title: Pencils and pens: an under-recognized source of penetrating injuries in children.
abstract: Unlike other sharp objects, pens and pencils are readily available to children both at home and school. Although case reports are published, no series of pen or pencil injuries have been reported in the recent literature. We therefore reviewed the incidence and injury profiles of writing  instruments as compared with other sources of penetrating trauma. The trauma registry from a large urban pediatric hospital system was queried for nonmissile, nonbite penetrating injuries from 2005 through 2009. Retrospective data was collected on demographics, injuries, operations, admissions,  and mortalities. Additionally, data regarding pen and pencil injuries from 2009 to 2010 were collected prospectively, and one case from 2003 was included retrospectively. Fourteen injuries from writing instruments were seen and involved the head and neck (9), chest (1), bladder/perineum (2),  and extremities (2). Eleven children were admitted and eight required surgical intervention. One child died from a transhemispheric brain injury after intraorbital penetration by a pencil. Penetrating trauma from writing instruments is not an uncommon source of injury and often requires surgical  intervention to remove the object. Injuries from pens and pencils can be severe or even fatal. Appropriate parent and teacher education regarding the potential risks may help to prevent such injuries.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Fisher
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Clifton
authors.forename: Amina M
authors.initials: AM
authors.lastname: Bhatia
mesh_terms: D000061:Accidents, Home / Q000706:statistics & numerical data*; D000293:Adolescent; D017677:Age Distribution; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000453:epidemiology* / Q000601:surgery