Firework and sparkler burns in paediatric patients
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
AJOPS | ORIGINAL ARTICLE
Bur
PUBLISHED: 31-03-2021
Firework and sparkler burns in paediatric patients
Daniel Ricciardello MBBS MS,1 Nam Kyu Yang MBBS,1 Kira Chamberlain MPH,1
Andrew JA Holland MBBS PhD FRACS(Paed)1,2
1 The Children’s Hospital at Westmead Abstract
Westmead, New South Wales
Background: While the consumer sale of fireworks
AUSTRALIA
is illegal in New South Wales, the sale of sparklers is
2 The University of Sydney legal—however, both still pose a significant risk of
Camperdown, New South Wales harm in the paediatric population. Anecdotally, burns
AUSTRALIA
services are aware that the misuse of sparklers can
OPEN ACCESS result in burns but there appears to be a paucity of
Correspondence
studies examining this incidence in the paediatric
population in Australia.
Name: Daniel Ricciardello
Method: A retrospective review of all burns related
Address: Burns Unit
The Children’s Hospital at Westmead
to the use of fireworks or sparklers referred to the
Cnr Hawkesbury Road and Hainsworth Street Children’s Hospital at Westmead (CHW) Burns
Westmead, New South Wales, 2145 Unit (BU) from January 2004 to December 2019.
AUSTRALIA This study was approved by the Sydney Children’s
Email: dricciardello@gmail.com Hospital network Human Ethics Research Committee
reference 2020/ETH00398.
Phone: +61 (0)2 9845 0000
Citation: Ricciardello D, Yang NK, Chamberlain K, Holland
Results: During the 16-year study period, 96 patients
AJA. Firework and sparkler burns in paediatric patients. were referred to the CHW BU with a burn as a result
Australas J Plast Surg. 2021;4(1):30–34. DOI https://doi. of a firework or sparkler. Sparklers accounted for 72
org/10.34239/ajops.v4n1.240 per cent (69) of burns, compared with 28 per cent
Manuscript received: 12 June 2020 (27) from fireworks. The mean age of those injured by
Manuscript revised: 25 August 2020 sparklers was five years compared with eight years in
Manuscript accepted: 28 August 2020 the firework group. Average total body surface area
Copyright © 2021. Authors retain their copyright in the (TBSA) affected for both mechanisms was similar—
article. This is an open access article distributed under the for sparkler burns (2.0%) firework burns (2.4%), with
Creative Commons Attribution Licence 4.0 which permits a range of 0.1–15 per cent. Hands were the most
unrestricted use, distribution and reproduction in any common area burnt in both groups comprising 59
medium, provided the original work is properly cited.
per cent (41) of sparkler burns and 48 per cent (13) of
Section: Burns firework burns. Twenty patients required a total of 32
visits to the operating theatre for acute management
of their burns.
Conclusion: This study demonstrates the potential
for significant injuries as a result of fireworks and
sparklers. These findings can be used to raise
awareness regarding their dangers, direct targeted
educational campaigns and guide safety advice
regarding their use.
Keywords: child, burns, burns prevention and control,
explosive agents, wounds and injuries
Australasian Journal of Plastic Surgery 30 2021 Volume 4 Number 1
Ricciardello et al: Firework and sparkler burns in paediatric patients AJOPS | ORIGINAL ARTICLE
Table 1: Patient demographics
Firework Sparkler Total
All patients (n) 27 69 96
Male (n) 20 36 56
Female (n) 7 33 40
Age (mean, range) 8.5 (1.0–16.0) 5.0 (0–16.0) 6.0 (0–16.0)
TBSA (% mean, range) 2.4 (0.2–9.0) 2.0 (0.1–15) 2.1 (0.1–15.0)
ICU admission (n) 3 2 5
Intubation (n) 2 1 3
Operating sessions (n) 8 19 27
Dressing/debridement 3 7 10
Skin grafting 5 12 17
Introduction burn at temperatures as high as 1100°C7 and that
Fireworks and sparklers are defined as devices remain hot once they have ceased to ‘sparkle’,
‘designed for the purpose of producing a visible with the potential to cause significant harm,
or audible effect by combustion, deflagration, especially in children.8,9 While anecdotally burns
or detonation’1 and form a significant part of services are aware that the misuse of sparklers can
celebrations for many cultures around the world. result in burns, there appears to be a paucity of
Given Australia’s multicultural society these times studies examining the incidence in the paediatric
of celebration include New Year’s Eve, Diwali and population in Australia.10,11
Chinese New Year. Concerns over safety have led The aim of this study was to determine the
to tight controls on the sale of fireworks to the incidence of firework- and sparkler-related burns,
public, with Western Australia the first state to the pattern of injury and outcomes in children.
ban the consumer sale of fireworks in 1967. This
was followed by Queensland in 1972, Victoria in Method
1985, New South Wales in 1987, South Australia in A retrospective study was undertaken from January
2001 and the Australian Capital Territory in 2009.2,3 2004 to December 2019 of children referred to the
Tasmania allows the public to purchase fireworks Children’s Hospital at Westmead (CHW) Burns Unit
with a licence, and the Northern Territory allows (BU) with burns related to the use of fireworks or
the public sale of consumer fireworks on Territory sparklers. The study cohort comprised children
Day without a licence.4,5 Despite this regulation, under the age of 16 years and included those treated
firework-related burns continue to occur in as inpatients and those treated in an ambulatory
New South Wales as a result of illegally obtained care setting. There were no exclusion criteria.
fireworks, with a number of these injuries
Data were entered prospectively into the New
occurring in the paediatric population.
South Wales state-wide Burn Injury Service (NSW
In contrast, sparklers are easily and readily SBIS) database. Information collected included
available in New South Wales as their sale is patient information (age and gender), mechanism
permitted given their classification as ‘shop of injury, location of injury, adequacy of first aid
goods’. Sparklers are made from a steel wire (defined as cool running water for 20 minutes
that is dipped into pyrotechnic slurry typically within the first three hours of the injury), presence
made up of a metal fuel (such as aluminium), an of parental supervision, percentage total body
oxidiser (such as potassium nitrate) and a binder surface area (TBSA) affected and mode of treatment
(such as dextrin) before it is allowed to dry.6 The (surgical or non-surgical). Descriptive statistics
end result is sparklers that have been reported to were used for the majority of variables.
Australasian Journal of Plastic Surgery 31 2021 Volume 4 Number 1Ricciardello et al: Firework and sparkler burns in paediatric patients AJOPS | ORIGINAL ARTICLE
Fig 1. (a) The right hand of a two-year-old patient who sustained a burn after picking up a lit sparkler from the ground. (b) The same burn following
debridement under sedation. (c) Progress of the burn at dressing change (remained unhealed). (d) Full re-epithelisation.
Analysis presentation, with three requiring intubation (two
During the 16-year study period, 96 patients were firework, one sparkler). Twenty patients required
referred to the CHW BU with a burn as a result a total of 32 visits to the operating theatre for
of a firework or sparkler (Table 1). Sparklers acute management of their burns. Eleven of these
accounted for 72 per cent (69) of burns, compared visits were for debridement and dressing changes
with 28 per cent (27) from fireworks. The mean and the remaining 21 were for skin grafting. One
age of those injured by sparklers was five years patient required partial amputation of their left
compared with eight years in the firework group. middle finger as a result of a firework injury.
Females accounted for 48 per cent (33) of sparkler Another patient required a further 19 visits to the
burns and 26 per cent (7) of firework burns. On 11 operating theatre in the five years following their
occasions burns were a result of the use of multiple burn for scar management.
sparklers simultaneously. While the injuries were Figure 1 illustrates the progression of a hand
distributed throughout the calendar year, 26 per burn sustained when a two-year-old male picked
cent (25) occurred during the Christmas/New Year up a lit sparkler from the ground. Following
period (20 December to 3 January). There was a initial debridement, the burn healed with regular
lack of parental supervision in almost all (90%) of dressings 18 days after the initial injury. The patient
cases. required regular follow-up for scar management,
Average TBSA for both mechanisms was similar which involved stretching, compression and silicon
for sparkler burns (2%) and firework burns (2.4%), dressings for approximately two years following
with a range of 0.1–15 per cent. Hands were the most the burn.
common area burnt in both groups, comprising 59
Discussion
per cent (41) of sparkler burns and 48 per cent (13)
of firework burns, followed by the head and neck, Despite the ban on consumer sales of fireworks in
lower limbs, upper limbs and trunk. New South Wales since 1987, this study shows that
as a result of their illegal use, burn injuries have
A total of five patients (three firework, two
continued to occur in the paediatric population.
sparkler) required admission to ICU on initial
Australasian Journal of Plastic Surgery 32 2021 Volume 4 Number 1Ricciardello et al: Firework and sparkler burns in paediatric patients AJOPS | ORIGINAL ARTICLE
Unsurprisingly, burns as a result of sparklers, other countries where a spike in firework injuries
which are legal and readily available, occur at a during periods of celebrations such as Territory Day
much higher rate. This pattern reflects findings in the Northern Territory, Independence Day and
of a recent study of the adult population in New Halloween in the United States, Guy Fawkes Night
South Wales where it was found that sparklers in the United Kingdom and the Diwali festival of
were responsible for 65 per cent of all firework- or light in India.10,14,17–20 This is particularly important
sparkler-related burns over a similar time period.12 to guide the timing of targeted public awareness
In Australia, sparkler packaging recommendations campaigns, which have been shown to reduce the
for minimum age suitability range from three to incidence of burns in several countries.10,17,21,22 With
eight years old. Despite this, the median age of the median age of burns victims being younger
those burnt by sparklers in our cohort was two than school age it is important that education and
years old. This is similar to a previously reported awareness campaigns extend beyond the school
series indicating that more than 65 per cent of all setting and into the community. Kidsafe and the
patients with sparkler burns are younger than five Australian and New Zealand Burn Association
years old.8,9,13 Further packaging recommendations (ANZBA) have well-established roles in injury
include that users must be under close adult prevention, for example in the areas of hot water
supervision and that only one sparkler should and friction burns from treadmills, which could be
be used at a time—both recommendations are used as a basis for similar campaigns for sparkler
regularly ignored, based on our cohort. This and firework injuries.
highlights a misconception that sparklers are safe As we are unable to compare our data set with
for children and emphasises the need to raise any pre-legislation data, the impact of current
awareness in the community regarding their firework legislation in New South Wales could
potential for harm. not be evaluated. Evaluation of legislation in
Consistent with previous studies, males accounted Italy, the United Kingdom and Denmark has been
for the majority of all firework-/sparkler- shown to substantially reduce the number of
related burns. The higher incidence in males firework-related injuries.10,21,22 While this supports
has been reported in both adult and paediatric the current firework legislation in New South
populations and previously has been attributed to Wales, it does suggest that restrictions need to be
possible higher levels of risk-taking behaviour in implemented on the sale of sparklers in order to
males.9,10,14–16 minimise their potential harm.
Given the hands are generally exposed in Conclusion
igniting and handling fireworks or sparklers, it
The findings of this study demonstrate the potential
is unsurprising that they are the most common
for significant injuries as a result of the use of
area of the body affected in our study. This
fireworks and sparklers. This information can be
corresponds with other studies from Australia
used not only to raise awareness regarding their
and overseas.9,10,14–16 As maintaining hand function
dangers but also to direct targeted educational
is of particular importance following burns, the
campaigns in the lead-up to particular events
immobilisation and rehabilitation often required
and guide safety advice regarding their use.
following the acute healing must be acknowledged
Furthermore, it highlights that the introduction of
when appreciating the significance of these burns.
restrictions on the sale of sparklers could potentially
An interesting finding is the high proportion of reduce the risk they currently pose to children.
burns over the Christmas and New Year period.
This is consistent with previous published data in Ethics approval
New South Wales regarding firework injuries and The Sydney Children’s Hospital network human
reflects similar patterns in Australia and several ethics research committee approved this study
(HREC Reference 2020/ETH00398).
Australasian Journal of Plastic Surgery 33 2021 Volume 4 Number 1Ricciardello et al: Firework and sparkler burns in paediatric patients AJOPS | ORIGINAL ARTICLE
Acknowledgements 11 Van den Boogaard CJ, Wallis BA, Kimble RM. Sparkler
burns and the potential for serious injury in children.
The authors would like to thank Anne Darton from J Burn Care Res. 2008;29(4):679–80. https://doi.org/10.1097/
the ACI Statewide Burns Injury Service Network BCR.0b013e31817db9bc PMid:18535464
for their efforts in data collection. 12 Yang NK, Tellam N, Jung M, Wijewardena A, Vandervord J.
A retrospective analysis of fireworks and sparkler burns.
Abstract Journal Plastic & Reconstructive Surgery. Royal
Disclosure
Australasian College of Surgeons 88th Annual Scientific
The authors have no financial or commercial Congress, Bangkok, Thailand, 6-10 May 2019. ANZ J Surg.
2019;89(S1):133–52. https://onlinelibrary.wiley.com/doi/
conflicts of interest to disclose.
epdf/10.1111/ans.15197
References 13 Fogarty BJ, Gordon DJ. Firework related injury and legisla-
tion: the epidemiology of firework injuries and the effect
1 Berger LR, Kalishman S, Rivara FP. Injuries from fireworks.
of legislation in Northern Ireland. Burns. 1999;25(1):53–56.
Pediatrics. 1985;75(5):877–82. Available from: https://pediat-
https://doi.org/10.1016/S0305-4179(98)00119-3
rics.aappublications.org/content/75/5/877/tab-article-info.
14 Nizamoglu M, Frew Q, Tan A, Band H, Barnes D, El-Mut-
2 Australian Capital Territory Government. Dangerous sub-
tardi N, Dziewulski P. The ten-year experience of firework
stances (explosives) regulation, 2004 [web report]. Canber-
injuries treated at a UK regional burns and plastic surgery
ra: Australian Government. [Cited 2 April 2020]. Available
unit. Ann Burns Fire Disasters. 2018;31(1):13–16. Available
from: https://www.legislation.act.gov.au/View/sl/2004-10/
from: http://www.medbc.com/annals/review/vol_31/num_1/
current/PDF/2004-10.PDF.
text/vol31n1p13.pdf.
3 Australian Capital Territory Government. Fireworks
15 Witsaman RJ, Dawn Comstock R, Smith GA. Pediatric
reform regulatory impact statement executive summary,
fireworks-related injuries in the United States: 1990–2003.
2009 [web report]. Canberra: Australian Government. [Cit-
Pediatrics. 2006;118(1):296–303. https://doi.org/10.1542/
ed 2 April 2020]. Available from: http://www.legislation.act.
peds.2006-0790 PMid: 16818578
gov.au/ri/db_35434/20090826-40550/rtf/db_35434.rtf.
16 Puri V, Mahendru S, Rana R, Deshpande M. Firework
4 Northern Territory Government. Dangerous goods reg-
injuries: a ten-year study. J Plast Reconstr Aesthet
ulations 1985 [web report]. Darwin: Northern Territory
Surg. 2009;62(9):1103–111. https://doi.org/10.1016/j.
Government. [Cited 2 April 2020] Available from: https://
bjps.2007.12.080 PMid:18603491
legislation.nt.gov.au/Legislation/DANGEROUS-GOODS-REG-
ULATIONS-1985. 17 Edwin AFL, Tania CS, Pape TCS, Pape SA. The impact of
recent legislation on paediatric fireworks injuries in the
5 Worksafe Tasmania. Do I need a fireworks permit? [web
Newcastle upon Tyne region. Burns. 2008;34(7):953–64.
page]. Hobart: Tasmanian Government. [Cited 2 April
https://doi.org/10.1016/j.burns.2008.01.018 PMid:18508200
2020]. Available from: https://worksafe.tas.gov.au/topics/
licensing-permits-and-registration/fireworks-permits/do-i- 18 Read DJ, Bradbury R, Yeboah E. Firework-related in-
need-a-fireworks-permit. jury in the Top End: a 16-year review. ANZ J Surg.
2017;87(12):1030–034. https://doi.org/10.1111/ans.14182
6 Ghengis Fireworks. Sparklers: how are they made? [Cited
PMid:29044852
6 May 2020]. Available from: https://www.fireworks.co.uk/
fireworks-information/sparklers-how-are-they-made. 19 Jorm L. Firework injures in New South Wales, 1992–93 to
2001–02. NSW Public Health Bull. 2003;14(6):110–13 https://
7 United States Consumer Product Safety Commission. CPSC
doi.org/10.1071/NB03032 PMid:12908000
reminds consumers to celebrate with safety this fourth of
July season [web page]. Maryland: United States Govern- 20 US Consumer Product Safety Commission. Fireworks annu-
ment. [Cited 2 April 2020]. Available from: https://cpsc.gov/ al report, 2018. [web report]. [Cited 2 April 2020]. Available
Newsroom/News-Releases/2019/CPSC-Reminds-Consumers- from: https://www.cpsc.gov/s3fs-public/Fireworks_Re-
to-Celebrate-with-Safety-This-Fourth-of-July-Season. port_2018.pdf.
8 Billock RM, Chounthirath T, Smith GA. Pediat- 21 Sheller JP, Muchardt O, Jonsson B, Mikkelsen MB. Burn
ric firework-related injuries presenting to Unit- injuries caused by fireworks: effect of prophylaxis.
ed States emergency departments, 1990–2014. Burns. 1995;21(1):50–53. https://doi.org/10.1016/0305-
Clin Pediatr (Phila). 2017;56(6):535–44. https://doi. 4179(95)90782-U PMid: 7718120
org/10.1177/0009922816664063 PMid:27550873 22 D’Argenio P, Cafaro L, Santonastasi F, Taggi F, Binkin N.
9 Smith GA, Knapp JF, Barnett TM, Shields BJ. The rockets’ Capodanno senza danno: the effects of an intervention pro-
red glare, the bombs bursting in air: fireworks-related inju- gram on fireworks injuries in Naples. Am J of Public Health.
ries to children. Pediatrics. 1996;98(1):1–9. Available from: 1996;86(1):84–86 https://doi.org/10.2105/AJPH.86.1.84
https://pediatrics.aappublications.org/content/98/1/1.long. PMid:8561250 PMCid:PMC1380368
10 Abdulwadud O, Ozanne-Smith J. Injuries associated with
fireworks in Victoria: an epidemiological overview. Injury
Prevention. 1998;4:272–74. https://doi.org/10.1136/ip.4.4.272
PMid:9887417 PMCid:PMC1730423
Australasian Journal of Plastic Surgery 34 2021 Volume 4 Number 1You can also read
