Toy ocular trauma emergencies in the US

Abstract

Purpose : From enhancing cognition and spatial skills to stimulating creativity and vision development, toys offer many benefits for children and parents. Though toys play integral roles in child development, their use is also associated with occurrence of ocular trauma and death. We performed a retrospective, epidemiologic analysis assessing toy ocular injury incidence and trends across the US.

Methods : We analyzed ten years of emergency department (ED) data from the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System (2009-2018). We identified toy-related ocular trauma (TOT) injuries presenting to EDs. We grouped toys by product category and patients by age in years (y). We analyzed normality with both Shapiro-Wilk tests and Q-Q plots and variances with Levene’s tests. We performed Student’s t-, Wilcoxon signed rank, and χ² tests and calculated 95% confidence intervals (CI₉₅).

Results : From 2009-2018, an estimated 90832 (CI₉₅ [72651, 109012]) TOT patients presented to US EDs. Median patient age was 8y (interquartile range, 3-22y). Patients aged 0-4y experienced 28.5% (n=25871; CI₉₅ [20.3%, 36.6%]) of TOTs; 5-9y, 28.7% (n=26060; CI₉₅ [22.2%, 35.2%]); 10-14y, 12.1% (n=10957; CI₉₅ [8.7%, 15.5%]); 15-24y, 8.0% (n=7263; CI₉₅ [6.5%, 9.5%]); 25-34y, 11.6% (n=10551; CI₉₅ [8.9%, 14.3%]); 35-44y, 5.4% (n=4892; CI₉₅ [4.1%, 6.7%]); 45-54y, 3.2% (n=2890; CI₉₅ [2.2%, 4.1%]); and ≥55y, 2.6% (n=2347; CI₉₅ [1.4%, 3.8%]).
Primary diagnoses were contusion/abrasion (59.7%, n=54226), other (24.9%, n=22661), conjunctivitis (6.3%, n=5750), foreign body (3.7%, n=3379), chemical burn (2.4%, n=2190), or hemorrhage (1.3%, n=1191). Laceration, hematoma, puncture, strain, and thermal burn were primary diagnoses in ≤1% of TOTs. Miscellaneous toys were associated with 72.6% (n=65966) of TOTs; projectiles, 17.0% (n=15453).
Mean annual TOT incidence increased by 790±327 (CI₉₅ [182, ∞]; p=.02) in 2014-2018 compared to 2009-2013. Annual TOT incidence increased by 20.3% from 2009 to 2018 and peaked at 10261 in 2017, yielding an increase of mean annual incidence from 8688±388 in 2009-2013 to 9478±620 in 2014-2018.

Conclusions : Nearly 26 TOT patients present to US EDs daily. Incidence of TOTs has increased proportionally faster than US population growth since 2009. There is need for public health and policy actions to decrease TOT incidence. We encourage manufacturers, legislators, and regulatory officials to reevaluate the efficacy of toy safety standards.

This is a 2020 ARVO Annual Meeting abstract.