Facial Lacerations Related to Recreational Activities: A National 10-Year Evaluation From US Emergency Departments

Abstract

Study Design: This study serves as a nationally representative retrospective cohort of U.S emergency department visits related to facial lacerations caused by recreational activities. Objective: The aim of this work is to offer a representative sample of facial laceration and identify the recreational activities associated with the highest risk of such injuries. Methods: We conducted a retrospective study of patients reported to the National Electronic Injury Surveillance System (NEISS) which collects information on injuries related to consumer products. Patients were included in our dataset from the time period of 2012 to 2021 if they sustained a facial laceration that was caused by a recreational activity. Results: Our findings reveal 2,383,761 facial lacerations between the study period examined. Young male white adults were more likely to sustain a facial laceration related to recreational activities. Injuries related to exercise equipment were also more likely seen in male patients. The most common cause of facial lacerations was associated with bicycles and basketball. Conclusions: This study found that young white adults are notably prone to facial lacerations, with recreational activities such as bicycling and basketball accounting for the majority of cases. Understanding these statistics is pivotal for implementing targeted strategies to prevent these injuries and their associated consequences.

Introduction

Facial lacerations are a common cause of emergency room visits in the United States, accounting for about 8.2% of total emergency department visits, according to data from the Centers for Disease Control and Prevention (CDC). These injuries can be caused by various factors, including falls, sports injuries, traffic accidents, trauma, and assault [1]. Often times, these injuries are exacerbated by inadequate facial protection during recreational activities: lack of mouth guards, helmeting, and eye protection [2]. While facial lacerations can range from minor to severe, even small injuries can significantly affect important facial cosmetic components, impacting both appearance and function. Facial lacerations can also result in a range of physical and psychological consequences for patients, including scarring, disfigurement, pain, and emotional distress [3,4,5]. In some cases, facial lacerations can also cause more serious complications, such as infection, nerve damage, concussions, fractures, or bleeding that may require surgical intervention [2,6].

Despite several studies describing the risk factors for facial trauma, there is still a lack of information on the epidemiological risk factors for facial lacerations in the United States with regards to underlying etiology in recreational activities [7,8]. Therefore, this research aims to provide a more comprehensive understanding of facial lacerations by describing their epidemiology with regard to recreational activities presenting to the emergency department over the past 10 years. Additionally, the study seeks to identify the associated variables and risk factors for this type of injury to guide both management and prevention efforts. By increasing knowledge of the causes and risk factors associated with these injuries, healthcare providers and policymakers can better address the needs of patients with these injuries and implement more effective preventive measures. (Figure 1 and Figure 2).

Methods

A cross-sectional study of patients reported to the National Electronic Injury Surveillance System (NEISS) from 2012 to 2021 was performed. The NEISS has collected information on injuries and complications related to consumer products for over 45 years. NEISS conducts a national probability sample on US hospital emergency room visits to depict larger epidemiological trends related to consumer products. Within our own dataset, patients were included if they had suffered a facial laceration while engaging in a leisure-related activity. More specifically, any patient presenting to a participating emergency department over the 10-year period of the study was included if they had a laceration on the head, neck, face, or other part of the cranium. Mean ages were computed for each activity category as well as distribution of injuries between sexes and different categories of activities. This data is publicly available consumer data that is exempt from the Institutional Review Board (IRB).

Results

A total of 22,824 unweighted and 2,383,761 (95% CI: 1,901,725–2,865,798) weighted observations were analyzed in the United States over a period of 10 years. The most common cause of injury was bicycles with one quarter of the documented cases (25.23%), followed by basketball with about a fifth (22.54%) and then football (6.47%). The least common causes of injury were dancing (1.05%), swings (1.24%), scooters (.90%), and trampolines (1.62%). Of the total observations, two-third (69.69%) were male and one third (30.31%) were female. The mean age of all observations was 20.57 years (SD = 11.15). The mean age varied depending on the cause of injury, ranging from 8.16 years for playground injuries to 41.28 years for exercise without equipment injuries.

The distribution of injuries by gender and age also varied depending on the cause of injury. The majority of injuries in the sports category were sustained by males, with the exception of softball where slightly more than a half (55.08%) of the observations were female. The mean age of sportsrelated injuries ranged from 8.42 years for slides to 23.89 years for all-terrain vehicles. Injuries related to exercise equipment were more common among males (59.62%) than females (40.38%) and had a mean age of 24.84 years. Injuries related to swimming pools were also more common among males (83.71%) than females (16.29%) and had a mean age of 14.16 years. The frequency of injury presentation was also varied by race. The majority of observations occurred among individuals listed as white (43.12%), followed by black (15.66%). The rest of the observations were comprised by individuals identifying as other (5.56%), Asian (1.8%), and American Indian (.27%). Interestingly, the frequency of injuries has decreased from 2012 to 2021 with an annual declined percentage of observations and the lowest number of injuries happening in 2020 (7.32%).

Discussion

The purpose of this study was to describe the relationship between recreational activities and the incidence of facial lacerations presenting to US emergency departments (EDs). In this study, we found that over a 10-year duration, approximately 2.4 million facial lacerations that presented to the emergency department in the United States were due to recreational activities. The most common culprit activity was bicycling (25.23%) followed closely by basketball (22.54%). Scootering (∼1%) was the least common cause of facial lacerations. Male predominance suggests that males are far more likely to experience a facial laceration in comparison to their female counterpart, and young adults were by far the most common age group represented in the cohort (mean age 9.91–41.28). Among racial groups, white children/adults were more likely to receive care in the ED. To the best of our knowledge, this is the most current epidemiological account of facial lacerations related to recreational activities that presented to EDs in the United States.

There has been a trend in the decreasing incidence of facial lacerations when comparing helmeted vs nonhelmeted recreational activities. Recreational sports where a helmet is mandated such as softball (2.46%), football (6.47%), and ice hockey (2.63%) had some of the lowest incidence of facial lacerations (

Table 1. Breakdown of Cause of Injury by Frequency, Sex, and Age.

). Although no protective headgear is currently suggested for basketball players, there should be increased public awareness regarding the potential dangers of this sport to the face and calvarium given the high incidence of facial lacerations recorded in our analysis. At the same time, the high incidence of facial lacerations that occurred due to bicycling, despite many state legislators requiring helmeting, demonstrates a potential lack of compliance and increased need for public health campaigns encouraging helmet use [9]. In comparison to the other recreational activities analyzed, bicycling without a helmet carries not only a risk for severe facial injuries, concussion, and fractures, it can also have morbid consequences; three quarters of bicycle-related deaths are secondary to head/ facial injury [10]. Additionally, it is worth noting that activities like the use of scooters, which have high rates of helmeting, constituted less than a 1% prevalence of facial lacerations in our cohort, emphasizing the potential effects that helmeting can have in reducing facial lacerations. (

Table 2. Demographics and Yearly Distribution of Dataset.

).

Race also seemed to be a prominent factor in this study. Those who label themselves as white were almost three times more likely to present to the ED with a laceration in comparison to black children/adults. Racial minorities of Asian Pacific Islander, American Indian, and Asian descent represented the lowest percentage of total ED visits. Although this is the first study to comment on the epidemiologic risk factors for facial lacerations, this finding seems to be congruent with prior national health statistic reports that have found that non-Hispanic whites are more likely to have a recreation-related injury [11]. At the same time, across healthcare systems, there are racial disparities in ED utilization resulting in differing care provided and health outcomes [12,13,14,15]. The racial disparities in ED presentation demonstrate the well documented structural barriers to healthcare access for racial minorities within the US healthcare system [16,17,18].

Taken together, over the past 10 years, there has been a gradual decrease in the incidence of facial lacerations presenting to the emergency department due to recreational activities. This could be due to the increased awareness and prevention of facial injury. During the similar time period, there has also been decreases in head injuries in other helmeted sports as well as a decrease in injuries from motorcycle accidents [19,20]. These reductions in injuries may represent the efficacy of public health campaigns and local mandates encouraging helmet usage [21,22]. Physicians play a crucial role in providing key educational awareness by emphasizing the importance of helmets and other protective gear that not only protects critical structures from lacerations but also from concussions and fractures.

Limitations

The NEISS database has served as an excellent tool for the estimation of emergency department visits. However, it does not necessarily include patients who may have presented for care elsewhere, subjecting our data to possibly underestimating the incidence of facial lacerations due to recreational activities. Despite this limitation, we were able to assess a large sample size improving the external validity of this research.

Conclusions

Recreational activities, especially bicycling and basketball, can result in minor to severe facial damage with serious consequences to functionality and aesthetics. We identified young male adults as a high-risk group and recommend early and thoroughly educating this demographic. Education is crucial in order to further decrease the number of facial lacerations.