Lawn mower-related injuries to children

Background: Despite current prevention efforts, approximately 9,400 children younger than 18 years continue to receive emergency care for lawn mower-related injuries each year in the United States. Methods: In this study, we analyzed data from a consecutive series of children treated for lawn mower-related injuries during a 53-consecutive-month period in the emergency department of a large, academic children's hospital. The objective of this study was to describe the epidemiology of lawn mower-related injuries to these children and to investigate the beliefs of parents regarding lawn mower use. Results: There were 85 children treated for lawn mower-related injuries during the study period. The mean age was 7.6 years (SD, 4.3 years; median, 5 years), and 65% were boys. Thirty-four patients (40.0%) were admitted to the hospital, including 3 (3.5%) to the pediatric intensive care unit, and 30 (35.3%) required surgical intervention in the operating room. There were 25 children with lacerations (29.4%), 22 with fractures (25.9%), 18 with amputations (21.2%), and 10 with burns (11.8%). The most common body region injured was the lower extremity, accounting for 57.6% (49 of 85) of injuries, including 33 injuries (38.8%) to the foot/toe and 16 injuries (18.8%) to the leg. The hand/finger and head/neck regions each accounted for another 18.8% of injuries. The leading mechanism of injury was run-over/back-over (22.4%), followed by other blade contact (17.6%), thrown object (12.9%), burn (10.6%), and a fall off the mower (7.0%). Lacerations accounted for 68.8% (11 of 16) of injuries to the head/neck compared with 20.3% (14 of 69) to other body regions (p < 0.001; relative risk [RR], 3.39; 95% confidence interval [CI], 1.99 < RR < 6.01). Twelve injuries (36.4% [12 of 33]) to the foot/toe were amputations compared with 6 (11.5% [6 of 52]) to other body regions (p = 0.01; RR, 3.15; 95% CI, 1.31 < RR < 7.58). Burns accounted for 20.9% (9 of 43) of injuries among children 5 years of age or younger compared with 2.4% (1 of 42) of injuries to children older than 5 years of age (p = 0.02; RR, 8.79; 95% CI, 1.16 < RR < 66.39). On average, parents believed that a child should be a minimum of 13 years of age to operate a ride-on mower with supervision. Eighty-six percent of parents indicated that they had made changes in safety practices after the injury event. Conclusion: Despite current prevention efforts, serious injuries associated with lawn mowers continue to occur to children. Parental education should promote compliance with the American Academy of Pediatrics policy recommendation that children should be at least 16 years old before operating a ride-on mower. Automatic protection provided by safer product design is the strategy with the highest likelihood of success in preventing these injuries. The voluntary lawn mower safety standard American National Standards Institute/Outdoor Power Equipment Institute B71.1-2003 should be revised to include more rigorous performance provisions regarding prevention of penetration of feet and toes under the mower and into the path of the blades, shielding of hot mower parts from access by young children, and equipping all ride-on lawn mowers with a no-mow-in-reverse default feature, with location of the no-mow-in-reverse override switch behind the seating position of the ride-on mower operator.