Most Common Consumer Products Associated With Hand and Wrist Injuries Presenting to US Emergency Departments: An NEISS Database Analysis

Abstract

Background:

Hand and wrist injuries place a large burden on US emergency departments, and the injury mechanism is often related to consumer products. The purpose of this study is to identify the consumer products most frequently associated with injuries of the hand and wrist that present to US emergency departments and analyze demographic variables and disposition status.

Methods:

The National Electronic Injury Surveillance System database was queried for hand and wrist injuries in patients of all ages from 2018 to 2022. Consumer product codes, demographics, injury sustained, diagnosis, and disposition were analyzed using descriptive statistics and multivariate logistic regression analysis.

Results:

Knives accounted for 11% of all injuries, and doors were the next most common consumer product identified (n = 15 827; 5.8%). The highest proportion of injuries occurred in patients ages 15 through 24 (n = 51 900; 19%). The consumer product varied significantly by age group: doors were most common for ages 1 through 9, sports equipment for ages 10 through 14, knives for ages 15 through 80, and floors or stairs for patients older than 80. Discharge disposition was primarily outpatient (n = 257 895; 94%). Age, male sex, stairs, floors, and windows were associated with significantly higher odds of admission.

Conclusions:

The most common consumer product codes involved in injuries varied significantly between age groups, likely reflecting different common injury mechanisms. Knives were the most common consumer product identified. Patients were more likely to be admitted if older than 65, male, or injured with floor, stairs, or windows.

Introduction

Hand and wrist injuries place a large burden on emergency departments (EDs) throughout the United States, accounting for approximately 13% of all injuries and 30% of all orthopedic injuries presenting to EDs. ¹ These injuries account for billions of dollars per year in health care costs annually and often result in significant disability that prevent patients from working or completing other activities of daily living.^2-6 Certain injuries, particularly fractures of the distal upper extremity, are becoming a greater cause for concern as the population ages and are presenting a risk for more hospitalizations, health care costs, and potential morbidity.^7,8 In addition, some specific populations may be at increased risk, including young male laborers who may be exposed to workplace hazards.^2-7

Prior studies have shown a heterogeneous mixture of results regarding injury mechanisms, injury types, and populations at risk. Traumatic mechanism of injury has been consistently identified as the leading cause of injuries to the hand and wrist, with some sources even reporting up to 80%, and the most common injury types typically include lacerations or fractures.^2-7 Various consumer products—defined as any article, or component part thereof, produced or distributed for sale to or use by a consumer in or around a home, school, in recreation, or otherwise—are often implicated in the mechanism, including machinery, firearms, cutting tools, motor vehicles, and sports products among numerous other examples.^9-20

Several epidemiological studies aimed at evaluating hand and wrist injuries presenting to emergency departments related to specific consumer products, but none have identified the consumer products that are most frequently responsible for these injuries.^9-20 Most prior studies are limited in that they only analyzed one demographic or consumer product. Many have focused primarily on power tools and saws used in manual labor, despite these injuries making up a small percentage of the total number of hand and wrist injuries presenting to EDs.^5,13,20 A number of these studies evaluated a single consumer product, often reporting on relatively unique causes of injury and neglecting other more common causes.^{10,11,14,15,18,19} In addition, many of these studies analyzed data from more than 5 years ago, reflecting a need for updated analysis as consumer products continue to evolve with new technology.

The purpose of this study is to identify the consumer products most often associated with injuries to the hand, wrist, and fingers, and to analyze the trends, patient demographics, and injury characteristics associated with each of the consumer products identified. In addition, this study aims to compare the consumer products identified for different age groups. This information will prove valuable for understanding what populations are at risk with respect to using different consumer products and can better inform providers in both counseling patients on how to safely use products as well as anticipating management of such patients to appropriately allocate resources.

Methods

All data were collected using the US Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS) from January 2018 to December 2022. The NEISS database is a nationally representative probability sample of about 100 EDs in the United States and its territories. All participating NEISS hospitals have at least 6 beds and a 24-hour ED where information on demographics, injury, and treatment information is collected. From the data collected by the NEISS hospitals, national estimates are made of the total of product-related injuries treated in US EDs.

The NEISS database was queried for all hand, wrist, and finger injuries (NEISS body part codes: 82, 34, and 92, respectively) in patients of all ages from 2018 to 2022. Information on demographics, the injury sustained, diagnosis, and narrative describing how the injury occurred and how the patient presented to the ED are included in the data. All cases were stratified into one of the following age categories by years old: under age 1, 1 to 4, 5 to 9, 10 to 14, 15 to 24, 25 to 34, 35 to 44, 45 to 54, 55 to 64, 65 to 80, and more than 80. Within each age category, the top consumer product codes by number of cases were determined and those cases were included in the analysis.

The primary outcome of interest was consumer products causing injury, which was determined within the whole cohort and within each discrete age category. Our secondary outcome of interest was patient disposition which served as a proxy for injury severity and was defined by admission versus discharge.

Descriptive statistics and univariate analysis of injury characteristics were performed for each year and stratified by age. A multivariable logistic regression analysis was performed using age, sex, and consumer products as factors in the model to analyze risk factors associated with admission using an alpha of 0.05 indicating statistical significance. All statistical analyses were performed using SPSS Statistics Version 27.0 (Armonk, NY: IBM Corp).

Results

The total number of cases of hand, wrist, and finger injuries that presented to US EDs from 2018 to 2022 was 273 377, which corresponds to a national estimate of 10 631 183 injuries during that span. Knives were the most common consumer product identified, accounting for 11% (n = 30 018) of all injuries, with doors the next most common (n = 15 827; 5.8%) (Table 1). Males were more commonly injured than females (n = 60%, P < .01). The most common injury type was laceration (n = 92 618; 34%) followed by fracture (n = 63 183; 23%).

Table 1.

Demographics and Injury Characteristics Among the Entire Sample of Hand and Wrist Injuries.

Characteristic	Reported cases (%)
Age (years old)
Under 1	1623 (0.6)
1 to 4	17 519 (6.4)
5 to 9	22 809 (8.3)
10 to 14	40 595 (14.8)
15 to 24	51 900 (19.0)
25 to 34	37 663 (13.8)
35 to 44	27 941 (10.2)
45 to 54	22 452 (8.2)
55 to 64	21 987 (8.0)
65 to 80	21 603 (7.9)
Over 80	7285 (2.7)
Sex
Male	163 743 (59.9)
Female	109 617 (40.1)
Other	17 (<0.01)
Race
White	128 043 (46.8)
Black	45 363 (16.6)
Asian	4702 (1.7)
American Indian	1002 (0.4)
Pacific Islander	401 (0.1)
Other	8972 (3.3)
Not stated	84 894 (31.1)
Injury type
Laceration	92 618 (33.9)
Fracture	63 183 (23.1)
Not stated	27 023 (9.9)
Contusion	26 710 (9.8)
Sprain	23 178 (8.5)
Foreign body	6859 (2.5)
Burn	6449 (2.4)
Avulsion	5771 (2.1)
Dislocation	3572 (1.3)
Puncture	3550 (1.3)
Other	14 464 (5.0)
Consumer product
Knives, not elsewhere classified	30 018 (10.98)
Doors, other or not specified	15 827 (5.79)
Ceilings and walls	11 353 (4.15)
Basketball	10 938 (4.00)
Football	9046 (3.31)
Stairs or steps	8814 (3.22)
Bicycles or accessories	8151 (2.98)
Floors or flooring materials	7063 (2.58)
Windows and window glass	4723 (1.73)
Soccer	4361 (1.59)

The highest proportion of injuries occurred in patients ages 15 through 24 (n = 51 900; 19%). The most common consumer product varied significantly by age group: doors were most common for ages 1 through 9, sports equipment for ages 10 through 14, knives for ages 15 through 80, and floors or stairs for patients older than 80 (P < .01) (Table 2). Sport-related injuries are among the most common, with basketball, football, and soccer-related products accounting for the fourth, fifth, and tenth most common consumer products associated with injury across all age groups, respectively.

Table 2.

Top 5 Consumer Product Codes Associated With Hand and Wrist Injuries for Each Age Group.

Age group (years old)	Consumer product	%	Reported cases
Under 1	Cosmetic or make up brushes	19.53	317
	Doors, other or not specified	11.21	182
	Metal containers	5.24	85
	Ranges or ovens, not specified	4.37	71
	Hair curlers, curling irons, clips and hairpins	3.82	62
1 to 4	Doors, other or not specified	24.51	4294
	Knives, not elsewhere classified	3.32	581
	Beds or bedframes, other or not specified	2.75	481
	Ranges or ovens, not specified	2.73	478
	Metal containers	2.61	458
5 to 9	Doors, other or not specified	11.48	2618
	Monkey bars, playground gyms, or other playground climbing apparatus	5.88	1342
	Bicycles or accessories	5.09	1161
	Knives, not elsewhere classified	4.83	1101
	Football	3.72	848
10 to 14	Basketball	12.55	5096
	Football	11.99	4869
	Soccer	5.28	2143
	Bicycles or accessories	5.08	2062
	Knives, not elsewhere classified	4.65	1888
15 to 24	Knives, not elsewhere classified	12.22	6341
	Ceilings and walls	9.10	4725
	Basketball	7.12	3696
	Football	5.33	2764
	Doors, other or not specified	4.34	2250
25 to 34	Knives, not elsewhere classified	17.71	6671
	Ceilings and walls	6.58	2478
	Doors, other or not specified	4.13	1554
	Windows and window glass	3.04	1145
	Stairs or steps	2.93	1102
35 to 44	Knives, not elsewhere classified	16.86	4710
	Ceilings and walls	4.27	1194
	Doors, other or not specified	4.00	1118
	Stairs or steps	3.24	904
	Bicycles or accessories	2.56	714
45 to 54	Knives, not elsewhere classified	14.97	3361
	Stairs or steps	4.51	1012
	Doors, other or not specified	3.51	787
	Bicycles or accessories	2.71	609
	Floors or flooring materials	2.56	574
55 to 64	Knives, not elsewhere classified	13.15	2891
	Stairs or steps	5.53	1216
	Floors or flooring materials	4.20	923
	Bench or table saws	3.20	704
	Doors, other or not specified	2.89	636
65 to 80	Knives, not elsewhere classified	9.98	2156
	Stairs or steps	7.52	1624
	Floors or flooring materials	6.90	1490
	Bench or table saws	4.61	996
	Beds or bedframes, other or not specified	2.74	592
Over 80	Floors or flooring materials	18.62	1354
	Stairs or steps	8.80	640
	Beds or bedframes, other or not specified	8.11	590
	Knives, not elsewhere classified	4.15	302
	Chairs, other or not specified	3.82	278

Discharge disposition was primarily outpatient (n = 257 895; 94%). A heterogeneous group of consumer products were identified in patients requiring admission, but the most common involved the floor (n = 770; 7.6%) or stairs (n = 667; 6.5%) as part of their mechanism. Patients aged 65 and older were significantly more likely to require admission compared with younger populations (odds ratio [OR] = 2.73, CI = 2.58-2.89, P < .001) (Table 3). Male sex was also associated with significantly increased odds of admission (OR = 1.29, CI = 1.23-1.36, P < .001). There were no significant differences among different races or body parts injured regarding admission status. Among the consumer product codes, only stairs (OR = 1.24, CI = 1.13-1.37, P < .01), floors (OR = 1.76, CI = 1.61-1.93, P < .01), and windows (OR = 2.13, CI = 1.83-2.48, P < .01) were associated with significantly higher odds of admission.

Table 3.

Multivariate Logistic Regression Analysis of Risk Factors for Admission of Hand and Wrist Injuries.

Variables	Odds ratio	95% confidence interval		P-value
		Lower bound	Upper bound
Age
>65	2.727	2.578	2.885	<.001
<65 (reference)	.	.	.	.
Sex
Male	1.29	1.228	1.355	<.001
Female (reference)	.	.	.	.
Consumer product code
Knives, not elsewhere classified	0.831	0.735	0.939	.003
Doors, other or not specified	0.674	0.592	0.767	<.001
Ceilings and walls	0.627	0.543	0.724	<.001
Basketball	0.428	0.352	0.521	<.001
Football	0.512	0.424	0.618	<.001
Stairs or steps	1.243	1.129	1.368	<.001
Bicycles or accessories	0.88	0.778	0.996	.043
Floors or flooring materials	1.761	1.606	1.932	<.001
Windows and window glass	2.129	1.828	2.48	<.001
Soccer	0.429	0.33	0.557	<.001
Other (reference)	.	.	.	.

Discussion

The most common consumer product codes involved in injuries varied significantly between age groups, likely reflecting different common injury mechanisms. Knives were the most common consumer product identified, particularly in adults. Patients who were admitted had a variety of consumer products involved, but the most common were floor or stairs. In addition, increased age, male sex, and windows were similarly associated with increased odds of admission. Lacerations and fractures were the most common injury types, which is consistent with the consumer products frequently identified.

Knives were consistently found to be among the top consumer products leading to wrist and hand injuries within all age groups, including as the most common product code for ages 15 through 80. Knives and other cutting tools have been often identified as a significant cause of hand injuries throughout the literature.^{6,7,12,14,15,17,21-23} Studies examining knife-related injuries found pocket knives and kitchen knives to be most commonly implicated, with injuries while cutting food or non-food items being the most prevalent situations.^14,15,23 Several proposals have been made to address knife safety to limit these injuries, including development of safer designs such as retractable blades, or placing warning labels on certain food items to make consumers aware of possible mechanisms of injury. ²³ In addition, policy changes could be proposed to enforce age restrictions on purchasing knives, as knife injuries in this study represented a large proportion of pediatric and adolescent injuries. The most frequent injury types identified were lacerations and fractures, likely as a result of knives or other cutting tools in many of the cases. Despite the abundance of studies examining hand injuries caused by power saws and tools, these injuries did not represent a large proportion of the injuries found in this study.^{7,13,16,17,20,24} This may be explained by a number of theories, including heightened awareness of injury threat using this equipment and subsequent increased use of personal protective equipment, as well as less overall use of this equipment compared with common everyday appliances such as knives.

Prior studies noted many hand and wrist injuries to be associated with sports participation.^{9,12,22,25-27} This is reflected in our study, with basketball, football, bicycling, and soccer all included within the top 10 consumer product codes for the entire sample. These injuries preferentially affected teens and young adults, with prior studies determining sports-related injuries to be among the leading cause of hand injuries in pediatric populations, and the leading cause for pediatric hand fractures.^12,22,25 Given the young age of those injured and often isolated injuries sustained from sports, these patients were rarely admitted. In fact, football, basketball, and soccer injuries registered the lowest odds of admission among the top consumer product codes.

Injuries involving elderly patients most frequently involved surfaces such as floors or stairs, likely representing falls—considering this is a common mechanism of injury in elderly patients. This demographic, particularly those whose injury mechanism involved the floor or stairs, had significantly higher odds of admission to the hospital. This reflects the severity of injuries sustained in this population, including distal radius fractures from falls, and associated comorbidities that put these patients at risk for admission.^8,28,29 Approximately 25% of distal radius fractures require surgical management, and treatment strategies have trended toward more aggressive management over the years.^28,29 In addition, Brown et al ⁸ found the rate of hospitalizations for distal upper extremity injuries has increased in recent years and, similar to our study, significant association of hospitalization with increasing age. This trend will likely continue as the US population continues to age and has an associated increase in comorbidities that make hospitalization necessary. However, surgeons and physical therapists can limit the chances of these injuries occurring by education on fall prevention strategies and ensuring patients have proper assistive devices.

Despite a higher total number of patients with floors or stairs involved in their injury mechanism being admitted, the highest odds of admission resulted from injuries associated with windows and window glass. There is not much literature examining hand and wrist injuries involving windows and, given that we did not directly examine the detailed mechanism of each injury, there is no obvious explanation for this finding. We therefore posit that these admissions likely represent degloving or deep lacerations to the hand and wrist from a high-energy mechanism such as motor vehicle collisions with the upper extremity exiting through the window, or via punching through glass. ³⁰ These can ultimately lead to severe “spaghetti wrist” type injuries with lacerations involving multiple structures including tendons, arteries, and nerves in the volar wrist, which would require admission for extensive reconstruction. ³¹

Our data also revealed significantly more male injuries overall and significantly more male injuries that resulted in admission. This reflects similar findings in previous studies, all of which attribute this discrepancy to increased male participation in sports and increased male participation in occupations that require the use of dangerous equipment.^21,27,32 In addition, men comprise a larger proportion of upper extremity trauma patients in general, and more often require referral to tertiary facilities due to complexity of injuries requiring hospitalization with specialty care. ³²

There were several limitations in this study. For one, the NEISS database is limited in the data that it provides. The granularity of the data is limited to the code definitions, evidenced by the generality of certain product codes such as “doors, other or not specified.” In addition, the lack of granularity made it difficult to differentiate injury severity. For example, while the database may separate based on amputation and laceration, there was no further classification of laceration such as depth or neurovascular involvement. Furthermore, the data relies on appropriate coding and sufficient details from the providers that contribute to the database. Given the size of the sample used in this study, it was not reasonable to determine specific injury mechanisms from the narrative provided for each patient case, so our study lacks details on specific injury mechanisms. In addition, there is a lack of follow-up data, so there is no information regarding patient treatments and outcomes beyond the emergency department. However, the strength of this study lies in the large sample size with national representation of many different care settings and locations, as well as the inclusion of all consumer products to be compared against each other in one study.

This study provides valuable insight into the dangers of many common consumer products as it relates to the wrist and hand, as well as the groups that are most at risk from these products. Further research is necessary to further characterize specific injury mechanisms, injury severity, and patient outcomes with respect to the specific most common consumer products involved to develop more targeted injury prevention strategies and refine treatment algorithms.