Assessment of Firework-Related Ocular Injury in the US

Abstract

IMPORTANCE Fireworks are popularly used for recreation but can lead to potentially blinding injuries. Studies quantifying the trend and national prevalence of firework-related ocular injuries are limited.OBJECTIVE To characterize firework-related ocular injuries treated in emergency departments (EDs) in the US from 1999 to 2017. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used the National Electronic Injury Surveillance System, a stratified probability sample of more than 100 hospital-affiliated US EDs representing more than 5300 nationwide hospitals. Deidentified individuals in the National Electronic Injury Surveillance System database who experienced eye injury due to fireworks between January 1, 1999, and December 31, 2017, were included. Analysis began February 2019. MAIN OUTCOMES AND MEASURESAnnual prevalence of firework-related ocular injury, firework type stratified by demographic information, diagnosis, event location/date, and patient disposition.RESULTS A total of 34 548 firework-related ocular injuries were seen in US EDs during the 19-year study period (estimated from 1007 individuals in the National Electronic Injury Surveillance System database). Overall, 664 individuals (65.9%) were 18 years or younger, 724 (71.9%) were male, and 512 (50.8%) were white. Twenty-eight patients (2.8%) sustained a ruptured globe, while 633 (62.9%) sustained ocular burn injuries, 118 (11.7%) had ocular foreign bodies, 97 (9.6%) had conjunctival irritation, and 46 (4.6%) experienced other severe eye trauma. Of 1007 individuals, 911 (90.5%) were treated and released without transfer, while 87 (8.7%) required admission or transfer to another hospital. The most common specified firework types included firecrackers (193 [19.2%]), bottle rockets (177 [17.6%]), sparklers (88 [8.7%]), roman candles (66 [6.6%]), and novelty devices (65 [6.5%]) (eg, poppers and snappers). Bottle rockets disproportionately caused the most severe injuries, including ruptured globe (odds ratio, 5.82; 95% CI, 2.72-12.46; P < .001). A total of 411 cases (74.9%) occurred at home. Injuries most commonly occurred near the time of Independence Day and New Year's Day: 707 patients (70.2%) presented in July, 74 (7.4%) in June, 101 (10.0%) in January, and 47 (4.7%) in December.CONCLUSIONS AND RELEVANCE These findings support that firework-related ocular injuries range from mild irritation to ruptured globe, and most occur frequently in those who are young, male, and white. Focused preventive methods and regulations may be imperative in decreasing fireworks-related ocular morbidity, namely from bottle rockets and especially near national holidays.

Injuries, treatment, and impairment caused by different types of fireworks; results of a 10 year multicenter retrospective cohort study

“…Vascular injury a 395 1 (0%) 95 1 (1%) 58 0 (0%) 17 0 (0%) 50 0 (0%) 5 0 (0%) 31 0 (0%) 139 0 (0%) Neural injury b 395 1 (0%) 95 1 (1%) 58 0 (0%) 17 0 (0%) 50 0 (0%) 5 0 (0%) 31 0 (0%) 139 0 (0%) explosive and homemade fireworks most often led to hospital admission, surgical treatment, and permanent impairment. Similar to literature from the past two decades, the number of patients treated annually did not show an increase or decrease over the past years [1,2,5,[12][13][14][15][16]. On a nationwide level, the absolute number of patients treated in the Netherlands has decreased from 700 patients in 2014 to 385 in 2020 [4].…”

Feel the Burn! Fireworks-related Otolaryngologic Trauma

“…While we did not explore firework-related ocular injuries, it is important to remember an estimated 34 548 of such injuries were seen in US EDs from 1997 to 2017. 19 We observed no general trend in the incidence of such injuries in the past 10 years (Figure 1). The vast majority of cases occurred in July (387, 71.5%), which likely corresponds to the Independence Day celebration during which consumption of private and public domain fireworks are commonplace.…”

“…Fireworks types were categorized akin to previous reports. 19 All population estimates were derived using NEISS calculated weights. 21,22 Diagnoses were categorized based on nature of the injury: burn, superficial traumatic injury (contusion, abrasion, superficial hematoma), penetrating trauma (laceration, avulsion, penetrating trauma), injury involving fractured bones of cranium, injury specified only as closed head injuries, cervical muscle strain, otologic injury (including acoustic trauma, tinnitus, hearing loss, and tympanic membrane perforation), other otologic injury (including foreign body, otitis externa secondary to foreign bodies, and Eustachian tube dysfunction), headache, intracranial traumatic injury (including, concussion traumatic brain injury, subdural hemorrhage, epidural hematoma, and subarachnoid hemorrhage), dental injury and fracture, and injury in which a diagnosis wasn't specified.…”

“…Fireworks-related injury trends have been explored and reported in the national population, 1 and in other specific areas of interest such as ocular injuries. 19 In this study, we assemble and analyze national epidemiologic data pertaining to fireworks-related head and neck injury. Our goal is to discern associations that may prepare EDs and head and neck trauma specialists, while guiding future policymakers and regulators.…”

Incidence of Ocular, Adnexal and Orbital Trauma at Different Tertiary Care Centers of Karachi.

“…Domestic accidents and assaults nearly make one third of injuries. [2,7,8] Apart from the various eye disorders causing blindness as seen in a US eye disease statistics survey, ocular trauma is also a big cause. [9] Various studies have shown varied orders of incidence of trauma according to the socioeconomic and cultural circumstances in the site of event.…”