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Know before you mow: A review of lawn mower injuries in children, 1990-1998
Know Before You Mow: A Review of Lawn Mower Injuries in Children, 1990-1998 By P. Chopra, P. Soucy, J.-M. Laberge, L. Laberge, and L. Gigue`re Ottawa, Ontario and Montreal, Quebec
Purpose: The authors evaluated lawn mower injuries in Canadian children from 1990 through 1998. Data regarding age of the patient, location, and severity of injuries were tabulated. Methods: Data were collected through the CHIRPP questionnaire (Canadian Hospitals Injury Reporting & Prevention Program). Initially, a regional study examined data in the pediatric population presenting to Children’s Hospital of Eastern Ontario (CHEO), Hoˆpital Ste-Justine (HSJ), and Montreal Children’s Hospital (MCH) emergency departments. This was followed by review of all lawn mower injuries reported in Canada (including all ages) that presented to the 16 emergency departments (ER) where CHIRPP is administered. Results: Ninety cases were reported between 1990 and 1998 (MCH) and 1991 through 1997 (HSJ and CHEO). A bimodal age distribution was noted with 36% (29 of 81) younger than 4 years, and 37% (30 of 81) 10 to 14 years of age. Ninety-three percent of all injuries involved children 14 or under. Lacerations were the most common type of injury comprising 29 (32%) followed closely by amputations, 26 (29%); burns and fractures were the other main subtypes comprising 16 (18%) and 12 (13%), respectively. Eighty-seven percent of all injuries involved distal upper or lower extremity. Forty-two
S
INCE THE INTRODUCTION of antibiotics to modern medicine, injuries have overtaken communicable disease as the leading cause of morbidity and mortality in children. Preventive research in this field has addressed injuries including scald burns, drowning, poisoning, and, more recently, the use of bicycle helmets. Childhood injuries associated with lawn mower use have been reported in the surgical literature for over 30 years; however, there has been very little research into preventive measures.1 In 1990, the United States Consumer Product Safety Commission reported 58,860 lawn mower–related emergency room (ER) visits annually with 20% involving the age group 15 years or younger.2 Not all injuries involved blade contact; run-over, passenger falls from ride-on subtypes, burns, and missile injuries to bystanders were the other potential mechanisms. In its position paper on ride-on type mowers, the American Academy of Pediatrics recommended to parents that no children be allowed to operate lawn mowers, even with adult supervision, and that children 5 or under be kept indoors during mowing.3 The purpose of this report was to review lawn mower Journal of Pediatric Surgery, Vol 35, No 5 (May), 2000: pp 665-668
percent (34 of 81) required hospitalization; another 37% (30 of 81) were classified as major injuries treated in emergency and followed up. In the national data set, 354 patients with 427 injuries presented between 1990 and 1995. Sixty percent or 214 of 354 were 19 years of age or younger; furthermore, 51% or 182 of 354 were younger than 15 years. Lacerations and amputations were the most common injuries comprising 50% and 12% respectively. Lower extremity injuries were the most numerous at 184 of 427 (43%). A total of 159 of 354 (45%) were treated in ER and required hospital follow-up, a further 70 (20%) required hospital admission. No fatalities were reported.
Conclusions: Recommendations for a proposed prevention campaign include the following: (1) children younger than 15 years should not operate lawn mowers, (2) children younger than 15 years should not be in the yard when lawn is being mowed, (3) no passengers should be carried on the ride-on style mowers, (4) wearing hard closed-toe shoes should be mandatory. J Pediatr Surg 35:665-668. Copyright r 2000 by W.B. Saunders Company. INDEX WORDS: Injury prevention, lawn mower.
injuries in Canadian children. We focussed on the age of the patient, location, and severity of injury. Our hypothesis was that injuries occur most frequently and are more severe in the under 15 age group. The second aspect of the project was to propose a pamphlet and poster campaign to promote prevention of these types of injuries through improved industry and public education and awareness. MATERIALS AND METHODS A retrospective review of data obtained through the Canadian Hospital Injury Reporting Prevention Program (CHIRPP) database was performed.4 This was a voluntary questionnaire-based data collection
From Children’s Hospital of Eastern Ontario, Montre´al Children’s Hospital, and Hoˆpital Ste-Justine, Canada. Presented at the 31st Annual Meeting of the Canadian Association of Paediatric Surgeons, Montreal, Quebec, Canada, September 23-26, 1999. Address reprint requests to Dr P. Soucy, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H 8L1. Copyright r 2000 by W.B. Saunders Company 0022-3468/00/3505-0002$03.00/0 doi:10.1053/js.2000.5938 665
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system administered in 16 emergency departments across Canada. In the initial study arm, data were collected from the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, Children’s Hospital (MCH), and Hoˆpital Ste-Justine (HSJ) both in Montreal. Data were acquired from HSJ and CHEO for the years 1991 through 1997 and MCH from 1990 through April 1998. CHEO data included children 18 years or younger, whereas 19 years or younger was the inclusion criterion for the Montreal data. The raw injury data were classified according to the age of patient, type and location of injury, and treatment administered. Specifically, the children were divided into age subgroups of 4 years or younger, 5 through 9, 10 through 14, and 15 through 18 or 19. Injury subtypes were classified as follows: lacerations, fractures, amputations, burns, and the ‘‘other’’ category, which included electric shock, strain or sprain, and internal organ and facial injuries. Severity of injury was categorized according to the level of treatment administered. Patients who left before emergency room assessment were categorized as ‘‘not assessed.’’ ‘‘Minor’’ injuries were those requiring either advice or treatment in the ER with no further follow-up required. ‘‘Major’’ injuries were those treated in the ER that required ongoing hospital follow-up. The second arm of the study included the CHIRPP data set for the years 1990 through July 1995 from all 16 hospitals and all ages.4 The raw data were once again analyzed according to the age, location, and type of injury as well as severity of injury. The results were observationally compared with those obtained from the regional data set.
RESULTS
Regional Data A total of 90 cases were reported in the 3 study hospitals. The data from MCH did not specify age of patient, location, or treatment of injury in 9 cases. Therefore, in that segment of the data, analysis of only 81 cases was performed. When divided according to age, a bimodal distribution was noted with 29 of 81 (36%) being younger than 5 years, and another 30 of 81 (37%) between the ages of 10 and 14. For the 5- to 9-year group an incidence of 16 of 81 (20%) was noted, and the fewest injuries were found in the 15 to 19 group with 6 of 81 (7%; Fig 1). Almost one third of all injuries were lacerations, 29 of 90 (32%), followed closely by amputation, 26 of 90 (29%). Fractures (18%) and burns (13%)
Fig 1. Bar graph shows the age distribution (by percentage) of lawn mower injuries both regionally and nationally.
Fig 2. Bar graph shows the type of lawn mower injury (by percentage) occurring regionally and nationwide. Laceration and amputation were the most common types of injury.
were the next most common classes of injuries followed by the ‘‘other’’ category comprising 8% (Fig 2). Over one half of all injuries (52%) occurred in the lower extremity followed by upper extremity (35%), trunk and abdomen (12%), and other (1% Fig 3). Thirty-seven percent of all patients were treated for severe injuries, and 42% required admission (Fig 4). National Data In the national CHIRPP data, a total of 354 patients with 427 injuries were reported. A total of 214 of 354 or 60% of all reported patients were 19 years or younger. The age group 4 years or younger included 94 of 354 (26%) of all injuries followed by 40 of 354 (11%) in the 5 to 9 age group, 48 of 354 (14%) in the 10 to 14 age group, and the remaining 32 (9%) fell in the 15 to 19 age group. Therefore, 51% of all nationally reported injuries occurred in the under 15 age group. The nature of the data set did not permit extraction of injury data on only the 214 patients who fell into the age group of interest, ie, 19
Fig 3. Bar graph documents the site of injury (by percentage) regionally and nationwide. The most common site was the lower extremity.
LAWN MOWER INJURIES
667
Fig 4. Bar graph shows the injury severity (by percentage) regionally and nationwide. Severe injuries occurred in 37% of cases, and hospital admission was required in 42%.
years or younger. Therefore, all national data analysis included the adults who were part of the CHIRPP dataset (Fig 1). The most frequent injury was again laceration or abrasion comprising 50% (215 of 427) of all cases. Amputations were second in frequency accounting for 53 of 427 (12%) of all injuries. This was followed by burns (49 of 427), fractures (47 of 427), and other injuries (15%; Fig 2). Lower extremity injuries were the most numerous at 184 of 427 (43%) followed by upper extremity (30%), truncal (6%) and other (Fig 3). Of all 354 patients, 2 left before treatment, 123 (35%) were treated in ER as minor injuries, and 159 (45%) were treated as major injuries (Fig 4). No ER fatalities were reported. Seventy patients (20%) were admitted, and the mechanisms of injury in this group are listed in Table 1. DISCUSSION
This was a retrospective observational study in which the incidence, location, and nature of injury as well as severity of lawn mower–related accidents in Canadian children were examined. From the national data analysis, of a total 442,478 injuries reported, 354 were lawn mower related (0.08%). Limitations of the CHIRPP data relate to its underrepresentation of rural, native, and older teenager populations. When national data were analyzed by age, 51% Table 1. Mechanisms of Injury in Admitted Patients (N 5 70) National Statistics Nonoperator cut by blades Operator slipped and fell under Fingers or hands caught by blade Slipped, tripped, or fell Hit by projectile object Burned Other
36 15 5 5 3 2 4
Data from Canadian Hospitals Injury Reporting and Prevention Program.4
(182/354) of all injuries reported across Canada involved the younger-than-15 age group. A bimodal age distribution was noted in the locoregional dataset with approximately one third of all injuries involving children younger than 5 years, and a second third involving the 10 to 14 age group. The national statistics showed a similar clustering of injuries in the younger-than-5 and 10 to 14 age groups, although the relative proportions were smaller (25% and 14%, respectively). A possible explanation for this high incidence is that the very young children are unaware of the potential danger associated with lawn mowers and, as a result, play in the yard or ride as an extra passenger on the ride-on style mowers. Furthermore, the 10 to 14 age group injury peak may be secondary to increased numbers of children actively involved in mowing at this age. Perhaps this responsibility is assigned somewhat prematurely when considering both the physical limitations and judgment of a preteen. The format of the raw data did not allow us to examine the severity and type of injury specific to one age group. The findings of the locoregional data of almost one third of the injuries being amputations was unexpectedly high. In the national data (with 40% older than age 19), amputations were the second most frequent injury; however, the relative proportion was smaller at 12% (53 of 427). Both data sets showed almost half of all injuries involved lower extremity. In fact, in the national data 34 of 427 and 3 of 427 amputations involved the toe or foot and leg, respectively (data not shown). In a review of orthopedic lawn mower injuries, Alonso and Sanchez5 in 1995 reported a long-term impairment of greater than 40% of the whole person associated with lower extremity amputation. Simple precautionary measures such as wearing hard closed-toe shoes could prevent such injuries. When analysis of the injury severity data was performed, the underlying assumption was that the most severely injured patients were the ones admitted to hospital. In the regional data, 42% (34 of 81) of the patients were admitted, whereas 20% (70 of 354) were admitted nationwide. Of these 70 most severely injured patients, only 8 were older than age 19. In fact, 60 of 70 (86%) were younger than age 15. This lends support to our hypothesis that a large proportion of the most severe injuries occurs in the younger-than-15 age group. Furthermore, 32 of 70 of these most severe injuries involved ride-on mowers (data not shown), and the most common mechanism of injury involved a person other than the operator who was cut by the blades (Table 1). We believe that the incidence of lawn mower–related injuries could be reduced by heightened industry and public awareness. The following guidelines need to be widely publicized: (1) children younger than 15 should not operate lawn mowers, (2) children younger than 15 should not be in the yard while the lawn is being mowed,
668
CHOPRA ET AL
(3) no passengers should be allowed on ride-on type mowers, and (4) wearing hard closed-toes shoes should be mandatory. These guidelines echo those outlined by the Research Committee of the Pediatric Orthopedic Society of North America and the American Academy of Pediatrics’ Committee on Accident and Poison Prevention (1990; although in this latter reference only ride-on mowers were discussed).6,3 The responsibility rests with the manufacturers to continue to maximize the safety features of these machines and to place prominent warning labels in the owners’ manuals as well as on the machine itself. For example, as of 1990 the ride-on mower industry had only voluntary safety standards, which included mechanisms ensuring that blade rotation would
stop within 3 seconds of activation of the ‘‘deadman’’ switch, single control for speed and direction with reverse being slower than advance, and automatic engine shutdown.3 The responsibility rests with physicians to warn parents as well as older children of the potential hazards associated with lawn mower operation and to suggest preventive measures. An awareness campaign currently is planned in the form of a poster and pamphlet outlining the hazards and operational guidelines with respect to mowing and children. The aim is to bring the message ‘‘know before you mow’’ into the shopping malls, schools, homes as well as doctors’ offices and emergency departments to shift the preventive responsibility from manufacturers and physicians to the public.
REFERENCES 1. Mayer JP, Anderson C, Gabriel K, et al: A randomized trial of an intervention to prevent lawnmower injuries in children. Patient Education Counsel 34:239-248, 1998 2. Adler P: Estimates for power mower related injuries 1983-1990. Washington DC, Directorate for Epidemiology, US Consumer Product Safety Commission, May 1988 3. Committee on Accident and Poison Prevention: Council on Child and Adolescent Health. American Academy of Pediatrics: Mower injuries in children. Pediatrics 86:141-142, 1990
4. Canadian Hospitals Injury Reporting and Prevention Program: Child Injury Section of Laboratory Centre for Disease Control, Health Canada, June 1995 5. Alonso JE, Sanchez FL: Lawn mower injuries in children: A preventable impairment. J Pediatr Orthop 15:83-89, 1995 6. Loder RT, Brown KL, Zaleske DJ, et al: Extremity lawn-mower injuries in children: Report by the Research Committee of the Pediatric Orthopaedic Society of North America. J Pediatr Orthop 17:360-369, 1997
Purpose: The authors evaluated lawn mower injuries in Canadian children from 1990 through 1998. Data regarding age of the patient, location, and severity of injuries were tabulated. Methods: Data were collected through the CHIRPP questionnaire (Canadian Hospitals Injury Reporting & Prevention Program). Initially, a regional study examined data in the pediatric population presenting to Children’s Hospital of Eastern Ontario (CHEO), Hoˆpital Ste-Justine (HSJ), and Montreal Children’s Hospital (MCH) emergency departments. This was followed by review of all lawn mower injuries reported in Canada (including all ages) that presented to the 16 emergency departments (ER) where CHIRPP is administered. Results: Ninety cases were reported between 1990 and 1998 (MCH) and 1991 through 1997 (HSJ and CHEO). A bimodal age distribution was noted with 36% (29 of 81) younger than 4 years, and 37% (30 of 81) 10 to 14 years of age. Ninety-three percent of all injuries involved children 14 or under. Lacerations were the most common type of injury comprising 29 (32%) followed closely by amputations, 26 (29%); burns and fractures were the other main subtypes comprising 16 (18%) and 12 (13%), respectively. Eighty-seven percent of all injuries involved distal upper or lower extremity. Forty-two
S
INCE THE INTRODUCTION of antibiotics to modern medicine, injuries have overtaken communicable disease as the leading cause of morbidity and mortality in children. Preventive research in this field has addressed injuries including scald burns, drowning, poisoning, and, more recently, the use of bicycle helmets. Childhood injuries associated with lawn mower use have been reported in the surgical literature for over 30 years; however, there has been very little research into preventive measures.1 In 1990, the United States Consumer Product Safety Commission reported 58,860 lawn mower–related emergency room (ER) visits annually with 20% involving the age group 15 years or younger.2 Not all injuries involved blade contact; run-over, passenger falls from ride-on subtypes, burns, and missile injuries to bystanders were the other potential mechanisms. In its position paper on ride-on type mowers, the American Academy of Pediatrics recommended to parents that no children be allowed to operate lawn mowers, even with adult supervision, and that children 5 or under be kept indoors during mowing.3 The purpose of this report was to review lawn mower Journal of Pediatric Surgery, Vol 35, No 5 (May), 2000: pp 665-668
percent (34 of 81) required hospitalization; another 37% (30 of 81) were classified as major injuries treated in emergency and followed up. In the national data set, 354 patients with 427 injuries presented between 1990 and 1995. Sixty percent or 214 of 354 were 19 years of age or younger; furthermore, 51% or 182 of 354 were younger than 15 years. Lacerations and amputations were the most common injuries comprising 50% and 12% respectively. Lower extremity injuries were the most numerous at 184 of 427 (43%). A total of 159 of 354 (45%) were treated in ER and required hospital follow-up, a further 70 (20%) required hospital admission. No fatalities were reported.
Conclusions: Recommendations for a proposed prevention campaign include the following: (1) children younger than 15 years should not operate lawn mowers, (2) children younger than 15 years should not be in the yard when lawn is being mowed, (3) no passengers should be carried on the ride-on style mowers, (4) wearing hard closed-toe shoes should be mandatory. J Pediatr Surg 35:665-668. Copyright r 2000 by W.B. Saunders Company. INDEX WORDS: Injury prevention, lawn mower.
injuries in Canadian children. We focussed on the age of the patient, location, and severity of injury. Our hypothesis was that injuries occur most frequently and are more severe in the under 15 age group. The second aspect of the project was to propose a pamphlet and poster campaign to promote prevention of these types of injuries through improved industry and public education and awareness. MATERIALS AND METHODS A retrospective review of data obtained through the Canadian Hospital Injury Reporting Prevention Program (CHIRPP) database was performed.4 This was a voluntary questionnaire-based data collection
From Children’s Hospital of Eastern Ontario, Montre´al Children’s Hospital, and Hoˆpital Ste-Justine, Canada. Presented at the 31st Annual Meeting of the Canadian Association of Paediatric Surgeons, Montreal, Quebec, Canada, September 23-26, 1999. Address reprint requests to Dr P. Soucy, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ontario, Canada K1H 8L1. Copyright r 2000 by W.B. Saunders Company 0022-3468/00/3505-0002$03.00/0 doi:10.1053/js.2000.5938 665
666
CHOPRA ET AL
system administered in 16 emergency departments across Canada. In the initial study arm, data were collected from the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, Children’s Hospital (MCH), and Hoˆpital Ste-Justine (HSJ) both in Montreal. Data were acquired from HSJ and CHEO for the years 1991 through 1997 and MCH from 1990 through April 1998. CHEO data included children 18 years or younger, whereas 19 years or younger was the inclusion criterion for the Montreal data. The raw injury data were classified according to the age of patient, type and location of injury, and treatment administered. Specifically, the children were divided into age subgroups of 4 years or younger, 5 through 9, 10 through 14, and 15 through 18 or 19. Injury subtypes were classified as follows: lacerations, fractures, amputations, burns, and the ‘‘other’’ category, which included electric shock, strain or sprain, and internal organ and facial injuries. Severity of injury was categorized according to the level of treatment administered. Patients who left before emergency room assessment were categorized as ‘‘not assessed.’’ ‘‘Minor’’ injuries were those requiring either advice or treatment in the ER with no further follow-up required. ‘‘Major’’ injuries were those treated in the ER that required ongoing hospital follow-up. The second arm of the study included the CHIRPP data set for the years 1990 through July 1995 from all 16 hospitals and all ages.4 The raw data were once again analyzed according to the age, location, and type of injury as well as severity of injury. The results were observationally compared with those obtained from the regional data set.
RESULTS
Regional Data A total of 90 cases were reported in the 3 study hospitals. The data from MCH did not specify age of patient, location, or treatment of injury in 9 cases. Therefore, in that segment of the data, analysis of only 81 cases was performed. When divided according to age, a bimodal distribution was noted with 29 of 81 (36%) being younger than 5 years, and another 30 of 81 (37%) between the ages of 10 and 14. For the 5- to 9-year group an incidence of 16 of 81 (20%) was noted, and the fewest injuries were found in the 15 to 19 group with 6 of 81 (7%; Fig 1). Almost one third of all injuries were lacerations, 29 of 90 (32%), followed closely by amputation, 26 of 90 (29%). Fractures (18%) and burns (13%)
Fig 1. Bar graph shows the age distribution (by percentage) of lawn mower injuries both regionally and nationally.
Fig 2. Bar graph shows the type of lawn mower injury (by percentage) occurring regionally and nationwide. Laceration and amputation were the most common types of injury.
were the next most common classes of injuries followed by the ‘‘other’’ category comprising 8% (Fig 2). Over one half of all injuries (52%) occurred in the lower extremity followed by upper extremity (35%), trunk and abdomen (12%), and other (1% Fig 3). Thirty-seven percent of all patients were treated for severe injuries, and 42% required admission (Fig 4). National Data In the national CHIRPP data, a total of 354 patients with 427 injuries were reported. A total of 214 of 354 or 60% of all reported patients were 19 years or younger. The age group 4 years or younger included 94 of 354 (26%) of all injuries followed by 40 of 354 (11%) in the 5 to 9 age group, 48 of 354 (14%) in the 10 to 14 age group, and the remaining 32 (9%) fell in the 15 to 19 age group. Therefore, 51% of all nationally reported injuries occurred in the under 15 age group. The nature of the data set did not permit extraction of injury data on only the 214 patients who fell into the age group of interest, ie, 19
Fig 3. Bar graph documents the site of injury (by percentage) regionally and nationwide. The most common site was the lower extremity.
LAWN MOWER INJURIES
667
Fig 4. Bar graph shows the injury severity (by percentage) regionally and nationwide. Severe injuries occurred in 37% of cases, and hospital admission was required in 42%.
years or younger. Therefore, all national data analysis included the adults who were part of the CHIRPP dataset (Fig 1). The most frequent injury was again laceration or abrasion comprising 50% (215 of 427) of all cases. Amputations were second in frequency accounting for 53 of 427 (12%) of all injuries. This was followed by burns (49 of 427), fractures (47 of 427), and other injuries (15%; Fig 2). Lower extremity injuries were the most numerous at 184 of 427 (43%) followed by upper extremity (30%), truncal (6%) and other (Fig 3). Of all 354 patients, 2 left before treatment, 123 (35%) were treated in ER as minor injuries, and 159 (45%) were treated as major injuries (Fig 4). No ER fatalities were reported. Seventy patients (20%) were admitted, and the mechanisms of injury in this group are listed in Table 1. DISCUSSION
This was a retrospective observational study in which the incidence, location, and nature of injury as well as severity of lawn mower–related accidents in Canadian children were examined. From the national data analysis, of a total 442,478 injuries reported, 354 were lawn mower related (0.08%). Limitations of the CHIRPP data relate to its underrepresentation of rural, native, and older teenager populations. When national data were analyzed by age, 51% Table 1. Mechanisms of Injury in Admitted Patients (N 5 70) National Statistics Nonoperator cut by blades Operator slipped and fell under Fingers or hands caught by blade Slipped, tripped, or fell Hit by projectile object Burned Other
36 15 5 5 3 2 4
Data from Canadian Hospitals Injury Reporting and Prevention Program.4
(182/354) of all injuries reported across Canada involved the younger-than-15 age group. A bimodal age distribution was noted in the locoregional dataset with approximately one third of all injuries involving children younger than 5 years, and a second third involving the 10 to 14 age group. The national statistics showed a similar clustering of injuries in the younger-than-5 and 10 to 14 age groups, although the relative proportions were smaller (25% and 14%, respectively). A possible explanation for this high incidence is that the very young children are unaware of the potential danger associated with lawn mowers and, as a result, play in the yard or ride as an extra passenger on the ride-on style mowers. Furthermore, the 10 to 14 age group injury peak may be secondary to increased numbers of children actively involved in mowing at this age. Perhaps this responsibility is assigned somewhat prematurely when considering both the physical limitations and judgment of a preteen. The format of the raw data did not allow us to examine the severity and type of injury specific to one age group. The findings of the locoregional data of almost one third of the injuries being amputations was unexpectedly high. In the national data (with 40% older than age 19), amputations were the second most frequent injury; however, the relative proportion was smaller at 12% (53 of 427). Both data sets showed almost half of all injuries involved lower extremity. In fact, in the national data 34 of 427 and 3 of 427 amputations involved the toe or foot and leg, respectively (data not shown). In a review of orthopedic lawn mower injuries, Alonso and Sanchez5 in 1995 reported a long-term impairment of greater than 40% of the whole person associated with lower extremity amputation. Simple precautionary measures such as wearing hard closed-toe shoes could prevent such injuries. When analysis of the injury severity data was performed, the underlying assumption was that the most severely injured patients were the ones admitted to hospital. In the regional data, 42% (34 of 81) of the patients were admitted, whereas 20% (70 of 354) were admitted nationwide. Of these 70 most severely injured patients, only 8 were older than age 19. In fact, 60 of 70 (86%) were younger than age 15. This lends support to our hypothesis that a large proportion of the most severe injuries occurs in the younger-than-15 age group. Furthermore, 32 of 70 of these most severe injuries involved ride-on mowers (data not shown), and the most common mechanism of injury involved a person other than the operator who was cut by the blades (Table 1). We believe that the incidence of lawn mower–related injuries could be reduced by heightened industry and public awareness. The following guidelines need to be widely publicized: (1) children younger than 15 should not operate lawn mowers, (2) children younger than 15 should not be in the yard while the lawn is being mowed,
668
CHOPRA ET AL
(3) no passengers should be allowed on ride-on type mowers, and (4) wearing hard closed-toes shoes should be mandatory. These guidelines echo those outlined by the Research Committee of the Pediatric Orthopedic Society of North America and the American Academy of Pediatrics’ Committee on Accident and Poison Prevention (1990; although in this latter reference only ride-on mowers were discussed).6,3 The responsibility rests with the manufacturers to continue to maximize the safety features of these machines and to place prominent warning labels in the owners’ manuals as well as on the machine itself. For example, as of 1990 the ride-on mower industry had only voluntary safety standards, which included mechanisms ensuring that blade rotation would
stop within 3 seconds of activation of the ‘‘deadman’’ switch, single control for speed and direction with reverse being slower than advance, and automatic engine shutdown.3 The responsibility rests with physicians to warn parents as well as older children of the potential hazards associated with lawn mower operation and to suggest preventive measures. An awareness campaign currently is planned in the form of a poster and pamphlet outlining the hazards and operational guidelines with respect to mowing and children. The aim is to bring the message ‘‘know before you mow’’ into the shopping malls, schools, homes as well as doctors’ offices and emergency departments to shift the preventive responsibility from manufacturers and physicians to the public.
REFERENCES 1. Mayer JP, Anderson C, Gabriel K, et al: A randomized trial of an intervention to prevent lawnmower injuries in children. Patient Education Counsel 34:239-248, 1998 2. Adler P: Estimates for power mower related injuries 1983-1990. Washington DC, Directorate for Epidemiology, US Consumer Product Safety Commission, May 1988 3. Committee on Accident and Poison Prevention: Council on Child and Adolescent Health. American Academy of Pediatrics: Mower injuries in children. Pediatrics 86:141-142, 1990
4. Canadian Hospitals Injury Reporting and Prevention Program: Child Injury Section of Laboratory Centre for Disease Control, Health Canada, June 1995 5. Alonso JE, Sanchez FL: Lawn mower injuries in children: A preventable impairment. J Pediatr Orthop 15:83-89, 1995 6. Loder RT, Brown KL, Zaleske DJ, et al: Extremity lawn-mower injuries in children: Report by the Research Committee of the Pediatric Orthopaedic Society of North America. J Pediatr Orthop 17:360-369, 1997