI, confidence interval • RR, relative risk • NMIR, no-mow-in-reverse

Accepted May 31, 2005.


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