A randomized trial of an intervention to prevent lawnmower injuries in children
Introduction
Ninety-one percent of non-fatal injuries and half of fatal injuries to children under five years occur at home 1, 2. Prior to age six most home injuries occur indoors. For older children most occur outdoors typically in front or back yards [3]. Accordingly, investigators have developed and evaluated approaches to prevent varied types of childhood injuries in and around the home. Injuries addressed by these approaches have included scald burns from excessive hot water temperatures [4], drowning in backyard pools [5], poisonings from hazardous kitchen and bathroom products [6], and falls from stairs and windows [7]. Although the topic of reports in the surgical literature for more than 30 years [8], childhood injuries associated with lawnmowers have not been the subject of preventive research and rarely have received attention from injury epidemiologists.
The Consumer Product Safety Commission (CPSC) using data from the National Electronic Injury Surveillance System estimates that there were 58 800 emergency room visits associated with lawn mower injury in 1990: 27 000 involving ride-on, tractor style mowers and 31,800 involving traditional, walk-behind mowers. About 7% of these visits required hospitalization. Following the July 1982 CPSC regulation which required `deadman' switches on all newly manufactured walk behind mowers, the incidence of injury involving this mower type decreased by 40% by 1990. However, for ride-on mowers where safety features remain only voluntary, there has been no change in injury incidence. In 1990 the CPSC estimates that there were 45 million walk-behind and 10.5 million ride-on mowers owned and operated by consumers in the U.S. This yields a rate of 2.5 injuries per 1000 units for ride-on mowers and 0.70 per 1000 units for walk-behind mowers [9]. While deaths due to walk-behind mowers are rare, ride-on mowers are responsible for about 75 deaths annually [10]. Nevertheless, walk behind mowers still account for a larger number of injuries overall than ride-on mowers.
The type of injury received from mowers is varied. Injury types include incidents of runover, backover, passenger falls from ride-on mowers, mower tip overs, and burns. Lacerations are the most common type of injury. Seventy-one per cent are to hands or feet, or distal areas of arms or legs [10]. Not all involve direct blade contact. About 17% of lawn mower injuries result from the striking of persons by objects thrown by mowers, typically rocks, wire, or glass. Rotary mower blades travel at speeds up to 3000 rpm, and can hurl objects up to 50 feet. Reports have documented `missile' injuries to the eyes, abdomen, chest and face 11, 12.
A fairly large proportion of lawn mower associated injuries involve children. Cutting and piercing by powered tools or other household appliances or objects (E-codes 919–920) are the fourth leading cause of childhood injury accounting for 11% of all childhood injury hospital emergency room visits 13, 14. For ride-on mowers 26% of injuries involve persons <15 years of age [10]. For walk-behind mowers about 13% of injuries involve persons <14 years [15]. Injured younger children usually are bystanders; with older children and young adolescents operator injuries are more common 16, 17. Case reports also suggest that the severity of mower injury is greater for children than for adults [18].
Several reports have called for multi-faceted efforts to prevent lawnmower injury to children 19, 20, 21. According to the Committee on Accident and Poison Prevention of the American Academy of Pediatrics, these efforts should include requirements for a minimum operating age, more safely designed products, and parent education [19]. Specifically, the Committee called for physicians to advise parents that children should not be allowed to play or be adjacent to areas where mowers are being used. In addition, children under age 5 should be kept indoors during mowing and no children should be allowed to operate mowers, even with adult supervision.
The purpose of this study was to evaluate the effectiveness of a video-based intervention to prevent childhood lawnmower injury. A video intervention does not require large physician or staff effort and therefore could be easily implemented in pediatric practices. Specifically, we hypothesized that parents viewing the preventive video would be more likely to keep children away from operating mowers and to clear the area of rocks and other objects prior to mowing. Recognizing the need for an improved theory base for pediatric patient education, the objectives of the study also included assessment of changes in parents' beliefs concerning the risk of lawnmower injury, its probable severity, the efficacy of preventive parental actions, and barriers to routinely performing them.
Section snippets
Setting
This study was conducted at the outpatient orthopedic clinic at Cardinal Glennon Children's Hospital in St. Louis, Missouri which serves a heterogeneous pediatric population from throughout the metropolitan area. Patients' diagnoses include a range of congenital, developmental and traumatic orthopedic conditions. In general, parents bring their children to the clinic for post-operative follow-up services. These parents were the target group for the injury prevention intervention that is the
Results
Of the 130 eligible parents approached in the clinic, 80 (62%) agreed to participate in the study. Half were randomly assigned into either the intervention or comparison group. Three-month follow-up data were received from 30 intervention group parents and 35 comparison group parents comprising the final study sample. This attrition difference (25.0% vs. 12.5%, respectively) between groups was not significant (X2=2.05, df=1, P=0.152).
However, since attrition differences approached statistical
Discussion
Between 1984 and 1992, twenty-three children were admitted to Cardinal Glennon Childrens Hospital in St. Louis for injuries resulting from direct contact with the rotary blade of a power mower. The children ranged in age from 27 months to 15 years. About one-third were mower operators, another third passengers of ride-on mowers, and the final third bystanders. All injuries occurred between April and August. The incidence and severity of these cases in our own setting prompted us to assess the
Practice implications
In summary, this study offers preliminary evidence that intervention at a clinical setting can produce changes in parental behaviors associated with the prevention of childhood lawnmower injury. Although a number of tertiary medical case reports exist, and although the CPSC has conducted occasional epidemiologic studies, we could not locate any other report of a proactive, systematic effort to prevent child mower injury. Further study is needed, particularly replication at a non-orthopedic,
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Pediatric Lawnmower Injuries: a 25-year Review
2021, JPRAS OpenCitation Excerpt :This is likely due to two factors: the first is continued high-risk behavior by consumers. Many lawnmower operators still allow children to ride with them on riding lawn mowers, and many still operate riding lawnmowers backwards with the blades engaged and without looking behind them before reversing the lawnmower.27 The second factor, as noted above, is that some manufacturers have not followed safety recommendations, such as disabling blade rotation while a riding lawn mower is moving backwards.16,17
Lawnmower accidents involving children: Characteristics and suggested preventive measures
2018, Archives de PediatrieCitation Excerpt :Stakeholders in the care of young children (health visitors, community nurses, physicians, etc.) could take on an active role in providing information and advice. A study of the prevention of lawnmower accidents found that watching a video significantly changed the parents’ behavior [10]. With regard to passive prevention measures, a lawnmower's instructions for use often include only a few lines on safety.
Lawn mower injuries presenting to the emergency department: 2005 to 2015
2018, American Journal of Emergency MedicineCitation Excerpt :Previous studies have shown that other types of injuries, including lacerations and strains/sprains, are far more common injuries [2-5]. These injuries affect all age groups and special attention is often given to preventing pediatric injuries [4,6-7,9-12,14-18]. However, those between the ages of 40–70 years old appear to be at the highest risk of being injured while using lawn mowers [3,5,13].
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2017, American Journal of Emergency MedicineCitation Excerpt :Despite stricter safety specifications and product design changes, lawn mowers continue to be an important source of serious pediatric morbidity in the United States (US) [1-18].
Lawnmower Injuries in the United States: 1996 to 2004
2006, Annals of Emergency MedicineKnow before you mow: A review of lawn mower injuries in children, 1990- 1998
2000, Journal of Pediatric Surgery