Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Orthopedic Surgery Division, Children's Mercy Hospital, Kansas City, Missouri.
J Bone Joint Surg Am. 2018 Oct 17;100(20):1719-1727. doi: 10.2106/JBJS.18.00096.
Unintentional injuries are the leading cause of morbidity and mortality among children 0 to 18 years of age in the U.S. An estimated 9,400 to 17,000 pediatric lawn-mower injuries occur each year. The aims of this study were to better define the epidemiology of lawn-mower injuries and to identify predictors of severe lawn-mower injuries to optimize public education and injury prevention.
All patients 0 to 18 years of age who presented to Children's Mercy Hospital (CMH), Kansas City, Missouri, during the period of 1995 to 2015 after sustaining a lawn-mower injury were identified using International Classification of Diseases, 9th Revision (ICD-9) codes. Demographic information and data regarding primary outcome measures (death, amputation, need for prosthesis, Injury Severity Score [ISS]) and secondary outcome measures were collected. Bivariate and multivariate analyses were used to identify risk factors for severe lawn-mower injuries.
One hundred and fifty-seven patients were identified, with a bimodal age distribution peaking at 4 and 15 years of age. Seventy-five percent of the subjects were male. Sixty-six percent of the patients were admitted to the hospital, with a mean length of stay of 6 days. An average of 3 operations were performed. Nineteen percent of the patients lived in a nonmetro/rural location. Lower-extremity injuries were most prevalent, affecting 84% of the patients. Forty percent of the patients experienced at least 1 traumatic amputation. Thirteen percent of the patients required a prosthesis after the injury. The average ISS was 8. Significant predictors of a higher ISS included an age of 0 to 9 years, a riding lawn mower, a grandparent operator, and a nonmetro/rural location. Younger children were more likely to be injured from a riding lawn mower, be the passenger of the mower or a bystander, be injured with a grandparent operator, and live in a nonmetro/rural location. Younger children also had a higher ISS and amputation rate, longer LOS, and more surgical procedures.
Education to protect younger patients should target parent, grandparent, and older sibling operators. Education for the older, teenage group should include safe mowing techniques. Efforts should also target nonmetro/rural populations and grandparents, specifically highlighting the severe dangers of riding lawn mowers when young children are passengers or bystanders.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
在美国，0 至 18 岁儿童的发病率和死亡率中，意外伤害是首要原因。每年估计有 9400 至 17000 例儿科割草机损伤。本研究的目的是更好地定义割草机损伤的流行病学，并确定严重割草机损伤的预测因素，以优化公众教育和伤害预防。
使用国际疾病分类第 9 版（ICD-9）代码，确定 1995 年至 2015 年期间在密苏里州堪萨斯城儿童慈善医院（CMH）就诊的所有 0 至 18 岁因割草机受伤的患者。收集人口统计学信息和主要结局指标（死亡、截肢、需要假肢、损伤严重程度评分[ISS]）和次要结局指标的数据。使用单变量和多变量分析来确定严重割草机损伤的危险因素。
确定了 157 名患者，年龄分布呈双峰分布，峰值分别为 4 岁和 15 岁。75%的患者为男性。66%的患者住院，平均住院时间为 6 天。平均进行 3 次手术。19%的患者居住在非都会/农村地区。下肢损伤最为常见，影响 84%的患者。40%的患者至少经历了一次创伤性截肢。13%的患者在受伤后需要假肢。平均 ISS 为 8。ISS 较高的显著预测因素包括年龄为 0 至 9 岁、骑乘式割草机、祖辈操作人员和非都会/农村地区。年幼的孩子更容易从骑乘式割草机、乘坐割草机或旁观者、由祖辈操作人员操作以及居住在非都会/农村地区受伤。年幼的孩子还具有更高的 ISS 和截肢率、更长的 LOS 和更多的手术程序。
应针对父母、祖父母和年龄较大的兄弟姐妹操作人员开展针对年幼患者的教育。针对年龄较大的青少年群体的教育应包括安全割草技术。还应针对非都会/农村地区和祖父母开展工作，特别是强调当幼儿为乘客或旁观者时骑乘式割草机的严重危险。
预后 IV 级。请参阅作者说明，以获取完整的证据水平描述。
