ROSEMONT, Ill. (May 1, 2020)—As people head outside to mow their lawns this spring and summer, children continue to remain at risk for serious injuries and death associated with lawnmowers. A new review article published in the May issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) analyzed 13 years of lawnmower injuries in children across the United States, identifying disparities that exist in national and geographic incidence rates and injury characteristics. Children in rural areas not only experienced a higher rate of lawnmower injuries, but had an increased rate of infections, amputations, inpatient stays and surgical complications.

Despite established safety guidelines and consumer awareness campaigns, it’s estimated that approximately 9,400 children are injured by lawnmowers per year in the United States.[i] Lawnmowers cause 12% to 29% of all pediatric traumatic amputations in the United States[ii] [iii] [iv] and are a leading cause of toe and foot amputations.

“Lawnmower injuries are largely preventable, but despite increased awareness, my colleagues and I continue to see a significant number of cases from May through October, some of which can be truly devastating,” said senior author Theodore Ganley, MD, FAAOS, orthopaedic surgeon with the Children’s Hospital of Philadelphia. “It’s incumbent upon us to further understand who is at risk and to accurately educate our physician colleagues, parents, caregivers and the U.S Consumer Product Safety Commission.”

This is the first lawnmower injury study to use the Pediatric Health Information System (PHIS), a database from 49 children’s hospitals located around the country, all affiliated with the Children’s Hospital Association.

“We wanted a novel way to study incidence related to overall population numbers that account for geographic variables when it comes to lawnmower injuries,” said lead author Ronit Shah, BS, medical student at the University of Toledo College of Medicine and Life Sciences.

From 2005-2017, the PHIS database identified 1,302 patients aged 0 to 18 years who presented to any of the 49 participating hospitals for a lawnmower injury. The study found that rural areas had an incident rate of 7.26 injuries per 100,000 cases, whereas urban areas experienced 1.47 injuries per 100,000 cases. The mean age for injury was 7.7 years; however, rural areas had a 60.3% higher percentage of injuries occurring in the youngest age group, children ages 1 to 5 years old, compared with urban areas (43.7%).

“One of the more shocking findings was the high percentage of young children in rural areas sustaining such a high level of injuries, which is most likely due to the increased use of riding mowers,” said Dr. Ganley. “I personally encourage parents not to give toddlers rides on lawnmowers for fun because when a child hears the mower, they are likely to run outside for a ride and the operator might not see or hear them.”

The risk to children is increased because of their small size and early stage of ongoing physical and mental development. In fact, the study also found that children younger than 10 years of age had a significantly higher proportion of moderate, major and extreme injuries compared with children older than 10 years of age.

The study also discovered:

• A combined 81.9% of all injuries occurred in the Midwest and South.
• Nearly half (46.5%) of all injuries required an inpatient stay. However, in rural areas, 56.1% of patients required an inpatient stay compared with 42.4% in urban areas.
• A significant difference was observed in infection rates between urban (4.8%) and rural (9.4%) locales. Moreover, rural communities had significantly higher complication rates, 5.5% versus 2.6%.
• The majority of injuries were located in the lower extremities (64.7%) and upper extremities accounted for 22% of injuries.
• The most common type of injury was amputation at 30.9%, and rural patients were 1.7 times more likely to undergo an amputation than urban patients. Additional injuries include open wounds/punctures/lacerations at 28.8% and factures/dislocations/bony avulsions at 24.2%.
• Most injuries occurred in males (78.9%), with the most prevalent racial group being Caucasians.
• The summer months of May to August had the highest frequency of injuries.
• The average cost of presenting injuries was $18,693; however, a difference was observed in the median cost of injuries between urban ($5,184) and rural ($9,473) areas.

“These injuries impart a physical and psychosocial burden on patients and their families,” said Dr. Ganley. “While people might assume that injuries are just related to the lawnmower’s blades, injuries also occur from projectiles such as rocks or sticks that eject from the lawnmower and burns due to touching a hot lawnmower after use. Because of these potential hazards, one of the safest things you can do is to make sure children are inside when a lawnmower is in operation, regardless if it’s a riding or a push mower.”

View the American Academy of Orthopaedic Surgeons position statement on lawnmower safety.

To learn more about lawnmower safety, click here.

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[i] Bachier M, Feliz A: Epidemiology of lawnmower-related injuries in children: A 10- year review. Am J Surg 2016;211:727-732.

[ii] Loder RT. Demographics of traumatic amputations in children. Implications for prevention strategies. J Bone Joint Surg Am. 2004 May;86(5):923-8.

[iii] Borne A, Porter A, Recicar J, Maxson T, Montgomery C. Pediatric traumatic amputations in the United States: a 5-year review. J Pediatr Orthop. 2017 Mar;37(2): e104-7.

[iv] Conner KA, McKenzie LB, Xiang H, Smith GA. Pediatric traumatic amputations and hospital resource utilization in the United States, 2003. J Trauma. 2010 Jan;68(1):131-7.