title: A chilling reminder: Pediatric facial trauma from recreational winter activities.
abstract: BACKGROUND
  Winter activities offer children and adolescents an outdoor recreational opportunity during the coldest months. Our objectives were to estimate the national incidence of facial injury associated with recreational winter activities. Furthermore, we analyze demographic trends and clinical characteristics of patients presenting to emergency departments (EDs).
  
  
  METHODS
  The National Electronic Injury Surveillance System (NEISS), a population-based resource, was evaluated for ED visits from 2010 to 2014 for children injured from "active" winter -undertakings (snowboarding, skiing, ice skating) and sledding/tubing. Entry narratives were evaluated for demographics, diagnoses, and other clinical factors.
  
  
  RESULTS
  841 entries amounting to an estimated 27,618 patients were evaluated. The most common injuries were lacerations (69.4%), contusions/abrasions (19.5%), and fractures (5.5%), with the most common fracture sites being the nose (60.9%), orbit (15.2%), and mandible (10.9%). Median age was 9 years (IQR 5-12), and 65.8% were male. A greater proportion of adolescents sustained fractures than younger children (8.1% vs. 4.0%). The majority of fractures were to the nose.
  
  
  CONCLUSIONS
  With nearly 30,000 ED visits over five years, participation in winter sports can be perilous. Adolescents harbor a greater risk of sustaining serious injuries than younger children, and patients injured sledding/tubing had a greater fracture risk compared to those participating in more "active" winter activities. As upper/mid-face fractures occurred in only 1.4%, these findings reinforce a very limited role for CT. These findings suggest a need for greater use of facial protection and closer supervision of older children participating in these activities.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA. Electronic address: psvider@gmail.com.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Bobian
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Houmehr
authors.initials: H
authors.lastname: Hojjat
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, The University of Tennessee Health Science Center School of Medicine, Memphis, TN, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Sheyn
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Zuliani
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, NJ, USA.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, USA; Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005151:Facial Injuries / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D022125:Lacerations / Q000453:epidemiology*; D008297:Male; D011998:Recreation; D012621:Seasons; D012887:Skull Fractures / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
keywords: Craniofacial trauma; Facial fracture; Facial trauma; Skiing; Winter sports