Pediatric firework-related upper extremity injuries: A 10-year review of cases presented to United States emergency departments, 2015-2024.

Abstract

Fireworks remain a prominent feature of U.S. holiday festivities but continue to pose significant risks, particularly to children and teenagers. Although earlier studies have examined patterns of pediatric injuries linked to fireworks before 2015, recent nationwide data are sparse. This investigation seeks to fill that void by evaluating nonfatal upper extremity injuries related to fireworks among pediatric patients seen in American emergency departments from 2015 through 2024. The goal is to provide a current, detailed summary of injury rates, demographic trends, anatomical injury patterns, and age-related vulnerability. This descriptive retrospective epidemiological study utilized data from the National Electronic Injury Surveillance System (NEISS), a database that generates nationally representative estimates of emergency department-treated injuries in the U.S. All pediatric firework-related injuries to the upper extremity reported between January 1, 2015, and December 31, 2024, were included in the analysis. Between 2015 and 2024, 434 pediatric firework-related upper extremity injuries were identified (NE = 16,872). The majority occurred in males (77.9%) and adolescents aged 12-17 years (48.4%). Injuries most commonly involved the hand (48.8%) and fingers (32.7%). Thermal burns were the predominant diagnosis (74.0%), followed by amputations (9.0%) and lacerations (6.0%). Most patients (78.8%) were treated and released from the emergency department, while 13.8% required hospitalization. Pediatric upper extremity injuries from fireworks remain a significant and preventable source of morbidity, with thermal burns and trauma to the hands and fingers being most common. Adolescent males are disproportionately affected, and injuries peak during holiday periods. These findings support the need for strengthened regulations and targeted prevention efforts to reduce the ongoing burden of firework-related injuries in children.