title: Lawnmowers Versus Children: The Devastation Continues.
abstract: BACKGROUND
  Accidents with lawnmowers can cause mutilating injuries to children. Safety guidelines regarding the use of lawnmowers were promoted by professional organizations beginning in 2001. The Pennsylvania Trauma Systems Foundation maintains a database including all admissions to accredited Levels 1 to 4 trauma centers in the state. The annual rates of admission for children in our state and the severity of injuries subsequent to introduction of safety guidelines have not been reported, to our knowledge. Ride-on lawnmowers have been associated with more severe injuries in children.
  
  
  OBJECTIVE
  We asked: (1) What was the incidence of hospital admissions for children with lawnmower-related injuries during 2002 to 2013 and did the incidence vary by age? (2) What was the severity of injuries and did the severity vary by age? (3) How often did these injuries result in amputation? (4) What types of lawnmowers were involved?
  
  
  METHODS
  This was a retrospective study using a statewide trauma registry. We queried the Pennsylvania Trauma Outcome Study database for children 0 to 17 years old admitted to trauma centers in Pennsylvania between January 2002 and January 2014 with injuries resulting from lawnmower-related accidents. All accredited Levels 1 to 4 trauma centers in the state are required to submit their data to the Pennsylvania Trauma Systems Foundation which maintains the Pennsylvania Trauma Outcome Study database. Demographic information, Injury Severity Scores, International Classification of Diseases procedure codes, and injury location codes were recorded. Type of lawnmower was determined from the narratives and was identified in 60% (119/199) of patients. Traumatic and surgical amputations performed during the index hospitalization were included in the analysis. Information on later surgeries was not available. Subjects were stratified by age: 0 to 6, 7 to 12, and 13 to 17 years old.
  
  
  RESULTS
  The incidence of lawnmower injuries in Pennsylvania was a median five of 100,000 children (range, 4-12/100,000) during the study period. The median age was 6 years (range, 1-17 years). The median Injury Severity Score was 4 (range, 1-75). Children 0 to 6 years old had higher median Injury Severity Scores (median, 8; range, 1-75) compared with those 13-17 years old (median, 4; range, 1-20; difference of the medians, 4; p < 0.001). A total of 53% of the patients (106/199) underwent at least one amputation. There were 83 amputations in or of the foot, 18 in the leg, 14 in the hand, and three in the arm. Ride-on lawnmowers accounted for 92% (110/119) of mowers identified by type.
  
  
  CONCLUSIONS
  The incidence of serious injuries to children owing to lawnmower-related trauma did not change during the 12-year study period. If children younger than 6 years had not been near the lawnmower and those younger than 12 years had not been operating one, at least 69% of the accidents might have been prevented. We recommend annual publicity campaigns during spring to remind the public of the dangers of lawnmowers to children.
  
  
  METHODS
  Level IV, therapeutic study.
authors: Penn State Hershey College of Medicine, Hershey, PA, USA.
authors: Mariano
authors: M
authors: Garay
authors: Department of Orthopaedic Surgery, Penn State Hershey Medical Center, 30 Hope Drive, Building A, Hershey, PA, 17033, USA.
authors: William L
authors: WL
authors: Hennrikus
authors: Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, PA, USA.
authors: Joseph
authors: J
authors: Hess
authors: Department of Public Health Sciences, Pennsylvania State University, Milton Hershey Medical Center, Hershey, PA, USA.
authors: Erik B
authors: EB
authors: Lehman
authors: Department of Orthopaedic Surgery, Penn State Hershey Medical Center, 30 Hope Drive, Building A, Hershey, PA, 17033, USA. darmstrong@hmc.psu.edu.
authors: Douglas G
authors: DG
authors: Armstrong
mesh_terms: D000061:Accidents, Home / Q000517:prevention & control; D000293:Adolescent; D017677:Age Distribution; D000673:Amputation, Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D004869:Equipment Safety; D051639:Gardening; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D010343:Patient Admission; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control